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Jun 4 • 9 tweets • 5 min read
1/ Two weeks ago we released our paper on the #LipidEnergyModel (#LEM) along with our video abstract for it. I'm pleased to say it has led to many great connections and expanded discussion.

I'm going to recap on a lot of these in this thread. 🧵 ...

2/ First and foremost, thanks to everyone for their extraordinary support in retweeting our announcement, sharing our paper, and letting researchers know of this model.
3/ As we state many times (including within the video abstract), this model doesn't describe all possible influences on cholesterol levels. For example, other things can impact LDL-C such as M/PUFA-to-saturated fat composition, fiber, genetics, medication, etc.
4/ The key question is to what degree and context each of these can have an influence.

For many I've talked to, the current assumption is that 50% or more of the increased LDL-C observed in #LMHRs can be explained from the increase of dietary saturated fat specifically...
5/ This discussion comes up often enough that @nicknorwitz wrote a brief article on this for CC which you can read here: cholesterolcode.com/lean-mass-hype…

He also made a video covering the same points here:
6/ Again, I think I can speak for @nicknorwitz and myself that we definitely don't discount the influence of saturated fat where compared to unsaturated fats in generally impacting LDL-C. We're just skeptical as to whether this substantially explains the LMHR phenotype.
7/ I was also encouraged to see @DrNadolsky's interest in #LEM and his thread from yesterday 👇

8/ While we list many ways to test the model within the paper itself, it occurred to me I could do a very simple experiment myself by simply losing weight and maintaining it, which the #LEM would predict a persistent increase in TC/LDL/ApoB details here👇
9/ But a reoccurring challenge is helping to better connect people outside the #lowcarb community with this central question:

❓How much are lipid levels the result rather than a driver of health or disease?

It's my hope both the #LEM and #LMHRstudy will help with this endeavor

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More from @realDaveFeldman

Dave Feldman Profile picture
Jun 3
1/ Cool thread via @DrNadolsky

FWIW, I think I've figured out the perfect experiment via weight loss alone.

If I were to lose, say, 10-15lbs but keep diet composition as identical as possible (thus no increase in sat fat), the LEM would predict increased LDL/ApoB independently
2/ This is a great design given there are now other food items that would change other than possibly a net reduction in overall calories to maintain at the lower weight (but if anything, that would mean less sat fat in the overall, ofc).
3/ Given how strikingly different each model would predict the outcome, it seems like a given I'm going to need to do this experiment.

There's even a chance I line it up before the fiber experiment. (Working out scheduling right now...)
Read 4 tweets
Dave Feldman Profile picture
May 25
1/ Listening to @theproof's podcast with @NutritionMadeS3 as I work. I'm really enjoying it thus far and I again commend Gil on his ability for distilling complex scientific discussion effectively in his YouTube videos.
2/ I just got through the part at 47:51 that had me stopping to write a couple thoughts... (the queued spot in the video linked here👇)

@theproof brings up one's individual need to want to feel a "part of a community" (very big deal in the diet space)...
3/ ... And that "...it can challenge our identity if we come across information that is directly challenging one of these very strongly held views from within that community that our fellow community members also hold..."
Read 7 tweets
Dave Feldman Profile picture
May 23
1/ I had the debate between @NutritionMadeS3 & @ifixhearts on in the background while working. Really enjoyed it

First and foremost, both gentlemen were very cordial and professional. No ridicule, name-calling, or any other emotive personal attacks, etc..
2/ Which -- as you all know -- I'm a strong advocate for.

@NutritionMadeS3 represented the pro-LDL/ApoB lowering position well. (Note I've linked/tweeted his videos several times)

@ifixhearts brought forward the importance of metabolic health, and fault in it getting ignored...
3/ One important difference I was especially interested in-> do we have enough data in hand to feel confident high LDL/ApoB is a strong independent risk factor regardless of metabolic health. Generally @NutritionMadeS3 appears to favor "yes", @ifixhearts favors "unsure" to "no"
Read 5 tweets
Dave Feldman Profile picture
May 23
Yes, @ProfTimNoakes — The study actually gets quite detailed in that area. Note they include LDL-C >= 190 strata across the range of metrics. In fact, they are far and away the largest sample of this with CCTA/CAC of any study I know of.
And of course, I would especially still love to see this stratification in particular…
Read 4 tweets
Dave Feldman Profile picture
May 10
1/Last weekend at @MetabolicSummit was incredible. Really fantastic speakers and guests discussing metabolism research around microbiome, circadian cycles, muscle mass and longevity (shout out @DrRagnar) and yes, even #LMHRs got lots of airtime (props to @bschermd & @JaimeSeeman)
2/ Wonderful to catch up with so many peeps, like the incomparable @TuitNutrition, @bschermd, @LuciaAronica, @ChrisPalmerMD — and the @DietDoctor team, @tednaiman, @LowCarbRD, @DrEenfeldt, & @bschermd.
3/ Also, the Gala event Saturday night was bitter sweet opening with a recent, yet very inspiring interview from @DrSarahHallberg before her passing, but ending with a packed dance floor and music to finish the night.
Read 4 tweets
Dave Feldman Profile picture
Apr 20
1/ Always honored to have your added opinions, @Lpa_Doc and I'll again mention I'm a tremendous fan of your work (and the #OxPL assay, btw)

The #LMHR phenotype is potentially providing a new window of investigation into lipid metabolism, but its high LDL risk level is unclear...
2/ ... Hence the importance of the #LMHRstudy (still recruiting, btw -- see LMHRstudy.com for details)

In the mean time, we regularly and often emphasize everyone should work with their doctor and understand the guidelines recommend against high cholesterol...
3/ ... There are many like this pt who are in the unusual position of having a severe medical condition that appears to be uniquely resolved through a very carb restricted diet.

With respect, the patient didn't immediately refuse any form of treatment...
Read 6 tweets

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