Dave Feldman - 'Cholesterol is a Passenger, Not a Driver'

alright guys I've got something really special for you today so buckle up because I put a lot of work into fitting the most important things I know and do a single analogy so first of all conflicts of interest none but I'll tell you about a bunch of great individuals at the end of the talk my bio I don't really want to spend a lot of time on I'm a software engineer I'm obsessed with lipids conducting crazy and of one experiments you could just google Dave Feldman and cholesterol you'll you'll find plenty on me I like to call myself a cholesterol traveler now because I've moved lipid numbers up and down several times through a series of experiments and I brought my LDL as high as 368 down to 98 all since the last time I was here but how am I doing this right well I like to say I'm working from a theory that seems to continue to keep on working and what I'm happy about is I managed to solve the two biggest problems the two biggest problems are I'm talking to two audiences all the time and unfortunately for the experts they prefer I don't simplify the language and to be fair they've got a good points but I also can't tell an entire audience of lay people all about lipid ology very easily I'm still kind of learning a lot about it myself so I'm excited because this analogy will be a way for me to get you the abstraction that I see the way that I see it because the most important message is the one that I want to get across to you as to what cholesterol is a passenger in so without further ado I bring you a wonderful story a tale of five problems so in a dystopian future our countries hit with a massive flood and the president turns to the Secretary of engineering that's a future cabinet position by the way and he says okay well the houses are fine because it's the future and everyone can work from their home it's all right but we still need to be able to get food to them how we gonna do that the engineer says actually it's fine we've got a really large company on the shoreline that can get the food from outside the country and ship it inside and that's the intestine delivery company and it has exclusive rights to get all of the food that's gathered from the outside and it has special ships these brown chips and I'm keeping it color-coded to remember Brown to deliver that food around to all of these different houses fantastic fantastic but after a little while they realized that it's still kind of uneven some of the houses are getting it sooner than others and unfortunately some of the houses aren't ready to use the food at the time that they need it so that brought us to the second problem a lack of local storage engineer says no problem no problem we're gonna have these food banks that we have all around these different neighborhoods and then that way as the ships come around sure they'll feed food to the houses but on top of that they'll read up the adipose food banks fantastic when I would come to the third and most serious problem and that's that we still have miss distribution these neighborhoods aren't able to talk to each other the adipose Food Bank can sometimes have enough sometimes it doesn't sometimes the ships have enough to carry sometimes they don't and so we now got to deal with the hardest problem of all balanced distribution for this the secretary of engineering worked with this whole team and he got a lot of work done he says we just need one central player I give you the liver delivery company and this one's great because guess what not only will all of the brown ships eventually make their way there but also all of the food that got lost and spilled out into the water and no one can capture that'll all eventually make its way back here as well and they have their own special purple boat and that too can deliver this food all around to the different neighborhoods presidents like this is fantastic so let me see if I got this straight food that's coming from outside the country party that's coming into the intestine well then that actually is going to be loaded onto these Brown ships that's going to be distributed and then all of the stuff that's in the food banks that spills off or spills off from trying to deliver it to the different houses that's actually also going to make its way to the liver and that delivered those purple boats are then going to going to counterbalance the amount that's coming from the brown boats and yes the engineer says that's exactly right in fact when there's more that's coming in from the outside then that actually means that there'll be less that needs to get pulled from the food banks and ultimately delivered via deliver right likewise it counterbalances in the other direction if we have a shortage of food that's coming from the outside we can counterbalance that with the purple boats and surprise I've been talking about lipids this whole time this is why I don't have a shining future as a magician yes the houses were cells the fatty acids where the boxes and of course if you've got three of those boxes you've got triglycerides that of course was energy being distributed everywhere but the main thing I wanted you to focus on the reason I really wanted to drive this home is all the way up to this point my story has been about only one thing distributing food which was actually just fat based energy so what were the means of delivering the food well on the brown line we've got chylomicrons chylomicrons start with a whole bunch of fat based energy and they eventually become chylomicron remnants and where do they end up they end up back at the liver the liver has its own line which has vldls and ideals right and if once they're emptied of all of their energy they return back but there is something missing from this schematic of course but remember this is the energy of energy delivery portion if you're watching this on a video I would be fine if you paused it right now pondered that for a day and then come back to this next part because the moment I bring up the c-word everything's gonna fall apart because it has too much of attention associated with it so now let's get to the fourth problem support so the president turns back to the Secretary of Engineering says you've been doing such a great job but unfortunately the flood wiped out all of our emergency services do you think there's any way you with your smarts could figure out a way that we can still get that support around to the houses I said yeah you know we'll do since these blue these purple boats are the most present of all of the boats that are sitting around in our country we're going to go ahead and outfit them with the special care package now granted their first job will still be delivery first job is still delivery the second job is support and that's what I'm