Dave Feldman – ‘The Dynamic Influence of a High Fat Diet on Cholesterol Variability’
25
August

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《酮好翻譯組》
KetoIsGood.blogspot.tw
翻譯:Leo Tseng 校對:愛麗兒 (2017年2月26日)
(於美國科羅拉多州布雷肯里奇市)
(舉辦之低醣研討會) 高脂飲食對膽固醇變化的動態影響
講者:Dave Feldman 先告訴你們 內容很多但時間很短 所以可能會有點快
但相信我 重要的部份我會講慢一點 首先 我沒有利益衝突 事實上 在研究這些時 我擅長損失很多錢
你等等就會知道了 先自我介紹一下 你可能認不出這張照片
等一會兒你就知道為什麼 我是個業務開發者、創業家
但自始至終我都自認是位軟體工程師 工程學對我來說很重要
它扮演了分析科學研究的角色 這是現在的我
因為我2015年4月開始生酮飲食 前7個月神采奕奕 從沒感覺這麼好過 黑暗日 在2015年11月降臨
當我拿到膽固醇數據 當然 比我預期的高很多 我姐姐和爸爸也一起生酮
但膽固醇沒有飆高 所以我很驚訝發現自己
是被低醣社群稱為『高反應者』 這當然讓事情變得有點棘手 我接著決定學習關於膽固醇和脂質系統的一切 (我們已經知道兇手是膽固醇)
(我們只需要足夠的證據來證明) 在學習關於膽固醇的時候
碰到這情境似乎相當常見 有很多在這個領域的人 對『膽固醇是壞人』這概念早已根深蒂固 這就是事情變糟的開始 他們要找到合適的證據只是遲早的事 但對我來說 我學到越多關於脂質的網路系統 越覺得像是身為軟體工程師常見的
分散式系統 所以 越看越像 我心想
是心理投射嗎 是我的工程師魂在作祟
還是它真的是個網路 這想法剛好在合適的時候萌芽 因為第二次抽血檢查
是在第一次的兩周之後 因為我有點想聽聽其他的意見 另外 雖然我等一會兒
會給你們看很多酷炫的圖表 這對我來說大概是最重要的一張圖
因為這開啟了這個旅程 從這裡可以看到我的平均脂肪攝取 我的三日平均脂肪攝取量是224克 第一次血檢時 得到的膽固醇值是329 兩周後 我過得很慘 我決定 只有在萬不得已的情況下
才攝取飽和脂肪 所以我的脂肪攝取量降到83克
但還在生酮的比例 這是我總膽固醇的數值 重點來了 我蠻確定我大概是世上唯一
看到膽固醇飆高100點 卻欣喜若狂的人 原因在於 在那天之前 如果這真的是反相模式 這就是實證 雖然這才4個數據點 從那開始
我決定進行極端的N=1實驗 用極端描述我的N=1實驗
就像是說太陽表面只是有點熱 你們可能早就知道 我經常進行量測 我每天早上 量血糖、量血酮、量血壓 事實上 我吃的每樣東西都拍照
並經常測量份量 任何東西 包括補充品、飲料、水 如果我沒辦法真的測量它
你會在我手機裡的照片看到很多我的左手 為什麼呢 這樣我就有體積的參考 我測量這些的原因是
這樣就能拿來和大量的血檢結果比較 你會看到很多血檢 真的很多血檢 過去15個月 我做了51次血檢 我想先告訴大家這些 因為我希望你們了解
我有多認真看待這些要告訴你們的資訊 現在來談談 我稱它為『反相模式』 首先 一點小小的回顧 低密度脂蛋白要比這個複雜得多 但這三個部份 我們會一直提到 需要大家熟悉一下 當我說低密度脂蛋白 就是你在報告上看到的LDL-P 對那些阿宅 我是指含有ApoB的脂蛋白 其他人並不需要知道 只要知道LDL-P指的是什麼 但在LDL-P裡面有三酸甘油酯和膽固醇 我要大家記起來 哪個佔的數量比較多 三酸甘油酯還是膽固醇
在待會兒的考試中很重要 你沒想到有考試吧 大約去年的這個時候 我碰上這些友善的人們
正打算舉辦Low Carb Vail (研討會) 大概因為我喋喋不休講得太快 對他們解釋這些有點困難 要解釋脂質系統就像工程機制一樣 要對這些醫師們解釋清楚真的很難
我希望有另一位工程師 一個剛好也了解膽固醇的工程師 幸運地 我真的遇到了
(左:Ivor Cummins) 當然我和Ivor聊了很多 告訴他以科學的角度來看 下一步明顯是 即使我以三個月得到這個數據 大概每次測試間隔13到14天 明顯下一步
是看我能否解開這個模式 但這次每天都測 所以連續7天都抽血檢查 我每天都抽血 每次測試都包含NMR 也就是核磁共振測試 來確保我得到完整的膽固醇數值
顆粒大小分佈等等 我照著飲食規劃吃 來誘發這個曲線 所以我就看出反相模式了嗎 是的 就在6次血檢之後 其中5次是每天 星期一那次是隔一天 任何工程師都會告訴你 接下來要加碼 我接下來就試試 能否以349克的脂肪攝取
誘發膽固醇大幅下降 結果正是如此 LDL-C降到218 對了 這是自生酮以來的最低值 好 讓我慢慢一步一步解釋 因為我希望各位在離開時能記住這個 這是LDL-C反相模式的逐步解釋 在抽血檢查那天之前的三天 如果我今天早上抽血檢查 星期日早上 那代表我可以拿昨天星期六
前天星期五 和大前天星期四 把這些天的脂肪攝取平均
我可以預測LDL-C的模式是如何 下一張圖要給你們看的是
我第一次有29個數據點 是Vail研討會之後 每對數據就是
平均脂肪攝取和LDL-C放在一起 所以 換句話說 只有那三天 以橘色的點標示的 和藍色點的LDL-C相關 為了讓你們更清楚看出反相模式 我要把左邊的軸上下顛倒 準備好了嗎 看起來就是這樣 這是相對比較 所以你可以看到 軸下方的數值不是從0開始
因此我們可以用看的比較 但阿宅可以看 皮爾森係數和線性迴歸 R平方和皮爾森相關係數 顯示極為相關 把它們重疊 並再次強調一下 每對數據都是之前三日的脂肪攝取和LDL-C 的確有些偏離點 但我都算進來了 我記得好像有3個點 第5天 第14天 抱歉 第19天 很接近最後 大概是第27天 好 來看看這個 HDL-C沒有反相模式 HDL隨著脂肪攝取增加而上升 皮爾森相關係數和線性迴歸指標
看起來沒那麼相關 但你可以看得出來 那是因為 HDL-C似乎有個最低底限 這可能是件好事 現在 我要再回來講LDL-P
它是裝載LDL-C的顆粒 LDL-P的顆粒數 Jeffry Gerber提過
Ivor提過 還有很多人也談論過 這有點像是脂質學家
認定動脈粥狀硬化風險的新浪潮 我們發現 越是研究這些數據
越覺得LDL-P套用的是不同方程式 它還是和三天的脂肪攝取窗口相關
但有兩天的缺口 回到我之前的例子 如果我今天早上抽血檢查 我會忽略星期六和星期五
而用星期四、星期三、星期二的脂肪攝取量 接下來這張圖 包括了剛才所有的數據點
但是 套用這個新方程式在LDL-P上 所以虛線的橘點 跟剛剛有點不同
是三日平均脂肪攝取量 但隔兩天缺口 我現在把軸顛倒過來 讓你看出相關性 皮爾森相關係數和線性迴歸係數
所顯示出的相關性更強烈 就目前來說 我並沒有納入所有的數據 這有點超過我所要講的
但我不拿八月之後的數據 是因為那時我開始加入運動
對結果會有些影響 我可以告訴你LDL-P
是所有我追蹤的指標中最一致的 當然以趨動許多影響因子來看
LDL-P是最相關的角色 也讓大家看一下 小的LDL-P 顆粒小的LDL-P
我大概看過百萬篇網路文章在講這個 大家常常提到各種方法來讓它下降
