My Respectful Reaction to Dr. Tom Rifai

[@williamgitchell6740]

I’m an anesthesiologist who discovered keto/carnivore less than two years ago. Short hop to 70 years of age I have lost 10 lbs and helped my wife drop her A1c from 6.2 to 5.6. I can’t adequately express my gratitude for your efforts and your exemplary professionalism. My BMI is 22 and of course my LDL and apoB are high. I have kept my weight down for years at the expense of constantly starving. Keto will be with me for the foreseeable future. I can’t believe mankind felt this good prior to agriculture. We need to better understand this metabolic response so everyone can feel better.

[@BeefNEggs057]

I agree - my wife is like don’t you miss food variety. I just don’t. I love every bite of beef eggs and butter. Never felt so good in my whole life. Depression gone. BP perfect. Don’t care about cholesterol. Liver can manage that just fine without doctors messing it up.

[@robertlaveyra9940]

I am a know believer in a low carb approach at my gym, because of this I continue to get people coming up to me relating their successes. Two days ago, a woman who is having great success said her father is now keto and says he will never go back. He was long time obese and now feels better than he ever has.

[@JMK-vo8pv]

Kudos to you, Dave Feldman, for not only being a consumate "scientist" but for aproaching this topic in a very honest and civil manner. It is a real shame that more "experts" in the fields of lipidology and cardiology are not joining with you to discover the truth about the nexus, or lack thereof, between lipoproteins and atherosclerosis. Please keep up your outstanding work!

[@realDaveFeldman]

FWIW, I do think it's changing... albeit a lot slower than I'd prefer. I come from technology where things change quite rapidly with data specificity and directionality, and I don't know if I can say its quite as rapid in some fields of medical science.

[@robertlaveyra9940]

I am honest but he’s got me on civil. Ha ha, actually I’m pretty good but once in a while I can push sarcastic boundaries.

[@angelaprosser9896]

Most of us have terrible experiences and little respect for a lot of medical Dr's. Especially following the past few years. I for one and VERY grateful for your work.....

[@joanie2shoes]

I enjoyed your discussion with Dr. Rifai. I did have to laugh wryly, however, when he kept admonishing you to tell people to work with their doctors. None of my doctors were the least bit interested in looking at any of the information I provided them on the benefits of the Keto/Carnivore way of eating, even though they could clearly see my weight loss, my reversal of NAFLD, my remission of type II diabetes, my lowering of blood pressure, and the many other benefits I told them about. They did just want to keep recommending statins to me because my total cholesterol and my LDL were very high, even though my HDL increased and my triglycerides were lower. I may be a LMHR, but I don't know as I'm still experiencing insulin resistance, and haven't gotten back fully to being lean! 😁😅

[@BeefNEggs057]

While losing weight your cholesterol and trigs will be all over the place. Just fasting will increase your LDL. Let your liver do it’s thing and leave it alone. Lowering cholesterol on low carb is highly unnecessary and harmful due to unknown and known side effects.

[@maryfranceshenrybell1289]

LMHR poses a real threat to a decades old business model -period. Just imagine if 25 percent of cardiology patients resolved their health conditions and no longer needed care: The American Heart Association estimates that the total cost of cardiovascular disease in the U.S. was about $378 billion in 2021. 25% of $378 billion = $94.5 billion annually. That’s going to result in loss of business for hospital systems, pharmaceuticals and medical device manufacturers with rippling effects downstream. The worst thing to happen with health care is it being made “for profit “ The best thing that’s happened to Health Care is Citizen Science Foundation 🧡

[@BeefNEggs057]

Yes terrible news for the corrupt medical scammunity. Dave can hire you to do bloodwork and sweep the floors.

[@dogphlap6749]

Strange how so much interesting research in the medical field is coming from folks who are not medical doctors e.g. Professor Seyfried (cancer researcher) and Dave Feldman (engineer).

[@EdJacobson77]

Dave, you are a true gentleman and possess infinitely more patience than I do. Your ability to be polite and respectful towards people who are clearly less intelligent than you, but think themselves more intelligent than you, is mind-boggling. You're an engineer. You're trained to study complex systems and identify the root cause. Doctors are trained to write prescriptions or perform surgery. Root cause isn't on their minds. They're mostly (with a few exception) over-glorified pill dispensers. That's why we need citizen scientists like you to fight the good fight. I'm rooting for you all the way.

[@efsmiley1995]

I marvel at your limitless patience, Dave. But I guess that just makes you the perfect ambassador for this cause. A mighty noble one at that.

[@ki-rort]

Dave, I think you are not giving yourself enough credit, but most engineers are excellent researchers. But I appreciate your humility and encouraging these discussions! ❤🎉

[@JennyMitich]

Agreed! You are always very clear and concise with your warnings and caveats, much more so than most people on the internet 👍🏻

[@brentbrouwer6135]

Naw, prolly just the fava beans and... a White Claw. Not that they wouldn't kill you, they would but they'd let it rot.

[@AnneMB955]

Dave, I applaud your knowledge of this topic. Just because someone is a doctor it doesn’t mean they know more than you. You are very respectful, I admire that. 👏🇦🇺

[@SamShank175]

It's like this guy hasn't actually listened to any of your videos. You and Nick are always saying you think it deserves more study. You guys never claim to know exactly what is going on or tell people to do as you do. Keep up the good work!