talking about here is cholesterol so I want to re-emphasize this again because this may be the most important slide and you might not realize it first job is delivery it doesn't both deliver and support it first delivers then it supports and that's extremely relevant to the rest of this analogy so without questions we're watching in the first job we're seeing this counter balance between chylomicrons and vldls in that delivering fat based energy and then after the chylomicrons deliver their energy they clock out they're done the vldls take about as much time to deliver the energy and they then have a second job they hang out in the neighborhood they chase off pathogens they get endocytosed into the cells for additional repair right they've got a second gig and they take that second gig pretty seriously so now we can add the LDL to our schematic and the HDL to our schematic even though I haven't talked about it yet you just need to know this with this little dotted line I'm talking about two different sides energy deliver on one side support on the other side very relevant when you're looking at these cool graphs I get to make that you'll see in other videos and this one of course I showed at the last breckenridge talk where I was pointing out that I was able to have dietary fat on a three-day average and isolated about right when I needed to do it in order to get resulting LDL P LDL P the support boat right Y was able to do that do i theorize well now you're starting to get it you're starting to get the abstraction I had less dietary fat coming in from the intestine delivery company which resulted in my body needing to upregulate vldls and what do the LDLs eventually clock out and become LDL P that's right likewise when my dietary fat was high sure enough my LDL P was low so don't take my data for it let's talk about the emerging data in the low carb high fat community now I used to lament that doctors I was meeting early on low-carb doctors they had this great wealth of data from their own patients on cholesterol numbers and in the spirit of being careful what you wish for I started this website and now I see like a dozen or more lipid profiles almost every single day like it's really ramped up to get to ridiculous levels but the neat thing is is we now can actually see the patterns that I was looking for in the first place and you might be surprised to find this out but metabolically healthy low carbs key is that they're metabolically healthy you would think as I certainly did as you go from overweight to lean what would happen to their cholesterol go down right go down it doesn't it actually goes up but what about if you go from sedentary to high energy higher energy demands anyone goes up goes up now I keep looking at this from the abstraction I just showed you and I keep thinking we'll wait a sec if the triglycerides are still staying low but I'm seeing more of the purple boats should I be concerned I don't know that I should so this was where the hypothesis was born it's the one I've been working on for quite a long time now and this is an overly brief version but basically high LDL cholesterol and particle count on a low-carb high-fat diet can be a reflection of higher VLDL secretion and use the key is and use these guys are actually needing to drop off these triglycerides at a higher rate and therefore becoming low-density lipoproteins right wouldn't it be great if we had a profile that showcased this perfectly some of you already know where I'm about to go we now have what we call the lean mass hyper responder so hyper responder is somebody goes on a low carb high fat diet they see their cholesterol go up substantially lean mass hyper responder was something identified back in July I wrote an article about it and honestly it was kind of a testing the waters thing I wanted to write this article and I wanted to see what the response was because I half-expected a lot of people to write in and say no no no actually I have an LDL above 200 I have triglycerides below 70 and I'm actually very sedentary and I have all these other issues etc no on the contrary I got inundated this is the most commented on posts of any of that I've had on the blog thus far and there's people all around the world and many of you who medical professionals in low-carb probably know a few that are lean mass hyper responders they tend to be very lean they tend to be very athletic now this all sounds great but what's the first thing you want to do this is why I'm so glad I ever took place before me we're all about the root cause you want to know how you know an engineer they're their own worst critic they have to be because their fellow engineering friends are constantly challenging them so they need to challenge themselves first that just have to fit that in so what I love this quote a great tragedy of scientists the slaying of a beautiful hypothesis by an ugly fact I say bring on the ugly facts so one of the advantages I've been able to have with a little bit of mine am equity moving up is I'm actually nearing about ten thousand followers on Twitter I get to actually get responses from a lot of the people that follow me and they're not all fans of low carb high fat let me tell you so I put this out question for those in the know are there any studies that show high LDL with high cardiovascular disease in spite of having low triglycerides and in doing so I managed to get one response from dr. t hats off to dr. T for this one from our friends at Framingham and actually I really liked this sample size because it was people who didn't already have cardiovascular disease and after excluding users for lipid-lowering therapy that's a big deal to me I don't like gene or drug studies that's a that's a talk I could do all by itself well sure enough I get into the chart and I'm like okay so their baseline here they have it at an odds ratio is zeroed out at triglycerides below 100 LDL below 100 low HDL which by the way was below 40 for men below 50 for women right and naturally as we would expect if you have a high HDL see odds ratio being lower is better you have the best version if your triglycerides are below 100 and your LDL is below 100 you have high HDL that's like the ideal profile right so we would expect if LDL got flipped and we started looking at a hundred and above the odds ratio would probably also flip right go to like 1.3 1.4 no actually it's next to the it's the next best risk marker and it's right next to it at 0.7 well okay maybe this was including a lot of people that in LDL of like 105 and 110 fortunately though they also had a category for people who had an LDL of a hundred and thirty and above how many people get prescribed statins for a hundred and thirty in above that's the high risk category right actually it's identical it's at point