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Dec 17

#CholesterolScience Show – With Joel Kahn

Show Notes

0:19 Intro

1:32 Dr. Joel Kahn’s backstory – past career, health, and how he came to understand cholesterol and heart disease.

5:56 How and why Joel started a plant-based diet

7:44 Joel’s thoughts on experimentation and guidelines from a clinician’s perspective

10:25 Health from a nutrition-based perspective, and Joel’s observations on the history of nutrition

Study mentioned: Mortality from circulatory diseases in Norway 1940-1945.

Study mentioned: Reduction of Mortality Rate in Coronary Atherosclerosis by a low Cholesterol-low Fat Diet.

16:45 The difficulties and ambiguities involving studies done on diets impacting health

Study mentioned: Anti-inflammatory Effect of Whole-Food Plant-Based Vegan Diet vs the American Heart Association – Recommended Diet in Patients With Coronary Artery Disease: The Randomized EVADE CAD Trial

18:40 Devil’s Advocate intro

18:50 Is there any value of any kind in having high values of LDL particles in the body and, if so, do studies account for this when looking at disease outcomes?

Study mentioned: The low-density lipoprotein pathway and its relation to atherosclerosis.

21:09 Is there a possible immunological benefit to high LDL particle count?

23:19 Many who go on a LCHF diet see their LDL go up but will likewise many see their HDL climb and their triglycerides drop. Is it possible that this could result in lower risk of CVD?

Researcher mentioned: William Roberts

27:52 Many studies tout changes in risk for CVD mortality yet show no difference in ACM. Doesn’t this run the risk of assuming there is an overall benefit where there is none?

Study mentioned: Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease.

31:30 Discussion on PESA study and silent atherosclerosis in apparently healthy people

Study mentioned: Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study.

Slide mentioned: Slide 1 (Click to enlarge)

 

34:18 The impression of the intention of scientists from the public

35:25 The importance of the data concerning HDL and triglycerides to the public

Study mentioned: Intensive Lifestyle Changes for Reversal of Coronary Heart Disease

38:35 The impact of money in medicine

40:44 Possible tunnel vision in engineering and research

42:22 Audience Questions Intro

42:30 Aren’t all apoB lipoproteins atherogenic?

NOTE: “apoB lipoproteins” is short for “apolipoproteinB containing lipoproteins”. ApolipoproteinB is an identifying protein on lipoproteins like chylomicrons (from the gut), and VLDL, IDL, LDL, and lipoprotein(a) (from the liver).

45:46 Could there be a case where HDL could be lower without increasing risk?

47:07 Apart from heart disease, what is the main concern you see with being a hyper-responder?

48:51 None of the risk calculators use LDL at all. Why? Why do they all show low risk as long as HDL is high and no blood pressure issues, etc.?

51:39 What do you make of the data showing LDL-C going up during fasting?

56:43 Why is high LDL bad if there is no oxidation or inflammation present? Is TG/HDL a better marker for coronary disease?

Slide mentioned: Slide 7 (Click to enlarge)

1:00:59 Why does atherosclerosis only develop in certain spots, and not evenly throughout the arterial vascular system?

1:06:32 Is there data on heart attacks and strokes in people with high LDL-P and LDL-C but with good [Atherogenic Index of Plasma], no Type 2 Diabetes, no elevated BP, low inflammation, CAC 0, etc

1:09:53 The importance of testing beyond CAC

Note: Joel Kahn mentions CIMT (Carotid Intima-Media Thickness) which is an ultrasound of the carotid arteries in the neck and can be used as an additional marker of CVD risk/progression.

1:13:12 Kudos to Dr. Joel Kahn

1:14:23 Doctors as consultants, and taking ownership of your own health

1:16:06 What comes along for the ride with meat that you find to be a problem for humans?

1:23:03 Any comment on LDL levels and infection risk?

1:25:02 Mendelian Randomization, what they say about LDL and risk, and possible issues with genetic studies

Slide mentioned: Slide 5 (Click to enlarge)

Slide mentioned: Slide 4 (Click to enlarge)

Video mentioned: A Century of Cholesterol and Coronaries

1:32:46 Final thoughts and outro

1:35:25 Where you can find Joel Kahn

Twitter: @DrJKahn

Website: https://drjoelkahn.com/

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Fred LanderMarkus MattiassonSandraAlexbill Recent comment authors

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bill
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Pritikin??

Sandra
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Sandra

I know, right? I thought no one took Pritikin seriously anymore. I remember someone in the late 1970s feeding her teenage boy pounds of pasta daily ala Pritikin – he ended up as an obese, unhappy adult with major mental problems. And I threw Dean Ornish’s book away years before I ever learned of LC because I read that his subjects spiked their triglycerides.

Alex
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Alex

Hey wait a second. High LDL particle count is bad regardless if there is no oxidation or inflammation present in the system? Did i miss something? its right the opposite of what i`ve read last time – no oxidation and LDL cannot pass cell barrier. Im confused сoz it’s like a pillar on which we doing right now and Kahn put this LDL-gradient depended thing now .

Fred Lander
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Fred Lander

Alex I thought the same thing. The liver does not recognize the boat so it floats around and gets embedded, eventually, in artery wall. Is it the altered APoB on the surface of the boat? What about the glycocalyx letting it through? Lots of things we do not understand fully .

Markus Mattiasson
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Markus Mattiasson

It would be interesting if you could get Ray Cronise on the show. He seems to be a smart guy.