[@realDaveFeldman]

To his credit, he concedes up front he's in the process of learning more about it. My hope is that he continues this journey, and I'm sure in doing so he'll hear us say another 100x this same key qualifiers.

[@eatanelkberger]

The good Dr Rifai must not listen to you often, if he doesn't already realize how often you say to work with your doctor, and that this is ongoing research is not a definitive answer. I enjoy this type of video and the more you make, the faster the message will spread.

[@realDaveFeldman]

I wasn't kidding when I said I probably say it more than any other non-medical professional on the internet. Regardless, I hope there's a point where I can properly have done my due diligence and we can move into discussing the science and data.

[@suprememasteroftheuniverse]

My friend, if they could they wouldn't only detract you. They would eat your liver. I don't meant it as an idiom.

[@DrTomMD]

You are right. I have not listened to Dave much until now. It’s not out of lack of interest. Just lack of time. But I’m getting into it. I have a feeling I can help add to the discussion as well as some of my colleagues, so appreciate your patience in the matter. Definitive answers to “big questions” don’t usually come so simply, quickly nor easily. I’ll be watching the Matthew Budoff video after this. Thanks all

[@TOMGARVEYtheKETOCOOK]

Four years on a keto lifestyle, 68 lbs. lost, from fourteen meds to three. retired Chef, lifelong cooking experience. Clean cooking!! My Dr. does not understand my way of life. The labs they want does not reflect on my diet. Still want me on insulin while they say I`m insulin resistant. Keep doing these videos Dave ....

[@dogcrazy25]

Why do drs want you on insulin? Are you blood sugars very high? Changing eatinh habits appears to resolve high blood sugar levels in most people.

[@TOMGARVEYtheKETOCOOK]

@@dogcrazy25 I`ve been doing keto / carnivore four years, the Dr. don`t seem to understand my lifestyle. The testing they does not conform to my diet.

[@suprememasteroftheuniverse]

Meat and fat are so powerful that when I relapse my diet and go on days, DAYS and weeks on a sugar binge my glucose levels continue low. My insuline resistance doesn't come back. Fortunately I get tired and sick and go back to pure carnivore. So I think "my doctor" has to swallow it. I'M NOT DIABETIC ANYMORE. I'm saying that sugar and plants are safe but that we become stronger to deal with it but now many are not. They don't have the NUTRIENTS nor the metabolic health. Meat and fat CURE! I don't take any medicine or supplements anymore. They told me I would die taking medicine to control glucose, cholesterol and OMEPRAZOLE. Not anymore. I couldn't sleep. I woke sometimes 10 times during a single night because of heartburn and reflux. Now I can live and they won't take it from me.

[@TOMGARVEYtheKETOCOOK]

@@suprememasteroftheuniverse There ya go!! This is good to hear.

[@jobrown8146]

Have you had a fasting insulin blood test done?

[@davidgifford8112]

I can agree with Dr Rifai that more “data” studies are required, that’s medical conservatism. That said I’m already fully convinced that the Lipid Energy model is correct and is relevant to everyone’s health not just the low mass responders. Resistance will remain high in vested interests such as Dr Dayspring whose reputation rests on fat being the driver of LDL which is the driver of CAD based on epidemiological studies.

[@rodneyhopkins2241]

Hello Dave, I am a LMHR here and have been very impressed with your caution and looking forward to the Longitudinal outcome of your ongoing study. Since going low carb I have been able to get my seizure meds reduced and hopefully eliminated. I like this view that LDL may have causality for plaque but is not the real reason for alway being perceived as bad behavior. Dave I appreciate all your efforts and work very much. Thanks

[@ericwuerl3976]

I lost 167 pounds in a year and a half with a high saturated fat high dietary cholesterol mostly carnivore diet with some fasting mixed in. My labs are currently amazing and optimal according to the standards and better than they have ever been in my life

[@wocket42]

But you might get a heart attack running a marathon in 50 years at age 100. So there is that. Needs to be weighted

[@judyhein3737]

Thank you Dave for what you do- important!❤️

[@williamburnell529]

I'm 66, a year ago I got a CAC of 1500, exercised very hard most of my life and mostly had physical jobs, I've been on 40mg of statins for 30 years because my doctor advised it, with the high CAC he put me on 80mg, I never felt that great before but with the higher dose I realized why, I got all the side effects. I want back to 40mg which my doctor disagreed with not that he had any other advice (like a carb free diet). Started looking into it and found several great channels like yours.I eat a low fat SAD diet with no thought about carbs and sugar all my life, I've cut out most carbs (all processed carbs), all sugar and the statins in the last year and feel better then I have in decades. Just got new labs and now I see I'm a LMHR. I'm thinking my high CAC came from 65 years of my carb and sugar diet and obviously the 30 years of statins didn't help much or at all with plaque. Any thoughts? Thanks

[@aurapopescu1875]

Statins actually increase calcified plaque... Have you had your soft plaque checked? There is an ultrasound test called CIMT (carotid intima media thickness), it's non-invasive, no radiation, takes 5 minutes.

