Active Low-Carber Forums
Atkins diet and low carb discussion provided free for information only, not as medical advice.
Home Plans Tips Recipes Tools Stories Studies Products
Active Low-Carber Forums
A sugar-free zone


Welcome to the Active Low-Carber Forums.
Support for Atkins diet, Protein Power, Neanderthin (Paleo Diet), CAD/CALP, Dr. Bernstein Diabetes Solution and any other healthy low-carb diet or plan, all are welcome in our lowcarb community. Forget starvation and fad diets -- join the healthy eating crowd! You may register by clicking here, it's free!

Go Back   Active Low-Carber Forums > Main Low-Carb Diets Forums & Support > Low Carb Health & Technical Forums > Cholesterol, Heart Disease
User Name
Password
Register FAQ Members Calendar Mark Forums Read Search Gallery My P.L.A.N. Survey


Reply
 
Thread Tools Display Modes
  #1   ^
Old Sun, Oct-21-18, 11:03
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,634
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default Feldman & Attia - Lipid Podcast - Some Uncomfortable Moments

Illustrating how much the idea of identifying blood lipids as health markers is far from settled, this podcast with Dave Feldman and Peter Attia encapsulates the discord and lack of scientific evidence with some ego flaunting and feather ruffling thrown in. I've followed each fairly consistently, and was surprised at the tone that developed during their first-ever exchange. In addition, the backwash from the follow ups is still churning. Feldman being transparent about all this only helps to push and force knowledge in this area. Lots to unravel here:

https://peterattiamd.com/davefeldman/

http://cholesterolcode.com/guesting...ause-mortality/

http://cholesterolcode.com/guesting...ters-prebuttal/

http://cholesterolcode.com/guesting...tured-thoughts/

http://cholesterolcode.com/dave-and...-attia-podcast/
Reply With Quote
Sponsored Links
  #2   ^
Old Sun, Oct-21-18, 14:09
Grav Grav is offline
Senior Member
Posts: 946
 
Plan: Banting
Stats: 302/187/187 Male 175cm
BF:
Progress: 100%
Location: New Zealand
Default

I haven't followed Peter Attia for as long as I've followed Dave Feldman, and I've only read through the first of those links so far, but from what I have read so far, it seems to me like Dave's getting exactly what he's often been asking for: ideas that refute his own. As you say Rob, he's very open about being self-taught in all of this and not being qualified at all.

If there was any niggle between the two of them during the podcast itself (which I also haven't yet listened to) then that's unfortunate, but on the flipside, debates such as this where opposing points of view are directly discussed between the two sides can often be the most interesting, for the sake of advancing the overall discussion on the subject. The Swiss Re conference earlier this year was particularly interesting for this reason also.

This will definitely take a while to digest. Thanks for the links!
Reply With Quote
  #3   ^
Old Sun, Oct-21-18, 22:22
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,634
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default

Quote:
Originally Posted by Grav
If there was any niggle between the two of them during the podcast itself (which I also haven't yet listened to) then that's unfortunate, but on the flipside, debates such as this where opposing points of view are directly discussed between the two sides can often be the most interesting, for the sake of advancing the overall discussion on the subject. The Swiss Re conference earlier this year was particularly interesting for this reason also.

That's exactly why I thought this exchange and subsequent posts in Feldman's blog about the podcast are so valuable. We are working to get answers to a topic that has had many certain yet debatable claims over the past 40+ years, and we should not be afraid to deeply explore all views on the matter for the purpose of finding the truth. Because we still have much to learn on the matter, opinions are going to be diverse and agreements will not come without the hard work to get to the facts. We are now starting to scratch the surface here.
Reply With Quote
  #4   ^
Old Mon, Oct-22-18, 08:28
khrussva's Avatar
khrussva khrussva is offline
Posts: 7,182
 
Plan: My own - < 30 net carbs
Stats: 440/211/210 Male 5' 11"
BF:Energy Unleashed
Progress: 100%
Location: Central Virginia - USA
Default

