Understanding Low-Carb Diets and Cholesterol – Interview with Dave Feldman

Understanding Low-Carb Diets and Cholesterol – Interview with Dave Feldman

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And we're live what's going on guys we are back with another installment i guess of the interview series yeah expert interviews yeah the stay-at-home series yeah so let us know if you guys are liking these you want to keep doing them who you want us to have on and if you.

Have any questions put them in chat we'll get to them today on the show we have dave feldman he is really like i'd say dedicated his life to cholesterol research and disproving the modern like uh high cholesterol causes heart disease that whole hypothesis.

We've had them on the keto for normies podcast episode 38 so it breaks down like cholesterol really gets he's a he's a teacher himself um and so whenever he speaks i feel like it's just so palatable it's so easy to digest and so you learn everything you need to know and.

Cholesterol code.com is a great resource as well so you should definitely check that out if you have any questions after this how's it going dave good good so i do have to jump in with one small correction or believe me i'll get flogged everywhere i i would not say that i've.

Dedicated it to specifically cholesterol research i in fact there's many things i'm interested in past this point particularly protein and other other things i want to do experiment wise the other factor is i wouldn't say that i'm dedicated so much to proving.

Ldl doesn't cause atherosclerosis more that i want to test it and that i believe we have whether intentionally or not may have found a context where if you go on a low carb diet and you see your ldl high and it seems to be for a metabolic reason it seems to be because you're powered by fat.

That maybe in that context high ldl is not bad in that's why we want to test it yeah so dave has a youtube channel and i was watching a couple of your videos earlier today so you're actually doing i don't know if it's the most recent thing you're working on but you have.

Like a partner in this some experiment you're doing where he has like the opposite viewpoint he believes the current mainstream uh high cholesterol causes heart disease and you're like joining up to do this it's kind of cool that you each have one opinion on it is that.

I forget which one that is yeah his name is dr spencer nadalski and he's um he's he can be somewhat colorful about the low-carb community and for what it's worth sometimes some of the things he says i think have some validity to it but the we actually met that way in that i heard him on a podcast he was kind of.

Challenging low carbers who might have a you know dismissive attitude towards ldl and so we got into some deep conversations about the biochemistry and at the point at which i determined that we were going to be putting together a study uh i said you know i would like to have.

A cross-opinion team like i would love it if we could figure out what it is we could agree on were the primary endpoints of the study you know what is what is it that we really want to see and if we could agree on that you know cross opinions as to what could be.

Tested then i would consider that to be a a feature not a bug unfortunately i find that a lot of the studies we read these days particularly in the area of cholesterol are done with like-minded you know colleagues and unfortunately are often reviewed by.

Like-minded reviewers and i think the only way we break out of that is to engage with people who have differing opinions and you know try to see where the best arguments land which as you know i do all the time on social media i try to seek out those people have different.

Opinions and that's how i met spencer so for someone kind of new who just kind of knows like the the general mainstream viewpoints of like high cholesterol is bad um can you in simple terms explain your current thesis on things uh yes so i'm gonna keep this very 101 uh but generally speaking of course i've grown.

Up as many people watching here today have in that yes high ltl it's it's almost like it's almost described kind of like you know a pathogen like you just want it as low as you possibly can that it's it's toxic that it's poisonous uh but you.

If you get into the physiology you learn actually the body is made up of cells the building blocks of life and cells particularly for the animal kingdom are made uh that like they're structured with cholesterol in fact cholesterol is a particular molecule that allows us to to have just the right amount of give.

And stiffness to allow us to be large multicellular beings that move around you know as plants don't have cholesterol they're not moving around so we have systems that are only possible uh because of cholesterol which is why it's in you know throughout the animal kingdom.

Now here's the catch the catch is that we also move cholesterol around in our bloodstream and that's where the argument comes that hey this may be a problem because we tend to find that there are people particularly those who have genetically high levels of cholesterol.

That may see more heart disease and that's that became the basis by which it was assumed that in any context lowering ldl cholesterol the so-called bad cholesterol is ldl in the bloodstream would result in a beneficial outcome and that you would have less cardiovascular disease and therefore you.

Know would live longer now that being said we now have the low carb context certainly in the last five ten years low carb has gotten very big the ketogenic diet has gotten very big and we see a number of people like myself that's what drove me into this that.

Went low-carb saw their cholesterol go up and likewise got concerned and that's what happened to me i got concerned i was like oh my gosh this is this is a big problem because i don't want to die of a heart attack of course and then being a software engineer particularly working on.

Networks as i started learning about what what system moves cholesterol around it's that field of study it's called lipid ology because it's lipids uh i recognized a pattern that i see often as a software engineer which is it actually is like a network.

It's very much it actually has lots of responsiveness to it there's lots of organs that participate in it but particularly the liver as to why it is at the levels that it's at and to kind of give you the elevator pitch basically what i'm positing is that the reason for why many.

Of us particularly ironically the healthiest and leanest of us will often have higher ldl cholesterol is that cholesterol is bundled in with the same fat based energy we use for fuel which is triglycerides now triglycerides this may this may be confusing to a lot.

Of people because you go on the low carb diet and you see triglycerides go down but the irony is that that's because your triglycerides are getting used at a higher rate that's that's the theory but because they're bundled together in the same kind of boat that your body makes.

Called a and are rapidly turned around as in those triglycerides are taken off of those boats it leaves behind the cholesterol that's in this boat so you just see a higher number of those total boats can i use a just a quick analogy that i think a lot of people can kind of identify with.

