Dr. Peter Attia - The Straight Dope on Cholesterol

Peter Attia, MD presenting at the Ancestral Health Symposium in 2012

[@andy4g63]

Thanks for putting this video with all the slides and graphs. The other variations, the camera was only on Peter without visual aid👍

[@Croatlik]

Great presentation! Thank you very much.

[@sandpquan]

This is what Captain Picard looked like when he was younger. 🙂

[@La_sagne]

this is what captain picard looked like in an alternate timeline where he took rapamycin instead of "tea, earl grey, hot"

[@jamesgordon8867]

So glad he does this 😊

[@nancysdsk]

Well done. Well-put. Clapping hands and hats off to you for putting this information available for ALL

[@rowandowland1391]

It's so important that this message cuts through. It's not because scientists / doctors are generally poor communicators. In this presentation its 'boats and cargo'. I've heard the same message explained using 'dump trucks and dirt' and 'online shopping delivery trucks and shopping' etc etc. There's a need to get the message consistent and clear. A role for a good communications expert to help shape the message that can be presented consistently around the world.. I hope there were no sugary soda drinks being offered to delegates during the break!

[@zhilahaghbin4766]

well presented and explained the subject that most have difficulty understanding the "discordance", and to this date the question he poses at the end is not unanswered, if only Apo B particles numbers are extremely high and the rest of CV risk and indices are very vert low what is the risk?

[@swarr5152]

Read the clot thickens by Dr. Malcolm Kendrick.

[@tomgoff7887]

Another danfgerous quack who misrepresents the evidence.

[@markwiener1091]

Damn near impossible for me in Pittsburgh to find an MD who knows anything about LP Pla-2, Myleoperoxidase or even Oxidized LDL. Damn near impossible for me to find any literature on how to reduce particle count. Damn near impossible for me to discern the risk/benefit ratios associated with: ordinary statins, zyptimag statin, ezitimbe, bempedoic acid, monoclonal antibodies, TG or esterified or phospholipid fish or algal EPA-DHA

[@t81629]

And why do you think that is?

[@markwiener1091]

I wish I knew. Maybe more evidence of a sick care system rather than a health care system.@@t81629

[@jamesmurraylegal]

Given that this lecture was 12 years ago, and there are medical research studies emerging every week, it would be useful to summarise the points made in the lecture which have been overtaken by newer research. Jim Murray

[@Pp-wn2gn]

Which points have been over taken?

[@davidzip8841]

It’s pointless to summarize them. The person that posted this misleading video just deletes comments like that.

[@kayfarquar2034]

2012? Have they answered the question in the meantime???

[@worldcitizenra]

At the 9:45 mark, Dr. Attia makes the statement that on a molecular level comparison basis phytosterols (plant versions of cholesterol) are far more atherogenic than cholesterol. Does any have a link to a research study supporting that claim? I've done a web search to try to find something to support it. All I get back in the search list is links to study reports and journal articles talking about phytosterols being better than cholesterol, effectively reducing cholesterol, and resulting in positive outcomes reducing the risk of atherogenesis.

[@worldcitizenra]

@Bob - Thanks for the link to Bart Kay. Although I wondered about the plant phytosterol claim, most of the rest of this video from Attia seems to be fairly accurate. His explanation and graphics about how the body's cholesterol system works and self-regulates is good. Plus, back when this video originated in 2012 he seemed to be very critical of the view that cholesterol is the overwhelmingly primary source of CVD. Back then he was on a full keto diet. I think he went off keto in the last couple of years and has adopted a more favorable view of statin intervention since then.

[@worldcitizenra]

@Bob - I took a look at Bart Kay. Not for me. In my mind, he comes across as pompous, arrogant, and self-aggrandizing. He clearly has a conflict of interest between the statements he makes and the products he promotes. He also seems to have a misplaced sense of perfection, ignoring his own mistakes while picking even the smallest mistakes by other people as being sufficient to completely discredit them. And where others at least cite scientific evidence for their beliefs, although perhaps based on a misinterpretation of the evidence, Kay seems to avoid mentioning scientific evidence, expecting his audience to accept his statements as fact simply because he made them. In terms of understanding the functioning and problems associated with the misfunctioning of the body's cholesterol management system, Ivor Cummins seems much more accurate and much better informed than Kay, Attia, Berg, or any of the others. But he is only trying to present accurate information about what is happening and the risks associated with various options. He isn't recommending either a product or a service to generate extra income for himself. kzbin.info/www/bejne/nKbNZ6GueKl1kJI

[@JamesRouzier]

Here it is pubmed.ncbi.nlm.nih.gov/31420554/ www.ncbi.nlm.nih.gov/pmc/articles/PMC8410723/

[@JackJensenTrader]

@@bobsdavenport As @worldcitizenra pointed out, Bart Kay has a bias (vengeance?) against Attia, and in addition to what he noted, Kay outright mis-states what Attia said in this video, claiming that Attia referred to "good" and "bad" cholesterol. And if you watch Kay's video, while he plays SOME sections of Attia's talk, for "some reason" doesn't play the section where Attia supposedly makes that claim. Attia expressly said that there is NO such thing as good or bad cholesterol. kzbin.info/www/bejne/nYjLoKhpg7Wkm8U

[@rajeevshrivastava4488]

Can someone tell me what is the gist of it?

[@greensmoothieparty]

Tim Russert was on statins and was unhealthy. For real health, you have to earn your lipid numbers through lifestyle choices.

[@reason3581]

Maybe he had high ApoB throughout his life before taking statins. You have to look at lifetime exposure.