因為公認它會造成血管粥狀化 小的LDL-P隨著脂肪攝取量增加而減少
所以我可以放心多吃脂肪 可以降到90以下 可說是少到量不出來 讓我們花點時間談談反相模式的背後理論 這理論有點剃刀理論 一旦對脂質學足夠了解
你真的可以感受到背後所發生的事 困難在於
我必須讓你進入工程師的思考模式 要這麼做 我必須強調這個重點 低密度脂蛋白有很多任務
很厲害 它做很多事情 但它的主要任務是運送來自脂肪的能量 這樣強調大概還不夠 所以我要用全大寫、粗體加底線 脂蛋白的『主要任務』是運送來自脂肪的能量 再一張就好 加大字體 讓你留下深刻的印象 我知道膽固醇一直以來都是閃閃發亮
被聚光燈照著的 而Ancel Keys這位天才
讓我們倒過來學習脂蛋白 但他的結論是值得商榷的
不管是運送量 或是活躍程度來看 毫無疑問
脂蛋白的主要任務是運送三酸甘油酯 也就是一綑綑的脂肪酸
我們所有低醣飲食的人常使用的 所以 如果用簡單的比喻 如果我們搭遊輪 想像這是LDL-P 三酸甘油酯是什麼 人 乘客 再延伸 那膽固醇是什麼 是救生艇 膽固醇常常搭乘脂蛋白 它們的確隨著循環系統四處旅遊 但脂蛋白常常放下膽固醇嗎 並沒有 但它們常常放下三酸甘油酯 很多膽固醇最終還是回到肝臟
走上不同的命運 例如 荷爾蒙 例如 膽鹽 等等 再次地 你可以像工程師那樣思維 觀察這些東西存在時的歷程 是的 沒錯 就像Jeffry Gerber提到的 它們也有次要任務
例如 運送脂溶性維生素 很重要 那個功能也比運送膽固醇活躍 現在我們開始了解
在抽血檢測膽固醇發生什麼事 我要先告訴大家LDL-P的兩大分類 乳糜微粒 我喜歡稱它為
你剛吃下食物的脂肪能量 在1到5小時 也有人說數分鐘
看你讀誰的研究結果 它們可能增加 但一般來說到5小時
它們都被肝臟吸收了 基本上 6到12小時 它們就消失了 不過 來自貯藏的能量 是由肝臟合成的 來自貯藏的脂肪能量 這些傢伙是源自VLDL的脂蛋白 它們還持續存在 我喜歡稱上面的為短跑者 它們快速奔跑 丟下能量
一下就達到終點 肝臟 (下面)這些是長跑者 為什麼這個這麼重要 重要在於
我什麼時候進行空腹抽血 我在空腹12到14小時之後抽血的
你應該也是 如果你那時抽血 代表什麼意思呢 那代表 只剩下前身是VLDL
來自脂肪貯藏的LDL顆粒被量測到 所以那些LDL顆粒中剩下的膽固醇
就是你會看到的 那就是為什麼
它們是很棒的間接對象
讓我們了解身體在做什麼 這是個過度簡化的卡通圖 但基本上 簡單來說就是這樣 我的身體似乎透過三日窗戶來觀察 透過窗戶觀察前三日 發現
『哇!我們能量充足!』 有許多來自消化系統的能量 我想我可以調降
不需要調升來自貯藏的VLDL 非常合理 相反的 假設我在匱乏期 沒吃很多食物 特別是 如果我的肝醣儲存量不高 我的身體會說我們必須調升VLDL
非常合理 我們必須確保有足夠的三酸甘油酯
在循環系統中供給細胞使用 在我這些N=1的實驗之後
下一步顯然就是進行 我稱之為『相同飲食實驗』 我很高興 我姐姐也有來 她也加入我的實驗 再提一次 我是高反應者 這些數字的確嚇壞我的醫生 但我有機會讓他們看這些數據
改變了一些人的想法 我姐姐比我大六歲半 她也是生酮飲食
膽固醇上升了一點 但數值還是很不錯 總膽固醇是230 LDL幾乎是我的一半 我們的做法是
13天之中 吃一樣的食物 只有家人才願意跟你一起跳這種坑 我非常堅持要做到最好
幾乎所有的東西都量測 有多徹底呢 我姐會告訴你 我在各別的鍋子裡炒蛋 才不會因為變冷黏住而少了一些克數 對吧 這是我們的總膽固醇 我是藍色 她是粉紅色 疊上我們每三日的平均脂肪攝取量 你可以看到我們的數值是如何
與三日平均脂肪攝取量呈反比變化 為了讓這個更有趣
我不打算給你們看所有的數據圖 我只展示她和我的數據比較
再次提到 她的數據幾乎是我的一半 但是她的變化量幾乎跟我的一樣 這是相對比較 所以左邊粉紅色的軸是她的 右邊藍色是我的 你可以直接看出這有多麼密切相關
皮爾森相關係數是0.94 現在來看看LDL膽固醇 一樣 在相對比較上 幾乎是一致的 LDL顆粒數 我希望所有數據都公開透明
的確有一個點受干擾 最後一個數據點 我標紅色的
數值是1201 這不在我預期之中 我想把它視為實驗室量測錯誤
但也可能有其他意義 我不知道 但若把最後一天的數據拿掉 再做一次圖 皮爾森相關係數是0.78
線性迴歸相關性也很好 但更有意思的是 這些『順便也量一下』的
HDL膽固醇和三酸甘油酯 這是個主要轉捩點 因為當初我看到我的脂質數字
隨著飲食中的脂肪上上下下 現在也有我姐的 和我在不同水平的數據 不止在相對比較上 甚至在HDL膽固醇和三酸甘油酯的絕對值比較上 三酸甘油酯的數據讓我著迷
因為那實際上就是血液中脂蛋白裝載的能量 最後我決定要做『膽固醇劇降實驗』
各位大部份是因為這樣認識我的 我決定在Ketogains研討會上進行
那是我第一次公開報告我的數據 我決定在期間加上最極端的實驗 是在10月9日進行的 我照了一張我在抽血檢查的照片
在兩天前 也就是10月7日 我聲明 你將會看到幅度最大的膽固醇下降
甚至在還沒進行10月10日的抽血前
我就這樣說了 那就是為什麼我放了張剪影
因為那還沒發生 結果如何 這是時間線 在10月4日、5日、6日
我吃很少的食物 在10月7日抽血檢查 然後我開始吃大量的食物
一日5000大卡 脂肪攝取達到461克 對了 給那些喜歡討論飽和脂肪的人
我吃下的飽和脂肪是每日274公克 順帶一提 這真的好辛苦 低醣高脂飲食很容易有飽足感
要吃到5000大卡 真的很難 數字的確下降
這大概是我第一次在網路上爆紅 總膽固醇下降66 LDL-C下降73 LDL-P呢
總是聽到大家談論如何從這型變成另一型 如何攝取不同油脂
加入不同運動 來改善 在三天之中 下降了1115點 這時 我決定要把這些寫下來 放在我的部落格 CholesterolCode.com 我一開始叫它『膽固醇下降方法』
但大家都叫它『Feldman方法』 方案一 基本款 是三天半加一次血檢 所以三天之中 吃高卡路里飲食
但維持在生酮飲食比例 然後在早上血檢 就像我一直跟大家說
請把數據分享給我 我想知道 不管結果如何 方案二 這個比較好 和我在Ketogains進行的比較接近
先進行低卡路里 再回到高卡路里 這樣就能誘發那個曲線 另外 是10天半的 4次血檢 那是我在Ketogains做的
也分享在部落格上 我其實希望每個人都做這個 因為前兩次血檢 建立了數據較多的基準線
而最後兩次也是 你會有較多數據的優勢
你能看到顆粒數的相關性 這需要五天才能看到 幸運的是 我找到一些願意嘗試的自願者 寫出方法就是希望會有自願者 Bill Davis 如果你正在看 謝謝你第一個跳出來
他馬上就做了 這是他的LDL歷史值 一年半來 每季量測的數值是138、109、174
我大概會說平均是130 他的最後一次血檢就是130 他執行3天每天5000大卡的方案
所有卡路里來自脂肪 他看到自己有史以來最低的LDL值88 順帶一提 他的HDL比LDL還高
從98變成112 下一個是Tom Sheest
我希望他也在這 但不幸 他必須待在家 他變化了一下加入斷食 有人說這個藍色和黑色對比不好
應該用白色字 但我會特別為各位指出來 他的斷食實驗
