-- It's a very fair point with regard to looking at different data, coming to different conclusions and so forth. We see this especially with nutrition science.cdamaden wrote:I agree. The thing frustrating to me, and was at the root of the question I asked Dave, was whether they are even looking at the same evidence. (Dave focused on how bias affects us all, which is true, but doesn't get to the heart of the question.) I would like to see a dialogue on what team A says is their most compelling evidence, then team B says what theirs is, and then require each team to discuss why the other team's evidence doesn't convince them to change their views. I feel like there is a lot of discussion on why team A (or B)'s model is flawed but less on debating the implications of experiments X, Y, and Z.floramaria wrote:... I find everyone’s explanations convincing, though mutually exclusive!
I would also add that Dave is very gracious and a model of humility and civility. It seems that many of the other members debating these points are too quick to be dismissive of other perspectives (those low carb people, those establishment lipidologist, those people who dismiss HDL, chortle chortle), which I guess is a bit of human nature and tribal but disappointing nonetheless. I lose a lot of respect for those who use ad hominem justifications.
This is why I specify a distinctive model by which I'm coming to these conclusions. Thus, my assertion is falsifiable -- hence the "#LCCholesterolChallenge" ( ). Something being falsifiable is at the heart of science. And I wouldn't be surprised if I have some things wrong. Indeed, I'm looking for it.
In other words, instead of grabbing studies A, B, and C that make a case while ignoring X, Y, and Z that dispute it, you make a hypothesis that *any* study (of merit, of course) can nullify. This is what I was getting at the end of the podcast with Peter. I was explaining how I'd like to get a very large dataset to test my hypothesis and test his counter-hypothesis as well.
This exchange toward the very end is where I sought to identify this:
The larger point I was emphasizing is that I'd be willing to make the bet on HDLc+TG being more relevant (it's falsifiable), and I'd suspect one who believed in the Lipid Hypothesis would take the other side of that bet. It would have been enjoyable if we could both agree on this fundamental, testable assertion before I succeed at getting these data sets queried (a project now in progress).Dave Feldman
The thing we’re dancing around here is, obviously when you have high HDLC and you have low triglycerides, it suggests a number of different things. But, more broadly, it’s suggesting a properly functioning lipid energy system, and probably not being in a state of challenge-
Peter Attia
HDLC tells us absolutely nothing. If we’ve seen enough from Mendelian randomizations and in other, how many more CTEP failures do we need to see? HDL cholesterol tells us nothing about HDL function. In fact, any time you increase HDL cholesterol pharmacologically, you seem to make patients worse.
Dave Feldman
I know, but these are modifications to the existing lipid system. If you block cholesterol-
Peter Attia
I get that, Dave. But, boy, if you’re gonna hang your hat on it’s all about HDLC triglyceride, I mean, wow, we are so far beyond that in the lipid world at this point. If you’re gonna go through this brain damage, make it for something worthwhile.
Dave Feldman
But, wouldn’t you predict right now, that if I did hang my hat on those two things, on those two markers, against LDLC or ApoB or LDLP, that it would fail. That if I were to say, “Hey, I wanna get a stratification just of high HDLC and low triglycerides.” That you’d say, “Sure, Dave.” I’ll bet you $10,000, I’ll give you 100 to 1 odds, those people with high LDL, even if you stratify for those two, will still have high rates of cardiovascular disease.
Peter Attia
Again, I’d have to completely see the patient population before I could even hazard a guess.
Dave Feldman
But, right now, you would assume that. Right?
Peter Attia
I am going to assume that LDLP is going to be a stronger maker of prediction than HDLC.
Dave Feldman
And that’s not what I’m making the case on. What I’m making the case on is, whether or not there’s a properly functioning lipid metabolism, which would be indicated by all three of those.
Peter Attia
No, you have absolutely no understanding of the lipid metabolism by looking at HDLC and triglyceride.
Dave Feldman
I think-
Peter Attia
Not even close. No, no, no, we can disagree on things that are nebulous. This is not nebulous, Dave. I mean, you do need … Again, I hate that I’m saying this, because I sound like a jerk and I don’t mean to. You’ve got to spend more time with lipid people, you really do. . . . You’re not dealing with your peers at this. You have to go and figure out … I mean, HDLC is just categorically not a useful metric. It is like a first order term on a … No, it’s not even that. In engineer-speak, it’s the fourth order term on a fifth order polynomial.