#CholesterolScience Show – with Dr. Spencer Nadolsky

Show Notes:

0:25 Greetings

1:36 Spencer’s background

3:35 The big seven questions intro and context into Spencer and Dave’s background together

4:52 Question Number One: What is your current opinion on the optimal range of Total Cholesterol?

5:24 Question Number Two: What is your current opinion on the optimal range of LDL Cholesterol?

5:55 Question Number Three: What is your current opinion on the optimal range of HDL Cholesterol?

6:43 Question Number Four: What is your current opinion on the optimal range of Triglycerides?

7:00 Question Number Five: In regards to cholesterol lowering medication, do you think too little or too much is being prescribed?

7:33 Question Number Six: If you had to guess a percentage, how much of modern heart disease is a result of diet?

8:10 Question Number Seven: Do you feel those on a low carb diet should take steps to lower LDL-C if it has increased, if all other cardiovascular risk factors have improved?

9:20 How Spencer’s opinion on cholesterol has developed, and how it has changed over the years

12:42 How Spencer sees LDL’s role in atherosclerosis

14:20 Coming from a position of skepticism towards the LDL hypothesis and why Spencer’s views changed

15:45 Study mentioned: ENHANCE trial

16:35 Study mentioned: IMPROVE-IT trial

16:50 Note: Genomic Wide Association studies refers to studies which look at genetic causes of something (e.g. high or low cholesterol) and associate it with occurrence of cardiovascular disease or other issues.

18:05 Do you feel there are positive things about having higher LDL cholesterol or higher LDL particle count?

21:30 Looking at All-Cause Mortality in people with hypobetalipoproteinemia or abetalipoproteinemia

Note: Hypobetalipoproteinemia is a condition resulting in unusually low levels of apoB containing lipoproteins (VLDL, LDL, chylomicrons, etc), abetalipoproteinemia is a similar condition resulting in near absent levels of apoB containing lipoproteins.

23:40: Social Media Questions intro

23:55 What is “Best practice” for evaluating desirability of statin therapy and weighing likely benefit versus potential adverse side effect?

26:00 The importance of having honest dialogue with your doctor (and others)

28:00 Is the focus in the right place for areas of interest and understanding for doctors (diet, and medicine)?

30:48 What is the current verdict on triglyceride to HDL ratios, and how do you correct a high ratio?

32:40 Question intro: Please include the ramifications of apoe4 in these discussions

33:00 Discussion on lean mass hyper-responders

35:40 Hyper-responders in Spencer’s clinic, and in Dave’s experience, and apoe4

38:00 Dysbetalipoproteinemia and apoe2/2 isoform

Note: Dysbetalipoproteinemia is a genetic disorder marked by increased levels of remnant lipoproteins due to impaired clearance.

39:00 Dave’s white bread and processed meat experiment and impact of energy metabolism on lipids

39:40 For hyper-responders, why does switching saturated fat for other fats lower LDL-P and is this beneficial?

42:15 What explains the rise in CVD in the industrial/developing nations and why do undeveloped people not have cardiovascular disease?

44:25 What is the importance of very high LDL-P in light of having pattern A in regard to cardiovascular disease?

Note: Pattern A is referring to having a majority of LDL particles that are a larger size, compared to having a predominance of “small dense” particles, classified as Pattern B. Pattern B is considered to impart higher risk of cardiovascular disease.

46:40 Genetically high levels of LDL versus dietary causes, are they the same? Will Lean Mass Hyper-responders develop issues like xanthomas?

51:50 How important/significant is RBC [red blood cell] cholesterol pool to our health, and how is it impacted by changes in the lipoprotein cholesterol pool?

53:15 Blog questions intro

53:35 What is the role of cholesterol on lipoproteins, if the energy model is correct?

55:00 Dave’s resistance training experiment

58:45 What does Spencer think about the study regarding all-cause mortality being inversely related to total cholesterol in women?

59:40 PCSK9 inhibitors, what to make of the data?

1:02:04 Quality of life consideration

1:04:10 Questions from the chat

1:04:35 How do they measure cholesterol if it’s water insoluble?

1:06:40 What does Spencer think about CAC scores?

Note: A Coronary Artery Calcium score is a CT scan that looks for calcified plaque in the arteries. The scores range from 0 to >1000 with 0 being very low risk, and >1000 being extremely high risk (of cardiovascular disease risk, as well as all-cause mortality).

1:10:20 Spencer’s blog post for Cholesterol Code

1:12:20 Where to Find Spencer Nadolsky

Twitter: @DrNadolsky

Instagram: @DrNadolsky

Facebook: Dr. Spencer Nadolsky

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5 years ago

Such a great discussion, thank you! The low carb world needs more civil discussions with opposing views (ie: is high cholesterol dangerous, even with other improvements of blood markers?).

Anne Mullens
Anne Mullens
5 years ago

Great discussion. Thanks for doing this. Can you contact me? I am doing a story for Diet Doctor and I would love your input.

Siobhan Huggins
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Anne Mullens

Hi – apologies for the delay in response, I gave Dave a heads up yesterday about this. 🙂

5 years ago

Along with higher cholesterol possibly showing a relationship with a better immune system, I think there is a relationship with blood clotting. Dr. Malcolm Kendrick has some interesting thoughts on this. I also have found studies on hemorrhagic strokes (ICH) and cholesterol/saturated fat. (I had a hemorrhagic stroke at 27 due to a brain AVM, which is how I got interested.)

Are a few of these studies. Also, just an observation and simplification, Japan had low heart disease but high hemorrhagic strokes (30% – 40% of strokes there were ICH, while this rate is 10% approximately in the US). It makes sense to me that many with high cholesterol (possibly lower HDL and higher triglycerides too) have blood that is more likely to clot, and the blood of people with low cholesterol is less likely to clot (good for less atherosclerosis, bad for people with AVMs 🙂 ). A big simplification, but I think this is interesting and something to look into.

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