代表他的三日平均脂肪攝取慢慢下降 正如我預測 他也認同的
他的LDL-C應該會上升 我想花點時間在這 讓大家都理解
這邊是當你斷食 你完全沒有攝取食物 你的LDL-C會上升 不止如此 LDL-C在斷食第三天達到最高值 這變得非常相關 下一個是 Richard Morris
有多少人聽過他 他是2 Keto Dudes之一 他今天也在場 他沒有做我偏好的那個方案
就是血檢比較靠近的 他變化了一些 而且他是第一個這麼做的 他每季驗一次血 他大約吃1500大卡 120克脂肪 他想 管他的
他進行的是 我本來想叫它夏威夷豆實驗 因為他大部份攝取的脂肪是從那來的
他的結果在這 粉紅色的是差異值 他的總膽固醇下降36 LDL-C下降31 意料之外的是他HDL-C也下降了
通常會升高 不過那項通常相關性比較低 他做完這個實驗後 他的醫生很驚訝 當他要做下一次測試時 醫生說
『你上次幫那個人做的測試』
『不要再做了』 果然 回到大約1500卡 120克脂肪 他回到幾乎和原來一樣的數值 和六個月前一樣 這符合我的理論 這比較像是偏好點
而不像一直變動的狀態 下一位是 Silvio Ferro 我和他常交換意見
他其實是比利時的醫生 希望我沒講錯你的名字 我很佩服
他做了完整10天的那個方案 第一排是初期三天 他維持一天750大卡 63克脂肪 你可以看到 他有高三酸甘油酯症 他的三酸甘油酯有點高
但因為他吃低卡飲食 也許因此而增加了些 你可以從他下一組檢測看出來 他把攝取熱量提高到5000大卡
脂肪增加到約500克 果然看到他的數字下降
尤其是LDL-C 我只留下第一組和最後一組
來更清楚看出差異 他也擅長使用這些方法
對於如何能運用到自己病人身上感到很有興趣 將脂肪攝取增加428克 428克的脂肪 讓他把LDL-C降了76 他的三酸甘油酯降了幾乎三分之一 Carl Franklin 最近很紅的
2 Keto Dudes的另外一人 我們請他先抽血檢查來看他現在飲食
所產生的基準線 大約是每日3000大卡 255克的脂肪 把卡路里拉低三天 當然他的總膽固醇上升
LDL-C上升 HDL-C下降 Carl也用NMR檢驗
所以我們可以得知LDL-P和小的LDL-P LDL-P上升264點 三天之後 在進食5361卡的新紀錄後 510克的脂肪 他的總膽固醇下降了58 我覺得我必須一直提醒大家這才花了三天 這三天 那三天 網路上大家常常在討論這些數值
低醣社群也是如此 大家認為它們像冰河 如果大家都這麼認為 我希望能打破大家這樣的想法 那就是 脂質系統是動態的、一直在變化的 我覺得我需要花一點時間
在演講中插入這些小提醒 它是如此動態 並且受到能量的影響 我們可以看到這些大家密切關注的數值
是如此容易被飲食內容所改變 我們也注意到 最值得關注的大概是 他的LDL-P下降了400點
在右下角那邊 目前為止 在那些我真的看過血檢報告的人中
不是網友留言幾句話的 在傳血檢報告給我看的23人裡
目前成功率百分百 那些把脂肪攝取量提高的 都看到膽固醇下降 其中9個是因為好奇而嘗試 10個是為了 要讓醫生不再煩他們 這10個人 他們不在乎膽固醇數值是多少 他們說 我只是想試試這對醫生是否有效 當然他們連絡我 我給他們一些建議
確認他們正確執行這方法 如我所說 請把數據分享給我 剩下4個 我有點怪罪Jeffry Gerber
(Jeffry Gerber在網上給這個建議) (Jeffry Gerber在網上給這個建議) 4個人用這來改善壽險利率 我還在等 第一個願意公開分享的人
但目前為止那4個人都不願分享 現在我想花點時間 來告訴你們一個人 大概是影響我最深的 這是Jill的故事 Jill不是真名 但她同意我分享她的資料 我就直接用說的 我遇見她是因為我的一個朋友
告訴她我的部落格 在她第三次膽固醇檢驗沒過關的時候 事情是這樣子 她在一年前開始生酮飲食 然後 這樣的故事大家大概很熟悉 她在各方面都覺得變好 逆轉第二型糖尿病 治好高血壓 而且很確信血檢數值
應該是有史以來最好 的確如此 在發炎的指標是如此 她的膽固醇是唯一上升的數字
而她的醫生馬上責備她 對她這麼說 『若無法活著享受它,生酮飲食好在哪?』 她決定要再做一次血檢
這樣的故事我總是一再聽到 她決定要『乖一點』 所以減少飽和脂肪攝取 她減少飽和脂肪 兩個星期後再驗 數字更高了 她後來做了第三次血檢 這次她哭了 她斷食三天 數字又創新高 她感到恐懼 她真的認為自己得了什麼病 目前正滲漏膽固醇進體內 她不知該如何面對這件事 當她看到我的部落格 那對她來說是很震撼的
她決定要來試這個方法 但最糟的是 在經歷那些後
她害怕攝取飽和脂肪 在那時 即使是正常的飽和脂肪攝取量
也讓她害怕 不過 就像她在Email裡跟我說的 這就像是最終章 她的最後機會
所以她盡量吃 雖然最後相較於我的方法
其實不是很大量 她的所有數字都改善了 膽固醇大幅下降
她把這結果拿去給醫生看 而醫生沒任何解釋 她馬上開除他 還是有點想哭 (……那個蠢測試毀了我的生活)
(害我忽略了身體一直告訴我的:它愛生酮) 當我讀到她的信時
(……那個蠢測試毀了我的生活)
(害我忽略了身體一直告訴我的:它愛生酮) (……那個蠢測試毀了我的生活)
(害我忽略了身體一直告訴我的:它愛生酮) 就是這世界上的Jill們 讓我想把這些資訊傳遞出去
(……那個蠢測試毀了我的生活)
(害我忽略了身體一直告訴我的:它愛生酮) 最後一些想法 我要回顧一個可能被遺忘的重點 不是單純多吃脂肪等於膽固醇減少 因為這有個偏好點的 我的偏好點看來比我姐姐的高 在開始低醣飲食之後 似乎是有個偏好點
我的身體以那為目標上下調控能量 但是 我是個工程師 當你告訴我一個東西壞掉了
我不會預期看到這種現象 這在我看來
像是很高程度的體內平衡狀態調控 直到我有強烈的證據 指出這是失調 否則我不傾向試圖降低膽固醇 即使它是如此高 對有些吃低醣高脂飲食的人
這可能會很高 就像我自己 高反應者 這有害嗎 我們還不知道 但我有很多理由覺得這並非不好 我實際上大概有28個理由
可以私下再跟你們說 實在放不進這個演講
但我對一些研究有很大的疑問 我和Ivor Cummins經常討論到
那些研究在工程學角度根本不可能過關 為什麼這些數據如此顛覆 脂質系統比大家認知的更不穩定 所有的膽固醇指標 每個你們剛剛看到的
都高度受到僅僅之前三天的飲食所影響 而所有的顆粒指標
都高度受到僅僅之前五天的飲食所影響 而這個影響模式是反相的
違反我們直覺的 攝取脂肪越高 LDL膽固醇越低 我真的相信 除非你有其他的代謝理由
或干擾的因素 而影響相關性 我真的相信 在場所有人 世界上所有人 影響的因子是一樣的 下一步 歡迎親自試試這些方法 只要花個幾天
你就能幫我們大家增加數據量 不相信我說的 證明我是錯的 歡迎試試 如果你是低醣界名人 例如 我不曉得 可能是Jason Fung 也許是 Ted Naiman 也許是 Jeffry Gerber 歡迎在你例行性膽固醇檢驗時 試一下我的方法 你只需要吃很多食物 只要保持生酮比例 然後再驗一次血
你會為我們產生推廣的效果 目前我正著手將這些整理成正式研究
若你能幫忙 請告訴我 因為我不是學術界的 我其實是工程師 學術界的緩慢齒輪有時令我沮喪 所以 我可能需要這方面的協助 有許多要感謝的人