seven as you can see on the confidence interval on the right side this isn't a fantastically large study but unfortunately I wasn't able to find any fantastically large studies so I got really honoree and I built this graphic and I pushed it around on social media and I really genuinely and not in a trolli way truly trying to peeing all of the biggest Pro LDL lowering experts that I know and you can if you if you ever get bored look through my Twitter feed you can see me doing this they said look look look you guys are saying we shouldn't take comfort in having low triglycerides and high HDL cholesterol when our LDL cholesterol is high so can you just bring me one study just one study the best study that you can so long is it's not a drug or a gene study that shows that we have higher rates of cardiovascular disease anyone want to guess how many studies I got zero I'm actually hoping I'm genuinely hoping that this feed in this video will help inspire some people to bring more into comments I'm sure there's a chance there's some out there but I still haven't seen it yet and what I am thankful for is it brought me around to something most people don't know about even in the low cut community it's called remnant cholesterol and I think when I think Wikipedia actually summarizes this really well they say look REMIC cholesterol also known as remnant lipoprotein is a very a thorough genic lipoprotein composed primarily of very low density lipoproteins that's these guys and intermediate did see lipoproteins that's these guys stated another way remnant cholesterol is all plasma cholesterol that is not LDL cholesterol or HDL cholesterol and this was a big moment for me because before I read any further studies I said this is actually a perfect match for what it is that I believe is ultimately the root cause of the disease so let's go back to our analogy again right I'm not worried about this what am I worried about I'm worried about this there's no good engineering reason and I state this all the time for a lot of energy to be part in the blood I cannot think of one and I've not had anybody presented to me yet so I have to emphasize once again when you think of things from a first job second job is it really that high levels of triglycerides are atherogenic or even as the remnant cholesterol people are saying that it's a more atherogenic particle I don't think so I think it's a failure of the V L deals from being able to drop off energy fat based energy version of triglycerides so what do you suppose remnant cholesterol is highly correlated with well I'll actually yes I'll actually drive that home I forgot that had this slide in here too so I'll have to fit this one in to really drive this point home VLDL to LDL lifecycle right how long do you think vldls last in the blood in a normal lipid emic person any guesses an hour yes three thirty to sixty minutes how long for ideal less than thirty minutes now if it doesn't get absorbed by the liver how long do they stay in that support role as a low-density lipoprotein two to four days in other words ninety nine to ninety eight percent of the rest of their life spot is for that long so yes where I was going was here with the studies sure enough it correlates closely to insulin resistance in fact Remnick cholesterol correlates much closer to insulin resistance than what I've seen with LDL as I ever brought up same thing with the scheme ik heart disease notice by the way as HDL is going down Remnick cholesterol is going up even with LDL hardly moving at all myocardial infarction remnant cholesterol was the lipid fraction most associated with premature mariokart myocardial infarction and my favorite of all all cause mortality now which graph do you think you would want to be in on the LDL moving up around remnant cholesterol moving up so here's the simple comparison somebody I've worked with a lot throughout this whole period I had they had about a 1 they have a 177 total cholesterol and an LDL C of 121 HDL 40 each cells a little bit low but triglycerides are 80 that looks pretty good right and now on low carb high fat two and a half years later they have a total cholesterol of 284 ldl-c of 201 hdl-c of 71 and triglycerides of 58 this is actually right at the cut points of a lean mass hyper respondent yet on the left side they have a remanent cholesterol of 16 milligrams per deciliter if they actually have a lower remnant cholesterol on the right side even for as high as their cholesterol numbers are well let me give you a little bit more of a challenge after I reveal who this person is I want to talk about Craig Moffett who by the way contributes a lot to our website Thank You Craig and he also will have some data that I'll show you in a second but would you guess that he is a lean mass hyper responder yeah he's actually very thin and he's very athletic his total cholesterol is 457 milligrams per deciliter and I hope you've had your beta blocker as ldlc is 335 his hdl-c is 109 and his triglycerides are 67 he is the picture of a far n lean mass hype responder so you would at least expect remnant cholesterol to probably go with scale right like probably it's just a bit higher anyway well you could probably do the math right now actually it's 13 milligrams per deciliter it's actually just 1 pip I heard in mind on my last test so how do you calculate remnant cholesterol well there is a caveat to that which I'll say in a second but yes you just take your total cholesterol you subtract your LDL you subtract your HDL you can be forgiven if you thought that actually this whole time total cholesterol was those two added together know that remainder is those VLDL votes those IDL boats and specifically the cargo cholesterol it's not inside them now the caveat I want to fit in a lot of you already know this LDL is typically a calculated number from the free dwelled equation so that is a little bit of a confounder but a lot of the studies are built on the freed wealth equation anyway so in that sense there's a little bit of fuzziness but generally speaking I tend to find this looks pretty good and this is what's neat I literally calculated this just this morning cholesterol code data from our site for remnant cholesterol we have a whole bunch of submitted labs that people have and I create the criteria of an LDL cholesterol of 200 milligrams of deciliter or above right that by the way is well into range of hyper cholesterol sorry familial hypercholesterolemia which means your doctor will almost certainly give you two medications before you can leave the office right there's probably statin police around the corner and you just cause the minute or something but with triglycerides of at least a hundred milligrams per deciliter or lower and what's neat is we now have a lot of entries just on the site of 405 the