Dave Feldman Profile picture
Engineering / Lipidology / Citizen+Formal Science 🎗 https://t.co/tKrrIdG1Yf (501c3) 🟡 https://t.co/EhKewtOfxz 🩸 https://t.co/D1LrI2dtIi
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May 23 5 tweets 3 min read
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...
May 23 4 tweets 2 min read
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.
May 10 4 tweets 6 min read
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.
Apr 20 6 tweets 3 min read
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...
Apr 18 4 tweets 2 min read
1/4 Retweeting via @Lpa_Doc -- click within to read 3 part thread. 👇

Also, per our video abstract:
"We remind viewers that existing guidelines and every major scientific institution around heart disease strongly advises against high cholesterol levels." 2/4 And,"While these data on our patient are comprehensive and provide potential new insights, they are limited in scope and timespan. It’s certainly possible this patient is an outlier, or that their progression of plaque will take place later, or many other such possibilities."
Apr 17 4 tweets 1 min read
1/4 FWIW -- the recent WDHR study using CCTA provided some very powerful data on this very question: jamanetwork.com/journals/jaman…

[Note the mean age was 58] -- "Second, we observed absence of plaque in 46.2% of patients with LDL-C levels of at least 190 mg/dL."... 2/4 ... "This proportion was similar to that in patients with lower LDL-C levels. Third, CCTA-ascertained absence of CAC indicated no detectable plaque in 86.8% of patients, including those with LDL-C levels greater than 190 mg/dL."
Apr 13 5 tweets 3 min read
1/ A lot of times polls like these are more interesting for the talk they generate than even the results themselves.

Here are a few featured comments and my added thoughts... 2/ A lot of people wanted greater specificity on what I meant by "rich" -- I left this more to the reader's interpretation. IMO, I'd have thought this would be in a highest quantile, such as top 1/3rd or 4th of typical aggregate diet.

Apr 8 5 tweets 3 min read
📊Polls ahead of #KetoSaltLake

Poll (1/4)
Lean Mass Hyper-responders (#LMHRs) are defined by:

+⬆️#LDL #Cholesterol at 190mg (5.17mm) or higher,
+⬆️#HDL-C 80 (2.07) or higher &
+⬇️#Triglycerides of 70 (0.79) or lower

In your opinion, cardio risk level of this profile is likely Poll (2/4)
Many demonstrating the #LMHR phenotype (but not all) consume a diet...

High in animal protein
High in red meat
High in saturated fat

In your opinion, if we were to further stratify the #LMHR population to those with the above diet, their cardio risk level would be...
Mar 9 6 tweets 2 min read
1/ The scientist in me is looking forward to this new, real world data emerging on #HealthConscious #Carnivores.

It will help provide data that helps confirm/disconfirm the long standing assumption that "healthy user bias" has been effectively adjusted for by researchers... 2/ If you're not familiar with "healthy user bias" (HUB), it's a known potential confounder where those who are doing what they feel is healthy in one regard (such as avoidance of red meat), can often have other likewise "healthy habits", such as more exercise, less smoking, etc
Mar 8 14 tweets 4 min read
1/ Yes! @NutritionMadeS3 -- please stay with this, it's important.

This goes back to what we were talking about last summer and why I keep drawing the distinction...

In fact, if you (and everyone else reading) would care to indulge me -- I'll unpack further... 2/ Let's definitely grant for a moment that ApoB containing lipoproteins (which we'll call ApoB-Lp) are participants in the process of ASCVD.

Can we likewise consider there are disease states (whether genetic or acquired) that result in both changes in serum ApoB-Lp *and* ASCVD?
Feb 27 8 tweets 4 min read
🎙An absolute *must listen*!!! 🎙

1/ This podcast episode via @HCTriage, the third in a series on #ScienceTransparency, the #ReproducibilityCrisis and how we got here is easily one of the richest, and most articulated explanations I’ve heard yet podcasts.google.com/feed/aHR0cDovL… 2/ Again, an incredible triumph in science communication by @crashcoursestan @olsenvideo @DrTiff_Phd among others.

👏 👏 👏
Feb 23 7 tweets 2 min read
1/ My thoughts on being a good #Moderator

First and foremost, your top goal is to service the debate, not your own opinions.

The best moderators are those who give no clue as to where they stand on the subject because it's their express duty to leave that to participants... 2/ All your interjections in the debate should come as no surprise to anyone -- especially the participants.

