1/ Okay, I've been getting lots of pings regarding @DBelardoMD appearing on @RealDoctorMike, particularly given discussion earlier in the video with regard to LDL-C and CVD.

I'll do a reaction thread for now, but I'd like to keep it respectful, ofc...
2/ *First, whether ur a @DBelardoMD fan or not, I have to emphasize I respect anyone willing to move against the grain of their community for where they feel the evidence takes them. While unrelated to lipids, she's endured a lot of unpleasantness for a principled re CVD reversal
3/ 2:08 @DBelardoMD: "Nowadays you want to get your LDL cholesterol as low as possible for cardiovascular risk prevention. So, primary prevention versus also secondary prevention."

->Of course, neither this or statements like these are controversial by conventional med standards
4/ 2:33 @RealDoctorMike asks if studies regarding saturated fat and its association with LDL and CVD outcome could be biased by those "living a very unhealthy lifestyle with that" @DBelardoMD points to metabolic ward studies on this showing increases in LDL with SFA...
5/ 3:22 "...One of the things that we have the most robust research in cardiology history is the predictability of LDL cholesterol being causative in atherosclerosis..."

Again, not controversial by today's standards -- but important for coming context...
6/ 4:13 @RealDoctorMike: I see a difference in that if someone can have an LDL of 90 vs if they raise their LDL by introducing, let's say, one egg a day or chicken... and it now goes up to 110. Have we seen the difference between a 90 and a 110 [in] primary prevention?
7/ @RealDoctorMike: "...Or is it solely if they go extreme and introduce a lot of saturated fats, go full #keto that you start seeing the 190s, 200s figures."

@DBelardoMD: (First explains diff between primary and secondary prevention)
8/ @DBelardoMD "For LDL targets in primary prevention, the more and more data that's coming out, we really want your lifetime exposure of LDL to be as low as possible..."
9/ @DBelardoMD "So, I would say, yes you want... someone without heart disease and without other risk factors, keep your LDL below 100. And if it's, the difference between a 100 or 110 or 90, it's not quite significant."...
10/ Again, none of this advice is unexpected for a cardiologist (vegan or not).

The reason this became super topical for many is @RealDoctorMike was effectively discussing #Keto #HyperResponder (perhaps even thinking of #LMHRs...?), particularly near the launch of #LMHRstudy
11/ Which is why a lot of this is moot given how close we are to looking specifically at this population and their progression of atherosclerosis with high resolution CCTA. 90 to 110 is certainly very different than "190s and 200s" LDL from the conventional perspective of risk.
12/ I'd definitely extend an invitation to @RealDoctorMike to review our research for the #LMHRstudy as it is released.

It will certainly be charting very new ground given the very high level of #LDL #Cholesterol in an otherwise healthy, non-FH population.

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More from @DaveKeto

20 Mar
1/ Thread – random thoughts on a Saturday walk...

- I used to read a lot of comics when I was a teenager, then nothing since. Reliving these superhero stories through movies have been hot or miss... until the MCU, that is. Thanks, #Marvel, you’re truly setting a new bar.
2/ if there’s one thing I definitely got wrong, it’s that I thought governments would be regulating or outright banning crypto by now, particularly with the rise of ransomware. Now it’s substantially mainstream and would be much harder to tackle given it isn’t held only by geeks.
3/ Kindness begets kindness... mostly.

I know some examples come to mind of those I’ve dialogued with where things went south, but they are far more the exception than the rule.

I’ve met so many people on social media with differences of opinion, but shared mutual respect.
Read 13 tweets
19 Mar
Okay -- watched the #JusticeLeagueSnyderCut -- my tl;dr thoughts...

Overall pros - definitely better than theatrical release, better character dev, cooler teaser moments

Overall cons - Some exposition material that didn't add much value in the first half, some meh music moments
But honestly, I'm more intrigued by the story around how this happened than the movie itself. This is the first situation I'm aware of that had a fan campaign for a rerelease actually result in a big budget do-over. This petitions are always started and typically go nowhere.
I don't know that Snyder and WB will rekindle the marriage, or for that matter, that they want to. But the teasers within the movie (you who've watched it know what I mean) are much more interesting to me than anything DC has been trying to tantalize me with so far...
Read 5 tweets
16 Mar
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)
Read 6 tweets
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
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
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

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