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0:00 Intro and Greetings
0:35 Ivor’s backstory
2:40 Cholesterol Conundrum – What’s changed since Ivor gave the presentation in 2014?
Video mentioned: Cholesterol Conundrum
3:55 Dave’s thoughts on Ivor’s Cholesterol Conundrum video
4:43 Do LDL particles drive inflammation in-and-of themselves?
5:43 Do LDL particles “BB gun” into the arteries and damage the endothelium (arterial wall)?
7:35 Devil’s Advocate Intro
7:50 Considering the majority of top lipidologists are in general agreement over lowering LDL cholesterol and particle count, shouldn’t Ivor (and other non-experts) concede to this point?
9:55 Even if one were to find a few outlier studies, doesn’t the bulk of the data on LDL cholesterol and particle count more than cover any skepticism of the lipid hypothesis?
Study mentioned: A consensus statement from the European Atherosclerosis Society Consensus Panel
Study mentioned: A Critical Review of the Consensus Statement from the European Atherosclerosis Society Consensus Panel 2017
12:30 Whether CAC is zero or not shouldn’t everyone take steps to prevent heart disease anyway? Wouldn’t you want to discourage a false sense of security from a zero score?
19:14 Discussion on no benefit from statins for 0 CAC results
21:37 Concerns over adjustments in the study
22:55 Submitted Questions from Social Media Intro
23:37 What tweaks to keto would Ivor suggest for people with genetically high cholesterol (Familial Hypercholesterolemia)?
26:18 ApoE4 and keto – does anything change if they’re already, in some way, metabolically deranged?
28:52 What is your opinion on keto and saturated fat for people with apoE4? And what is your ApoE status?
30:32 How soon after receiving a CAC Result above 0 should you re-test?
32:00 Is there any strong mechanistic evidence that real world changes in human serum LDL can alter the rate of active or passive movement across the arterial glycocalyx or endothelium without pre-existing damage to the area?
35:31 What is LOX-1 and what is it for?
36:48 Could aspects of atherosclerosis be serving a purpose?
37:50 Differences in LDL types in healthy and diabetic people and its effects on endothelial cells
Study mentioned: Low-density lipoprotein in hypercholesterolemic human plasma induces vascular endothelial cell apoptosis by inhibiting fibroblast growth factor 2 transcription.
40:18 Different contexts for high LDL-P – metabolically healthy vs diseased
42:05 What is your opinion on high lipoprotein(a)?
NOTE: Lipoprotein(a) is considered an important cardiovascular risk factor. Like HDL and LDL it is a lipoprotein found in the bloodstream in humans, however it has a unique apolipoprotein: apo(a).
Blog post mentioned: The Big Deal about Lipoprotein(a)
44:25 LP-PLA2 as a risk factor – and what is “high”?
49:17 Why did Ivor call Ancel Keys misinformed?
NOTE: Ancel Keys was a physiologist and researcher, most known for his Seven Countries Study (first presented in 1955), and for popularizing the idea that saturated fat and cholesterol cause heart disease.
55:06 Your thoughts on taking statins on a ketogenic diet?
56:58 How would a person on a whole food plant-based diet lower their cholesterol? And for someone leading a healthy lifestyle is high cholesterol still a risk factor?
1:01:00 Is isolated high LDL high risk?
1:05:07 Updated 2018 guidelines
Article mentioned: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol
1:06:45: Where does the LDL >190 mg/dL cutoff come from?
Study mentioned: Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up.
1:09:55 Could context matter for calculating Total/HDL?
1:11:55 Assuming saturated fat raises LDL, and assuming LDL causes heart disease assuming all other things remain constant can it other factors influence risk?
1:14:54 Questions from Chat Intro
1:15:18 Please tell us about your high ferritin, and how it relates [to health]
1:21:08 The apparent modern pushback against HDL
Study mentioned: HDL and cholesterol: life after the divorce?
1:27:45 For Lean Mass Hyper-responders on LCHF/keto if there is temporary systemic inflammation is there reason to lower LDL/apoB to avoid atherogenesis?