I recently joined Dave Feldman's LMHR (Lean Mass Hyper Responder) FaceBook group. Dave's always in search of more data. He put this targeted group up for both information gathering and debate. It is an interesting mix of people with many of us posting lab data, CAC scores, etc. There are approximately 800 members. Most are LMHR -- or at least have very high LDL cholesterol. Some have LDL-C at 300+ or 400+ and don't seem to care -- or even seem proud of it. They've bought into Dave's theory or the generally accepted position that cholesterol doesn't matter for those doing LCHF/keto. However, most members have joined because they and their doctor's are freaking out about their crazy lipid panels after going keto and they are looking for answers. Some members are MDs & RDs just looking to better understand this phenomenon. Unlike here and other "weight loss" oriented groups, many - if not most of the LMHR in that group started Keto for reasons other than losing weight. Many are younger, athletic types. Some are just very lean. My being a 'big loser' makes me sort of an odd duck in that group. At the moment Dave's theory of what makes a LMHR is 1) Not IR (metabolically healthy) and 2) Keto + Lean, Keto + physically active, or both. I think that my activity level and diabetes reversal are the things that 'qualify' me as a hyper responder.

I'm glad to be part of this group. The debate goes on and given my LMHR status I do want to know how this plays out (and contribute if I can). The science is not 100% settled. It wasn't settled when they decided to make fat & cholesterol that bad guy decades ago and it is not settled now. When I do keto my LDL-C doubles. When I eat LCHF right at my keto carb limits my LDL-C falls into a reasonably doctor pleasing range.

My problem is that I do better when I keep my carbs well down into the keto range. As I have chased better LDL-C numbers I find that I'm walking the 'slippery slope' of my carb limits. When my target is 40 to 50 net carbs each day keeping the eating within reason is harder. Frankly, I don't feel as good when I'm eating more carbs. With the exception of that darn LDL-C number, my gut tells me that keto is where I belong. At the moment I'm working on returning to keto. Once the reins are let out it is work to tighten things up again. I want to feel better. I also want to take care of a few pounds that I put on over the summer. My LDL will shoot up again. That's a given. But I will be heating healthy, whole foods and staying active. And I'll keep my head in the game about the latest science regarding the 'associated risks' of high LDL-C. What else can I do? I'd rather error on the side of staying lean and healthy. The way I see it, if I'm going to check out of this life early I'd rather be living a vibrant life up to the day of a massive heart attack than return to the path that I was on. Slow death by obesity, diabetes & alzheimer's certainly looks less appealing. If something new comes up to make me change my mind about keto, I'll consider making changes. But until then I'm returning to a VLC diet - perhaps for good.

Link to Dave's LMHR FB Group

Last edited by khrussva : Mon, Oct-22-18 at 12:19.
Reply With Quote
  #5   ^
Old Mon, Oct-22-18, 11:26
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,634
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default

Quote:
Originally Posted by khrussva
The debate goes on and given my LMHR status I do want to know how this plays out (and contribute if I can). The science is not 100% settled. It wasn't settled when they decided to make fat & cholesterol that bad guy decades ago and it is not settled now. When I do keto my LDL-C doubles. When I eat LCHF right at my keto carb limits my LDL-C falls into a reasonably doctor pleasing range.

My problem is that I do better when I keep my carbs well down into the keto range. As I have chased better LDL-C numbers I find that I'm walking the 'slippery slope' of my carb limits. When my target is 40 to 50 net carbs each day keeping the eating within reason is harder. Frankly, I don't feel as good when I'm eating more carbs. With the exception of that darn LDL-C number, my gut tells me that keto is where I belong.

