Anybody interested in a lipid chat with Dave Feldman?

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Re: Anybody interested in a lipid chat with Dave Feldman?

Postby DaveKeto » Tue Dec 18, 2018 5:05 am

JimBG wrote:4) As a former risk manager and also having a background in chemical engineering I respect his approach in looking for root causes, taking a fresh problem solving perspective and challenging current dogma. That said I can't help but coming away with the view that based upon his personal experience, engaging a handful very smart folks, doing a great deal of reading of related studies over the last couple of years, as well as accumulating some of his own anecdotal data, that his will overturn key features of the vast body of knowledge accumulated over decades by many scientists, doctors and researchers who have devoted their entire lives to this field. In my opinion that is very unlikely.


I think your point is well taken here, Jim.

In essence, you're pointing to the evidence being limited with regard "the triad" and the existing data that we have with hyper-responders (particularly LMHRs).

This is why I'm actively pressing for more data that examines all three of these axes. We already know low HDLc and high TG are deleterious. They are both components of metabolic syndrome and the definition of atherogenic dyslipidemia.

All that being said, this is ultimately an assertion toward qualitative evidence over quantitative. It wouldn't matter to me if there were 100 studies that focused only on LDLc or 1,000,000 -- if the added stratification of high HDLc and low TG reduced its relevance to nearly zero, it would would make the previous body of evidence far less meaningful in this regard. In a sense, that's already happened with total cholesterol preceding LDLc, and LDLc preceding LDLp. The better metric should overtake the weaker one, particularly if you've already captured it (as is the case with HDLc and TG having already been gathered).

A bigger question for me is why we'd resist examining a more effective measurement in the first place.

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Re: Anybody interested in a lipid chat with Dave Feldman?

Postby mike » Tue Dec 18, 2018 10:18 am

DaveKeto wrote:In fact, I've started a series, #CholesterolScience, where I'm intentionally seeking out opinions across the spectrum to advance this discussion further. Currently, I've interviewed Spencer Nadolsky https://www.youtube.com/watch?v=6UsnzkpMmDI, Ivor Cummins https://www.youtube.com/watch?v=RxRzj_i9fJg, and Joel Kahn https://www.youtube.com/watch?v=JHzfU7TgcGo -- with Dr Tro Kalayjian coming this Wednesday)

More than anything, I'd like to get some of these tougher questions explored.


Dave, in you podcast with Ivor, it sounds like you are both proponents on Animal protein. Can you explain why, and how much of the diet you would suggest be protein? Are we talking land or sea? It is mentioned that if patients are concerned about high lipid levels, you might lower animal fats and add in some more carbs, but that neither you nor Ivor seemed converned about higher lipids in metabolically healthy folks.

I'm not remembering where I saw this for sure, but maybe the Attia podcast, you went through a flow chart, where you kept saying these various folks (LMHR, etc.) were not at risk for higher levels. At the very bottom, you are left with the non-metabolic healthy individuals with pattern B. But you stop there. What about these folks (like me)? As I said in a question to this podcast, I've had diabetes for 20 years, but my original diabetes doc never seemed that concerned - that it was because I had diabetes. I had a stress test done that was fine, and I had a CAC of 4 a few years ago.
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Re: Anybody interested in a lipid chat with Dave Feldman?

Postby DaveKeto » Wed Dec 19, 2018 10:21 am

mike wrote:Dave, in you podcast with Ivor, it sounds like you are both proponents on Animal protein. Can you explain why, and how much of the diet you would suggest be protein? Are we talking land or sea? It is mentioned that if patients are concerned about high lipid levels, you might lower animal fats and add in some more carbs, but that neither you nor Ivor seemed converned about higher lipids in metabolically healthy folks.


As always, I'd use the term, "cautiously optimistic". I make no claim of certainty with regard to metabolically healthy being low risk from higher lipid levels. But given both the existing research I've gone over, my own personal data (like the CIMT changes at very high LDLc/p), and the energy model itself -- I do think there's a strong case to be made for this optimism.

mike wrote:I'm not remembering where I saw this for sure, but maybe the Attia podcast, you went through a flow chart, where you kept saying these various folks (LMHR, etc.) were not at risk for higher levels. At the very bottom, you are left with the non-metabolic healthy individuals with pattern B. But you stop there. What about these folks (like me)? As I said in a question to this podcast, I've had diabetes for 20 years, but my original diabetes doc never seemed that concerned - that it was because I had diabetes. I had a stress test done that was fine, and I had a CAC of 4 a few years ago.


Regardless of LDL levels, there already is enormous evidence for improving your metabolic health both for CVD and non-CVD.

Moreover, as mentioned in the presentation, I think there can be bad reasons for high LDL, but the tip off commonly appears to be high triglycerides and low HDL for either (1) metabolic derangement, (2) a challenge event such as an illness that impacts lipid response, (3) some combination of the two. And again, these are only the most prominent reasons from what I can gather. There very well may be categories we have yet to identify.

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Re: Anybody interested in a lipid chat with Dave Feldman?

Postby Julie G » Fri Dec 21, 2018 9:39 am

Hi all! Thanks for your patience on the show notes from our webinar. Thanks also to Tincup and TheresaB for their help in putting them together. We're still awaiting a few additions, maybe corrections (?) from Dave. He's also offered to share his PowerPoint so we'll update as more information becomes available.

Show Notes from Webinar with Dave Feldman


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