In other words, clearly define the rules in advance on what you'll be enforcing, and ideally, you should announce these to the audience at the beginning as well.
Feb 22 4 tweets 1 min read
Poll 1 of 4 (Please answer all four polls)

Which of these have the biggest association to heart disease? Poll 2 of 4

What is the *second* biggest association to heart disease? (Choose a different answer from your first)
Feb 13 4 tweets 2 min read
1/ I think this is a fair question to bring forward given a severe MI can associate with reduced LDL at admission and within days of the event.

But that's also why I like this study design so much -- they exclude known CAD (coronary artery disease) at baseline... 2/ For a relevant example-- this study makes direct comparisons on symptomatic ("chest pain") patients ultimately diagnosed AMI (acute myocardial infarction, aka heart attack) vs symptomatic yet diagnosed as not having had an AMI... journals.sagepub.com/doi/full/10.41…
Feb 13 18 tweets 8 min read
1/ #Study #MegaThread

A new study dropped with a trove of data I've long waited for around #CCTA/#CAC scans and #LDL #Cholesterol

✅ >23k studied (!)
✅ Largest sample of CCTA w/ ≥190 #LDL to date (!)
✅ Very uniform study population

Let's unpack...
jamanetwork.com/journals/jaman… 2/ First, be sure to check out this short thread from the lead author, @MaBMortensen.

2 quick notes:
a) While there'll be lots of data appreciated by LDL skepticism, @MaBMortensen maintains LDL-C is still "an important causal RF"
b) Usual epi caveats, etc
Feb 6 5 tweets 2 min read
1/ Reminder: I realize it’s the single hardest concept to get across, but for all these years I have and continue to suggest there’s a crucial case of lipoprotein profiles as often more a reflection of disease than the independent drivers of it. (ie — from 2018 re general👇) 2/ For example, I certainly know so much more on the workings of #LEM* than when I tweeted this from 2018, but does the foundation still hold up… do I think this is more relevant or less? Definitely more!

(*Obligatory mention of @nicknorwitz here and others re coming paper!)
Feb 1 5 tweets 2 min read
1/ Hi guys! Just dropped a new interview with Bill Cromwell (@Lipoprotein) on Youtube regarding their Precision Health Report platform.

I really love their model and suggest you check it out...


2/ They've kindly agreed to provide a coupon code "CITIZEN" for their package to help get both a discount and allow opting in your anonymized data to our OYL anonymous data pool. (Just like we do at our site)

No, there's no $$$ or compensation for us or anything like that...
Feb 1 6 tweets 3 min read
I'm incredibly honored at @nicknorwitz's offer for a transplant -- so blessed to have such a good friend they'd donate their own...

- eyebrows! 😂

Okay, but seriously, let's talk about disappearing eyebrows and how it can potentially signal reasons of concern... 2/ Occasionally I get a doctor (often a Dermatologist) ask if I've checked for hypothyroidism given it can be associated with loss of the outer eyebrow.

However, this is usually resolved when they see my eyebrows up close given it doesn't follow the same pattern... Image
Jan 29 5 tweets 4 min read
1/ A very busy time

But in this late moment of calm before the weekend, I'm finding myself truly humbled that our #LMHRpaper is finalized and has crossing so many interested eyes.

I hope many will agree with us this phenomenon is well worth researching.

cholesterolcode.com/our-paper-on-l… 2/ Via @nicknorwitz: "... this paper has stimulated vigorous discussion, risen to the top of its journal for all time reads, and is among the top 15 trending papers across all American Society of Nutrition associated journals for the year 2021." nutrition.org/15-trending-nu…
Jan 23 4 tweets 1 min read
1/4 Three #polls

I’m going to do a brief video soon on messaging.

But first I want to get a few polls* on what those following my account feel themselves 👇

(*yes, I know there’s a margin for trolling, as always. 😂) 2/4 When I’ve said I’m “cautiously optimistic” regarding context of metabolic fat-adaptation, you take that as…

1) I’m very confident LDL is of no concern.

2) I don’t know if LDL is of concern in this context, it very well could be. But I current lean toward the optimistic.
Jan 19 10 tweets 3 min read
1/ One of the toughest skills to master is avoiding sarcasm save those moments where you're pretty sure it will be well received by almost everyone.

Occasionally, I do a self check to see how that's going. Gotta say, I'm pretty pleased with some of the most recent ones... 2/ Everyone can related to the "I'm doing Diet X..." challenge. This one from May...