1/ Really great thread by @Lpa_Doc in response to @ethanjweiss.

Read completely before returning here for my added thoughts...

[Warning: this one will get a little geeky]
2/ Per @Lpa_Doc's (2) and (3) in the thread, when we have "normal" TG levels (guidelines would say < 150, I prefer < 100) then most cholesterol in ApoB-containing lipoproteins (ApoB-Lp) are in LDL and there's little VLDL-cholesterol...
3/ But where TG is high, there's more utility in looking at ApoB given it lumps remnants (VLDL/IDL) with LDL.

-- But IMO, that's also the problem. We want to disentangle where remnant association is much more relevant than LDL association...
4/ I don't typically like ratios, but if I'm getting arm-twisted, here are the two I'd lean toward:

1) OxPL-ApoB / ApoB

or

2) Non-HDL / ApoB

That second one isn't highly studied, but it should be. We already have a lot of metrics on it in existing datasets everywhere...
5/ And it's relevant to this topic with regard to ApoB-Lp cholesterol on a per-particle basis.

NHANES data shows a high Non-HDL / ApoB to be associated with lower all cause mortality (but that was back-of-the-envelope analysis, will go deeper with biostat help eventually)
6/ So in short, I don't like looking at ApoB in isolation as I think it's a safe bet it will be much less predictive than looking at it combination with either OxPL-ApoB or non-HDL.

(Regardless, we're getting all this data and more in the LMHR study, of course.)

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More from @DaveKeto

5 Mar
1/ I’ll be interviewing @KetoCarnivore soon. In preparation, I watched this talk of hers from 2019 that I found very interesting...
2/ She provides some counter opinion analysis regarding both simplified metrics of “nutrient density” and the protein leverage hypothesis (ie @tednaiman). Or more specifically, the challenge in these approaches having potential bias that isn’t easily apparent...
3/ To be sure, I don’t have a very strong opinion myself in this area as I tend to focus more on lipid trafficking (and generally try to avoid the nutrition debates overall).

Moreover, I’m still plotting to do @tednaiman’s P:E diet as an experiment soon along w/bloodwork...
Read 5 tweets
5 Mar
1/ The blood test (assay) I'm especially interested in is called "OxPL-ApoB" and it's ultimately offered through @BostonHeartDX

If looking to get it:

1- You may want to first check with your doctor to see if they can order it directly (sometimes insurance will cover)...
2/

2- There may be online services that you can order it with, but to be honest, I haven't checked which do yet

3- We offer it and other Boston Heart tests through OwnYourLabs, but full disclosure, this program is a beta right now. You can sign up here: ownyourlabs.com/boston-heart-b…
3/ If you do get the test, please consider sharing back the data to us at CholesterolCode.com. I'm especially interested to see if this data further confirms my hypothesis that the majority of hyper-responders will generally have relatively low OxPL in spite of very high ApoB
Read 4 tweets
19 Feb
1/ Interesting thread by @mak_sysepi regarding a recent study on HDL-C with a massive sampling -- 15.8 million! academic.oup.com/ije/advance-ar…

Note this tracks my favorite metric, All Cause Mortality.

(Hat tip @DrNadolsky)
2/ If you already follow my work, you've known for some time that I value looking to HDL-C alongside triglycerides. In particular, I like to compare the "low carb lipid triad" to atherogenic dyslipidemia. HDL-C is a very important part of each...
3/ The paper we're working on for the Lipid Energy Model focuses on studies that demonstrate HDL-C going up and down as it relates to metabolism, both in a health and diseased state.

It's worth noting a very common association of high HDL is alcoholism.
Read 5 tweets
9 Feb
A paper combining Triglycerides/HDL-C and All Cause Mortality with dialysis patients --

This deserves a #ReadingThread... (at least between my calls and meetings today)...
"In fact, traditional CV [cardiovascular] risk factors, such as hypercholesterolemia and obesity, have not been found to be reliable predictors of mortality risk in these patients..."
"... as previous studies have shown these factors are paradoxically associated with better survival in the hemodialysis population."
Read 15 tweets
7 Feb
1/ There really has been a sea change I've noticed lately with regard to both the #LipidTriad and the #LMHR phenotype.

I'm not going to call anyone out, but I will say there are many who I had several spirited discussions in the past few years...
2/ ...who considered high LDL = "high" risk, full stop...

... but are now expressing #LMHRs may actually be at "low" risk of cardiovascular disease (in spite of having LDL in the 95% of the pop), just that they "could be better" if they have these LDL levels lower than they are.
3/ It's worth emphasizing their position hasn't changed with regard to higher LDL = *more risk* of CVD. Thus, it would still be better for #LMHRs to have lower LDL, all else being equal.

But the magnitude of difference in the assumed risk has changed for many.
Read 6 tweets
6 Feb
Ah — looks like I have a podcast for my walk today...

... I may be adding comments to this thread as I listen...

@FoodLiesOrg @TuckerGoodrich @drcateshanahan
Had to run minute 23 Tucker brings up that there are some amount of these PUFAs that are necessary and obligate to the body, but the quantity is typically much higher in the modern diet due to heavy use of seed oils...
... I bring this up because I do think @TuckerGoodrich is often portrayed by others as though he’s against any amount of PUFA in the diet. As always, I’m #ProNuance. ;)
Read 5 tweets

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