Dave Feldman discusses: Cholesterol Patterns, Heart Disease Risk, Diet and Current Research

Check out the latest Low Carb Conferences podcast as Dr. Jeffry Gerber interviews Dave Feldman who will be speaking at Low Carb Denver 2023, Feb 23-26, health & nutrition conference. Attend in-person or virtually and support nutrition science. Register for discount tickets to the conference: lowcarbconferences.com/#tickets.
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In this podcast we discuss: Cholesterol Patterns, Heart Disease Risk, Diet, Lipid Energy Model and Current Research
Dave Feldman is a senior software engineer, entrepreneur and a citizen scientist. He began working with programming and system engineering at a very young age and has always enjoyed learning new mechanistic patterns and concepts. After starting a Low Carb diet, Dave found his cholesterol numbers increased considerably. He then began reverse engineering the lipid system through self-experimentation and testing, finding it was very dynamic and fluid. Using his engineering skills he saw patterns in cholesterol profiles associated with Low Carb diets that brings new light to our understanding regarding cholesterol and heart disease. The term "Lean Mass Hyper-Responder" has now been cited in peer-reviewed literature thanks to Dave's work including his published and ongoing research, the Citizen Scientist Foundation LMHR study citizensciencefoundation.org/... and the Cholesterol Code cholesterolcode.com/.
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[@Roberto-cg2gr]

Hope Kraft test will be included in LMHR experiment

[@minaprice7840]

I had a very interesting chat with my doctor yesterday. I have been on a water pill for a while for blood pressure. She said she started having some higher bP numbers so she began the water pill herself. She said her LDL which had never been a problem started going up. We are experimenting now because when I am really low carb I lose a lot of water so I don’t need the water pill. She has taken me off my water pill for the next 3 months to see if my LDL comes down. Just throwing that out there because low carb causes a lot of water loss.

[@sharonillenye8036]

oh! very good observation.

[@iss8504]

Dave, appreciate you. Now I know why my trigs seem high as I fast, despite being low carb. I am going to stop fasting around the time I want to do bloodwork.

[@daisiesushitam984]

Ideally, you should fast between 12-14 hours before doing bloodwork for trigs. Trigs will be high if you fast beyond 14 hours because fat will be mobilized for energy. Under 12 hours, dietary fat may still be in transit. Dave explains in this video. kzbin.info/www/bejne/onvHeXl5bq1qj7c

[@HollyGeee]

Fascinating! Looking forward to the results for the LMHR group.

[@nooks12]

Can one be a Canadian and in this study?

[@bobcocampo]

Hope CIMT to detect soft plaque will be included in the test

[@candywoodgate7409]

I have total cholesterol of 11.9 Hdl 1.7 Ldl 9.2 Triglycerides 2 HbA1c 35 66 years old, no fh, low/normal bp, 9st 2lb, 5’ 2”. I know that about 20 years ago I was 4.5 but I couldn’t say whether that was hdl or ldl or total cholesterol. I am pretty much carnivore for a couple of years but keto for around 12 years. I think I may be a lmhr but all I am to my doctor is a wilful non-compliant mi waiting to happen. I have been refusing statins for about 7years. I am in the uk and the lipid numbers you give are a bit confusing for me.

[@daisiesushitam984]

Off-topic question for Dave: Have you ever included thyroid tests in your bloodwork panels? Are they in the optimal range?

[@cocosilkworm]

That's a good question considering the reputation keto has for tanking people's thyroid hormones, right? He has made a video about it here which might answer some questions about it but I think any LMHR needs to rule out thyroid issues, as well as a number of other things that could be pushing up cholesterol. They also mention keto upsetting women's hormones and menstrual cycles. That's another area that needs more research for sure! kzbin.info/www/bejne/e6ild6Wgf7SWrLs

[@daisiesushitam984]

@@cocosilkworm Thank you!

[@susanbeever5708]

Check out how hypoosmolality leads to upregulation of TRPV4 on endothelial, macrophage and osteoblasts and causes cytoskeletal changes that cause a break in the endothelial to endothelial cell bond in the endothelial monolayer, the production of M1 inflammatory macrophages that produce cytokines and ROS that oxidize lipids and then phagocytize the oxLDL and wind up getting through the broken endothelial cell layer while osteoblasts turn into osteoclasts and osteoporosis takes place. Oxcarbazepine an anti seizure medication upregulates TRPV1 and TRPV4! TRPV1 cayses the hypoosmolality via hyponatremia. Lastly, TRPV4 blocks the reabsorption of potassium on the renal collecting duct.