Um imagine imagine ships in a harbor and imagine you guys are with me and we're looking down at this harbor and we're seeing that there's you know 100 ships and i say wow that's way too many ships there there should be less ships that deliver the cargo that they're doing to wherever.

It is that they're going and you guys here that way he said let's just watch let's watch what the ships do and sure enough as we're watching the ships we're seeing a lot of ships going out and they've got their cargo as they're going out but they're coming back empty so because most of the ships we're.

Seeing at any given time are empty you go well i i think dave that they're just succeeding i think they're succeeding at delivering their cargo i go okay that sort of makes sense but i'm worried because usually when i see a lot of ships in a clump then it concerns me.

Well we we leave we come back a year later and now there's a thousand ships okay now that's definitely too many ships when i see a lot of ships stuck like that that's a problem and you go now wait a second let's watch sure enough we're seeing that more of the ships are going out and coming back without their cargo.

And there and therefore you feel confident that a lot's going on okay so a lot's going on as far as the delivery is being successful but now let's turn it around let's say that there's a lot of ships with a lot of cargo they don't seem to be getting out of the harbor therefore you could come to the.

Conclusion that they're failing at delivering their cargo now all i need to do is add one more detail that should hopefully make this make sense imagine all those ships come standard with life rafts and because they all have life rafts they'll leave with the cargo drop off.

The cargo and they'll come back but the life rafts are still in play well life rafts you can associate with you know bad outcomes if there's a lot of life rafts you see out in the water you're probably concerned right but you you wouldn't ever go on a boat that didn't have life rafts on it well the body wouldn't ever make a lipo.

Protein without cholesterol in it guaranteed so if those lipoproteins those boats that your body is making to ship out the triglyceride energy that you're powered by have cholesterol standard then of course you're going to have more boats and more cholesterol in each of those.

Boats i hope that converted well but that's that's kind of the gist of it yeah so then another big prong of your thesis is the lean mass hyper responder right and that's actually a current you can talk a little bit about the big project you're working on so could you explain the lean mass hyper.

Responder and then i guess a follow-up is what about the people that don't fit this category that go on a low-carb diet and they get really high cholesterol that's then we assume it's bad yeah so let's actually let's take let's take each of those a little bit separately.

The first is i know for anybody who's just now being introduced to that term it sounds it's a mouthful lean mass hyper responder let's take one step back and talk about just hyper responder before i ever got involved with the low carb diet the term hyper responder was kind of.

Uh bantered around by a few different doctors who were just kind of getting a sense that indeed some people went on a low carb diet saw their cholesterol go up so there's hyper response to cholesterol going out as i kind of came in started doing more of my research i realized that there was actually a very distinctive pattern.

That you would see with people who were especially lean and often very insulin sensitive very healthy often times fit and they i called this term lean mass hyperresponder because observationally they seem to be generally very lean they tend to be very healthy and again they tend to have excellent.

Cardiovascular risk markers everything else you would normally worry about high blood pressure high waist to hip ratio all of those things are out the door just that their ldl would be high and in the case of lean mass hypersponders would be the highest but it couples with also high.

Hdl the so-called good cholesterol and low triglycerides again that cargo that we're talking about that's in the boats now high hdl is a good cardiovascular risk marker and low triglycerides is a good cardiovascular risk marker by themselves and so it was especially.

Interesting that you know particularly for me as an engineer that this pattern is so distinctive and across i mean all genders ethnicities ages because it to me it seems very suggestive of a kind of alignment of all these things coming together now per what you were.

Just about to mention obviously there are many people especially outside the low carb community many doctors who would say this is a problem i don't care if it's for mechanistically you know fat trafficking reasons high ldl is bad.

Period in any context that's the prevailing theory right now is that if you have high ldl you're in a bad way full stop so after trying for about a year and a half to privately raise money to do a study specifically only mass hype responders and risk i finally uh houston last year at low.

Carb houston i just i decided heck i'm just going to go on a stage announce that we're going to open uh a foundation to raise money and just you know make this study ourselves and i i got to be honest guys i had no idea if it would work or not and um like the.

Lowest amount that we could raise was 50 000 but what we're trying to get to is 200 000 and that's it's a really daunting number to ask a whole bunch of people in mass to contribute to but i'm happy to report that we're actually just about there not not to the 50 000 but we're just.

About to the 200 000 mark we've raised 82 000 and we now have an anonymous donor who's gonna match us once we hit a hundred thousand so we have just eighteen thousand dollars to go um but this is very powerful because these lean mass hyper responders they are.

Almost a gift to science in a way because they've created they have a new context normally when we see high ldl it's coupled with a whole bunch of other bad cardiovascular risk markers other things that can give you heart disease lean mass hyperresponders have super super high ldl but all of the other.

Cardiovascular risk markers are super low so if high ldl high bad cholesterol causes heart disease full stop then certainly we should we should be seeing lean mass hype responders developing anginas that's kind of like the you know the heart issues the um uh xanthomas a number of other.

Markers in advance of it and certainly uh we'd be worried about heart attacks but why not just go ahead and do a study to find out and uh so we're we're getting close we're actually about to submit our irb hopefully by the end of this month or beginning of next month um and we're just about there to.

Hopefully set this up i mean uh just to mention real quick this is at citizensciencefoundation.org um of course we appreciate your support if anybody watching this wants to jump in so what is your theory then i guess before we do the experiment itself what is your theory on like the.

Bad ldl being so high with lead mass hyper responders and like how it's impacting them uh well again i think it's i think getting back to that analogy with the boats in the harbor it's because you necessarily need more boats so if you're.

