October 8, 2018

Podcast

Dave Feldman: stress testing the lipid energy model (EP.19)

"I am on a journey of science, not of advocacy: I'm going to be quite a skeptic."  —Dave Feldman

by Peter Attia

Read Time 30 minutes

In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.

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Note: this podcast gets technical at times and refers to many visuals during the discussion. The graphics, figures, and tables alluded to are provided in the show notes. In addition, there is commentary by Thomas Dayspring, M.D., in the show notes, providing corrections, clarifications, and amplification. Dave Feldman provided many graphics and some additional comments that are included in the show notes.

For the transcript of this episode, please visit this page, where there is more commentary from Tom Dayspring.

We discuss:

  • Peter’s synthesis of Dave’s energy model [5:00];
  • Dave’s lipid energy model;
  • Dave’s inversion pattern experiments;
  • Dave’s journey from software engineer to cholesterol enthusiast [15:00];
  • Standard blood panels, sterol panels, and what moves the needle when it comes to particle numbers [18:30];
  • Hyper-responders [20:00];
  • Lipoprotein transport [33:45];
  • The lean mass hyper-responder phenotype [47:30];
  • The progression of atherosclerosis, CAC, and CIMT [52:30];
  • Testing for oxidized LDL [55:30];
  • All-cause mortality and clinical endpoints [1:01:15];
  • What does “LDL as causal” mean? [1:05:15];
  • Dave’s low carb cholesterol challenge and drug & genetic study qualifications [1:13:15];
  • If all other markers are in a healthy range, but LDL-P is high, is the patient at risk? A couple of case studies, and a self-experiment [1:27:30];
  • Peter’s three-day exercise and ketosis experiment [1:41:00];
  • What are remnant lipoproteins? [1:45:00];
  • What might cause lean mass hyper-responders to have higher LDL particle numbers? [1:53:30];
  • A case study from Dave of a lean mass hyper-responder [1:56:30];
  • Mass balance and cholesterol flux [2:05:30];
  • Can a higher degree of cholesterol explain the lean mass hyper-responder phenotype? [2:10:00];
  • Peter’s LDL during his keto-fast-keto experiment [2:13:30];
  • Does substituting saturated fats with monounsaturated fats lower LDL-P and LDL-C? [2:15:45];
  • Dave’s carb-swap experiments [2:22:15];
  • Dave’s carotid intima-media thickness tests [2:41:15];
  • Looking for studies that stratify for high HDL-C and low TG alongside low and high LDL-C [2:53:00]; and
  • More
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