但我想特別感謝我的姐姐 Darla 謝謝妳參加這個實驗
對我們來說 那真的是個轉捩點 我的演講到此 謝謝大家 謝謝 還有一點時間 開放大家問David問題 謝謝 我講太快嗎 – 我有個小問題 – 這邊有個小問題 – 左手邊 左邊 是 請說 – 一個問題 你有測量肝臟酵素和一些其他參數嗎
– 有什麼影響嗎 當然 我有追蹤CRP、AST、ALT 我也追蹤鐵蛋白 我的鐵蛋白偏高
我懷疑是我的飲食中的鐵含量較高
但實驗前後我儘量一致 我的CRP一般大概是0.53左右 除非我跑長跑 長跑後我會有較多發炎反應
但那對長跑來說很常見 – 但攝取那麼多脂肪
– 你沒有看到ALT、AST有什麼異樣嗎 沒有 事實上
我想打破一些關於這方面的迷思 許多素食飲食者都說
高脂飲食會增加肝臟的負擔 因為他們認為VLDLs從肝臟合成
因此這麼認為 事實上 正好相反 當你吃低醣高脂飲食 你的肝臟簡直在休假 因為 你從我的演講得知 大部份的乳糜微粒在小腸合成 以工程學來說 有個概念叫信任足跡
肝臟會說『我不用處理那些』 因為你的肝臟是個嚴謹的代謝夥伴
總是忍受你的一切 當你吃果糖進身體 誰來處理呢 肝臟 當你吃很多脂肪 肝臟就像是說
『這很好』『繼續走吧』 – 太好了 謝謝 – Dave 我是George Newman
– 謝謝你的演講 – 我也是個工程師
– 我正在處理一些數據 – 我在11月初進行了7日斷食 – 然後也驗包括NMR等等 全部的指標
– 但只看LDL的話 – 我的LDL-C是170 – 然後在1月10日 我又驗了一次 – 吃的是我平時的生酮飲食 – 幾乎是素食的生酮飲食 – 而我的LDL是134 很有趣 – 我還沒試過像你一樣
– 大幅提升脂肪攝取 – 我的飲食大概是75到80%卡路里來自脂肪 – 你知道
– 血檢前三天當然也是如此 你有辦法在素食飲食達到這比例 – 幾乎是素食 大部份素食 有意思 – 大部份的脂肪是來自
– 橄欖油、夏威夷豆、酪梨等等 有意思 我想等等跟你聊聊 – 我正好也帶有Apo E4基因 是 順帶一提 我是3/4
(註:Apo E3和E4) – 我也是 喔 太好了 – 首先 做得好
– 你做的這些實驗太棒了
(發問者是Ivor Cummins) – 當我第一次在Vail的研討會遇見你
– 第一次的9個數據點 – 我們都同意這絕非偶然
– 它們所代表的意義非凡 – 當我和別人提起你的實驗
– 總說這是一個新的科學發現 – 在花費數十億美金在那些膽固醇研究之後
– 及數十年來脂質學家的研究 – 這真的是個科學新發現 – 這也讓我們對以往常聽到的那些
– 升起疑問 – 我想這麼說 – 從我所有研究LDL-P的結果看來 – 我相信它對於好或不好結果的預測
– 是相關性的 – 我認為有很大量的機制組成的假設 – 建構成現在這樣的理論基礎 – 但最終
– 若LDL-P驅使壞的影響 – 我還是認為那是相關性數據的結論 – 你如何看待你的研究數據呢 是的 如果我可以強調那點就是 以工程師角度
我們不喜歡這種假設 就是如果一個裝置或一個物品
有多功能或負責多重任務 認為它的高使用率只因為單一原因
這是過度簡化了 所以 我認為 比如LDL在免疫上的角色
上升並不令人驚訝 快要死的人 有比較高的可能性 體內LDL上升 因為它扮演修復的角色 那就是其中之一個可能
我可以理解相關性是怎麼來的 那就是為什麼 直到他們能除去或控制
LDL顆粒在修復功能上對實驗的影響 他們不可能認定它是壞人 他們必須先這麼做 才是科學上所謂的精準 而問題在於 他們現在無法有效控制條件 就說『讓我們姑且相信膽固醇是壞人吧』 – 讓我以這個結束這個話題
– ApoB過高 – 最強大的應用就是反映胰島素阻抗 – 我認為那是它獲得如此威望的原因 – 但若你沒有胰島素阻抗
– ApoB卻因為其他的生理因素偏高 – 我認為ApoB的大部份歷年來的威望
– 是胰島素阻抗的促成的 – 胰島素阻抗是背後潛在
– 產生不好結果的病理原因 – 所以我認為那是ApoB在過去十年來
– 成為焦點的原因 – 最後一點 如果你們要看ApoB
– 你一定要看ApoB和ApoA1的比值 – 你不該不理會ApoA1 – 我認為全世界目前 都喜歡只看ApoB – 這有點丟臉 只是解釋一下你說的 我現在驗NMR的數據
同時也驗ApoA1和ApoB 我的ApoA也很高 Fat Emperor
是TheFatEmperor.com嗎 是 我要幫他推銷一下
因為我最喜歡的一張圖 是他網站的ApoB和ApoA與各種代謝失調的比較 所以 只是想提一下 – Dave 謝謝 – 我的先生是位工程師 我對那感到抱歉 – 我的問題是
– 女性的排卵周期會如何影響或參與作用 – 會不會你姐姐的那個異常值
– 是因為這個影響 之前有人問過
其實我對這非常感興趣 那就是為什麼當有女性和我討論
我會試著加入這因素 我姐同意我說 她已過了更年期 我知道這個可能會是個考量點 當你學習和研究更多
特別是內分泌系統以及其對女性的影響 你們女人比我們男人重要多了
還有演化方面那些 這是事實 我不會驚訝 如果女性
有更複雜的脂質調控機制 尤其是在更年期之前 目前還沒參與者 試了這個方法
顯示有這樣的機制 因為幾乎所有參與者的年齡都較大(更年期)
他們較常看醫生 所以較容易想來參與 – 若以你的直覺來看
– 是不是避免在生理期測試比較好 如果我非要猜的話 我會說 大概是吧 如果一定要猜的話 但那個 那超過我能力範圍了 – 請對麥克風講 – 女性即使在更年期之後
– 還是有荷爾蒙周期 – 我記得是黃體刺激素不再出現
– 所以不會排卵 – 就我了解
– 雌激素還是像之前會有周期 當然 – 不好意思
– 可以對著麥克風再講一次嗎 – 避開女性周期的第19到21天
– 其他時間都可以測試 有意思 但真的 科學家會希望有女性同事
願意做這實驗到這種程度 要求我姐姐做這麼極端的實驗
已經夠困難了 因為她是真的愛她弟弟 才會願意 – 我是Jeff Gerber – David 你該受到讚揚 – 你把非常複雜的數據濃縮並簡化 – 讓這群聽眾能夠了解你在做的事情 謝謝 – 去年到處都能看到你 – 我試著了解這些
– 因為我不是工程師 – 不過
– 除了降低保險費用 – 我想不出任何理由
– 來吃一天5000大卡的高脂飲食 – 除了要證實你的理論 沒錯 – 對我來說
– 你說的這些在臨床應用上的含意 – 是量測脂蛋白
– 其實是告訴我們能量平衡狀態 沒錯 – 那將會推翻一切 – 因為它如此動態、不穩定 – 而且它跟心血管疾病風險無關 – 除了身為相關性的無用角色
– 就像Ivor說的 是的 事實上 我可以用我最喜歡的比喻來簡化嗎 你最可能死在裡面的一種交通工具
是救護車 如果你有9分之1的機率死在救護車裡
顯然你應該避開這個死亡陷阱 對吧 這就是為什麼大家必須
以膽固醇是修繕的角色來看待它 而它真是如此 你不會對於有人在救護車旁死亡感到驚訝 因此 我們不應該對膽固醇
抱持一樣的假設 就你的論點 是的
若附近有更多救護車 那可能令人憂慮
因為可能有更多人死亡 但也可能只是
我有了更多經費來買救護車 我只是想加強照護
我不知道 – 我們應該結束這段了 他說我們應該結束在這 讓我們休息10分鐘 謝謝 Dave 很有意思的內容 謝謝