If you're leaner and i'm going to get a little bit more biochemi here for just a second if you if you think of think of your body fat your subcutaneous fat that's all around your body it's sort of like food banks and they're food banks for the cells nearby that are not those fat cells so your.

Muscle tissue it likes that you have fat near it right and so of course those cells themselves have their own supply of energy and so forth but as far as getting it outside of the cell it's good to have a nearby food bank and that's that's what its purpose is for.

Well if you've got a lot of fat and not a lot of muscle then you got a lot of local storage local storage of that fat right so if you if you were to imagine you know um food banks all around your town and the need for moving the food supply between them it's not.

That high if you have a lot of stuffed up food banks okay now let's change the dynamic let's say that you have a low amount of inventory per food bank and a lot of hungry people outside of it and then let's say let's say i'm just you know i'm like flexing up my.

My forearm here and that's the only target of interest the the muscle tissue in my forearm is the only one that wants to make use of the energy that i'm supplying it now again in this context i'm low carb so i don't have glucose or glycogen in the same quantities so i'm mainly powered by fat.

Well my my local food banks are in limited supply so there needs to be more redistributing of fat all around my body to the locals so i need a more global distribution of those boats to keep resupplying not not just my muscle tissue there but also my fat stores there.

Like here's an easy way to think of it is there a way that i could get one of you guys to get a low amount of subcutaneous fat on one arm and a high amount on the other arm can you do that i don't think so no no you can't because it's constantly being redistributed that's actually the.

Genius of the human body it's it's a redistribute this is why thinking of it like a network really helps because when you keep thinking about it as a constant redistribution process from the liver's perspective it doesn't need to know everything that's going on everywhere.

It's thinking of it kind of like here's one more analogy that really helps a lot of people think of it like a buffet line if you're if you're running if you're running a diner that has as many cells as you have in the body which is 100 trillion customers and that diner everyone's you know.

Ordering specific food that's hard to do but it's very easy to run a buffet because you don't have to watch all of your customers or all of these cells you only need to watch the buffet line and make sure that it keeps getting restocked right so the liver can keep telling.

If indeed it's running lower in relative energy that's available and then act on it it already does this with glucose but it needs to also do this with fat in the scenario where your glucose is low so it's constantly taking those the free fat that's being released from your fat cells packaging them up into these boats.

And then sending the boats back out and all it does is just bring up the frequency if you have less and less fat mass it's just bringing it up so that it rounds around the different food banks all around i know i mixed up a whole lot of metaphors there but.

Hopefully i'm kind of getting across the the concept of this redistribution is the key and if you have less and less fat mass you have more and more redistribution and there's there's other things that support this outside of the low carb context for example if you fast.

A lot your cholesterol goes up if unfortunately the disease of anorexia does supply further evidence before you start breaking down lean mass they tend to see dyslipidemia which is higher and higher ldl again i think that this is just part of the process of the redistribution so what about standard american dieters.

With high usually i think obesity and high cholesterol is correlated right so wouldn't you expect to see like lower cholesterol in standard american dieters that are overweight or is that just because they're not doing a low carb diet and here's where we get into a little more.

A little more nuance so you do tend to see somebody with higher ldl in relative terms if they have a profile called atherogenic dyslipidemia atherogenic dyslipidemia is marked by specifically having low hdl cholesterol the so-called good cholesterol.

And high triglycerides now getting back to the cargo and the boats what's happening you're seeing a harbor full of boats with lots of cargo on it they are failing at delivering their cargo right it makes sense your food banks don't have any more room.

To stuff more food in them but your body is still making the boats because there's so much of that fat still in your bloodstream and so it's it's cycling just just like it would with a lean mass hypersponge but but with a huge failure rate and that results in.

That profile of the low hdl and the high triglycerides the high triglycerides that's that's a direct measure of fat in your blood so yes whether you're low carb or you're on a standard american diet i don't care who you are you guys already know this about me that's the first thing i look at.

In a lipid panel i don't even look yet at ldl i'm very interested in triglycerides especially in hdl and let me just fit in just real quick for those people who are low carb and are getting a blood test if you see your triglycerides being high please note that you want to be sure.

That it's fasted it's a fasted blood test of at least 12 to 14 hours because you will likely have high triglycerides if you get a blood test you know a few hours after you've eaten because you quite literally installed that fat into your bloodstream so just just that little bit of a side.

Is an important one to fit in we're never talking about having high triglycerides in a blood test okay so um what was that who did the pe diet what's that guy's name uh peter i forget isn't it who is it ted naaman type name it okay yeah so we did we did the pe die or we read the book we did a little experiment with.

That for one day so his does does his theory is this cohesive with yours where he's kind of saying like energy toxicity excess calories can show up in triglycerides right like that you you see it there before you see it in like high blood glucose and insulin resistance.

Yeah try high triglycerides in a fasted state is carries the same concern with me as high insulin in a fasted state there's no there's no good reason when you're fully fasted and um uh metabolically stable that you should have a high amount of energy parked in your bloodstream that's.

Persistently hanging out in your bloodstream you know what i mean okay yeah and and so to his point on the pe diet i'm not i i kind of like the term energy toxicity but i kind of i i differ from many other people in this field in that.

I still want to think of things in terms of a profile like what is the root cause that resulted in the lipid profile as opposed to the lipid profile is itself the root cause does that make sense yeah yeah we seem to treat cholesterol as its.

Own like co it's the cause right correct correct and i've i've said that i think i even said this in an offhanded comment a lot of people latched on to but it's pretty accurate which is that i don't i don't think any lipoprotein is.

Itself the boat the lipoprotein i don't think any protein is itself inherently atherogenic when it's synthesized i think broken systems are atherogenic so i think the the like the one i just mentioned the um uh the atherogenic dyslipidemia i think that's a profile i mean really.

