2/ First, I definitely DO NOT want anyone to interpret anything I've said as reflective of analysis with secondary prevention. I'm quite upfront that I prefer looking to lipid research with regard to so called, "primary prevention" (populations without prior heart attacks)...
3/ Second -- and as always -- I want everyone to work with your doctor. Yes, I do think your doctor needs to likewise work with you and your health goals, but this is a given.
If I had a heart attack, I'd definitely be working with my doctor and considering all the options...
4/ I would not dismiss their advice and experience out of hand and would likewise do my due diligence to be a better informed patient on what my next steps are.
But again -- and with emphasis -- I don't genuinely know what I'd do given this area is much less familiar to me.
5/ So to answer @ethanjweiss concerns very explicitly, my not commenting on what I'd do personally should not in any way be taken as implicit advice to *not* take cholesterol lowering medication. I can't emphasize that enough.
👆 And please feel free to retweet this thread.
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2/ For me, this journey started 6 years ago with alarmingly high total and LDL cholesterol following my going on a ketogenic diet. I became obsessed with trying to understand why and begin reading everything I could on lipidology...
3/ I found through a series of experiments there was quite a bit of change I could induce based on dietary patterns. As I developed and executed this "citizen science" research, I turned it around back to the community to hopefully help us in advancing this important topic.
2/ Let's have some fun and use a relatable analogy...
Imagine you had exactly two kinds of stores in the neighborhood: bakeries and butcher shops.
You normally get groceries from both, but recently the bakeries were closed down, so now you just get meat only for meals...
3/ Now that the bakeries are down, there's more demand on the butcher shops, so they are having more inventory sent to them.
But then, the neighborhood increased while the number of butcher shops actually decreased, and this required an even higher rate of shipments to restock.
1/ This would be a good opportunity to clear the air on a few things...
Per @DrNadolsky's tweet, we don't know everything we want to know about #atherosclerosis. Almost everyone would agree it is multifactorial, and most of Med would ascribe the central risk driver to LDL/ApoB..
2/ First, I agree glucose going up and down -- in and of itself -- is not inherently a mechanism of concern.
The key questions of interest are by how much and for how long -- and from this, can we determine if there is a dysregulation?
3/ I was listening earlier in a Clubhouse chat to @Dr__Guess discuss her recent study and how "all over the map" glucose levels were for these T2D patients -- which is unsurprising given the nature of the disease.
2/ @BioLayne “… if you torture the data enough, you can get it to show what you would like it to show.”
This is actually a variation I was one of my favorite quotes of all time.👇
3/ it’s also very prescient in its timing. I was actually just talking with @NutritionMadeS3 yesterday, and why I tend to be more interested in studies that work off open or shared data sets given the level of transparency in the statistical instruments being used…
The majority of things I'd "take back" have more to do with my having a simplified version of certain concepts that I now much more about (and would present as such)
But I'll be hit up on those things that are more overtly incorrect...
2/ Probably the biggest is my originally saying "Low Density Lipoprotein's primary purpose" is to deliver fat for energy. I had meant it at the time as the class opposite HDL (thus, all ApoB). Sure, a few slides later I differentiate with VLDL, IDL, and LDL...
3/ But the more appropriate way to have stated the same thing would have been: "The primary purpose of ApoB-containing lipoproteins overall is to deliver fat-based energy."
However, I don't think I'd like this statement as much either given how ApoB impacts immune other mechs...