fascinating new mendelian randomization study quantifies risk associated with triglyceride-rich lipoproteins (VLDLs etc) & their remnants

concludes ~4x more atherogenic particle for particle than LDL particles (maybe even more)

interesting implications
jacc.org/doi/abs/10.101… this indicates that 2 populations with the same ApoB level would have different risk depending on what type of ApoB particles are elevated (LDLs? VLDLs? both?)

some contrary views presented by Sniderman:
sciencedirect.com/science/articl…

“Are eggs good or bad?”

A fascinating recent study looked at this perennial question.

HT @TheBhupiThakur


🧵🔽sciencedirect.com/science/articl… Re: heart disease in particular, we can find heterogeneity in the literature. Some studies point to a signal of risk for eggs, others find no stat sig effect.

One of the main differences between science and Social Media content is how they deal with heterogeneity.

The Twinkie diet

In 2010, a nutrition Professor set up an experiment

he ate 1800 cals/day mainly from ultraprocessed sweets, Doritos, sugary cereal and Oreos
edition.cnn.com/2010/HEALTH/11… over 2 months, he lost 27lbs. his BMI came down to the normal range

his LDL-C dropped 20%. his triglycerides, 39%

his anecdote illustrates a couple points:

▶️we can lose weight on almost any type of food, as long as we cut calories enough

Once you understand HDL-cholesterol is not causally protective, it's straightforward to see why some of the popular ratios can be misleading

quick 🧵 using TC/HDL-c as example to make the math easier let´say my HDL-c is 40mg/dL and my total cholesterol (TC) is 200

That’s a TC/HDL-c ratio of 5

Does high ApoB still raise risk if I´m “metabolically healthy”?

The evidence indicates it DOES.

(thread) The idea that cholesterol level is completely irrelevant has largely subsided.

As the public is exposed to more scientific evidence, it has become increasingly obvious that blanket denial is not realistic.

So a more nuanced idea emerged.

“it´s about context”

"low cholesterol correlates with higher all-cause mortality so having high cholesterol is protective"

a misunderstanding that refuses to die

we know with a very high degree of certainty that this idea is *wrong*

3 lines of evidence: 1) lowering cholesterol via randomized clinical trials or genetically determined shows, if anything, *lower* total mortality

this comfortably supersedes the associational U-curve
ncbi.nlm.nih.gov/pmc/articles/P…
thelancet.com/action/showPdf…
academic.oup.com/ije/article/44…
thelancet.com/journals/lanhl…

How I got COVID and how you can avoid it 🧵

For the last year+ I've been essentially secluded, helping my mom recover from cancer (so far, successfully, but it's a daily battle) She's >70yo, transplanted, immunosuppressed and recovering from cancer

COVID could be devastating for her

it could be lethal

so we've done everything in our power to keep her safe

Top takeaways from @Drlipid's new podcast with @PeterAttiaMD

00:07 recent evidence has emphasized:

1) atherogenic lipoproteins are the crux of ASCVD

2) effect of TGs on lipoprotein concentration/function

3) diminishing relevance of HDL-C

4) Lp(a)

peterattiamd.com/tomdayspring6/ 00:32 brain cholesterol is separate from plasma; most cholesterol in the body is inside cells, not in bloodstream; most cholesterol in blood is in RBCs, not lipoproteins ▶️ so reducing serum cholesterol has little to no effect on cellular cholesterol requirements

Do eggs raise our cholesterol? How can we make sense of the confusing contradictory messages?

(Short thread)

Full video here:
I thought this was pretty clear to most but I kept getting this Q so I made a short video going over the evidence. Here's the gist.