Think about this for a second somebody spends their whole life without the profile of atherogenic dysleupidemia they become type 2 diabetic they get atherogenic dyslipidemia their hdl goes way down the triglycerides go up and their ldl marginally goes up and then interestingly the ldl gets the blame.

Specifically in this context now naturally my first instinct is to go now wait a second shouldn't we test this by looking at those people who have high ldl who do not have atherogenic dyslexia in fact if they have the opposite that's even better if they have high hdl and.

Low triglycerides and that's what that's why lean mass hyper responders i think may have more of an impact than they may ever realize if indeed it proves to be true that high ldl is not the cause of heart disease in this case okay interesting and then you're always.

Doing experiments i was scrolling through cholesterol code.com that's the website is that your website yes yeah so there's forums on there there's like a big participation user participation is pretty cool um and you're always doing some crazy stuff and the latest one is like a liquid diet i didn't read up on this one.

But explain the current experiment yes so one area that we've not covered is that there is an important there are a number of different things that can change your cholesterol levels particularly total and ldl that we haven't talked about that don't have to do with energy.

And one of those is of course the comparison between saturated fat monounsaturated fat and polyunsaturated fat now it's generally kind of known through the literature that particularly polyunsaturated fat if you replace more saturated fat with polyunsaturated fat you'll tend to see.

Your ldl go down the reasons for that are fairly it's kind of a long list of possible reasons for that but there's one particular one that i'm especially interested in that's a little esoteric which is that i think that there may be greater oxidation of those lipoprotein bones.

And they may be getting removed at a faster rate by what's known as scavenger receptors and throughout your body you have things like immune cells or your endothelial cells they're grabbing things that are modified and an ldl particle that gets oxidized.

Is modified you you find it tends to associate with bad outcomes people have more heart disease when they have greater you know detected oxidized ldl in their bloodstream and so i'm doing part of the reason i'm doing this experiment is not just to test if i bring.

Up my mono and polyunsaturated fats by consuming olive oil versus a high saturated fat via butter where i do believe that the uh the ldl will go down on the pufa side or the i should say the olive oil side versus the saturated fat side but on top of that i also am doing ox ldl testing directly.

So i want to see if the proportion of oxidized ldl is higher with the olive oil than it is with the saturated fat so you're doing mono versus saturated fat in effect yes i mean olive oil is mostly monounsaturated fats and so i may add an extra arm i'm i'm.

Hesitant to have a predominantly pufa oil for one that would be the most interesting one yeah yeah but no one really does like a super high pufa diet yeah there's there's an oil called grape seed that's very high pufa um it's of course the seed oil and it's not.

I don't know i'm i may i may have to build up the courage for it but i'll say this regardless the quantity of pufas that i'm getting while on the olive oil side of the interventions will be much higher than what that will be on the butter side so i feel like we'll get but the other the other reason i was.

Doing this was because i didn't want to just be about those different types of fats there's specifically a lot of advice out there to replace butter with olive oil like butter and olive oil are sort of the two things that end up head to head a lot.

So i wanted to just do an experiment to really you know flush this out and so as you mentioned it's a liquid diet experiment so this is literally what i'm doing i'm consuming keto chao which is of course a product that's a meal replacement entirely through all four weeks and then.

For the first week which started today by the way um having olive oil for the um for the base fat for the keto chow for seven days getting a wide spectrum blood test at the end of the seven days i actually just got one this morning too by the way for the baseline and then switching over.

To butter for the next seven days and then it's a double crossover which means i'm gonna repeat the cycle again for week three it's gonna be olive oil for week four it's gonna be butter because i think this data is going to be poured over.

A lot i'm getting 27 blood tests um it's it's quite extensive all the different things i'm getting including lots of uh inflammatory markers and cbc all sorts of stuff i'm i'm very curious as to this being the only variable of change just how much it'll matter.

What my source fat will be what is butter um as a percentage of calories saturated fat i think it's well it's definitely the the vast majority i don't have the breakdown in front of me right now but i'm sure somebody can google it it's uh.

But okay your assumption on the outcome what do you think yeah so i'm positing that i believe that the olive oil will reduce my ldl uh and i'm putting out there that i think i could be wrong but i think that the proportion of oxidized ldl will be higher for the.

Olive oil there is a pretty well known study right that shows replacing saturated with monounsaturated fats reduces total cholesterol i think there's well there's a number of them but i don't know that i've seen any that are doing quite what i'm doing not.

That's not a brag that's me just being obsessive about can i can can i get as you know so many diet studies are like oh we've replaced something yeah exactly we we replaced um a standard american diet with this other diet wow the other diet so great.

Like i i in general i'm already too obsessive about what the selection of the foods are that are being used to the extent to where yes i'm i'm willing to go so far as to just do a meal replacement shake because guess what i'll know that's exactly the same constant all the.

Way through i'll know that it's preparation is exactly the same in fact to emulsify the butter i'm having to use warm water but i don't have to do that with the olive oil but i'm doing it anyway just in case that's some possible confounder so i i want to keep.

Everything is exactly the same as i possibly can even down to meal times to my exercise exactly when i'm exercising i just because i feel like to me that's like barely adequate i feel like in order to really get that distinctiveness and this is also why i'm doing a double.

Crossover it could be that the order in which i consume these makes the difference in that if you know i did the the first one and then you know anyway this is why double crossover is just great i think is it all the same flavor keto it is it's all chocolate which really by.

