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Dave Feldman Profile picture
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16 Mar, 6 tweets, 4 min read
1/ Great new thread by the incomparable, @Lpa_Doc -- covering a number of my favorite topics.

Read his thread and return for my added thoughts...
2/ Vilhjalmur Stefansson is a well discussed explorer among the #LowCarb and (of course) #Carnivore communities.

But even more interestingly, he may have been the first #LeanMassHyperResponder of record*

(* Kinda -- as Sam notes, we didn't advanced lipid panels then)
3/
4/

👆

Naturally, this part of the discussion gets hotly debated in and outside #LowCarb circles. CVD similar, yet higher ACM, however -- harsher environment, less sophisticated healthcare, etc.

Myself, I don't consider Inuit the most ideal corollary..
5/ For better or for worse, with the rise of #Keto/#Carnivore we are now entering a natural experiment with many Vilhjalmur Stefanssons all around us. Very low carb, animal-centric diets with corresponding high #LDL #Cholesterol for a sizable proportion of this population.
6/ The good news is that we're nearing the #LMHRstudy to better understand risk around this diet-induced hypercholesterolemia.

CitizenScienceFoundation.org

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More from @DaveKeto

Dave Feldman Profile picture
15 Mar
1/ How much does "Dietary Cholesterol" impact blood cholesterol levels?

This has been making the rounds lately and I have an experiment from 2018 is key to this question 👇

Remember the "White Bread and Processed Meat" experiment? cholesterolcode.com/the-tandem-dro…
2/ If you've followed me a while, you know I believe it isn't the actual ingestion of cholesterol on #LowCarb that has a big impact on serum levels -- it's predominantly the trafficking of fat. (See CholesterolCode.com/model)

But this is actually a very testable distinction...
3/ All we need is an experiment where I consume a lot of (1) low fat food that still (2) has ample amounts of cholesterol.

Thus, the "processed meat" side of the experiment is key if it has a decent amount of cholesterol -- and it does.

For example 9/21/18 I ate the following..
Read 8 tweets
Dave Feldman Profile picture
14 Mar
1/ Long running thought exp'nt:

If a drug did many of the same things with one's lipid profile as a #LowCarb diet, particularly decreasing triglycerides while increasing #LDL #Cholesterol:

1) Would it reduce ASCVD risk?
2) And if so, would it be more acceptable than #LowCarb?
2/ If you haven't heard, SGLT2 Inhibitors have recently emerged and have been gaining a lot of popularity. Data thus far shows they typically:

1) Decrease TG levels
2) Increase #LDL #Cholesterol levels
... yet...
3) Reduce risk for cardiovascular disease
3/ Naturally, that has the attention for those of us interested in how triglyceride trafficking and turnover could be relevant to #LDL increasing for what may turn out to be non-pathogenic reasons (kinda my focus ;) )

CholesterolCode.com/model

But wait -- it get's better...
Read 7 tweets
Dave Feldman Profile picture
13 Mar
1/ Thread ➡️This is a good spot to remind everyone why @DrNadolsky, @DrRagnar and I are doing the #LMHRstudy

(@nicknorwitz, I'm going to use you as an example, if you don't mind)

Nick has an LDL-C of 521, well into range of Homozygous Familial Hypercholesterolemia (HoFH)...
2/ FH, particularly HoFH is highly associated with atherosclerosis and is considered a substantial risk.

Cases of HoFH are extremely rare, but are considered a cornerstone of the lipid hypothesis as many with LDL-C levels (comparable to Nick's) demonstrate CVD as children...
3/ Brown and Goldstein have seminal work on this topic.

In particular, this is worth reading in regard to this subject: ncbi.nlm.nih.gov/pmc/articles/P…

(Warning: this includes many graphic images of xanthomas, which are more common with high LDL FH)
Read 9 tweets
Dave Feldman Profile picture
7 Mar
1/ 🤔Thought Experiment Thread🤔

The five assessments of Metabolic Syndrome are:
- High waste/hip
- High TG
- Low HDL
- Elevated BP
- Elevated fasting glucose

👆3 or more, you have MetSyn.

But what if you had just one of them, but at the top 3% for the general population? Image
2/ For triglycerides, I have some numbers handy from NHANES...

Hypothetical: You had *no other* cardiovascular risk factors save triglycerides in the top 3% of the general population (above 339 mg/dL)

What would you speculate your risk level for CVD is?
3/ Same with HDL...

Hypothetical: You had *no other* cardiovascular risk factors save HDL in the lowest 3% of population (below 30 mg/dL)

What would you speculate your risk level for CVD is?
Read 8 tweets
Dave Feldman Profile picture
7 Mar
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...
Read 6 tweets
Dave Feldman Profile picture
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

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