[@wocket42]

Statins can decrease inflammation, which might be good. I don't think you got permanent damage from them, if you feel well now.

[@carolynzane8879]

Frankly the seeming lack of interest by those you and Nick have called out for an honest discussion is so shocking. Surely these people don't honestly believe there is nothing more to be learned in the field. Getting to Dave's point that this may be basic physiology. I am a 58 year old woman who went keto at 208 lbs and obviously insulin resistant. I lost 50 lbs and reversed kidney disease, also avoiding a double knee replacement, before I had lipids measured to discover that I fell into the group of LMHR at160 lbs and 5' 10" . Not even down to my final weight now but my LDL is the only thing my GP wanted to acknowledge. The medical establishment is so confusing to me.

[@Mr_Fission]

Conventional wisdom is not the cure for widespread modern metabolic dysfunction, it is the cause of it. Keep pressing the boundaries of knowledge. When you start taking fire from the old guard, it means you are over the target. Press on.

[@ArcoZakus]

"Conventional wisdom" = oxymoron in this case.

[@aurapopescu1875]

Thank you so much for all the work you are doing, Dave 🙏🙏🙏❣️❣️❣️

[@ElizabethMillerTX]

Dave your patience and courtesy will save lives. Thank you. I'm glad that Dr. Rifai has joined the conversation.

[@realDaveFeldman]

🙏🙏🙏

[@suprememasteroftheuniverse]

He did not join the conversation. He's trying to mitigate the damages. He's trying to control and divert.

[@radagreene5087]

@@realDaveFeldman Response video, yawn! I would be interested if you cared to comment about the alternate cohort, some of whom "tend" to have very high LDL, namely AN Anorexia Nervosa patients and causation as evidenced by that group.

[@prettybirdbeenlpeacock6592]

​@radagreene5087 I don't understand what you are asking for. Are you being snarky or asking a sincere question? Hrs already looking into the LMHR cohort that is not mentally ill which would throw a whole other layer onto this syndrome. One thing at a time or let someone else fund that research

[@radagreene5087]

@@prettybirdbeenlpeacock6592 I'm giving him a tip .... the research has ben done already. Just search for ANOREXIA V HYPERLIPIDEMIA.

[@tonydavis3796]

"Great claims require great evidence". Does that hold for all the research supposedly linking saturated fat consumption and dietary cholesterol, or even elevated LDL, to the risk of cardiovascular disease?

[@jillengland3277]

Yes I like your ad-hoc video. My thought about the doctor reference to LMHR as ‘esoteric’ showed a lack of empathy to the group of us to whom it is a daily reality and a reminder that the medical industry would like to force us to take statins and make the entire insurance government/tax/insurance industry pay for them. No thanks. Regardless of how high my lipids are I will never take statins. LMHR? In my case I don’t care. Would never have noticed if Dave had not discovered it and set up “own your own labs”. By the way I made my decision about taking statins by researching Cholesterol reading Malcolm Kendrick’s books, not from listening to Dave/Nick/and Company.

[@jonathanmagic5633]

There is so much money to be made from prescribing a drug many don't need and has potential for harm. I'm 70yo fit still work full time with zero risk as per numerous scans and tests (CAC is zero) and yet my GP is disgusted with me because I refuse to go on a statin just because of my age and cholesterol is slightly high. $$$

[@dcazador7401]

It’s to interesting to me these guys are willing to extrapolate fully from an “esoteric” population of homozygous FH but dismissive of drawing any conclusions from LMHR, although it is clearly a physiologic response from which we can learn something more widely applicable.

[@realDaveFeldman]

I speak regularly on HoFH for this very reason. Brown and Goldstein were publishing on a population far, far smaller than our LMHR study cohort, but those data were quite compelling then as it is today when there are no comparators - the catch is that now we do have comparators in LMHRs, but that should likewise bring out curiosity at the highest levels to study them in helping to test this hypothesis absent molecular FH.

[@CashMoneyMoore]

It's because it aligns with all the other data on ldl, that reducing it leads to better outcomes and those with genetic mutations that lower it do.better and higher do worse. That is until lmhr's which it seems ldl is behaving differently

[@dcazador7401]

Yes it should! History will vindicate you, Dave. Thanks for your patience and perseverance.

[@victorcotu]

​@@CashMoneyMoore All the other data, like studies made with rats on the "industry" standard HFD (high fat diet), which consists in inducing morbid obesity and diabetes, by feeding them with huge amounts of sugar, fructose, and many times even omega-6 rich vegetable oils. Where you can call the diet high in fat, because anecdotically the amount of fat is higher than carbs. Once the rat's health is, as expected, completely destroyed, they go ahead and unashamedly blame any health issue present on fat.