The way tastes weird i've already done some test runs from last week it tastes so weird to mix chocolate with olive oil it's just not yeah it doesn't sound great and then the day before you started did you go just like super crazy with foods or did you you know.

I had to hold back so that was yesterday i i there were a whole bunch of different foods i wanted to eat knowing it was my last day and this is one of the problems one of the problems is that i know my run-in with my baseline could get affected if i eat something.

Quirky and just the mere chance that it could really mess with everything was just too big so i i kept it to burger patties with cheese i did let myself have half a pint of keto ice cream i think it's the enlightened one i don't know if you.

Guys have had that one um but otherwise i stuck to my guns to be you know boring staple version of my diet now i will tell you after this whole since 28 days are up the cuffs are off i'm probably going to go to town on all kinds of things i don't even want to.

Talk about it so it's going to be it's going to be interesting and then what must also be nice this is a side note is that you probably don't have to take as many pictures of your food next year oh are you still doing that i don't know it's five years running i know i saw the burger.

And fist picture on twitter this morning and i was like you're not going to be doing that right next to like a shaker bottle though it is it's always there's no exceptions to that rule every any day so i haven't always recorded everything that i do in chronometer which is my.

Main um my main tracker of choice it's usually through experiments but right now you could pick any day in the last five years and i could audit that day and come up with the chronometer um because i had those photos in the cloud right now of.

Everything i ingested for that day and this is probably one of your wife's favorite aspects about you i imagine yes i have to once again give homage to my wife that she is a freaking saint for how much i mean think about it i think it think if you you guys are at least married to.

Each other you're both into this yeah and imagine getting married to somebody who was not into this in the first place yeah and then occasionally they come to you and they go yeah so for the next four weeks whatever social plans you had that all around eating anything all that's out the door.

I need to eat it this time this time and this time actually i have a fun little anecdote to share with you there's one time where there's a a musical that came to town that she was really excited to see and i think it's dear dear evans dear i forget what it is but anyway it's the one with the guy who has a cast and.

I had an experiment that was running in the course of doing that and i i was adamant about eating at the same times every every time and unfortunately this um musical starts at 7 30 and my eating time was at 8. i said okay fortunately i did plan at least to the extent to where i can bring it portably.

So it is eggs hard-boiled eggs and cheese and it was the added sugar experiment too so it also included um uh include some dextrose in the form of bottle caps so i had those with me as well so we're they still sell those this isn't cool.

Uh yeah but it was the only one of the only ways i could get just direct dextrose as opposed to high fructose corn syrup i used to love those i did do back in the day like the soda flavored ones yes the exact same i like those a little bit more than the fruit ones but so we're we're in this audience.

Everyone's dressed to the tea like reaching in and grabbing like hard-boiled eggs and like munching on them and she's next to me giving me the cold but hey davis data it it might have made a difference if i if i had eaten at six instead of eight and i just wanna.

Exclude that possibility and then have there been any experiments that you've started and you've just like quit halfway through and like not told people oh uh there's a two we do that all the time yeah matt always does that we start a video and then we never finish it but see you're actually losing good data.

By doing that because even if you quit it's it's worth emphasizing what you decide to do and then why you quit because it could be that that was related to the experiment that's true i didn't think of it like that wow so for one without question uh siobhan my colleague.

And i have done a number of experiments where in the course of the experiment we have detected a clear mood change and that's one of the benefits of doing experiments this way because usually if somebody falls off the wagon of their diet it's because it's in the it's in the midst of some other catalyst you know.

They're they their friend was in from out of town and now they're going to party like and so they don't know if it was the friend and their interest in doing it as to why it is that that's why they're feeling bad the next day because they were.

Up so late and a whole bunch of or was it really just changing your diet right yeah and so this is this is the cool thing about being the one who initiates the catalyst and that you know everything else has been eliminated except for those changes you made in the food.

And so by the same token you may find that if you guys start an experiment and then you're like i'm going to abandon this experiment i i just haven't been able to get up at the same time each morning something like that and you just even send that out you just you guys have a large enough audience you may have other people that go you.

Know what i kind of want to replicate that and see if you know anything like uh what happened there would happen with me and um again all data is good data in my opinion yeah it would be fun to do like some kind of group experiment where we aggregate all the data.

Yeah but it's a lot of work but uh having uh like looked at obviously thousands i would assume tens of thousands of cholesterol panels and stuff have you noticed any like isolated foods that impact things like someone mentioned maybe alcohol i know you spoke previously about.

Coffee at a conference we saw you at like vegan diets like really lower saturated fat diets things like that and zero cholesterol diets yeah unfortunately this is this is why i often say looking at ldl cholesterol is kind of like looking at the last chapter in a long book.

Unless you know what happened before then and everything that affected the story you just don't know so i'm just going to list off a whole bunch of things of course you've heard about fiber fiber can impact your levels we we hear not just about move but also about pufa but you know what also.

There's um there's exercise as you guys know i did a resistance training experiment work i had to eat everything exactly the same every single day with the only intervention being the exercise twice that had a substantial impact on my ldl i of course medication supplements they can have an impact on it but that.

That's just on what you ingested now let's talk about time temporally when you get your blood test will be relevant which is why i mentioned that being 12 to 14 hours fasted um if you're low carb or so that your triglycerides aren't high from what you ate not too long ago there's a.

You you mentioned um around the same time we were looking at coffee sensitivity there's something called uh triglyceride carryover i like to call it which is it's carried over in your sleep coming into the next day and then when you have the you know the dawn phenomenon it seems to be right in the wake of the dawn.

Phenomenon that it comes way down uh but yes there's there's the coffee sensitivity that's another thing that can impact your lipids particularly your triglycerides and that some people particularly when they go super super low carb find that their triglycerides are persistently high even when they're fully fasted.

