1/ Okay, let's talk ANGPTL3-4-8 model. Mega thx to @nicknorwitz for getting well ahead of me on the angptls and their influence on LPL.

Here's the central figure, which we'll be referencing.

(Don't worry if you get lost, I'll unpack this more below..)

royalsocietypublishing.org/doi/10.1098/rs…
2/ "Lipoprotein lipase (LPL) is a rate-limiting enzyme for hydrolysing circulating triglycerides (TG) into free fatty acids that are taken up by peripheral tissues."

Translation: LPL is like a key cells use to open lipoprotein boats to offload their fat-fuel cargo (TG)
3/ "Postprandial LPL activity rises in white adipose tissue (WAT), but declines in the heart and skeletal muscle, thereby directing circulating TG to WAT for storage; the reverse is true during fasting"

Sure, post-meal we do more storing in fat via LPL, otherwise we do less.
4/ I actually presented on this a couple months ago regarding LPL in particular.

But if we think of cells being the ones to manage their own expression of LPL...what influences whether the cells will do so in the first place? How does the cell *know* the right levels to express?
5/ Well, we're in the process of finding out...

But one substantial impact we've learned a lot about recently are ANGPTL (short for "angiopoietin-like") 3, 4, and 8. All three of these are LPL *inhibitors*.
6/ "Angptl3-4-8 model: feeding induces Angptl8, activating the Angptl8–Angptl3 pathway, which
inhibits LPL in cardiac and skeletal muscles, thereby making circulating TG available for uptake by WAT, in which LPL activity is elevated owing to diminished Angptl4;..."
7/ "... the reverse is true during fasting, which suppresses Angptl8 but induces Angptl4, thereby directing TG to muscles."

So ANGPTL4 puts the breaks on LPL for our fat cells,
ANGLPTL3 & 8 put the breaks on LPL for our muscle/cardiac cells.
8/ So look again at figure 1 above for the fasting state (top half). ANGPTL4 is slowing uptake of fat into fat cells by LPL, which makes perfect sense given it leaves more for cardiac/muscle.
9/ Conversely, when fed (bottom half) ANGPTL3 & 8 are slowing down uptake of fat for cardiac/muscle from lipoproteins via LPL, leaving more of these available for the fat cells to store instead.
10/ There's still quite a bit I'm not covering and hence why it's worth reading the paper.

But this highlights an important tenant of the #LipidEnergyModel we're working on – which is the crucial signaling relationship between adipocytes and the liver to manage lipid trafficking
PostScript: Another shout out to @nicknorwitz for his extraordinary collaboration on the model. If you're not already following him, you should be.

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More from @DaveKeto

5 Aug
1/6 I'd like to both retweet and add on to @NutritionMadeS3's point here...

Again, and with emphasis, my position is one of cautious optimism. That's an explicit acknowledgement of uncertainty, even if I have a leaning toward the positive in this context...
2/6 I discuss this at length in 13-15 of my pinned tweet

Hence the importance of #LMHRstudy

I'd hope this were self-evident, but if I were completely certain high LDL + high HDL + low TG = low risk in fat-adapted context, there'd be no effort for a study
3/6 I've chatted with @NutritionMadeS3 and others on evidence I consider very compelling regarding the connection of health and illness for lipid metabolism and their impact on lipid profiles. But I likewise stress we'd be better served with prospective data in this context
Read 6 tweets
2 Aug
1/ Heard enough Lipoprotein Lipase (LPL)?

The tl:dr -> There's more selective control with fatty acid exchange in tissues than we fully understand... but we have a lot more we've learned recently...

#LipidEnergyModel @nicknorwitz

sciencedirect.com/science/articl…
2/ "Preferential uptake of FAs into high demand tissues such as the heart, muscle and brown adipose tissue cannot be achieved by non-specific uptake, which would acutely distribute FAs equally into all cells."

- Translation: there's some selective trafficking going on here.
3/ "A second uptake process modulated by activity of capillary lipoprotein lipase (LpL) involves FAs derived from triglyceride (TG) rich lipoproteins (chylomicrons and very low density lipoproteins." (VLDL)

- Yes, lipoproteins + LPL = hydrolysis of TG to cells
Read 11 tweets
23 Jul
1/6 Yes -- this article is over 3 years old now and I then presented on Remnant Cholesterol (RC) at LC Denver earlier that year.

In rereading this article, there are a few things I'd update -- but the general focus on systemic outcome relevance still holds...
2/6 A more updated article on this, along with further thoughts, can be found here: cholesterolcode.com/thoughts-regar…
3/6 If you read nothing else, check out this section from the article, and why I'm so vocal about *not* looking only at #ApoB (which lumps non-LDL and LDL) together.

Again -- and with emphasis -- this is part of the larger hypothesis. But all the more reason to research it...
Read 6 tweets
21 Jul
1/ I have a new favorite term: "unadjusted hypothesis-naïve exploratory linear regression"-- and it comes from @Ad_SotoMota, who @nicknorwitz and I are honored to be working with in this new project (news on that soon...)

I don't typically see the term as it's rarely employed...
2/ My layperson explanation is that this is explicitly letting the data speak for itself. Literally starting from scratch and seeing what patterns machine learning tells us are emerging. No adjusting the data at the beginning of the process which can bias the outcome (of course)
3/ I'm much more used to methodology sections describing several steps of adjustment selection by the researchers. This isn't to imply any wrongdoing by any means, but understandably, this can be problematic if one or more underlying assumptions for adjustments are incorrect...
Read 5 tweets
20 Jul
1/5 Polls!

While I am sure there will be some trolling (there always is 😂) I do want to check in on some general opinions regarding my work.

Let’s get started…
2/5 Which of the following two statements about me is more accurate?

1) I am obsessed with looking at lipid values in isolation (such as LDL by itself, leaving out HDL, triglycerides (TG), etc)

2) I am obsessed with looking at lipid in combination (such as LDL+HDL+TG together)
3/5 True or false –

I regularly give my opinion on LDL without any discussion on HDL and/or triglycerides.
Read 5 tweets
13 Jul
1/ Very cool experiment and thread by @ScepticalDoctor who did a more #PlantBasedKeto and saw low #LDL #Cholesterol given high MUFA/PUFA relative to sat fat, along with high fiber (which supports my prior thread)

If looking to keep LDL low, this might be worth considering...
2/ As per my various tweets before this one on the topic, and not to beat a dead horse, I feel it is too often "low carb vs plant based" is often assumed the latter *must* be high carb -- thus, "low carb, animal-based vs high carb, plant-based"

... This is a false dichotomy...
3/ There are definitely some of us who are, as I like to say, "cautiously optimistic" with regard to higher LDL as appears to be resulting from metabolic fat adaptation in the context of higher sat fat, lower MUFA/PUFA and low to no fiber. But this risk degree is uncertain...
Read 6 tweets

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