DeepSummary
In this episode, Dave Feldman shares his hypothesis that high LDL cholesterol levels in metabolically healthy individuals could be a physiological response rather than a pathological one leading to heart disease. He discusses current research on the link between high LDL and cardiovascular disease in those following a ketogenic diet, and argues that much of the existing data focuses on metabolically unhealthy populations.
Feldman describes an experiment conducted by his colleague Nick Norwitz, where Norwitz consumed Oreo cookies in addition to his ketogenic diet. Surprisingly, this led to a 71% drop in Norwitz's LDL levels, more than what a statin medication achieved. Feldman suggests this supports their "Lipid Energy Model" which proposes that high LDL in lean individuals may be related to fat adaptation.
The episode explores the nuances around LDL, including the difference between soft and hard plaque, the role of endothelial health, and Dhru's personal experience with his own LDL levels. Feldman emphasizes the importance of considering overall metabolic health markers rather than focusing solely on LDL.
Key Episodes Takeaways
- Dave Feldman hypothesizes that high LDL cholesterol in metabolically healthy individuals on a ketogenic diet may be a normal physiological adaptation rather than pathological.
- The controversial 'Oreo experiment' by Feldman's colleague showed dramatic LDL reduction by adding Oreos to a ketogenic diet, challenging the conventional view of LDL as inherently harmful.
- Feldman emphasizes considering overall metabolic health markers like HDL, triglycerides, and inflammatory markers, rather than focusing solely on LDL levels.
- Direct imaging of arterial plaque buildup through CT angiograms may provide more insight than just blood LDL levels alone.
- More research is needed specifically on metabolically healthy individuals with high LDL to better understand the nuanced relationship between LDL and cardiovascular risk.
- Feldman challenges the conventional stance that all high LDL is pathological, arguing that existing data largely focuses on metabolically unhealthy populations.
- The role of the endothelial lining and how LDL particles interact with it is an area of contention and further study.
- Feldman calls for transparency in data sharing and subgroup analyses to understand which populations may truly benefit from LDL reduction.
Top Episodes Quotes
- “The hypothesis is the exact scenario I'm describing where I myself, who tend to be leaner and more metabolically healthy, and saw my cholesterol go up from going on a ketogenic diet and becoming adapted to consuming fat, that actually the higher level of cholesterol may be physiological as opposed to pathological.“ by Dave Feldman
- “The reason I bring this up right now in totality, is more of the talk right now is on the Oreo versus statin experiment, and that's a credit to Nick Norwitz in that, yes, just before that was a 41 randomized control trial metaanalysis that's not gotten nearly as much play, but for which we would definitely hope that more of the people who are critics of the lipid energy model would have looked at, because it very much substantiates this leaner component, particularly as you get lower than, say, 25 BMI and the association of change in LDL cholesterol as would be predicted by the model.“ by Dave Feldman
- “For me personally, I feel as though I'm doing my due diligence in that. Like you, I've got a CT angiogram. I've actually had two. I've had a total of three cacs and two CT angiograms. But to be fair, a CT angiogram includes a CaC. You probably already know this. The first pass they make is to check on your calcification. So when I say that the reason I bring this forward is regardless of what's happening within my blood, nothing beats actual detection of the disease itself, you're going to have a tough time convincing me that anything is as important as actually looking at the geography of the heart.“ by Dave Feldman
- “So once we have that, once we have that data in hand, at least to be able to say it for those folks who are metabolically healthy, that would be the first step to us getting a better sense of this more complex version, at a minimum, of what we think we understand today.“ by Dave Feldman
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Episode Information
Dhru Purohit Show
Dhru Purohit
3/4/24
The current thoughts around LDL cholesterol center on the fact that there is no scenario in which high LDL numbers could occur in healthy individuals. Traditionally, the belief is high levels of LDL can lead to a greater risk of cardiovascular disease regardless of metabolic health. Today’s guest is here to share his hypothesis and research on how higher cholesterol levels in metabolically fit individuals could be a physiological response rather than a pathological response that can lead to disease.
Today on The Dhru Purohit Show, Dhru sits down with Dave Feldman to discuss high levels of LDL in metabolically healthy individuals. Dave shares the current research on high LDL and cardiovascular disease in individuals eating a ketogenic diet. He also shares his personal approach to focusing on metabolic health and the key markers critical to overall health. Dave discusses the process and findings of the Oreo experiment conducted by his colleague and explains why this experiment further proves their hypothesis on how LDL particles move through the body.
Dave Feldman is a software and platform engineer, entrepreneur, and founder of the Citizen Science Foundation. Through a series of self-experiments and partnering with formal researchers, he has since published the "Lipid Energy Model," which may explain this phenomenon.
In this episode, Dhru and Dave dive into (audio version / Apple Subscriber version):
- Dave’s hypothesis on LDL (00:24 /00:24)
- Rethinking our approach to high LDL (2:17 / 2:17)
- The research on high LDL and cardiovascular disease (10:00 / 6:48)
- The Oreo experiment and what it shows about fat adaptation (17:23 / 13:45)
- The pushback to lean mass hyper responder (27:36 / 24:15)
- Soft plaque versus hard plaque and the risk of cardiovascular disease (37:50 / 35:04)
- Dave’s personal approach in focusing on overall metabolic health (51:42 / 48:30)
- Fasting Insulin and Vitamin D (59:33 / 53:45)
- Endothelial health and cardiovascular health (1:03:28 / 57:45)
- The vegan’s twin study and the correlation to LDL (1:21:17 / 1:15:49)
- Dhru’s experience (1:32:17 / 1:26:36)
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