And and we found that a few people not a lot but a few people a fraction will seem to have a sensitivity to coffee and many of them have experimented with this and have supplied back the data to us and sure enough uh their their triglycerides go down when they cut coffee out.

And i remember you said the people that depend on coffee the most tend to be the ones that it impacts their cholesterol the most right yeah i mean it's it's anecdotal but it seems like the people who love their coffee substantially and see the triglycerides that it's.

It's hilarious because there's been a few cases where somebody had high trigs it was unexplained and we're like oh do you drink coffee yeah can you quit it for you know a week yeah no problem you know what i'll quit it for three weeks and those people turn out to not have the issue.

Against anecdotal but the people the people were like oh you may have high drinks from a coffee sensitive well can you think of anything and i'm like well just cut it out for like a week are you kidding me cut it out for a week yeah it's i've seen daggers fly out of eyes over.

Telling this to some of my family members so i i do i am cautious because i actually realize what a religion coffee is for some people it's pretty substantial what about something like mct oil yeah so mct oil is one of those areas that's a little bit fuzzy for us right.

Now i've kind of wanted to do experiments around it but i don't know if you knew this it's most people who try to do a large consumption of mc2 oil it has a lot of nausea and a lot of problems with it i'm thinking of doing an experiment similar to what i'm doing.

Right now with a portion of my fat replaced with mct and then then we could see you know just how much or how little it might have an effect on it okay then what about um like zero cholesterol diets and like really low saturated fat diets yeah so zero i mean if you're look okay.

So you may have heard about my white bread experiment uh the white bread experiment okay so what happened the headline of it i guess you could say is i went from a low carb high fat diet where my ldl started i want to say it around 296 and seven days later i brought it to 83.

So a drop of 213 milligrams per deciliter how did i do that well i specifically chose a diet that was low fat high carb but on purpose i made it a diet nobody would recommend it was white bread and lean processed meat so i was trying to demonstrate the energy model in that.

Guess what i'm trafficking less and less and less of those boats that carry around my fatty acids and therefore less and less of the cholesterol that comes standard with those boats right the reason i bring this up in this context is a lot of times people think it's meat.

That causes high cholesterol i have tons of lean processed meat so no i would i would offer once again it comes back to whether you're being powered by fat or not so bringing this back around to the zero cholesterol if you have zero cholesterol are you going to have.

Cholesterol detection well in that white bread processed meat i had a very anthrogenic profile the the super super low hdl i set a record for myself from the lowest hdl super high triglycerides i want to say it was around 220 something like that fully fasted and lots of detectable ldl though the ldl.

Itself the ldl cholesterol was low i had lots of ldl particles so having no cholesterol on my diet wasn't you know or having little cholesterol in my diet wasn't really going to impact it that much i think again it comes back around to how much you're trafficking which is.

Not how much you're just making because you already make more cholesterol than you ingest even on a low carb high fat diet it's how much you're trafficking it around that's what gets detected in the blood test is the boats in the harbor yeah so i think still.

Since we first interviewed you the thing that stands out the most that maybe like the masses could most find as useful is like you go you get your cholesterol checked once every couple years and it's really just like a small snapshot like you were saying seven days you change your cholesterol like 200.

Points so i think people have to understand that it's like a moving target and i guess maybe if you're doing a pretty consistent diet for years and years then it's telling you i guess a little something but we definitely i would say put too much weight on cholesterol or i guess what's.

Your opinion do we put too much yes yes yeah look at a minimum i i think i think it's it's crazy to me that we would make lifelong therapy decisions off the single cholesterol test given given the research you read one percent of one percent of.

My research exactly what you talked about matt it may it may turn out and i want to be a good scientist and acknowledge this it may turn out that high ldl in any context even with lean mass hype responders does cause uh atherosclerosis the buildup of plaque.

In the arteries we've got to be good scientists and get to the point where we can find out for sure but at a minimum unfortunately many different doctors will get a high cholesterol reading particularly from somebody who went low carb and say you must have the genetic disease from the.

Familial hypercholesterolemia you need to take steps to lower it via medication now i'm not getting medical advice i'm not giving medication advice but i do want to say this i do want to say be aware that your lipid levels indeed were probably in the case of going low.

Carb and you had low ldl your whole life were probably not genetically increased it was probably as a result of the diet that's that's my opinion and i think i think we've got lots of data to back this opinion up at this point so i think before anybody goes on you know before they take large steps.

For the rest of their life as far as medical therapy goes particularly if it comes from a blood test just consider consider looking at how much your blood test can change that may not have to do with genetics especially if it didn't seem to be that way before.

Yeah it seems to me like we get a little bit out in front of the science and people just start saying like science says and then it becomes the narrative that we all kind of go by and the newest addition to this this sort of family at least in my opinion is these it's.

Like uh customized nutrition based on your blood tests you know like these these type of things like you get your 23andme ancestry you get like some blood drawn and it tells you exactly what you're supposed to eat so to your knowledge is there any like genetic mutations.

Or or certain things like that that could play into your ability to handle for instance a keto diet or like a higher fat diet ancestry even yeah i think that there is and i think that in talking to some doctors uh who researched this more specifically that that's the case but that they're.

That they're much more so for example i think that there are cases of people who cannot handle a low-carb high-fat diet or a ketogenic diet just that i think that they're extremely rare given everything i've come to learn up to this point in time so for example some people do have a.

Problem with the trafficking of fatty acids and the the uptake and use of them but they're real corner cases i mean this i don't want to throw out any numbers but i'll just say odds are we you and all of us we probably know very few if any it's usually one of those super.