six total of that I found 138 that met this criteria how many of those hyper responders who are typically on a low-carb high-fat diet for the highest medium highest and medium risk categories combined we ended up with a total of nine out of the hundred thirty-eight for the medium lowest quintile 44 for the lowest quintile of remnant cholesterol 84 so over 90 percent of those that have submitted in concern to our site about their high levels of LDL cholesterol and in particular and picking them out for those who have 200 and above over ninety percent of them have very low remnant cholesterol now they're not some I do have some caveats this presentation doesn't discuss the influence of glucose and glycogen and so forth and if you follow my work you know that I and my whole phase two is based on being able to manipulate that as well also I do believe there are bad reasons for higher LDL cholesterol however they are typically related to still having higher triglycerides and for that matter also with HDL you do want to keep an eye on HDL and at least determine that if you have low HDL that's actually genetically influenced so how am i doing on time 10 minutes yes okay I'm excited about that that that analogy I worked on for a long time so this is great we can actually look back at the inversion pattern that I had had from the prior talk and you guys probably remember this for those who've already seen it for those who haven't real quick the inversion pattern is I found in my data and I've shown this over and over again with with a large number I've had a total of 88 blood draws at this point insane engineer as it turns out if I were to take my cholesterol this morning then I would look back to the three days of dietary fat and I would find they had the greatest influence on what my ldlc would be and likewise it's also a three day window for LDL P but there's a two day gap and Craig Moffatt I didn't get a chance to include it he actually replicated this experiment entirely with four different data points and you can look it up on the cholesterol code site where he also talks through and I don't have the slides for it but he basically did exactly the same thing and prove the same inversion pattern for both ldlc and LDL P now what's neat is in in the summer of last year we actually got a bunch of people together for the kita fest cholesterol experiment which by the way just opened its Kickstarter small plug July July 11th through 17th we managed to get a bunch of people to eat very low low calorie but still ketogenic for three days and everybody did a water fast and then we all took a blood test one blood test then gorged out on fat for three days and then took a second blood test and what do you suppose happen well first I posted the hypothesis before the experiment began and I said I suspect it'll get much lower well I'm thankful for pts Diagnostics who helped pay for all the blood work and we actually got people like this guy who actually helped to contribute it and people like these people to help eat a bunch of the fat they were all a part of it and voila we ended up with what I like to call the broken ladder so you see on the left side the Friday of all of the tests that were drawn and you see on the right side the Monday of the second of all the tests that were drawn and all that fat was eaten in between so what do you see most of those lines doing going up down sideways yeah actually about 19 had a decrease of between five to 38 percent of their LDL cholesterol only three had an increase it was only one or two percent now you look across the board if you take them all across the board is a drop of 16 percent of their LDL C in the three days for a total of twenty five point seven drops in milligrams per deciliter so let's look at that protocol for the last time I did I done this at Breckenridge that part on the left is actually what I'd shown from before and we had 100% success rate so far and that was when we had a lot less people now it's approximately 85 percent of a success rate and there actually has some caveats that we found that I think I also have a slide in here for but at that time nine had tried out of curiosity ten had used it to get their doctor off their back well between comments on Twitter Facebook could read it vlogs we have somewhere over a hundred people that have tried it by this point we've lost count but it's absolutely amazing that it's still holding to about that eighty five percent success rate given how many people have done this and last time at least four people had used this to improve their life insurance rate at my last count I found 13 all low Carver's again I kind of blamed Jeffrey Gerber he was the first to tweet out about that so look here's some here's the possible protocol pitfalls if you're considering doing the Feldman protocol and anecdotally these elements have been the most common use of MCT or coconut oil we kind of discourage because that seems to be a confounder this is also a new one use of coffee sorry it seems like coffee does in fact have some different effects on the lipids and has had impacts for our protocol results and also some with hyper hypothyroidism appear to have some unexpected results and that's also worth pointing out so in summary more vldls may be trafficked on a low-carb high-fat diet for fuel I know I haven't talked about ketones I know I haven't talked about glucose but I'm telling you it's a big elephant in the room that nobody talks about you get a lot of direct delivery of fatty acids via vldls and this may result in a higher presence of its later stage as an LDL particle resulting of course in what it carries the passenger LDL cholesterol right this may not only be appropriate but may be mechanistically necessary and this all relates back to why there's so much overlap with remnant cholesterol even though they're coming to very different conclusions than I am I don't believe VLDL and ideal let me just put it this way I don't believe any lip or protein is atherogenic I believe broken systems are atherogenic so remnant cholesterol is a far stronger indicator of risk of both heart disease and all cause mortality than LDL C and finally Remnick cholesterol typically drops on a low-carb diet I think the reason there hasn't been a lot of attention to remnant cholesterol is because there's not a drug for it yet it's just my opinion I wanted to thank my patrons because I don't accept any money from any business entity I've made that a rule upfront because I didn't want to I didn't want to compromise the integrity of the data I am honoured to have a hundred and nine people who directly pull money out of their pockets small amounts that actually allow for this research to happen so please if you could thank them for me and thank you so much I hope you enjoyed this