Some stunning facts about the microbiome

(including how it can help you lose weight and fight inflammation, cancer, diabetes)

(short thread)

full video: 1) we're more microbial than human

we're effectively supra-organisms, and may have more bacterial than human cells

only 1% of the genes we carry are human. the other 99% are in our microbiome (bugs in out gut). ALL of those genes can impact our health

nature.com/articles/nrmic…

@USDA just released its literature review report (835 pages!!!) that will steer the 2020-2025 Guidelines

1st impressions:

1) focus on obesity/overweight (70% of Americans!), particularly children, and food insecurity/racial disparities (couldn't agree more) 👍💪

(cont.) 2) focus on *dietary patterns* over isolated nutrients or foods 💪💪👍

(cont.)

full report: dietaryguidelines.gov/sites/default/…

Weight Loss: Myths & Tips

(short thread summarizing studies by Kevin Hall and others and inspired by his recent hour-long talk)

video here: portion control and other attempts to 'eat less' backfire bc we don't burn calories at a constant rate

weight loss triggers hormone changes (e.g. leptin) that cause us to a) burn less cals b) be hungrier

it's the ultimate uphill battle

Your Cholesterol Lab results explained
(a primer on LDL and blood lipids)

- LDL vs LDL-cholesterol
- why cholesterol isn't the main problem
- LDL isn't 'bad' per se
- HDL isn't 'good cholesterol'

(short thread)

full video:
Lipoproteins are our body's solution to transport fats in the blood stream 🩸

🔬Lipoprotein = fat (lipo) + protein

low density lipoprotein = LDL

high density lipoprotein = HDL

lipoproteins are the vehicles that carry fats (like cholesterol and triglycerides)

*Ending social media 'oil wars' (nutrition, not Middle East)*

(short thread)

Olive oil: heart-healthy or cause of heart disease?

Some of the most vicious social media nutrition wars are not over sugar or bacon but over... olive oil

video summary:
one of the main concerns raised against olive oil: post-prandial dampening of flow-mediated dilation (FMD), a measure of artery wall function

e.g. Vogel 2000

sciencedirect.com/science/articl…

This was an excellent debate. Highly recommend to anyone interested in nutri sci

Perfect showcase of how a topic can be discussed scientifically without devolving into the circus for clicks we are often presented with in mainstream nutrition 'debates'

(short thread)

https://twitter.com/nutritionorg/status/1268271645510324224

I was surprised by the topic; I thought the 'yes' position had an overwhelming advantage

I couldn't even imagine how Krauss would structure a compelling 'no' argument

yet he made great points and highlighted areas of uncertainty and caution with nuance

I learned a ton

What do we know about Intermittent Fasting?
(short thread)

1) It's an effective weight loss strategy, with the metabolic benefits that normally come with it (e.g. improvements in gluc metab)

(cont.) 2) In mouse models, benefits of IF not fully explained by calories/weight loss

BUT

3) in human trials, benefits of >24h IF (Alternate day fasting, 5:2) generally track with calories and weight loss (benefits comparable to continuous calorie control)

pubmed.ncbi.nlm.nih.gov/26384657/

Are people really split btw stopping the virus and protecting the economy?

Brand new Yale study: it's not even close

84% of respondents prioritize stopping the virus, EVEN IF IT HURTS THE ECONOMY

Thread. maybe it's mostly the elderly? (self-interest)

maybe younger people worry less about the virus and would like to get back to work/normal life?

no.

>75yo prioritizing fight against the virus: 76%

millenials: >90%

all age groups strongly favor focus on the virus not economy

Highlights from The European Atherosclerosis Society Consensus Statement 2020

(thread)

"71% and 43% of middle-aged men and women, respectively, have evidence of subclinical atherosclerosis"

academic.oup.com/eurheartj/adva… "Extensive evidence from epidemiologic, genetic, and clinical intervention studies has indisputably shown that low-density lipoprotein (LDL) is causal in [atherosclerosis]"

@GardnerPhD puts the plant protein concerns to rest

“protein-rich foods such as legumes, nuts and seeds, are sufficient to achieve full protein adequacy in adults"

mdpi.com/2072-6643/11/1… @GardnerPhD (cont)
"The claim that certain plant foods are missing specific amino acids is demonstrably false. All plant foods contain all 20 amino acids, including the 9 indispensable amino acids"