Rare genetic diseases now again i want to be a good scientist we don't know we don't know we don't have very long term data on keto in particular where we can say oh well there's you know this large population of people who've been fully keto for 50 years and that's also kind of a challenge in the.

Fact that because this kind of comes up with the plant-based community as well people don't typically people just in general just as we are typically don't hang on one diet particularly some macronutrient specific diet for decades at a time people experiment with diets.

And so unfortunately we don't know a lot of times when somebody has an adverse reaction to the diet that they took on that they thought was represented is represented in the way that it would have been you know advised by those people and again this doesn't just apply to low carb this is just.

Every commute there's just a problem with diet science in general okay and then um i remember i don't know it might have been like a year ago i remember you got like this new data set it was just uh and you were like going through and analyzing it and it was supposed to be like one of the bigger data sets of cholesterol numbers.

Can you go over that a little bit i forget the big takeaways yes so you're talking about inhanes yeah in inhanes is a um it's a data set that's actually collected by the cdc so and i think it may be the largest publicly accessible data set and uh i was thankful to get a.

Hold of it because the very first question i was asking you know back in november of 2015 right away was i was going you know look does higher ldl correlate with more death for that matter does low ldl correlate with greater longevity less death.

And i found that it was it was hard to get that because you'll find study after study that goes oh more cardiovascular disease but that doesn't really tell me a lot because if you die less of one thing it doesn't mean that you're not dying more of one or more more other things.

Unrelated to that thing right my favorite example uh now is um free soloing rock climbing that's people rock climb without safety equipment right yeah we saw the documentary yes yeah ever since i saw that i it's stuck in my head and i'm like you know what this is a good example i'll bet you.

These guys die less of heart disease so you could say rock climbing without safety equipment will reduce your risk of dying of heart disease by like 99 because they die at age 40 from falling right so dying dying sooner then that thing that would have.

Otherwise killed you doesn't tell you you would die less overall so i was happy to get a hold of inhanes why because the very first thing i went for was look when do people die relative to their ldl and like many studies that were out there before i got a hold of it indeed uh people with higher ldl tend to.

Associate with greater longevity as then they die there's american dieters modern us when was the data set from the the data sets like throughout the united states they take it they they go into like two-year cycles oh yeah it goes from i think the data i was looking at was from 1999 to 2015. okay and some of that data gets released.

To some researchers even or like the most most recent cycle sometimes gets to researchers sooner but regardless there's about a good 15-year gap to look at for follow-up and to be sure you know i want to give due to those people who would claim it's.

Reverse causality as in if you have certain diseases that result the diseases themselves result in lower ldl then that creates the association of low ldl with mortality when in fact it was the disease that caused both but but to be fair you can't use.

That in one direction you've got to do that in both directions in other words you can't likewise look at people with atherogenic dyslipidemia and a slightly higher ldl and say it's the ldl that's causing it when indeed it could be something else that's causing both the atherogen dyslipidemia and the mortality.

And the high ldl you see what i'm saying like it's it's interesting because they they do this a lot when it comes to cholesterol and lipids is that they'll say oh we see this association that's good enough for us we don't need to do any further digging deep well that's why i like getting a hold of.

Enhance because naturally i didn't just look at ldl alone i also wanted to look at those people who had high hdl and low triglycerides and i'm telling you one of the coolest things that i found was those people have those three that i call it the triad.

High ldl high hdl low triglycerides high ldl high hdl low triglycerides they have the greatest longevity of everybody in the data set even over those people who had low ldl but high hdl and low triglycerides so what does someone like dr spencer say about that have you talked to him about.

That i do but again it always rounds back for people with prolipid hypothesis it always rounds back to assumed reverse causality there's probably some undiagnosed disease as to the reason why there's a greater skewing in that direction is that um is does.

That even out though like the so what you're saying basically is like the people that lived really long with low cholesterol they got cholesterol low cholesterol towards the end due to some condition right that's right that's do does the same happen up in the opposite like they get high cholesterol.

Towards the end of life from certain other conditions yes well this is this is exactly you know what i would like to bring up as well for ex for instance you can have um certain immune responses that are going to upregulate the amount of ldl cholesterol that you're going to see.

Right so it's the it's actually it's kind of a whole nother subject to talk about but but in effect those ldl boats that we were talking about before they are also engaged in your immune response you actually use them immunologically to fight disease and particularly pathogens and to.

Provide alpha tocopherol the vitamin e as an antioxidant all of those things are part of it which is again which is why we just all we have to do is look at the balance sheet do people with low ldl you know what what's their greater association of risk factors well they tend to die more of.

Cancer for example right well that's very relevant because that's connected to the immune response but again it's associational data so maybe it is reverse causality you know what let's just take a step back and look at just all cost mortality full stop.

Now again and with emphasis i don't think it's the high ldl that causes greater longitude i do think it comes back to being a profile is high ldl high hdl triglycerides probably a good sign of a healthy lipid system i think that it probably.

Is but again you know we need the data to find out okay and then the obvious question is does people that take cholesterol lowering medications and they successfully lower their cholesterol do they live longer than people that just go untreated yeah so there's a study that i'm going.

To point to where it looked at all intervention trials that took place after the regulation reform that was in 2004-2005 because there was the whole violence scandal a whole bunch of stuff that they said okay we need to have more stringent laws on how studies.

Are done so he looked at all cholesterol-lowering trials from i want to say it was 2004 all the way up until when this paper was written which i want to say is 2015 2016. and i believe that there were 29 29 different trials and was looking at all cost mortality was looking at the.