91 thoughts on “Dave Feldman – ‘The Dynamic Influence of a High Fat Diet on Cholesterol Variability’

  1. So VERY VERY COOL. Thank you Mr Engineer! I love your commitment and am so very impressed. I'll be sending people to this video, where there's a question about cholesterol.

  2. Thank you SO much for this video.  It was highly informative and eye-opening. I, too, teared up a bit.  I especially enjoyed your explanation regarding liver enzymes.  I think you did so well.

  3. OMG, listened again. Great stuff.

    There is some confusion based on the feedback I received in the conference course evaluations. It has generally been advised to reduce saturated fat and even calories when LDL-C or LDLp are high and this is still the case. Dave's experiment however is counter-intuitive to this advice as his results show exactly the opposite. So what's going on here?

    Important to understand that Dave's experiment is highly atypical. Shifting from a low calorie keto diet of 800 calories to a whopping high calorie keto diet of 5000 calories in an attempt to modify cholesterol over only a few short days just to prove a point. This is not a standard keto diet nor are most people checking cholesterol this frequently. The context of Dave's experiment is different then what most of us are doing.

    As Dave mentioned in his talk everyone has a certain cholesterol 'preference point' that usually reverts back following his experiment. I suspect that it is this cholesterol 'preference point' that responds more typically to the standard recommendations to reduce saturated fat and calories. I hope this clarifies.

    What do you think Dave?

  4. Hyper responder here…been on Keto 6 months and have LDL numbers on the very high side with great Trigs and HDL. This video is very informative although it really does not answer the key question which is why does this happen to some people and is it dangerous ? Hopefully further research will answer these questions. In the meantime I have decided to increase my MUFA's and PUFA's (healthy foods and not factory oils) as well as increase my carbs which probably takes me out of ketosis. As I am lean and insulin sensitive this is not a big issue , just wanted to get the numbers more in line with conventional thinking pending further research results.

  5. Thanks Dave, see you found Ivor as I am big fan of his … as you said engineers … I had to do a power point presentation to convince my doctor that Omega-3 testing is critical, since the "Cholesterol" theory has died … doctors are at a loss and do not think that "All Fats" are important. As engineers we "Solve Problems" or else the proverbial bridge will "Fall Down", and as you know the health of the average human is falling down. Doctors have no clue and some use the word "Idiopathic" which makes you wonder where the basic research went or when did we start ignoring metabolic sciences.