[@CalaverasSteve]

I'm a retired emergency physician who has type 2 pre-diabetes. I was obese, hyper-tensive, with low HDL and high triglycerides. My pre-diabetes is now reversed (and I use that word mindfully knowing that my genetic predisposition to metabolic syndrome is still there) using a low carb approach. I was able to lose the weight and lower my triglycerides and raise my HDL on a low carb nutritional approach, but my blood pressure was still stubbornly high. It wasn't until I adopted a ketogenic diet and raised my keto-mojo measured BHBs to at least 1.0 that my blood pressure finally came down. My BMI was 31, it is now 22. I need to keep my carbs under 15/day to maintain a BHB of 1.0 or higher to keep my systolic blood pressure below 120. I have done the N of 1 cross-over study raising and lowering my carbs, and yep I need to be 15 or lower to manage my blood pressure nutritionally. So be it, my meals are delicious and I don't need carbs to make them so. What I did need to do was adopt a zero sugar/processed carb approach because of my life long love of sugar/sweetness to quiet the chatter in my brain desiring sugar. I just never eat anything with sugar (real or fake), flour, or fructose. I am again an N of 1. I am not recommending to my family and friends who are continuing to eat processed carbs and are metabolically unhealthy that they increase their consumption of saturated fat!!!!!! Dr. Rifai, I hear you loud and clear about the potential spillover of this approach to those who are still metabolically unhealthy. I eat way more saturated fat with lots of red meat daily compared to my former diabetic self, and my triglycerides are now 51, down from the 161 that they were. I deeply appreciate that both Dr. Rifai and Mr. Feldman are taking a gentle non-posturing approach to this. Those who are strident on both sides of this conversation I have no respect for. Stridency indicates to me that those individuals have their egos caught up so they can no longer listen, they have nothing to offer this dialog.

[@nancyknettell2360]

LOL N of 2 now...if you include me (and probably now millions more I am sure). Metabolic Health biomedical engineer here supporting primary research and development for over 40 years in the Cardiac, Diabetes, Genetic/Cancer industries. As you are a physician, although I know you not giving specific advice here to me or anyone else, I am chosing to take your advice as a "for real" doctor. Well already took the advice 8 years ago even when my severely obese 300 pound former physician warned me away from keto/carnivore with a prescription for statins tucked in my medical record and ordered already at CVS! Fired that one! She is still metabolically sick and I am down 140 pounds, reversed my Type 2, and am in perfect metabolic health now. Have a new more tolerant doctor now although eye rolling and patronizing concern is still happening. Need more Metabolic Health trained Primary Care Physicians.

[@bryanspencer4856]

Thanks! Keep up the great work!

[@thefisherking78]

15:50 YES. That's why I follow this research. Even at my leanest, fittest, and lowest carbohydrate intake of my life, I did not personally see a rise in LDL. But if the lmhr phenomenon represents what you think it does, it essentially disproves at least one fundamental assumption about how we think all of lipid metabolism works and how we should interpret our own data. It has implications for all of us in what metrics we focus on and how we evaluate them.

[@biodivers5294]

Listen carefully, and respond carefully. You're doing great things in a great way!

[@RussBrown-sj7tx]

Nobody knows LDL like Dave Fieldman does. These people are " haters" because you are ruffling their feathers. David, it's time to take the gloves off...

[@suprememasteroftheuniverse]

That's what I think.

[@JasonFuhrman]

Love the response videos! Thank you for your work

[@gray45374]

Wait, I remember thinking Dave was overdoing it a little with the repetitive caveats about cautious optimism and working with your doctor. It's obviously the sensible approach to take and kudos to him for it, but it really baffles me that some folks think he doesn't caveat enough.

[@pvee-xp3sk]

Great video! Thanks for all your work!

[@robyn3349]

Thank you! It’s personal for me. Thank you!

[@DrTomMD]

14:00 - I agree. At the very least I can say you’re at the highest echelon of the professional and careful

[@jirilacina3730]

I appreciate your work, Dave. Keep iit up, continue for all of us. Ignore this type of arrogant people.

[@sabine8419]

Eliminate carbs, then fat intake doesn't matter. Eating excess carbs leads to de-novo lipogenesis, and chronic fat accumulation from carbs/sugars leads to metabolic disease.

[@yolandarojas9832]

Muchas gracias 😊

[@michaelsliwinski8044]

It is very difficult for many people to admit they are wrong about any given subject. And when they are faced with doing so in public, it often becomes humiliation.

[@bettykramos1802]

Yup! Used keto to get rid of pre diabetes…

[@kwasiAsareBoye]

Thank you Dave, keep up the good work.

[@davisgrove8931]

Great video! Thanks for all of your hard work.

[@stephendavidrathburn8952]

If this guy was really interested in the outcome of Daves research, he would try the keto diet and run all the tests on himself that he has such easy access to. That would at least help him start healing from his arrogant bias.

[@Roberto-cg2gr]

Have a Mendelian Randomization on Insulin Resistance and All cause mortality

[@Oscar_AH]

Thank you for this type of videos. They are greatly clarifying.

[@realDaveFeldman]

I keep getting a lot of pings by friends and colleagues to do more of these "respectful reaction" videos, but I'll admit the OCD in me obsesses about quality, editing, etc.

[@colinvankeith4814]

Where does your patience come from? I’m envious!

[@jobrown8146]

His diet?!?!?

[@ArcoZakus]

@@jobrown8146, Your comment might seem silly to some people who read it, but probably not to anyone who has experienced the psychological benefits of eating a proper human diet.

[@jobrown8146]

@@ArcoZakus Thanks. I agree.