Channel: Low Carb Down Under

Views: 109,700

Rating: 4.9279413 out of 5

Keywords: Low Carb Down Under, www.lowcarbdownunder.com.au, LCDU, Low Carb Breckenridge 2018, #LowCarbBreck, #LCB18, Remnant Cholesterol, Lean Mass Hyper Responder, www.CholesterolCode.com, LDL-C, HDL-C, Triglycerides, Feldman Protocol, N=1, VLDLs, Low Carb High Fat, LCHF, Dave Feldman, Ketofest

Id: 0LuKwsz9Woc

Length: 28min 16sec (1696 seconds)

Published: Sat May 12 2018

Reddit Comments

[u/RangerPretzel]

hallelujah! I've been waiting for this talk to be released on YT.

[u/tsarman]

Boldly going where no man had gone before ... these are the voyages of the Starship Feldman!

[u/-lespritdelescalier-]

It's not clear to me if the test results from his experimentation are from fasted or non-fasted blood draws. The presented evidence is all focused on remnant particles and triglycerides in a non-fasted context. However, non-fasting/postprandial lipids can vary widely from fasting lipids in individuals, especially if the meal is high in fat or cholesterol. Can anyone shed light on this? I suppose I should just contact him directly.

[u/dem0n0cracy]

https://denversdietdoctor.com/dave-feldman-cholesterol-is-a-passenger-not-a-driver/ slides

[u/[deleted]]

Great presentation! Dave's getting slick at this whole gig.

Here's the study he mentioned: http://circoutcomes.ahajournals.org/content/9/3/206.long#F1

It demonstrates that high HDL and low trigs are powerfully protective. The high HDL - high LDL group had better results than the low cholesterol group.

[u/[deleted]]

Coconut oil and coffee confounds the lipid measurments? Has he written about this anywhere yet?