Thread by @DaveKeto

1/ #ListeningThread for @PeterAttiaMD's new podcast with @DrSarahHallberg

Full disclosure, I have tremendous respect for Sarah and all the incredible mountains she has moved in nutrition and health, not to mention just being an incredible human being.

2/ Oh boy -- just 1 minute in and Peter is asking Sarah about dietary fat vs observed composition in vivo! I have a feeling I'm really going to like this episode...

3/ Sarah: "Fatty acids play a critical role, study after study, in cardiovascular risk." -- Love this line...

(Though I'd add a few caveats with regard to lipid profile, but more on that another time)

4/ "...right now we're at the tail end of our five-year data collection of the longest and largest trial looking at nutritional ketosis as a means of reversing type 2 diabetes..."

Okay -- this is worth a moment of pause all on its own given it's staggering significance...

5/ In some alternate universe where there wasn't a Sarah Hallberg or Steve Phinney taking this crucial initiative, would we have anything like this massive, longitudinal @virtahealth dataset?

I think it's fair to point to other aspects of their program with regard to process...

6/...Such as the constant communication and care through their app and its platform.

But I remember a lot of assumptions about why long term keto wasn't feasible that aren't typically asserted anymore given this hard data. Credit Sarah for opening this new, important chapter.

7/ Yes! Happy to hear Peter considers fasting triglycerides of over 100 is considered "elevated" [instead of the guidelines of 150]*

(*To be sure, TG is a noisy marker, so I don't get overly concerned about a single test of, say, 115 when typically below 100 for most)

8/ Yes! At 26:00 Peter is talking about looking at microvascular damage as early indicators of risk [example semi-NSFW, but highly relevant]

Also mentions retinal imaging for the same early warning sign purposes. Couldn't agree more.

9/ More Peter: "...let's look at the actual place where the damage is taking place and make the assessment on an individualized basis as opposed to using these sort of population-based metrics which move in the right direction but for any one individual can be quite misleading."

10/ Again, couldn't agree more.

Nothing trumps the actual detection of disease outcome, period.

11/ 27:45 "Okay, with that background, let's kind of dive into this nerdy, nerdy fatty acid stuff..."

Me in joyful anticipation... 👇

12/ Sarah goes into why increased *dietary* saturated fatty acids doesn't typically result in increased *serum* saturated fatty acids.

Cites very interesting stepwise study here: journals.plos.org/plosone/articl…

13/ So this definitely gets a big geeky as they are getting into POA, SCD-1 driving increased VLDL (via increased cholesterol and TG synthesis pathways), and how this all results in a different fatty acid composition found on these lipoproteins in the bloodstream...

14/ But this is *extremely* relevant to me as it provides an important clue on the synthesis of lipids in the liver relative to those provided to it. That distinction is very important as the former is tightly correlated to disease and the latter is not.

15/ I'll concede I have some disagreements with how the liver function / role is described a little while after that, but I want to put a pin in that for now.

16/ It looks like second half Sarah is discussing her personal journey with lung cancer. I'll concede I want to stop here for now and pick this up tomorrow when I'm in a better space to listen to it. I don't want to be part way in and then having to pause as I head to bed.

17/ But as a heads up, when I first learned of the news it hit me a bit hard as I'm one of the many, many, many people who has benefited from Sarah's kindness. Specifically, she has helped me make many key connections with my research and offered great advice many times over.