[@condoguy710]

Does this suggest that down regulating TRPV4 is beneficial ? If yes m, what would help deactivate it

[@susanbeever5708]

@@condoguy710 TRP receptors are a highly conserved system since before amoebas, and from what I observe cannot be singled out in a systemic way because they will cause malfunction elsewhere. The key is not to upset the system in the first place. One exception is the focal application of topical capsaicin to desensitize TRPV1 in diabetic neuropathy as short term relief from burning skin pain. The answer actually is to not up-regulate TRPV1 in the first place since too much causes insulin resistance and many diseases such as diabetes, atherosclerosis, osteoporosis, cysts, arterial spasms that lead to cramp fascicular syndrome and transient ischemic attacks, even myocardial infarction. Monosaccharides such as glucose, insulin and drugs such as ephedrine, oxcarbazepine, glp-1 receptor agonists and other agonists such as capsaicin in hot peppers, pH and temperature change and toxins stimulate TRPV1.

[@condoguy710]

So if the energy model posits that the lipid markers go in reverse of “idea” while fasting , does that suggest fasting for a blood draw will get results that a doctor would see as high risk and want you on a statin ? Sorry if I misunderstood what Dave was suggesting

[@andreacooper7092]

That’s all me!!!!

[@flolou8496]

My HDL is in the high 40's to low 50, Triglycerides under 100 (seems lately to range between low 80's to high 90s) but LDL Cholesterol around 190, I'm attempting to get the LDL back below 180 by going off eggs for 3 weeks, and cutting back on meat, I was suprised 2 weeks ago to find my LDL still had not gone down at all, with my latest round of superdoes of Red Yeast Rice and Niacin, so I decided to add additional garlic and citrus bergamot supplementation to try and bring LDL back down, if that doesn't work in the next two week's, I'll be left with accepting the idea I might be a LDL hyper responder:

[@joeberrouard3743]

Red rice yeast is mold, just wanted to let you know since most people don’t know that

[@flolou8496]

@@joeberrouard3743 Too much on my mind and too many projects needing attention, but in case doing a deep dive into Re Yeast and the mold toxicity question you rise, I would just say upfront, that there are other products people have been eating for years that are a product of mold, I'm not a healthcare professional or nutritionist or dietician, but even I know that blue cheese is a product of mold, but I'll look into this some more later, who know's maybe the Red Yeast Rice can lower cholesterol but raise liver enzymes as it attempts to deal with the ''harmful mold'' ????

[@iwonaj4116]

@@joeberrouard3743 it contains a statin, lowastatyna.

[@joeberrouard3743]

@@iwonaj4116 yes, and mold

[@Jslaughter90]

I have the same cholesterol values and struggling to identify the best method to safely lower LDL.

[@kristivatland3701]

I am about 4 months into carnivore diet. Main reason is to help my autoimmune. My previous lab work has always been very good. However, my recent labs …. Cholesterol in the 500’s , LDL in the 400’s , HDL 78 and Triglycerides 64, ratio is a 7 , VLDL 13. I guess this greatly concerns me that my LDL and total Cholesterol went extremely high in such a short time. Could you give me some ideas on why and what I could do to reduce my LDL and Cholesterol while keeping the other numbers at their current value. My doctor wants to start

[@whlawson5812]

Doing a monthly test for TC, LDL, trig, HDL in a pharmacy is quite cheap. I regretted not doing these tests once every 2 month while on low carb. My TC was close to double the upper limit at end of my 1st year on low carb and while my weight had drop from 82kg to 71kg. Then my TC starts dropping gradually by the 18th month - lower by about 40% to 6.1mmol/dl. In the 18th month I added 5000 vitamin D3 with Mk7 vitamin K2 180mcg to my daily multivitamin & 3g of PAN salt which was from day 1 of low carb. Also add 2.5mg Crestor for a short duration 3 months. After 1 month after stopping Crestor the TC is 4.8mmol/dl. Trig at 0.9mmol/dl, HDL at 1.5mmol/dl. LDL at 2.8mmol/dl. Today at 65.5kg.😂😂😂. Regards.