Well stated, and this is exactly why I'm watching and listening to these discussions and new ideas on lipids. I do far better when I'm around or below 20-25 grams of carbs per day. That slippery slope is always potentially looming in the background, as I was a carb addict in the past, and I know it would be so easy to become one again. Attia, Dayspring, Feldman, Krauss, and others are deep into research; yet, we currently have no practical answers regarding accurate lipid health markers. Simple disagreements over the presence or not of LDL receptors in endothelial cells is a good example.

I'm taking the same approach, Ken. I'll keep my carbs low, eat healthy whole foods, and stay close or in the keto range, as that's where I do best and feel great. I'm hoping we can get something definitive on blood lipids as valid health markers and receive some guidance that adjusts for WOE. Until then, my simple N=1 adjusts for how I feel, and that's the best I can do. The good news? Much more to come as this dialog continues and more good minds contribute to it.
Reply With Quote
  #6   ^
Old Mon, Oct-22-18, 12:38
cotonpal's Avatar
cotonpal cotonpal is offline
Senior Member
Posts: 4,308
 
Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
Default

I guess I'm just an ostrich. I eat my keto diet, my weight remains stable, I walk every day (now that it is not hot and humid) and easily get 4-6 miles in, my bg's are "normal", half a dozen "diseases" or more are gone, and I take no prescription drugs. In December I turn 70. It's been a decade since I had my cholesterol checked. I have no idea what my numbers are. I am curious but since I know I won't change the way I am eating I don't see the point in having the test. The fact that cholesterol numbers get prioritized over so many other possible measurements just doesn't make sense to me. I sure they mean something but I've just opted out of the game. I figure I"m doing really well all things considered. Perhaps I'm just a luddite as well as an ostrich.
Reply With Quote
  #7   ^
Old Mon, Dec-10-18, 14:32
teaser's Avatar
teaser teaser is offline
Senior Member
Posts: 13,305
 
Plan: mostly milkfat
Stats: 190/152.4/154 Male 67inches
BF:
Progress: 104%
Location: Ontario
Default

Lots of stuff in there to have trouble understanding.

I do have to say, I never really understood why there being a reason for increased ldl cholesterol--if it's due to increase in a subclass of fat trafficking due to increased reliance on body fat, that's fine--but why that particular cause of increased ldl cholesterol would mean that increased ldl cholesterol wouldn't have an impact on heart disease is a bit beyond me. If it's true that the pattern is harmless for most people on a ketogenic diet--you might have to go to reduced inflammation/reduced oxidation of ldl cholesterol, reduction in insulin etc. for an explanation. Or it might be that in some situations of increased cholesterol, say starvation, there are preserved pathways that prevent it from having an atherosclerotic burden. There is at least one model where starvation does increase atherosclerosis, the apoE-deficient mouse.

The question of whether ldl cholesterol and particle count is increased for the transport of fat for energy or as a result is interesting. Decreased clearance is a possible consequence of low insulin;

Quote:
However, a decreased LDL uptake by the liver could be a second mechanism contributing to increased LDL levels. This is supported by studies showing that insulin, which is decreased during energy deprivation (Becker et al. 1971), increases hepatic LDL receptor gene expression (Streicher et al. 1996) and LDL receptor-binding (Salter et al. 1987).


https://academic.oup.com/jn/article/129/11/2005/4721856

Giving a subtype of insulin resistance that might be problematic. If insulin is high, but LDL is also high, maybe a weird situation to try to avoid.

Peter's suggestion that the main purpose of ldl particles is reverse transport of cholesterol--dietary cholesterol, we tend to not absorb much of it into circulation. The cholesterol we store in our fat tissue might be a different story, perhaps there is an increased need for clearance of cholesterol as a result of increased lipolysis. A housekeeping role secondary to a fuel-source role.
Reply With Quote
  #8   ^
Old Mon, Dec-10-18, 14:54
khrussva's Avatar
khrussva khrussva is offline
Posts: 7,182
 
Plan: My own - < 30 net carbs
Stats: 440/211/210 Male 5' 11"
BF:Energy Unleashed
Progress: 100%
Location: Central Virginia - USA
Default

Quote:
Originally Posted by teaser
... The question of whether ldl cholesterol and particle count is increased for the transport of fat for energy or as a result is interesting. Decreased clearance is a possible consequence of low insulin;
...
Giving a subtype of insulin resistance that might be problematic. If insulin is high, but LDL is also high, maybe a weird situation to try to avoid. ...

