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Mar 24 • 5 tweets • 4 min read
🧵Followup on #salt comment last night:

Took 3 readings of my blood pressure this morning:
113/78
106/68
98/74
Average: 106/73

Context:
- Male, 49
- Moderate exercise
- Moderate-high stress career
- Supp 6-10g of salt daily when #keto* to relieve fatigue, cramping (for >5 yrs)
2/ So everyone on #keto should be like me and take copious amounts of #salt?

Well, sorry, but the answer appears to be:
👉 Your results may vary.... a lot.

On the little-to-no salt side, check out @KetoCarnivore's recent discussion on this
3/ Also check out this short video answer in a Q&A from Steve Phinney regarding salt intake research
4/ And check out @davidludwigmd discussion on this regarding #keto research
5/ But for me personally (and a fraction of folks who found the same) I definitely appear to need a lot of salt when #keto. Here's a tweet from almost half a decade ago where I was relaying my frustration in constantly ruling it out...

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More from @realDaveFeldman

Dave Feldman Profile picture
Mar 23
1/ #Metabolism, #lipids, and #ASCVD
#megathread🧵🧵🧵

Okay, I want to revisit and breakdown my position on this crucial topic and the challenges in communicating it.

⚠️ Get comfortable, as this could get long.

Ready? Let's go...
2/ First, it's worth reviewing why there's a high level of confidence low density lipoproteins (LDLs) drive atherosclerotic cardiovascular disease (ASCVD)

For an excellent, lay-person video, I recommend @NutritionMadeS3's from a couple years ago 👇

3/ Also in the name of arguably the most cited meta-analysis for the Lipid Hypothesis to date:

"Low-density Lipoproteins cause atherosclerotic cardiovascular disease"

This meta combines lines from genetic, observational, and interventional studies.

pubmed.ncbi.nlm.nih.gov/28444290/
Read 25 tweets
Dave Feldman Profile picture
Mar 12
Maybe. I hope so.

Let me just say a major problem with the #diet and #nutrition space is just how many sides seek to oversimplify these things.

And as unpopular as it is to say it, I think there's way too much focus of folks having extremely quick success as though it's common.
I know it's well intentioned.

But I also know many people in my own family who have struggled their whole lives to lose weight and assume if they don't have this near instant drop to their goal weight like <fill in the blank success story> then they are doing it all wrong...
... I can't tell you how many times I point out truly new, record-setting successes with people I know personally -- but it's their own record, their own health journey.

But they often can't see it because they hear they "won't be hungry anymore on <fill in blank diet>"...
Read 5 tweets
Dave Feldman Profile picture
Mar 11
1/ My thoughts on #Satiety & @DietDoctor 🧵

If you've followed me a while, you know I try to avoid the "diet debates" (tho not always successfully)

However, I have been getting a high frequency of DMs/messages/calls regarding DD's new endeavor for a #lowcarb alternative
2/ Let me first start off by saying I don't think any diet is inherently superior to all others.

I *do* think the #lowcarb diet is under-utilized for populations that can uniquely benefit from it.

However, I also believe most of us have many more options than is often assumed.
3/ Moreover, I consider @DietDoctor's long history of providing a "one stop shop" platform for all things #lowcarb/#keto with high quality guides, videos, and tools to be without equal.

It made it extremely easy to refer everyone in DD's direction, particularly beginners.
Read 16 tweets
Dave Feldman Profile picture
Mar 9
1/ Yes-- I've been meaning to literally do an entire talk on Simpson's Paradox because the concept is really quite simple.

Here's an example:
✅Hypothesis: higher body weight causes higher blood pressure.

💡If we only had scales and BP cuffs, we'd certainly see the relationship
2/ Let's further point out we could demonstrate it over three lines of evidence: observational (epi), interventional (Rx), and genetic (🧬)

Epi: When randomly grabbing a large population of Americans, we find those who generally weigh more generally have higher BP ✅
3/ Rx -- interventions that generally reduce weight, also generally reduce BP ✅

And lastly, 🧬 -- most genes that associate with lower weight will generally have lower BP ✅

Now obviously we have more advanced tools these days than weight scales and BP cuffs...
Read 7 tweets
Dave Feldman Profile picture
Mar 5
1/4 "also is the LEM (Lipid Energy Model) mutually exclusive with high LDL being atherogenic?"

Yes and no.

Yes -- in that the two should be treated as separate questions. It may well be that LEM is true, yet high LDL is independently atherogenetic and vice versa.

However...
2/4 No -- in that it was actually metabolic dynamics having an impact on lipid profiles that led me down the road we're at now.

Function vs dysfunction (or successful regulation vs unsuccessful regulation) having an upstream impact on lipid levels should be strongly considered.
3/4 But currently, it is assumed these influences are either irrelevant or the impact known -- at least to the extent that it is commonly assumed high LDL is pathogenic in every context (hence, little need to prospectively study metabolically healthy populations with high LDL)
Read 4 tweets
Dave Feldman Profile picture
Feb 7
1/ Got lots of pings on this one (including from @theproof)

But it's worth unpacking just how many variables are in play and why I obsess so much about controlling for them when the shifts are relatively small...
2/ If you're just tuning in, I've done over 50 experiments with many of them hypercontrolled (like below) where I literally eat to an exact meal plan with exact timing, have nearly identical exercise, and try to sync sleep schedule as best as possible. cholesterolcode.com/the-oxldl-repl…
3/ It's because I know there's already a lot of things that can alter lipid levels even in the very short term. Not just days, but *hours*.

Check out this prelim data where I was testing 6 times over each day. And these are the means of the last 3 days...
Read 12 tweets

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