[@jerseyjim9092]

If you're worried about your LDL, the only thing that's going to move the needle to so called safe levels are high doses of statins, zetia or a pcsk9 inhibitor. You're likely a hyperabsorber and/or hypersynthesizer of cholesterol. The only other solution would be to drop your saturated fat intake to 10% of daily calories. It worked for me but but it was unsustainable. I think my highest LDL was about 200. A super low saturated fat diet dropped it to 90. I had genetic testing which was negative for FH but sterol testing showed I was both a hyperabsorber and hypersynthsizer of cholesterol. The normal treatment protocol would be high dose Statin with Zetia. I'm intolerant to statins so I chose a pcsk9 inhibitor which allows my to stay keto/carnivore while keeping my LDL in the 70-80 range. I have a moderately high calcium score so until there's something more definitive as to the claim that high LDL isn't a problem, I'm hedging my bets.

[@whlawson5812]

I think you could do your lipid test, at the end of every month, in a pharmacy for USD10 or less. I regret not doing a test every month & keep a detailed record on everything My reading of high TC, high LDL was double the "normal max" when tested at 6th month after starting in low carb. BMI had drop from 29 to 25. I could not remember exactly when I stopped taking avorstatin. Test on the 18th month show about 40% drop in TC but still over range. BMI stabilized to around 24. On the 25th month a big drop to almost the normal range for TC & LDL. HDL : trig ratio is 1: 0.9. BMI holding around 24. 20th to 23th month did took Crestor statin of 2.5mg. 18th months onwards did add 5000unit vitamin D3 c/w vitamin K2 into my daily multivitamin & 2 to 3g of PAN salt. So keep a log book & do lipid test monthly in a pharmacy is a good way. Year 2020 vs 2021vs year 2022 blood work by lab indicates big improvement liver health. Your journey on low carb or keto could take 2 years like mine before you see results that you wanted to be. Regards.

[@jerseyjim9092]

My wife's cardiologist used to bug her about about going on a statin until she came back with a zero calcium score.

[@andreacooper7092]

I would be a perfect candidate

[@obrotcho8289]

Great video! I am keen on getting your advice wrt my recent lipids test results: TC 273 HDL 59 TG 58 LDL 208 TG/HDL Ratio 1.0 I take medication for hypertension and am suspected of having Familial Hypercholesterolemia (have corneal arcus, so it seems). Quit Statins 3 months ago. I do intermittent fasting 18:6 every day for 2 months. Have lost about 10kg. BMI of 20-21. Performed an Ankle Brachial Index DIY with a score of 1.5. I will really appreciate your advice Dave Feldman. Your lifesaving videos have served as my health guide these past months.

[@iwonaj4116]

Don't trust the ratio as i did. I ended up with 2 stents in my heart saving my life,

[@orionthehunter9107]

My wife started low fast and carb 3 years ago when after a cholesterol check her levels were a little high. Close to 300 total cholesterol. After a year she changed to keto to lose weight. She lost over 20 pounds. 136 down to 116. A few months ago she had her cholesterol checked with advanced lipid test and her numbers of both hdl and ldl skyrocketed to 851 total. What the heck happened? Triglycerides, A1c, hemoglobin, sugar levels all good. O2%, blood pressure excellent. She exercises daily. Alternates from free weights, yoga, cardio, etc. What's going on here?

[@sportysbusiness]

Dave calls your wife a 'lean mass hyper responder'. Look it up, he explains what and why.

[@orionthehunter9107]

@@sportysbusiness Thank you so much for the info. My wife is freaking out. This is going to be a game changer for her. Thanks again👍!

[@brendawolszleger4895]

Did you say low fat and low carbs ?

[@orionthehunter9107]

@@brendawolszleger4895 yes low fat and low carb.

[@orionthehunter9107]

Update. My wife introduced a little carb in her diet and within 5 weeks dropped her cholesterol 151 points. I guess she needed some carbs in her diet.

[@andreacooper7092]

This is ME!!!! I can send you my calcium test which is 0 my triglycerides are low but the ldl and hdl is high! Oh an my seizures are low now

[@pauljohnmark]

Dave, Do you know whether your ABCG8 is T,T? Yet another factor in your cholesterol and phytosterol levels. I bet the T,T gene variant is over represented (relative to the average in the US pop) in your LMHR cohort

[@brendaparkman8018]

I am a LMHR and my ABCG8 is C;C.

[@diego168]

That’s interesting Dr Gerber that you say that for ten years people which have had high ldl also have zero calcium scores. So what do you think it’s a reasonable high level for ldl??

[@diego168]

@@ericeric9208 wow that was amazing answer thank you so much. I will read more about glycation. So which test measures the damaged ldl? Do you mean ldl small/midium. Or it’s a total different test ?

