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Nov 28 • 9 tweets • 10 min read
🧵1/8 Here's an easy thread for reference on our current papers. 👇👇👇

🔖 Bookmark this!

We cover:
- High #LDL on #lowcarb/#keto
- Lean Mass Hyper-responders (#LMHR)
- The Lipid Energy Model (#LEM)

- And, ofc, our #LMHRstudy underway right now
2/8 The #LMHRpaper was our first describing the #LMHR phenotype

- #LDL #Cholesterol of 200 or higher
- #HDL #Cholesterol of 80 mg or higher
and
- #Triglycerides of 70 mg or lower

Which is actually common for lean, very folks on #lowcarb/#keto folks. doi.org/10.1093/cdn/nz…
3/8 Our second paper brings a case report on a single #LMHR with extremely high #LDLc (~500 mg/dL) for 2.5 years, their eating patterns, and current CT angiography.

(⚠️Please note this is a single case report and should be considered anecdotal, ofc) doi.org/10.3389/fendo.…
4/8 We also have a short (7min), yet highly illustrative video abstract on our case report.
5/8 Our third paper details the Lipid Energy Model (#LEM), a comprehensive hypothesis detailing *why* we believe #LDL #cholesterol rises substantially in the context of very #lowcarb, #keto diet.

doi.org/10.3390/metabo…
6/8 We likewise have a short (5min) abstract for the Lipid Energy Model that's well worth your time to watch if you're interested in a high level overview.
7/8 Our fourth paper is my "first first author" where I detail my highly controlled three phase diet experiment, performed in duplicate. Myself and others apply principles of the #LEM in demonstrating an acute drop in #LDLc over-consuming saturated fat. doi.org/10.1097/MED.00…
8/8 Lastly, we have the #LMHRstudy now underway.

We're tracking plaque progression of #LMHRs in via CT angiograms.

The existing Lipid Hypothesis would predict emerging and rapid progression of vascular plaque. We'll have data soon. 📊

See LMHRstudy.com for details.
9/9 Addendum! Forgot to tag all the wonderful coauthors -- not the least of which being my good friend and collaborator, @nicknorwitz

In alpha by first name:
@AdrianSotoMota
Anatol Kontush
@bobkaplan
@davidludwigmd
@BudoffMd
@siobhan_huggins
Stefanos Parpos
@DoctorTro

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More from @realDaveFeldman

Dave Feldman Profile picture
Nov 29
1/ 🧵 I like a lot of @NutritionMadeS3's videos, but I'll concede this one was a little mixed, so I wanted to share some notes (it gets better by the end)

As always, I hope this will be received by everyone in a productive, respectful manner.
2/ myth: “CAC score of 0 means no plaque”

👆I feel this is another statement that is extremely categorial and unrepresented by the vast majority of knowledgable proponents for CAC.

We were chatting about this before on the debate questions...

3/ As an analogy - if someone were to make a video that outlined:
"Myth: LDL-C < 70 will keep you from ever having a heart attack" -- and then knocked it down, it would rightly be considered a strawman position of proponents more knowledgeable and representative of the whole.
Read 9 tweets
Dave Feldman Profile picture
Nov 22
1/ Alright, let's chat the #NHANES (IV)

As usual, I'll give my caveats this is back-of-the-envelope on data I wrangled via CDC on this expansive dataset -- and it's associational, ofc (observational)

So what are the lipids like for those who live to 100yr in NHANES?
2/ Remember, these aren't the lipid levels taken *at* age 100+, it's what their levels where at the time of examination 15-20 years prior.

This is very relevant when considering reverse causality given this extreme gap in time for all who were reaching centenarian status.
3/ First up -- #LDL #Cholesterol.

Yes, 73% of you correctly guessed 130mg/dL is the mean average for these 32 individuals (lipids taken age 85 or earlier).

LDL mean average: 130 mg/dL

0% 25% 50% 75% 100%
72.0 102.5 126.0 154.0 215.0

Read 9 tweets
Dave Feldman Profile picture
Nov 21
1/4 Back-of-the-envelope:

There are now 32 NHANES participants with lipids & mortality data who have lived to at least age 100 (age + followup > 100yr.), thus earning the designation of "centenarian"

What was mean avg #LDL-C for this group from their bloodwork 15-20yrs prior?
2/4 What was the mean average #HDL #Cholesterol (#HDL-C) for this group from their bloodwork 15-20yrs prior?
3/4 What was the mean average #Triglyceride (TG) levels for this group from their bloodwork 15-20yrs prior?
Read 4 tweets
Dave Feldman Profile picture
Nov 18
Standard caveat, ⚠️this isn't medical advice, ofc

My personal priority list:
1️⃣CCTA (CT Angiogram)
2️⃣CAC (Coronary Artery Calcium scan)
3️⃣Inflammatory markers
4️⃣Lipid markers
2/ CCTA gives a scan of both calcified and non-calcified plaque in the arteries of the heart.

There's an extremely small risk of adverse effects from the contrast dye, and a low exposure to radiation with the latest machines.

However, CCTA scans can be pricy (ie $500-1000)
3/ CAC is just the calcification of the coronary arteries, but it is surprisingly correlative to soft plaque AND is very predictive of future events. Check out @khurramn1's work on this for more info.

It also requires no contrast dye, is lower radiation, and typically $99-300.
Read 7 tweets
Dave Feldman Profile picture
Nov 17
🧵 New paper on comparing advanced lipid testing (NMR) with body fat (adiposity) - ht @nicknorwitz

High adiposity associates with:
- ⬆️ #ApoB & #LDL-C
- ⬆️ #triglycerides
- ⬆️ levels of all fatty acids

How does this relate to #LEM? Let's unpack... /1

nature.com/articles/s4385…
2/ "Adiposity-related hypertriglyceridemia is mainly driven by increased numbers of triglyceride-rich VLDLs (which carry the largest proportion of triglycerides in blood). Concurrently, the cholesterol in these lipoproteins also seem to be higher at higher adiposity levels."
3/ And these next sentences are key -- take special note of the underlined text... Image
Read 7 tweets
Dave Feldman Profile picture
Nov 8
1/ Respectful rebuttal 🧵:

I think you make valid points with regard to a diet community having bad actors that can reflect on it, @jerryteixeira -- but I'd push back that one has to tow the party line on high fat and/or high meat in #keto or get hammered.

Some examples...
2/ I myself have brought up #PlantBasedKeto many times over to raise awareness, even though I try to avoid the diet debates. But I've not suffered any repercussions from the keto community.

3/ DietDoctor.com is arguably the largest resource for #LowCarb diet, and in the last couple years have put out a great deal more material on higher protein with lower fat as a diet direction option. Many low carbers prefer this emphasis over higher fat as a %
Read 5 tweets

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