swampf0etus wrote:Hi Dave and everyone following these comments,
I'm afraid that this is going to have to be my last response. Sorry if I’ve not responded to everyone. I just don’t have the time.
I hope I’ve not offended you Dave, I do actually have a lot of respect for you and your experiments. A lot more than everyone else in the low carb circles.
No worries. I'm actually very difficult to offend.
I often find the most powerful things I've learned come from trying to defend a position and being unsuccessful at it. The trick is to acknolwedge when this is happening and understand why it requires self-evolving to a new position.
DaveKeto wrote:I don’t think I’m more *qualified* than other lipidologists.
I wan't saying that YOU do. I was saying that others may think this. I'm pointing out that there are many others in this field that have more relevant qualifications and decades worth of research and experience in this area. They just need to be aware of this when reviewing your work, that's all.
Your point is well taken. And indeed, while I can’t do it at every possible mention of [my name=cholesterol-is-irrelevant], you will notice I don’t speak in categorical dismissals. In fact, I often fit in occasional tweets like this one — https://twitter.com/DaveKeto/status/852256998594715648
However, with that said, I’m sure you would likewise agree that there have been countless episodes through history where medicine has gotten a specific, unproven hypothesis that seemed reasonable and was treated as fact. This is particularly the case when financial outcomes are built on this assumption and the treatment for it. It’s not a good or evil thing, it’s just human nature.
DaveKeto wrote:Shouldn’t the elderly population be populated with those who naturally have lower LDL-C/-P? Or to put it another way, if LDL-C and/or LDL-P is independently atherogenic, wouldn’t all-cause mortality increase parabolically, thus leaving only lower level carriers as survivors the older a population gets?
This is something that used to have me confused. The question sounds straightforward, but I think it's quite complicated.<snip>
On this we completely agree. But here’s the catch — there are a number of things that truly are “independent” risk factors.
An obvious one is smoking. The more you smoke, the higher your risk of dying. And like most independent risk factors, there’s a strong association and a clear curve curve with use and quantity. Without question, there are multiple factors that play into this risk such as exercise, genetics, diet, etc — but when you control for all of these, you still have smoking as an independent risk factor.
Another obvious one is waist-to-hip ratio. The more visceral fat you have, the higher your risk. And this too has a strong association with all cause mortality and clear curve to it.
I don’t categorically dismiss cholesterol having an association with atherosclerosis, even though it is a weak one when shown in large studies (relative to the risk factors above, for example). But the problem is that LDL particles (not just cholesterol) are in use for many purposes within our bodies, such as reparative for injury or immunological for infectious events (the body often upregulates LDL particles to bind to pathogens in this circumstance).
Thus, I’m surprised high cholesterol isn’t *more* associative with death, given it’s likelihood to have LDL particles engaged in a final (if futile) stage of life-saving measures for the context. Much like I’d expect people to be more likely to die in the proximity of a doctor than not. A doctor has a high association with death, but not because he/she is the killer.
Which is why I completely agree — it’s complicated! Trying to control for the *positive* association of LDL particles given its many roles in a diseased or injurious state is probably something we may not be able to see in years if not decades.
swampf0etus wrote:But using small points like this to undermine the whole lipid hypothesis reminds me of 9/11 truthers clinging to any tiny bit of unexplained evidence to hold up their whole conspiracy theory, despite seeing every other piece of their argument debunked and shot down in flames. Even if this one, small argument can’t be explained does that mean all the other explainable evidence can just be ignored to falsify the whole argument?
I'm not saying that you are any kind of truther or conspiracy theorist, by the way.
That was very colorful, swamp — but I do feel this paragraph isn’t befitting your otherwise very cogent, debating style.
The reason I wanted to start with that point is that it isn’t easily dismissed. If LDL-C/-P is indeed an independent risk factor with all things being equal, then populations would shed more and more of those with naturally higher amounts as they aged. If the answer to this is “it’s complicated” (to which I agree), then the converse — “it’s simple” — would almost certainly be wrong. Thus, saying LDL-C/-P will independently increase your risk of dying is too simplistic. Wouldn't you agree?
Note that this is why I’m so adamant about examining the lipid system as a *system* and why it matters to me to review only studies that have all cause mortality as an endpoint (I just tweeted on this very thing recently https://twitter.com/DaveKeto/status/878651154812420096
). For example, if the body is more likely to kill you from CVD while saving you from cancer or AD and the net outcome is a longer lifespan, then I’m okay with that (and I suspect most people would be too).
EDIT: swampf0etus, if you're reading this right now and it's still the weekend -- STOP! Go get time in with your family. The internet will still be here on Monday. One thing no one argues about is the importance of family for long term longevity. I don't want any responsibility for shortening your lifespan.