    And yes, it is ok to "Fire your Doctor", in fact there is a web site dedicated to this "Run by Doctors …" in my case my hospital is a teaching hospital … so to change anything, you have to change the curriculum … Doctors have a PhD in medicine and just regurgitate what Doctors of Science PhD's discover … very few Medical doctors have additional PhD's,

    70 Going On 100 … the Centenarian Diet

  6. This is amazing! I am a hyper responder. My total cholesterol hit 14 a month last August after I started low carb and my doctor flipped! She referred me to a cardiologist with strict instructions to him that he 'give me a good talking to'. I haven't made that appointment. I am now ketogenic. I haven't retested and I haven't been back to my doctor either. I am trying to find a doctor more sympathetic to my woe but haven't yet.

  7. I like your video really very impressive. could you please tell me any information about the tendency of fatty liver with high fat diet? I am also on ketogenic diet for 2 months and trust me i love it and plan to stay forever but i am also skeptical about high fat doing to my liver with all that chylomicrons from gut to liver in the system. would love to hear from you ! thank you

  8. Despite knowing that cholesterol is a meaningless test, it is always hard to ignore the scare tactics that your doctor plays when you refuse medication. This video has explained it the best way ever. Now, I have a better understanding of cholesterol. Thank you Mr Feldman.

  9. Very interesting video. But what I dont get: studies regarding fat intake show increases in ldl-c with a high fat intake. E.g.

    The Human Metabolic Response to Chronic Ketosis Without Caloric Restriction: Physical and Biochemical Adaptation https://www.ncbi.nlm.nih.gov/pubmed/6865775
    "four weeks of a eucaloric ketogenic diet (EKD)–isocaloric and isonitrogenous with the EBD but providing less than 20 g CHO daily"
    "the mean serum cholesterol level rose (from 159 to 208 mg/dL) during the EKD"
    This wasnt a weightloss study, in which weightloss itself reduces ldl-c.

    So generally fat intake, especially SFA more likely increases ldl-c and ldl-p (when not accompanied by weightloss) and only in a scenario in which you heavily overconsume fat with e.g. 5000kcal/d there is some sort of short term lowering effect.
    While this is interesting, a lot of people might take this the wrong way…

    You can find a paper by Thomas Dayspring, lipid expert, and some case reports that to decrease ldl-c and ldl-p while doing a high fat diet the most efficient way is trying to exchange SFA for MUFA, e.g. olive oil instead of butter.
    http://www.lecturepad.org/dayspring/lipidaholics/pdf/LipidaholicsCase291.pdf
    or Peter Attia on this
    http://eatingacademy.com/cholesterol-2/random-finding-plus-pi

  10. When I started LCHF my doctors seem to ignore that my T2D was reversed and focused on my fasted cholesterol numbers. I had tests done every 3 months and I always scheduled them on a Saturday morning but I was curious why my LDL-C numbers were not as a good as my wife's – I am much more physically active than her too. This presentation just strengthened what I was starting to suspect that exercise really affects the numbers as recalled my activities before the tests. I play hockey Friday night after dinner during 13 hour fast! Or did a lengthy bike ride before the fast… current cholesterol testing is flawed. Now I can't help to think that our dietary guidelines to lower saturated fat was done on purpose for the pharmaceutical industry

  11. Very interesting talk. I think this kind of data is an example of how the health and food industry view things as correlation or causation depending on their own agenda.

    This is an extraordinary display of critical thinking and discipline. Good job Dave!

  12. Hi. Thanks for the video! Do you have any data on people with high Lipoprotein (a)? Are there any recommendations then for people with very high Lipoprotein (a)? I believe Ivor Cummins falls into this category too.

  13. all I can say is wow. as a former bodybuilding and physique competition athlete this information explained it all. my internal medicine doctor was always on me for having "high cholesterol" only being in the 225 range but my HDL was almost 100. can't wait to share your information. OUTSTANDING

  14. I have a different hypothesis for the variation/correlation. On the protocol, your're just taking LDL out from the blood circulation in to the digestive system. Cut down on fat, and it is reabsorbed back in to the bloodstream. Yo-yo. How about finding the cause of the elevated LDL or purge it from the system? My LDL skyrocketed on LCHF, partially because my intake of fiber wet down. I added another HF in LCHF, High Fiber, and my LDL came down faster than it went up. I take 4 doses of psyllium (first thing in the morning, between meals and before bed) Each dose is about 2 teaspoon heap of psyllium with 30ml cold water.

  15. wow. im glad im accidently come across this video. because i also worry about my lipid profile which 324 chol, 75 tri,55HDL, 244 LDL

    i was about to give up a keto.

    but now i know

    thank you.

  16. Dave Feldman's presentation puts the nail in the coffin of the idea that increased fat intake, especially increased saturated fat intake, will induce more atherogenic blood markers. This presentation should make low fat advocates, if they are honestly seeking the truth, rethink their position.

  17. Interesting tech stuff! I'm going to sound a bit like an asshole but I just want to make a bit of a criticism: I applaud what he adds to the conversation but I would warn that though he is a software engineer and thus a scientist, he is in no way an expert on nutrition. Also, this data is basically just anecdotal. He has one test case of himself and from what he presents it appears zero experience in nutritional science or medicine and thus conducting medical research. Bravo for the info but we need to be careful about who we assign the noble title of "expert" to. I wouldn't listen to an MD who decided to look into how to build a better commercial airliner. Don't get me wrong, the engineering science may have methodologies that are useful in medicine, I just think it's important to keep the bar for science, studies, opinions, and experts very very high. Such is under threat today. Everyone thinks their an expert these days. Perhaps I would suggest speaking to the fact that this is not a published study and that he is not a research MD. As it is, the data was presented in this context which I believe is somewhat misleading. That being said, he's done a ton of work and while much of it is over my head, I have no doubt it is valuable to the community. Bravo!

  18. You know what, i had today a conclusion on 'inversion' just by using logic and my knowledge from last months.
    And now YouTube suggested to watch this video.
    Odd events occur.

  19. Well, I'm going to be part of the ones who do this to get their doctor off their back while keto. Great talk, some new info, and I've read almost every book under the sun on this.

  20. What about cortisol levels being raised from being too low carb? I have high cortisol and am told to increase my carbs.

    My cholesterol is 304, HDL 88. VLDL 13. LDL 203. Trigs 66. My doctor told me to go on Lipitor. I told her not even at gunpoint.

    I too have high ferritin levels. 588. My doctor doesn't seemed concerned about this though they are about serum calcium which is 14.4.

  21. I'm confused. The stuff I've been reading all suggests that total cholesterol and even total LDL correlate very poorly with metabolic disease, and that the numbers that do correlate with metabolic disease are the triglyceride/HDL ratio and the VLDL count. So that the idea would be to keep HDL up and triglycerides and VLDL down. It's certainly very clear that, contrary to the official advice, there is absolutely no need to worry about saturated fat and total fat in the diet. If this experiment holds up with large-scale numbers, it would explain why there is no need to worry.