I had two cholesterol tests taken during the first 6 months eating LCHF (< 30 net carbs). My LDL-C was 141 a month into this WOE and 129 at the 6 month mark. My average weight loss was 15 pounds per month during that period. I was also still quite insulin resistant. My BG didn't normalize until I was eating LCHF for nearly a year. It was the next cholesterol test -- 13 months into the diet - that my LDL jumped to 250. So near as I can tell, the jump in LDL happened at a time when my insulin resistance was resolved. Other confounding factors: I'd also dialed down the carbs to < 20 net and started experimenting with intermittent fasting. So who knows for sure.

When I was neck deep trying to figure this LDL craziness out, I ran across a Dr. Sara Hallberg video where she postulated that the high LDL phenomenon with some low carb individuals might have something to do with regaining insulin sensitivity. So I would suspect that my experiences are not unique.
Reply With Quote
  #9   ^
Old Mon, Dec-10-18, 15:45
teaser's Avatar
teaser teaser is offline
Senior Member
Posts: 13,305
 
Plan: mostly milkfat
Stats: 190/152.4/154 Male 67inches
BF:
Progress: 104%
Location: Ontario
Default

Sort of why I used the "subtype" ahead of insulin resistance. Insulin does this, that, and the other. When insulin resistance is suggested as, insulin resistance-->increased insulin at subcutaneous fat (or visceral for that matter)-->increased fat, the assumption is that the tissue is still responsive to the fattening effect of insulin. Here I was sort of referring to whether the liver would be responsive to insulin's effect on ldl uptake specifically.

Another effect of insulin is the production of VLDL. Sometimes when type II's first go on insulin, they'll have a reversal of fatty liver--this is because insulin resistance kept them from repackaging triglycerides as VLDL for export. The liver taking in ldl cholesterol, partly because it needs raw material for vldl production probably makes sense.

One thing I wonder about. A lot of us went around for decades with insulin probably considerably higher than it is now. So we've got this cholesterol transport system, used to very high insulin levels. Bring insulin down to normal, even ideal levels, and things don't always go to what's normal and ideal--an example is the problems with electrolytes people can experience. If some of the activities of insulin normalize, but some don't, maybe we get these little weirdnesses.
Reply With Quote
  #10   ^
Old Tue, Dec-11-18, 22:53
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,634
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default

Most recently, Dave Feldman is focusing on the idea that the liver is possibly recirculating cholesterol, thus adding to the question of what does this phenomenon mean and how does this impact lipid test results? He mentioned that currently, there's no way to know unless you get into hard-to-do tracer models. By the way, this discussion can be heard on a podcast (Dr. Bret Scher) on DietDoctor.com. Well worth the listen.

So, the question remains, what do, if anything, blood lipid levels mean in relation to cardiovascular (atherosclerotic) health? Anything? As mentioned before, I'm very suspicious of claims that high cholesterol, high LDL are an indication of poor health. I believe that my experiences are not unique and no longer worry about lipids. I know how to get them to a level that is considered healthy by those who have established lipid levels as a health marker. I have done this (one of my N=1s) by eliminating dairy in all forms and gotten lipid results considered to be very healthy. Are lower levels of LDL really healthy or are many going through a futile exercise based on flawed assumptions that the exceeding of certain blood lipid levels are indications of health risks?
Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

vB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -6. The time now is 04:03.


Copyright © 2000-2019 Active Low-Carber Forums @ forum.lowcarber.org
Powered by: vBulletin, Copyright ©2000 - 2019, Jelsoft Enterprises Ltd.