1:30:18 Can anything be done to improve particle size and number?
1:33:22 Should you be concerned about isolated low HDL if all other markers look okay?
1:39:57 Keto critics say keto is unhealthy long-term but provide no reasons. Is this because there are no reasons, or if anyone knows a reason please let us know.
1:42:55 Where you can find Ivor
Facebook: Ivor Cummins
Website: The Fat Emperor
Youtube: Ivor Cummins
1:43:15 A note for Joel Kahn
1:46:26 Credits and Outro
At this point when is Apo B considered high risk. I’m a 3/4. ApoB 123. LDL-P 2000’s sdLDL-c 42 Lp(a)-P 51. My last Inflammation levels Fibrinogen 449- hscrp1.0 Lp-PA 209 Oxidized LDL 55. My FBG has been running 120s-130s. Only high in am. I just met a new Lipidologist last week after FMD was unable to help with my lipids. Statins were mentioned but I refuse to go that route. Is there ever a familial indication that make that a valid therapy? Currently following LC diet with non- saturated fats predominantly. Just started metformin to help become more insulin sensitive after berberine and ALA did not affect am FBG. Any upcoming studies you are conducting? I’d love to take part.
I just wanted to follow up to my previous comment and share that after 4 weeks of low carb my inflammation markers are all back into normal range, ldl dropped 50 points and LDL-P reduced From 2000s to 1200s.. so I guess I answered my own question- diet can and will keep my doctor at bay with suggesting statins. Having gifted my family with their Apoe4 status for Christmas – I am excited I can also share methods to manage it too. Thanks for your continued good work.
Sure. Glad to hear you’re happier with your numbers.
It’s funny, you provide a lot of metrics but now HDL or triglycerides. You might want to run your numbers through our CholesterolCode.com/report tool if you haven’t already.
Thanks Dave, HDL is 80 and Triglycerides are 61. I’ll check out your report tool. CIMT coming soon.
Ah — so yes, a LMHR.
If you haven’t already, read this page: https://cholesterolcode.com/lmhr/ and consider checking out our LMHR Facebook group: http://facebook.com/groups/leanmasshyperresponder
Thank you for a great interview!
I appreciate the open-mindedness and especially the discussion about APOE4, which is always controversial.
Thanks, Markus. It’s definitely a very active topic these days in the liposphere.
My calcium score is 0.
We have hyper familial cholesterolemia–my recent lipid profile: total cholesterol 393, HDL 72, TGL 79, LDL 306 [blood glucose 96]
Had a MRI done due to feeling dizzy:
(new) doc says i need to start taking 20mg of statin right away–SHOULD I TAKE IT?
p.s. I should’ve mentioned the mri was of the brain. This was the exact impression:
T2 high signal intensity foci in deep and subcortical white matter of both frontoparietal lobes–probably demyelinating foci/change of arteriolosclerosis.
46ys, Asian female; live in south asia. My cholesterol has always been extremely high. According to recent dexa scan I could gain to lose 3 kgs.
The calcium score test was part of a comprehensive health package–the reviewing doc, upon seeing my mri report, said I am a walking time bomb for stroke, said I must immediately start taking statin; all other health markers appear normal, including thyroid, which i suspect is low even though according to “standard” parameters they are within range.
I have been eating variations of keto/paleo/low carb for several years now..
I have been stocking up on supplies preparing for coronavirus outbreak to be apparent in my very densely packed third world capital city & been stressing for few days whether to get statin or not.
This interview was very illuminating–I follow both of you on twitter. I need to listen to it several more times. Thank you.
Hi – we can’t comment on whether you should or shouldn’t comment on medication as we’re not doctors and can’t give medical advice – and just importantly it ultimately comes down to your feelings on if you want to take them and your own comfort longterm.
It may help to check out some people who discuss arterial calcification and medication on both sides and come to your own conclusions.
Some examples are David Diamond, Ivor Cummins (from this episode), Peter Attia, and Thomas Dayspring – all have varying opinions that are worth considering.