#CholesterolScience Show – with Ivor Cummins

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Show Notes

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?

Slide mentioned: Slide 2

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?

Slide mentioned: Slide 5

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?

Slide mentioned: Slide 3

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?

Slide mentioned: Slide 4

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

Twitter: @FatEmperor

Facebook: Ivor Cummins

Website: The Fat Emperor

Youtube: Ivor Cummins

1:43:15 A note for Joel Kahn

Slide mentioned: Slide 1

1:46:26 Credits and Outro