  22. Top man for doing this work. As a GP I'm not a big fan of the cholesterol theory as a major risk factor for heart disease. I agree in the context of insulin resistance this may be an indicator of poor dietary factors. However I run the professional risks of being vilified by my community of doctors and an industry geared towards statin prescription. The work of Malcolm Kendrick is a good summation of the data, you may already be aware of this but it may help you put to bed some of your fears about cholesterol. My brief synopsis (and opinion) is that unless you have a strong unprovoked family history of heart disease there probably is little to worry about cholesterol is vital for some many functions and in many cases lower level can be associated with risk of other chronic disease and inflammation as you are aware and in turn cancer risk. One further note is I ignore all studies on rodents and animals with a dissimilar diet to us and the effects of ketogenic diets which get widely drawn into these arguments for obvious reasons (I imagine I wouldn't live very long if I just ate grass so why a rabbit would be healthy on a high fat diet is fairly self explanatory).

  23. Very interesting! I have been struggling with these issues recently. I have been doing intermittent fasting for 5 months, lost 6kg, BMI down to 23. When I did a checkup 2 weeks ago, I expected to see perfect results. Everything was good except total cholesterol was around 290, LDL around 210, which shocked me. In terms of diet, I avoid refined carbs as much as I can but other than that I basically eat everything. The doctors say I should avoid saturated fat. It seems much more complicated than that.

  24. It's interesting that so many engineers (like myself) have taken such a large interest in the research behind this diet. I haven't been able to tear myself away from the research (as a scientist), long enough to work on my other research (which is nanotechnology and quantum wires). But what this "study" suggests is that a much larger study is needed. These data seem to have turned existing ideas about lipids and cholesterol levels in the bloodstream on their collective heads.

    For one thing, these cholesterol tests, only indicating the "last three days" of intake, suggest that they're virtually meaningless indicators of health, and too many primary physicians, out there, playing "cardiologist" to their patients, are prescribing medications to "stop the slaughter," seem only to be killing us, not curing us.

    Because of my insatiable need for answers, like Dave's, as an engineer, one cardiologist remarked that it appeared I know more about this than most primaries. This is egregious. Why is my primary pretending to be a cardiac specialist in the first place?

    At any rate, a LOT more data are needed for any reasonable conclusions to be drawn about this particular aspect of the Keto diet. And we currently have no or few long term studies on it. What should the norms be on this diet? Should my blood pressure be higher or lower? (Turns out it was higher, and then I noticed in one of the lectures by Dr. Phinney, that you have to increase your intake of Potassium, and I had since dropped several of my high-potassium carbs.)

    At the end, in the Q&A, I recognize the voice of yet another engineer who has become prominent in this discussion/experiment – Ivor Cummins, from Ireland, who gives some interesting talks. I've been a fan of Robert Lustig for many years, and taken to renouncing fructose in my diet, only to find, only today, that some fructose managed to sneak its way back in (YIKES!). And 20 years ago or more, I was telling family and friends to dump those transfats (hydrogenated or partially hydrogenated oils). Today, I'm telling friends that even olive oil isn't all that good for you (for the Omega 6/3 imbalance.

    What a battle! It's not just the food industry, but the powerful corporations, the food and sugar industries, right here in Florida, who desecrate Florida's beautiful and pristine waters, filling them with the nutrient runoff that pollutes our lakes and rivers to the point of being too toxic to swim in.

    But I'm not ever one to jump in and believe everything I see or hear. If you point at a study, likely, I'll chase it down and read it. It's good to be careful which ones you quote.

    Excellent and revealing talk – thanks!

  25. Really helped me. I've been on Keto for 5 weeks and had the same experience as "Jill" I tried to be "good" a few days before my cholesterol, it showed 312. I was crushed because I've been feeling so good on Keto. I'm going to try the Feldman Protocol and send this dude the results

  26. Still listening to your video so I don't know if you will cover this but I was told by a heart doctor if your LDL is large particles(this test isn't covered by insurance yet, I believe) you're are fine and statins should never be used to diminish these protective particles.

  27. Thanks a lot for all your study and experiments, Dave! From my knowledge and experience, total cholesterol as well as LDL are affected greatly by food made out of palm oil-food like baked goods and instant noodles. My cholesterol level dropped dramatically when I spent some time being away from baked goods containing palm oil, refined sugar, and thus fat (like sweets, cake, pastries..) that i had used to have a lot. This means my less intake of fat affected the dropped cholesterol level. And I've seen a documentary proving that a guy who had just fast food for an entire month (he had greasy fast food but never had carbs and refined sugar) and had his total cholesterol and LDL dropped after the month. I'm not sure what kind of fat-containing food you have during your experiments but I think what matters is not just fat but what kind of fat we have. It seems that fat from baked goods can negatively affect cholesterol level but fat from greasy food doesn't (like you have proved) although they are both saturated. I wonder what you think about it? Thank you!!

  28. What a great presentation. Landed on this to research my doctors recommendation to go on statins immediately. I am on a LCHF diet, run 60mpw with an LDL of 228. I'll never go on statins anyway, but your research has given me some great confidence to continue on the diet. Thank you for all your hard work

  29. This was fascinating. Props to Dave for, along with Ivor, bringing a systems-based engineering mindset to biomedicine. I appreciate that he's calculating Pearson correlation coefficients and regressions to demonstrate the mathematical impact of this approach. The next step will have to be to take all these n = 1 experiments and conduct a parallel cohort randomized controlled clinical trial as a short-term feeding study in a metabolic ward, and then a subsequent one for replication as a free-living study (with appropriate biochemical measurements to confirm adherence, etc.) and shoot for publication. The data are so intriguing, someone's bound to be interested, despite "conventional wisdom (e.g. indoctrination)." Great stuff.

  30. As an aside, I think if Dave really wants to help the Jills of the world (although I'm sure he is already), he should also consider delivering precisely this kind of talk to the people who eventually construct and then reconstruct the medical standards of care guidelines – e.g. academic physicians and medical students, respectively. The number of "Jills" they will influence going forward is tremendous. The impact it might have, as he changes perspectives in this arena, could be almost unfathomable.

  31. My recent blood test showed higher ldl with my dr wanting to put me on statins. I refused that route and all 3 of my children are mad at me for refusing those, insisting I'm committing suicide by not taking them.(?) Anyway, my question is: how can I increase my fat intake? I put butter in my coffee and use a lot of butter, etc. I find it hard to eat a lot of veggies, but I do eat fruit such as blueberries and strawberries. Help!

  32. Very very interesting. My HDL marker is higher on keto which increased my total cholesterol hence my natural path was not concerned. I have blood drawn and compared biannually. Thank you

  33. So, a vast majority showing how low carb diets supposedly increase cholesterol … do so only if the diet was low carb HIGH PROTEIN ! Not high fat.
    Now it doesn't surprise me anymore.

  34. I have been on the Keto diet and intermittent fasting since April 1st 2017 and have lost 80 pounds. I still have another 60 pounds to go. Well,I just got my blood test results back today and I am very concerned. My Cholesterol results were as follows:
    Total CHL: 204
    HDL: 36
    Triglycerides: 45
    LDL: 154
    Non HDL/CHL =168
    CHOL/HDLC Ratio = 5.7
    Do you have any advice on what I should do about these results? I

  35. This was awesome information. Now I understand why my cholesterol jumped to 310. I had just finished a 4 day fast. I know a bit extreme. I was in ketosis and couldn't believe it raised my cholesterol but now I now understand why it jumped. I decided to ignore the results and not start taking statins as my Dr would have preferred. I'm glad I didn't . I am worried about the life insurance point you alluded to in the video. I suppose I could game the system and do the 500g of fat for 3 days before the test 🙂 . I heard somewhere that when they lowered which is considered above the norm for total cholesterol from 240 to 200 that most of the people that approved the decrease where associated in some way with statin companies. Awesome video. Keep up the good work!.