[@victorcotu]

High carbs -> high inflammation + insulin resistance -> body stressed + brain grasping for energy -> mind stress and anxiety -> much harder to deal with any enviromental stress, like for ex: trying to argue with a bunch of irrational, narcissistic, hypocritical mass murderers.

[@kenadams5504]

I'm new to science culture , but its particularly stunning to witness the dogmatic adherance that seems prominant in so many Fields of Science.....it seems conspiratorial until a distinct pattern repeats again ,and again ,and again .

[@CairnsLobster]

I think this term 'respectful reaction' is a modern adaption of Peer Review in 2024. I dont like too much nasty stuff with content makers going after eachother in the health space. That creates uncertainty and confusion at a time when theres a exploding health crisis globally. But a respectful reply is a adaption in a way to how science is done. Yes the gold standard is research papers are completed and then there is formal review by peers. The reserach space is corrupt with money being the biggest player and therefor corporations but that I hope can be improved on if more consumers get educated and more involved in how research is done and influenced. I am trying to understand this subject if anyone knows anything I am trying to understand Lobbying and Influencing Research Grants etc on Lobster Mobility FB. Great video mate, Andre

[@Dr_Boult]

Dave good reply and like the format. Overall, you personally do a great job caveating, but maybe you need to call out people that. "misattribute" your optimism since it's easy to comment/quote out of content. It would also be interesting for you to address why there are many Lean keto folks that are not hyper-responders -- maybe a pole at LMHR or a broader "survey" to get a feeling how many it is?

[@Michael-pn2ye]

Love the video keep it up 👍

[@ugdayiskfay3718]

Dave is simply the best.

[@robertlaveyra9940]

I like this format. You can stop and comment on each aspect of the dialog, spending as much time as needed. I also like the smoking analogy because it too, can depend on many other factors but as we now seem to agree on, it is a big factor. Lastly, like others, I appreciate your non-emotional, level headed response.

[@verticalhorizon8723]

Thank you for your insights. The Lipid Energy Model explains the high levels of LDL in lean people. You have extensively discussed it in papers and podcasts with solid arguments. But how does it explain the “normal” levels of LDL in “overweight” people on a Keto Diet? I feel that this has not been discussed enough.

[@DrTomMD]

Just winding up here at #ARDD2024 post semi-late dinner: cup of vegetables, and about 6 ounces total of shrimp, salmon, halibut, plus a glass of red wine in case you wanted to know), and only eight minutes and 15 seconds into this but can already say I appreciate you Dave, very much. I am listing and already thinking that I might try keto on myself. BMI is already around 25, fairly muscular (legacy of my teen and early 20 bodybuilding days) and baseline apoB 70 mg/dL (triglyceride similarly around 70 mg/dL with A1c 5.2 and fasting insulin less than 5) My thought is I would go, first time in a long long time, on keto with an ultra saturated fat, ultra low cholesterol, high fiber version and see if what my apoB does. N of 1 (which ironically is the design of XPrize healthspan competition trials, but that’s a different story) Thoughts? OK, on listening to the rest. Can’t remember if I sent a DM on to you with my email and phone number, but I will double check after the video and I get to my hotel room(wonderful night walk here in Copenhagen)

[@CyanOgilvie]

To the point that LMHR is seen as a population of rare unicorns and not representative of the majority - do we actually have any data to support the existence of the complementary population: those who are lean, follow a ketogenic diet, have otherwise good CVD risk markers (no MetS), but DON'T have high LDL? I've yet to find one. My sample size is not huge, but I've been playing in this space for about 5 years now. I'd love to see a study that finds a population with no MetS, is lean, keto and is steady-state for at least 2 years in diet and weight, which quantifies their LDL distribution - I would be very surprised if the low-LDL side of the distribution has much weight at all. If the lipid energy model is correct it would seem to exclude that pattern (absent any unusual genetics or external forcing factors). After years of meeting these rare unicorns under every rock you lift it starts to feel like it's just the response of normal physiology to these operating parameters, not a subpopulation at all.

[@realDaveFeldman]

Hence my addressing this directly. And once more, what moved the needle so much for so many 50 years ago was Brown and Goldstein’s work on children with homozygous familial hyper cholesterolemia. This is a one in 1 million genetic possibility, so understandably their sample size was extremely small (literally just a handful of patients when they started). I would honestly be surprised if there are 100 or more with homozygous FH detailed in the literature currently via case series or otherwise in the last 50 years together.

[@DrTomMD]

At Detroit Metro airport, looking forward to flying out to Vegas to meet Dave tomorrow to record the first episode for his new podcast!

[@JohnWilliams-gy5yc]

If nobody has gone SWJ when pharmas funded LDL studies around the world. Well, I'm curious what will happen if "meat" and "diary" have some ideas to fund other cohorts like this.

[@rosemarylincoln2583]

Very interesting and yes, worthwhile doing this style of video thank you.

[@realDaveFeldman]

Glad you enjoyed it

[@laurengianna9944]

I’m so confused with all of this. I’m 57 female always had high cholesterol never took meds. CAC was a 7 I’m a former smoker who was around second hand smoke my whole life. Went for a CIMT and I’m in the 25 % percentile with low risk of heart disease. But they found a thyroid nodule 🙄. BMI is under 24 now. Started carnivore December 2023. Lowered A1C crp 0.8. Trigs to hdl ratio pretty good too. ApoB was high.