[@greensmoothieparty]

@@reason3581 Summarizing the Current State and Evidence on Efficacy and Safety of Statin Therapy - American College of Cardiology (2016) In a meta-analysis of 27 randomized trials and 174,000 participants, for every ~40 mg/dL LDL-C reduction with statin therapy, the relative risk of major adverse cardiovascular events is reduced by ~20-25%, and all-cause mortality is reduced by 10%. Note: most people who take cholesterol lowering medications still experience cardiac events, advancement of their disease, and even death from their heart problems. In 2010, Medicare (CMS) began offering the Intensive Cardiac Rehabilitation (ICR) program that teaches heart disease patients about the lifestyle choices that will halt their heart disease progression. Sadly, most physicians don't even mention this program to their heart disease patients. It should be required as part of informed consent to other treatment options.

[@reason3581]

@@greensmoothieparty Your preaching to the choir regarding the importance of lifestyle/diet when it comes to CVD. I’m the number one fan of Ornish and Esselstyn. They deserve the Nobel price for their research! I think we agree lifestyle should be emphasized more. However, I think we shouldn’t be so purist that we discard medical treatments because it’s not ”natural”. In terms of ApoB levels it seems like the lower the better. Especially if you’re interested in longevity and you want youthful arteries when you are 100 (or 150) maybe you need both a healthy diet AND ApoB lowering medication? Just a thought…

[@JackJensenTrader]

That doesn't argue that statins didn't help. Besides being a singular anecdotal case, it could be that he would have died even sooner without statins. That observation merely says that (his level of) statins didn't prevent his heart attack.

[@davidzip8841]

Why are you posting a speech that he made probably 12 years ago? Particularly when he would not agree with all of the points made in the video.

[@JackJensenTrader]

Because it was a good overview of the topic. Many aren't willing (or able) to follow Peter's current presentations. He goes far into the weeds. Now, he's gotten "better" lately, and is starting to simplify his presentations. And by and large, on the most important points here, he still would agree with (to my knowledge).

[@Codydoggy]

Ask Prof Tim Noakes 😁

[@robert111k]

It seems Attia has recently bumped into the eternal youth fountain.

[@campyc40]

The video is from 2012...

[@robert111k]

@@campyc40, then maybe we should look for another longevity guru.

[@Type2DiabetesLol]

hahaha

[@johnadair6108]

Here's a better question. How often does atherosclerosis occur in the relative absence of small dense LDL particles? It sounds like the small Dense particles are required to do the initial damage to the blood vessel wall allowing the larger particles to "join the party".

[@reason3581]

I recommend listening to Thomas Dayspring on The Proof podcast. They go through this in detail. The large LDL are still small enough to get in. All that’s needed is an ApoB concentration above a certain level for the process to start. No initial damage or inflammation needed but it will speed up the process.

[@johnadair6108]

@@reason3581 Thank you. Here's an interesting point. I recently saw that insulin intolerance/metabolic disease breaks down the protective interior layer of blood vessels which allows the Lippo proteins to enter the wall. He didn't mention that at all. Thanks again!

[@glennlockwood7608]

@@johnadair6108 endothelial glycocalyx

[@bscsmscs1578]

@@reason3581 This can't be true since people with the highest LDL/Apo B have the longest life & decrease of Apo B with Statin would have saved lives. But in reality, increase in life span even with high statin dosage is 4 days. They say only time statin is showing its superiority is that it save lives after having the first MI

[@reason3581]

@@bscsmscs1578 kzbin.info/www/bejne/l2TPeXukhK2sqJo

[@johnadair6108]

What about oxidized LDL particles? The particles that the receptors in the liver can't recognize. Are all small dense LDL particles oxidized? Is it possible for large LDL particles to be oxidized? And isn't it necessary for LDL particles to be "small" in order to have more of them? There is obviously a missing piece to this puzzle...hardly the straight dope!

[@andy4g63]

Try and watch Dr Tom Dayspring... He explained in detail

[@bscsmscs1578]

@@andy4g63 Tom Dayspring===STATIN guy, another useless guy!!

[@amihanov]

Well... this is just my thinking. But maybe it's all related in the sense that if particles are not being cleared after some time since it's inception, getting oxidized might be inevitable. So if you clear it on time it never gets oxidized. I don't know, but I know for sure that these guys are saying that it's the number and not the size

[@55north17]

Much too complicated and esoteric for the layman. Peter's acquired a huge depth of knowledge but assumes that his audience has his specialised vocabulary and ability to rapidly interpret statistics. I was only able to stick with the talk because of my recognition and respect for Peter's abilities. The shots of his audience seemed to indicate that he'd lost many of them to.I wonder, respectfully, if he would consider delivering a dummies guide to his lecture.

[@JackJensenTrader]

If you listen to his current podcast, that observation DEFINITELY tracks! Fortunately, he will occasionally do a quasi-Cliffs Notes version. But yeah, he often gets too much into the weeds for me, but I didn't think that this lecture was a "bad" as some of his current stuff. It's amazing how many people DO keep up with the minutiae and understand it all, but there is a population that does (see a comment in this thread from someone calling Attia and others professional smoke sellers). Personally, I need people like Attia - another is cardiologist Anthony Pearson aka The Skeptical Cardiologist (podcast) - and others to read and explain the research, even if Attia doesn't always simplify it enough. One advantage of them is they can also vet the research, to help determine the validity of the research.

[@kaptainh5538]

Why does Fruit raise Trigylcerides

[@JackJensenTrader]

For a reply by Dr. Attia, you should go to his site/channel; I merely shared this old, good presentation of his: www.youtube.com/@PeterAttiaMD. And studies indicate that fruit intake may actually reduce triglyceride levels: www.acc.org/latest-in-cardiology/journal-scans/2018/10/11/16/16/relationship-between-intake-of-fruit-separately