End point of do you know does the intervention group that takes the cholesterol medication see an improvement in all cause mortality and effectively no i mean across it there was no improvement on all-cause mentality again me being a good scientist the.

Statin trellis would say hey wait a sec that's because you know the trials weren't powered enough to show a difference in all-cause mortality now if i'm talking to that same devil's advocate i go why not why why do you want to be able to make a claim that something is.

Life-saving if you can't confirm that it's life-saving getting back to the rock climbing without safety equipment how do we know that certain interventions aren't uh increasing the risk that you die of something else and therefore reducing the chance you.

Die of that thing in question right yeah yeah and so it again this is this is why cholesterol-lowering medication data is just not as interesting to me because it's it's a bit too esoteric it's very short-term and it's got a lot of issues like this i have to imagine.

There's tons of like the decks stacked against you have to prove the medicine doesn't work right because there's so much money on the side of the medicine kind of works like let's just go with it where it has to be like really concrete like the medicine is bad and then maybe we'll stop taking.

It but it's a lot of money on the side of the medicine it's not so convenient well it's it's it's a special as data goes it has a special distinction particularly with cholesterol so in the case of in the case of epidemiological data like the inhanes.

That's openly accessible we can all talk about it we can all get access to it in the case of genetic study a lot of the genetic data is available a little less available than the epidemiological data but in the case of in the case of cholesterol-lowering medication it's i mean the the people who are in favor.

Of the narrative that ldl is bad in all contexts they have all of it it'd be like if you you know if somebody were to go on trial and they're charged with murder and only the prosecution has access to the data and so they get to show the analysis and so forth to the the jury but the defense doesn't have the normal.

Process of discovery where they can have their own experts look at it that's it's just different in that regard and that's again that's kind of why i don't like getting drawn into it too much because a lot of times that gets turned around into hey you must therefore be.

You know anti-medication or anti-statin or anti-cholesterol-lowering drugs and let me restate i'm not that i'm just not as excited about the data until we have you know a little bit more of an objective means of being able to both collect it and examine it okay yeah so um how when did we first start testing cholesterol.

Well that's a good question uh i think it's first observation i want to say goes back to the mid 1800s but i'm not certain i think the point in which the early beginnings of the lipid hypothesis were forming were the famous rabbit studies which were in like i want to say the early 1900s.

And um yeah and yes effectively he uh the scientist in question was having rat he was giving rabbits a kind of chow that included an infusion of cholesterol i believe don't quote me on this one but i do know that ultimately he achieved getting cholesterol into their diet that did result in higher.

Atherosclerosis and it's not to replicate this with omnivore animals but wasn't able to accomplish that with omnivore animals like i think he used dogs and and rats but he wasn't able to get that same effect um which is why it was pushed back on for a while that was kind of like the.

Earliest beginnings and sort of more of the awareness that this cholesterol was ending up in these fatty streaks and you know connecting hey this may be the diet that's ultimately bringing it there yeah cause i was wondering like what is an uh early 1900's healthy not really like modernized human what.

Does their cholesterol panel look like so it's almost seeming like we don't really have like a solid baseline of like what before the foods of modern commerce and stuff what was cholesterol levels but i guess we can like approximate for that pretty easily right.

Yeah i mean kind of it's i don't know it's hard because your your ability to ascertain the true ingredients of foods back then while they were certainly more simple the dietary habits on a per person basis i mean i just don't know how strong that data would be i am interested um but i i don't know it's very.

Speculative all right well it's been over an hour we should probably wind down where can the people find you well of course cholesterol code.com is not just as it was originally a blog but it's now kind of a resource site for people who are very interested in checking out their own cholesterol.

Numbers right now they can go to cholesterol code.com report we actually have a tool there where people can feed in their own numbers and basically what we would likely say in social media back to you based on what your numbers are is programmatically built into that.

I'm very active on twitter of course says dave keto keto and lastly of course i won't miss the opportunity to do one more pitch if you want to help us study lean mass hype responders and really get to the root of this i i honestly cannot think of a bigger study.

That will bring us the kind of data we're looking for than to actually test the the ct angiograms of lean mass hyper responders in over a span of time to confirm it and right now we believe that can be in just one year and that's at citizensciencefoundation.org it by the.

Way is a a fully public charity with 501 c 3 status so um you know talk to your tax preparer but uh it's a good cause i i stand by that yeah and i'm looking at cholesterol code i'm going to link the foundation the the the donation that you're talking about i'll link that.

In the description if you guys are rewatching this video but you also have the feldman protocol for a cholesterol drop that you've been doing that for a while so if you guys are interested in that he has the full protocol on cholesterol code.com and yeah thanks for joining us it's been.

Great so much dave thank you love seeing you guys again i'm a little sad we won't be running into each other and uh conferences anytime soon but wait are you still playing do you play in the world series of poker right uh i like i.

I used to this is obviously absorbed all my time and usually i have other commitments uh i did play a little bit last year but it's usually in just a tight window it's like a few tournaments or something like that there's there isn't one this year because of the pandemic yeah i was thinking maybe i would try.

Making a run at one one of these days yeah you may have to wait a year because it's not a good time for it all right well thanks so much for taking the time have a good day thank you for having me on yep all right guys that's gonna do it um so keto for normies is the podcast you can subscribe 38.

Yes oh yeah number 38 but you also post all of these on the podcast feed i do um so definitely check those out if you guys miss these or you just like listening to the audio it usually goes up on sundays but yeah that's dave check out cholesterol code.com and the what is that.

The um citizens i linked i'll link it in the description the citizens science foundation something like that for donations all right

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