[@doddgarger6806]

Dr Paul Mason explains that every cholesterol particle will have an apob on it so just because you have high apob doesn't tell you if your LDL is type a or b which is more important by far it tells you if you have glycation taking place

[@laurengianna9944]

@@doddgarger6806 how do I find out then? Thank you for responding.

[@jobrown8146]

@@laurengianna9944 I think it might be the particle size test. Might be called NMR lipid profile.

[@laurengianna9944]

@@jobrown8146 I had the apoB apoA test done. B was 212 and apolipoprotein 250, apoA1 174 lipoprotein a 12 LDL 307. My pcp doesn’t know much about all this. I’m schooling her and sending her info and she loves learning about it.

[@andrewrivera4029]

At 58 years young BMI 22 on OMAD carnivore I’m still insulin resistant although I’m otherwise healthy so I choose to stay on carnivore for the long term.

[@MyFatAdaptedLife]

The primary reason why Tom Rifai, Lame Norton, Peter Attia, Mohammed Alo, and others comment negatively against the LMHR phenotype is due to professional jealousy. They are jealous of the success that you, Nick, and Adrian achieved through the lipid energy model. You developed a revolutionary model that could potentially effect metabolic health in a positive way...and they're jealous of that. They haven't come up with anything.

[@stx7389]

😂😂😂

[@timeaftertime3563]

I think Lean mass hyper responders are more common than people think. I was a "SOFI" (skinny outside fat inside) and I think most sofi's will turn out to be Lean mass hyper responders when on a low carb lifestyle. My BMI is now 22, ldl 200. I believe it's really fine.

[@BigVine-m5i]

Oh, Tom Dayspring? The guy who can't figure out why he's been overweight for decades, even though he's an "expert" on lipids?

[@jobrown8146]

That's a good observation. Because I listen to videos, not watch them, I hadn't considered that.

[@BigVine-m5i]

@@jobrown8146 I'm not speaking out of turn. Dr.Dayspring admitted such in an article posted by Dr. Peter Attia. The article talked about Dr. Attia's friendship with Dr. Dayspring over the course of many years. Even after Dr. Attia told Dr. Dayspring that there might be a way to mitigate some of his maladies, using low carb, Dr. Dayspring continued to have problems. I would not trust anything that comes out of Dr. Dayspring's mouth on the subject. I'm betting, though that Dr. Attia has since taken down that series of articles. They were eye- opening. It was not on a video.

[@BigVine-m5i]

@@jobrown8146 Sorry if this gets posted twice. I'm not talking out of turn here. Dr. Dayspring himself said as much in an article by Dr. Peter Attia. Dr. Attia was discussing his friendship of many years with Dr. Dayspring. Dr. Attia even suggested to Dr. Dayspring that many of his maladies might be mitigated by a low carb diet. I don't think Dr. Dayspring bought into it. I wouldn't trust anything that comes out of Dr. Dayspring's mouth. This info came from an article, not a video. Dr. Attia may have taken down the series of articles this came from.

[@tarpara]

One only has to listen with one’s ears to Tom Dayspring to know he’s a quack. He is a certifiable nut

[@wocket42]

But he lost weight over time, no? Maybe he's secretly doing keto.

[@sabby123456789]

I have the ApoE4 allele and cholesterol hyperabsorption mutations in my ABCG5/G8 genes so I am supposed to be on a diet low in saturated fat and dietary cholesterol or else my LDL particles will be high. However, getting rid of saturated fat and egg yolks made everything unpalatable. Egg whites with broccoli and olive oil just does not taste as good as whole eggs with broccoli cooked in butter. I ate like this for 5 years and finally gave up. Even the experts on ketogenic and LCHF diets say that people with the ApoE4 allele are an exception to the rule and should be eating more fish and olive oil instead of saturated fat. So now I just take cholesterol medications. Some people have criticised me for putting too much emphasis on my taste buds and being poorly parented because of this, but I figured that because cholesterol medications are now available and are getting better with less side effects and I only have one life to live, I want to enjoy my egg yolks and butter with medications. It is funny how those who avoid saturated fat want to guilt trip others who do not. My mental health has improved since adding egg yolks and butter back in my low carbohydrate diet. I do not wake up with a rain cloud over my head and do not have a chronic angry mood throughout the day like I did for the 5 years I only ate egg yolks and butter sparingly.

[@beacomrie343]

I was told I was a hyperabsorber per Boston Heart. Funny thing was though when I went very low fat my cholesterol went up 100 points. Drs. scratch there heads and have no answer as to why that would happen . They just want me on repatha. Of course I am not going to do that as 1 month on statins gave me neuropathy. I have recently decided I will probably never have my cholesterol tested again and just enjoy life. I am a lean active 64 yr old female. Not keto but low carb real food only.