[@diego168]

@@ericeric9208 what can be done to prevent or lower damaged ldl? Just by being on a keto/carnivour diet will you prevent glycation??? And if you have some Damage ldl how can it be removed ? Fasting ???

[@diego168]

@@ericeric9208 thanks again for your reply. So how can one check for oxidize ldl. I’ve been doing carnivour meat and butter for a few months saw my ldl double at 222, triglyceride go low 58, hdl 51, Calcium score zero. I have a better understanding how ldl carriers work. When I saw ldl of 222 I got nervous and started adding carbs again. But then I read about lipid energy models. So I’m trying to get back into my carnivour way of eating

[@diego168]

@@ericeric9208 thank you so much. This was tremendous help. Yes I’m so interested in learning more about this.

[@at2step]

What about linoleic acid rich seed oils? Tucker Goodrich and others point to them as a cause (?) of damaged ldl (oxidized ldl?). Is it the ldl ship that's oxidized or the cargo? Just some thoughts of a dummy.

[@russbrown6453]

Yup. I guess I have to pick my poison. High LDL, or prediabetes? More MEDS...etc

[@nicolewalker5502]

I'd go with high ldl no meds . Sugar in the blood is damaging but high ldl isn't predictive of cvd.

[@eliseville]

@@nicolewalker5502 Actually, Feldman’s ground-breaking study is just started. It will be next year at the earliest that we “may” be able to scientifically claim that with clear evidence!

[@timcollins8214]

@@eliseville I'm in this study and much can be ascertained just upon us coming in for our first scan. With our LDL already super high, arterial plaque should already be apparent when we show up. Without divulging everything I've heard about the other participants, let's just say that very little plaque has been found in any of us. The most extreme was one person with a 500 cholesterol who STILL measured zippo. If there's some elevated risk here, then it's outside what we would traditionally look for. Just this one observation coupled with our diet and fitness levels is far more clear evidence than what my own doctors have on their side (they simply saw my LDL and tried to get me to take statins... I wanted to look at the broader evidence before deciding)

[@eliseville]

@@timcollins8214 How incredibly exciting for you to be part of this ground-breaking & paradigm-shifting study!🎉 Do you know/can you share the metabolic history of the general study participants’ (or even just your personal) entrance into Keto? Do you know if any/many come from obesity/diabetes or perhaps even epilepsy (both life issues for me!) or are all/most from actual lean/athletic backgrounds with no metabolic problems? I understand there is a facebook group, but I have yet to break my rule against it, even to expand my knowledge of this group I seem to be a member of, though I am still technically obese at BMI=30 having lost 80 pounds so far. My own lean athleticism was the decade before brain surgery that left me epileptic, carbamazepine/(Tegretol)-medicated & therefore severely Low D Hormone! (That sequence quickly let me double in size.) I only found Keto a couple years ago🙁over 2 decades into obesity, but lost 80 pounds so far on Keto/IF. Ultimately, the 2nd scan will truly prove how healthy high LDL can be (with high HDL & low TG.) But I am extremely glad to hear how positive the first scans already are. Luckily, my doc has not pushed me to go on statins. But it would be wonderful to be able to assure her that for LMHRs, high LDL does not increase atherosclerosis and perhaps Keto even decreases calcium over time in ketosis!??? Crossing my fingers!

[@timcollins8214]

@@eliseville I started getting fat before I went Keto more than 8 years ago, I was consuming a lot of sugar and had to ween myself off it. Prior to this, I was very athletic through my 20s, competing in college and beyond. My blood panel took some time before it became worrisome to the doctor, but then I also went a few years without doing a lipid panel. I'm not in the facebook group, so what I know is what I've asked that they've told me. When asking about the group's athleticism, it didn't seem to be something big that needed mentioning, they just told me that the people in the study did tend to be on the leaner side but it didn't sound like all of us were physical specimens or anything. I only asked about calcium scores going down AFTER my initial visit, and they weren't going to tell me anything in that regards. I bet if I had asked in person they might have told me if anyone reduced their score.... since more than half the participants have actually finished their year already. As of right now, I'm satisfied that as long as you're metabolically healthy, high ldl numbers probably don't mean what they mean in a general population that is metabolically sick on average. In fact, I'd guess my high numbers give me health advantages from resistance to illness, improved energy and hormonal levels and the likes. We shall see what they say when the study is complete, which by my estimate should be very early 2024.

[@pwcrabb5766]

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