  36. Just out of curiosity, when you raise your fat and calorie levels that high and you see the inverse effects on cholesterol levels, what effect does it have on your weight? Would do you recommend as fat levels for an ongoing basis? thx.

  37. Dr Phiney says only triglycerides can be used as fuel in the fat cell, not cholesterol;
    https://www.youtube.com/watch?v=MNfjkTyBUdQ

  38. We’re about to bio-hack my husbands lipid bloodwork! His a1c is 4.8 and TG 116 and the dr said drastically change your diet bc your total cholesterol of 260 is waaaay to high…this is the first time I’ve heard of hyper-response, going to study up!

  39. Great research! I'm a practicing physician and curious your thoughts on familial hypercholesterolemia and morbidity/mortality rates associated with such. These patients often die at a young age due to CVD. I'm trying to understand if there are any ideas about these people in particular concerning their high cholesterol levels and early onset heart disease. This is probably the one thing that makes me apprehensive about recommending a diet which can elevate LDL numbers so drastically

  40. I am plagued by some zillion questions. I wonder what happens with a person's cholesterol on high fat keto who has extremely little or let's say no stored fat to mobilize during fasting. Their cholesterol would not go higher if there was no fat there to use. It might want to, but it wouldn't be able to. So the question then is why does the body WANT to, and does this mean it NEEDS to, as in are high particles the preference? Or is it the reaction to what it interprets as a bad situation (body fat burning.) And is this reaction good for us or bad for us? Is the only way to mobilize stored fat accompanied by having your particles go up? Is using stored fat then "bad" for the body in the way of, something like "well, you are using stored fat, so you are probably under environmental stress, so here's more stuff to do body repairs?" I mean, it can't be healthy to leave fat in storage forever, but maybe the body feels that way. Why does the need for particles want to go away when food is consumed? Does stored body fat create high particles while dietary doesn't? So our body interprets a bad state every time we burn body fat? Or is it truly just going where it's needed? How else do we get health without removing bad body fat, and why doesn't the body see it this way, or is it instead truly gaining health by increasing particles? Also, does your body prefer to do things differently (at a higher rate) than your sister because your metabolism may actually be higher? I don't remember where I heard this but people who like to store fat actually have higher metabolisms. I'm sorry for all these questions especially if they are already answered in the video but this is what I'm left with after watching. Thanks 🙂

  41. This video is not for the ordinary man. Dave could have done better by sharing the gist of the whole work and his message in say 4 minutes. The experts can spend 40+ minutes on this video if they wanted to

  42. Great Video! I'm only at 5:30 into the video, but I need to say that (even) as a mathematician and systems engineer with a background in philosophy of science, I know that doing science with "N = 1" is entirely defensible. The medical literature is full of individual "case studies" – single persons, about whom massive data is collected across time, and (possibly tentative) conclusions are drawn from it.   Also, I think it's very good for non-medical people to look at medicine using a "systems approach", in order to critique medical theories, and make new medical discoveries. Another non-medical professional who is doing this sort of analysis is Stephanie Seneff , who does research in cholesterol metabolism also.I started Low Carb in 1999, and my triglycerides have ranged from 44 to 69 during that time, with no upward linear trend across the last 19 years.I am a somewhat "high responder" with my LDL. With my total TC about 250. But my HDL ranges from 55 to 80.  My HDL is ALWAYS higher than my triglycerides.

  43. Warning ! The triglycerides over HDL ratios I see recorded here are alarmingly bad. The ratio is a much more important indicator of danger than total cholesterol.

  44. i tried a low carb diet and my triglycerides were measured at 1400…i was extremely careful, no sugar, no fruit, no starches..it was epic fail for me,,

  45. Speaking from flood hit Kerala.
    I have type 2 diabetes and is trying a reduced carb diet. I am 63. No other health issues.
    Do you think this would work for a diabetic?

  46. I'm having difficulty understanding the bottom line here. I'm not an engineer, scientist or physician. Can anyone explain the protocol to a layperson like myself?

  47. Maybe I am daft. But wouldn't ldl particle size best be figured out as LDL-p divided by ldl-c? I buy that often a high ldl-p might mean small particles, but not always. The ratio should give better idea of particle size.

  48. I have been on keto for 6months, losing weight (24 lbs) , went off statins and metformin, and doing great. I was so expecting this visit to the doctor to be great! My HDL's had increased to 87, cholesterol increased from 158 to 343, triglycerides dropped from 63 to 44 and LDL went up from 83.3 to 247.1. My endocrinologist said, "you will look skinny in your coffin!" He wants me to start back the statins and I DO NOT WANT TOO. My A1C is hanging around 5.8-6.0 and he was OK with that. I am very frustrated with my doctor! I will forward this to him and we will see the response. A firing like Jill maybe in the future! Also… what have you found in correlation with hormone swings and cholesterol. I am 50 and starting the change. In the past, my endocrinologist could NOT get my thyroid regular as long as I was on birth control. I fussed then that this hormone was affecting thyroid function BUT he refused to listen then as well!

  49. Great stuff, definitely interesting to see the effects of a severely fatty diet on someone with high cholesterol in the acute setting.

    There is a major issue with applying these results to ketogenic diets in general, and I suspect a large part of the reason the LDL drop has not been reproduced in randomized clinical trials or even consistently in the user comments – Dave didn't wait long enough to see the impact of diet on the liver. As he point outs (13:55), VLDL lipogenesis by the liver is on the order of days to weeks. So why would you measure the serum levels daily? Needs to try the same studies but be more patient, the Pearson/R2 will likely be absent after a few weeks. Otherwise dietary changes are going to be over-represented, which was demonstrated so eloquently with your sibling study.

    Experimental models seem to support the idea that VLDLs get irritated by inflammation → fatty passengers pop off → adhere to the glycosylated arterial wall (sugar turns the walls of your arteries into sticky sandpaper). Diathesis stress. Without fat, sugar is far less impactful and without sugar fat has far less effect, but neither is benign in the aging individual because we will always 'see-saw' in and out inflammation.

    Ideas for future tests:
    Check other more reliable indices of cardiac health coronary artery calcium and intimal wall thickness of your carotids over time. Look at all-cause mortality if enough people jump on board. Then you might have a chance of changing national food guidelines.

  50. This all looks great, but now makes me worry since I don't have a gallbladder, that I'm not processing all of these fats properly.

  51. What can I say? One of the best step-by-step presentations I’ve viewed. May I commend you on your visuals and express my gratitude because those pictures help “make simple” (allow understanding) the information and makes it meaningful and that is empowering.

    I’m one of those people who believe that MY HEALTH is MY DECISION and MY RESPONSIBILITY and I hold ownership of my health … I will NEVER handover my health to a doctor …. I’ve found too many to be OUT OF TOUCH with what is changing.

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