[@patriciakeller4826]

Maybe LMHR's aren't all that small of a group. At 70-something, my bmi is under 25, and after low carb for a year, my LDL skyrockeded. My doc was surprisingly unaffected. Maybe he has heard of your work.😊

[@jobrown8146]

My personal theory is that there have always been LMHRs but it's only been since about the 1980s that cholesterol has been focussed on which was at the time when the diet was changing for the worse, prior to that LMHR would not have been "noticed". This also coincides with the worsening of the diet. Interestingly it was soon after that the smoking was reduced. Also to be considered is when seed oils increased, low fat (which means higher sugar) and also not just an increase in processing of foods but also an increase in the intake of processed foods. That a bit of a jumble of thoughts but I hope it's understandable.

[@vtlc2865]

I love you Dave

[@juhoevert7273]

In Finland there is not a single medical doctor who understand LMHR and discussion with doctors makes them just angry.

[@peterwebb8732]

I cannot agree that a group such as the LMHR should not be studied because - If I hear Dr Rifai correctly - he fears that people who are NOT LMHR might apply the study results to themselves.

[@stx7389]

Actually SFA makes you much more insulin resistant

[@saintwithatie]

SFA **can** lead to a relatively small increase in insulin resistance (as opposed to the much larger increases caused by other factors), not "much more" insulin resistant.

[@gaurd3]

10:48 so tired of this nanny thinking.

[@ThePhilGrimm]

Is there anywhere I can watch, listen to or read your thesis on LMHR or the Lipid Energy Model that doesn't have caveats or cautions? I'd really like to hear what you think [or even hope] the outcomes might be. I wish I could work with my doctor but they can't even give me a lipid panel that I can compare with the the rest of the world. QRISK2.

[@robertlaveyra9940]

It turns out, there is still a lot of resistance to insulin resistance.

[@CashMoneyMoore]

"if any of those conditions are not met" spoken like a software engineer 😂. I'm very curious how you think this lmhr cohort data could open the aperture of apob understanding in the larger discussion of lipidology. My current takeaway is that if you are closer to miami hear cohort than lmhr, you may want to lower your apob even farther (or maybe better yet, become an lmhr). Just based on the initial association with TPV and ldl,hdl, triglycerides.

[@realDaveFeldman]

I don't know - I'd want to stratify the MiHeart by HDL and TG to further elucidate those associations. If you've followed my hypotheses regarding the LEM, and as suggested in this video, the *why* of a given exposure (ie LDL-C) to a given outcome (ie plaque volume) may prove relevant, and if so, we'd want to confirm/disconfirm as much as we can.

[@stx7389]

11:25 absolutely not, let them do an insulin ogtt, masking the symptoms is not reversal

[@saintwithatie]

As there are numerous reasons for the results seen when an OGTT is performed, it is not a definitive test for diabetes. It is merely an indicator that could suggest issues and must be followed up with other diagnostics.

[@stx7389]

@@saintwithatie no that doesn't happen on low carb plant based diet, next

[@saintwithatie]

@@stx7389 What do you mean? What doesn't happen?

[@stx7389]

@@saintwithatie out of range ogtt results

[@saintwithatie]

​@@stx7389 I'd definitely be interested in knowing how you arrived at that conclusion but I'm a bit confused as to the relevance of "low carb plant based diet." We're already talking about low-carb diets (ketogenic diets are low-carb), and I'm not understanding the relevance of being plant-based.

[@thefisherking78]

I love how Dave's reaction videos are nothing like the smug dunking that takes place in so many others.

[@DrTomMD]

11:00 - 12:15 what I hear you saying here is keto does not help people get metabolically healthy ( i.e. doesn’t resolve insulin resistance) So…If keto just controls blood sugar - the price of having lower glucose and lower LDL is staying metabolically unhealthy? If keto is not fully resolving insulin resistance, that’s a problem. If it is resolving and slow resistance then once they eliminate IR, based on your rationale, their LDL should go very high since they no longer have IR Phenotype in therefore should become an LMHR I.e. metabolically healthy on keto

[@victorcotu]

Quitting smoking doesn't resolve lung cancer, nor it removes completely in 5 years, the harm done to your lungs over 20 years. Taking statins doesn't resolve artherosclerosis, not in 2 years not in 40 years.

[@jacqueslucas8616]

One out of 2 adults has diabetes or insulin resistance! Yet our medical system basically ignores it! Why? So they can sell more drugs and medical services!

[@machdoctor]

What would you say to someone who is pre-diabetic and starts a keto diet to improve their metabolic health, but then gets a high LDL/APOB score? My numbers don't make the cutoffs for LMHR, but I am close. My doctor is very conventional in terms of health guidance.

[@colinvankeith4814]

I would prioritize normalizing the metabolic dysfunction first and following keto diet has shown great success. Conventional health guidance has a terrible track record. Be curious and seek results. Regarding blood test markers are always in flux and are highly variable on an individual basis. Nobody is within “normal” range of every marker.

[@machdoctor]

@@colinvankeith4814 That is what I was trying to do until I received an APOB of 125. That sent me through a rabbit hole and since I can't say I am metabolically healthy, its hard to just ignore the marker. My doctor wants me to go on a statin. I'm considering going off low carb and re-testing, just to see if that improves my APOB at the expense of my glucose/insulin - my version of the oreo test.

