Thread by @realDaveFeldman

🧵 Dec 9th anniversary thread

On this day in 2015 I received a lab result that would alter the course of my life.

Just two weeks earlier I had gotten my very first bloodwork after half a year on #keto that showed my total and #LDL #Cholesterol had nearly doubled (!)… /1

2/ With that first test I was overcome with shock and curiosity — much more former than the latter.

I wanted to get a repeat test to confirm this wasn’t a lab error.

I wasn’t ready to give up #keto, but I was miserable enough that I ate considerably less.

3/ At the same time I learned as much as I could about Lipidology - which focuses on how the body moves lipids (like cholesterol) in the blood.

And to my surprise, this system is already very familiar to me as a software engineer given it is a distributed object network.

4/ (Skip this tweet if not a geek)

Some examples for my fellow nerds:

- It has variable packet sizing
- It has “headers” in the form of apolipoproteins
- It has “load balancing” via cholesteryl ester transfer protein (CETP)
- It has “capacity signaling & mgmt” via adipokines

5/ Anyway…

Eventually Dec 9th of 2015 comes around, but now I have a lot more questions than answers given what I was reading on the mechanics of the lipid system.

If it’s just as simple as “consume less saturated fat” — well, no problem. I was consuming half my diet anyway.

6/ But no — the opposite happened — my total and LDL cholesterol *increased* further.

I don’t have the LDL numbers handy (I’m visiting family), but I remember my total had gone from 329 (1st test) to 425 (2nd test).

That was a big 🤔🤔🤔🤔🤔 moment

Afterward, I was obsessed…

7/ I started tracking everything I consumed and keeping detailed dietary logs. I also continued to get blood tests, about one every two weeks.

And I started a blog to report this journey as it happened at CholesterolCode.com

8/ My understanding was very crude back then but eventually it further developed its way to the now published #LipidEnergyModel (doi.org/10.3390/metabo… — special thanks to my co-authors, particularly lead @nicknorwitz, and my co-senior author, Anatol Kontush)

9/ But while the mechanisms are interesting, what about the risk?

Do I have a firm certainty yet on whether high #LDL #Cholesterol and high #ApoB levels drive a high risk for atherosclerotic cardiovascular disease (ASCVD)?

Short answer —> I don’t know.

Hence the #LMHRstudy…

10/ In 2019 I went through the extensive process of forming a public charity (CitizenScienceFoundation.org) and managed to crowdfund a study around those with this “triad” of high #LDL and #HDL #cholesterol alongside low #triglycerides.

11/ This endeavor is the first of its kind in many respects. To the best of my knowledge, there’s never been a study that actively sought to isolate extremely high #LDL-C (top 1%!) in an otherwise low risk population to observe its independent impact on development of ASCVD.

12/ To be sure, many in this population often have a diet very high in saturated fat, red meat, animal protein, and/or low in fiber. (Thus, may be considered high risk dietarily)

In fact, many with this triad are consuming animal products almost entirely (ie “#carnivore”).

13/ Unsurprisingly, this study has gathered a lot of interest and I’m thankful for the many wonderful people who’ve helped us to get this far.

In fact, we’re now in talks for more studies around this research and I’ll have more to share on that this coming year.

14/ I’ll be able to speak a bit more in depth on ApoB in particular, how it is central to the #LipidEnergyModel/#LEM, and why I think this research could impact how we look to its association with risk in my talk at #LowCarbDenver this February.

15/ Needless to say, the research has been accelerating since this journey began seven years ago.

It’s getting harder to predict just how much will change year-over-year.

But for me, that’s a feature, not a bug.