[@Gengh13]

If you look at the relative risk contributions to atherosclerosis you will see that there is a much higher association with elevanted fasting insulin (diabetic/pre-diabetic) than elevated LDL, elevated LDL doesn't seem to be a powerful predictor but metabolic health seems to be.

[@machdoctor]

@@Gengh13 Agreed on LDL, but I don't think that is the case with APOB. If I'm not mistaken, even @nicknorwitzPhD would say its an important risk factor.

[@rhshrimpton]

It's so frustrating to hear conventional doctors refer to LMHRs as some strange, nearly irrelevant creatures that don't represent the majority of humanity. LMHR probably used to be the NORM. The level of health humanity is experiencing now is the anomaly.

[@hikerJohn]

Almost everyone in my extended family has metabolic syndrome but they are dying of cancers and not heart disease. No one is getting Alzheimer's, not even my 95 year old aunt. Even I had cancer but survived it. I had Kidney cancer and so had the kidney removed. Only my Uncle who died from complications of alcoholism did not die of cancer.

[@wocket42]

What is your conclusion?

[@hikerJohn]

@@wocket42 I don't have one yet

[@jacqueslucas8616]

If one gets real lean will one become a LMHR?

[@fourftr]

Wonder if the Dr has bought Stock in big Pharma

[@DrJK-wm9ec]

LDL does not cause CVD Mic drop

[@ArcoZakus]

Bart, is that you? ;-)

[@richienell]

Excellent video and information as usual. However, the irony continues to be mind boggling to me, (even my mind that is high in fat and cholesterol). The root of roots of causes for the foundation of this great truthful information as well as many others regarding heatlh and absolute proper nourishment is..... the large majority of medical doctors being UNeducated about our health but instead educated in the business of diagnosis and prescriptions. But yet, you Dave and everyone else STILL makes sure to say....."Make sure you work with your doctors", etc. etc. Why oh why? That is the entire criminal issue here. Stop listening to your MDs for your day to day metabolic health for crying out loud! Stop drinking their Koolaid, iced or hot. If you don't, then none of this great truthful info will really matter to your personally person. Instead I suggest stop listening to your doctors because they are doctors and continue teaching THEM the truth because they are doctors and should learn it. In the same way Americans continue to say..."Be American, buy American made automobiles"......Instead of, American automobiles should be made by Americans that are worth buying. Make them like a Japanese made Land Cruiser and I would.

[@pmccord9]

"High cholesterol in the diet"? Isn't there zero correlation between dietary cholesterol and blood cholesterol since ingested cholesterol is broken down in digestion? Interesting to see the state of reactive denial in a doc who would have to realize he's been wrong about lipids his entire career.

[@BigVine-m5i]

What's a gila monster study?

[@CashMoneyMoore]

The gila venom led to the discover of glp-1 and the development of semaglutide and other drugs. I think his point is that an "esoteric" observation can lead to some fundamental understanding and treatment options in seemingly unrelated fields

[@jobrown8146]

@@CashMoneyMoore Thanks. I had also been wondering what that study was.

[@roccosakai8206]

Such ad-hoc videos - for sure! Yes please! Just slightly shorter if possible :)

[@realDaveFeldman]

As the saying goes, "Ask an engineer what time it is... and he'll tell you how to build a clock." 😂😂😂

[@OIOnaut]

Is it respectfull to through MDs who are indoctorated to main stream, centralised, patent oriented, symptom treating and forever sickness promotoing by classifications of specialities and journal capturing, policy lobbying, under the bus. I do not think so. That is where they need to go. Engineers rule. I am an engineer and a brother of a neurologist. He is fat and sick and I am LMHR super human.

[@jacqueslucas8616]

Nice job Dave…the medical community has been so against u from the beg….interestingly I recently saw a short vid from attia admitting that inflammation and insulin resistance playing a roll in heart disease!

[@w4rsh1p]

This guy sounds confident enough to put mycotoxins in drinking water

[@jacqueslucas8616]

Evidence based position! About god damn time…..wth haven’t we progressed on heart disease and stroke in the last 50 yrs??? Cuz the basic theory on high cholesterol and LDL is looking weaker and weaker

[@fredsmit3481]

Dave, At 2:53 you talk about obese people consuming a moderate amount of a ketogenic diet. Most people on a real ketogenic diet that are on the diet for several years are not obese. I think your paper causes a lot of confusion by using the word KETO 66 times. Most scientists define ketosis as the body producing .5mmol/L of ketones. The word keto comes from ketosis, ketone and ketogenic. The word keto does not come from the word low-carb. Ketogenic diets are diets that put people in ketosis and you did not even measure one ketone in your entire study. Thus, you have no idea if people were on a ketogenic diet. You rely on self-reported information which has been shown to be very inaccurate and unscientific. Many people cannot remember what they ate yesterday, much less several years ago. By relying on people’s memory of what they ate several years in the past, your data is suspect. My suggestion for improvement in your data is to measure ketones. If people produce ketones then they are on a ketogenic diet. I really would like to see a scientific study of real keto diets and the effect of a real keto diet on cholesterol and health.

[@juhoevert7273]

Please, say it more simply. Difficult to understand what is your opinion?