Dr. Spencer Nadolsky – Board certified family and obesity physician taking his lipid boards this spring. Former division 1 NCAA heavy weight wrestler.
New Series
Next week Tuesday (November 20th), I’ll be interviewing Dr. Spencer Nadolsky on the first #CholesterolScience series. This show is meant to incorporate many different viewpoints on cholesterol and lipids. (See his page here: drspencer.com)
As many of you know, I’m a bit more cautiously optimistic with regard to higher LDL cholesterol and particle count where I believe there is insulin sensitivity and metabolic health, often reflected in low fasting insulin, low triglycerides, and high HDL.
This is why I’m extremely excited to have Spencer as our first guest as he will be giving a different opinion — you could say, a cautiously pessimistic point of view. In fact, he’s currently working on an article to be published right here on CC in the coming future on this very topic.
I’d particularly like to laud Spencer for being the most curious of those outside the low carb community with regard to the lipid energy model, prominent studies cited in favor of cholesterol, and the general opinion of low carbers in general to best construct a rebuttal. If you all know me well by now, you know how seriously I take moving this conversation forward and truly welcome serious discussion and constructive feedback.
General Format
This will not be a formal debate with Spencer and myself. Rather, I’ll be collecting questions here and on social media that we’ll curate and let him know about in advance. I want this to be generally relaxed and productive. I want any/all who have great information to share, whatever their viewpoint, to feel they can come on the show and express their ideas and research.
With this in mind, I want to ask everyone to be sure they are especially respectful of differing opinions on this show. Please don’t personalize. Feel free to attack their ideas (constructively), not the people themselves.
Rebuttal Rule
Naturally, if this series gets legs, more and more guests may remark on prior guest appearances. As with a more formal debate, if one guest references a previous one specifically and their position, I’ll do my best to allow the targeted guest to have a rebuttal response in a separate video, blog post, etc.
How to Ask Your Question
You can ask questions of Dr. Spencer Nadolsky in advance of the broadcast one of two ways:
- Comment to this blog post down below
- Comment on twitter using the hastag: #CholesterolScience
Again, keep it respectful and fun.
Omg my ldl is 5.46 – Hdl is 1.90 -Triglycerides are 0.54 … my Dr. Is very conserned.. I have been doing Keto for 1 yr .. I fell great but I am getting scared because he is telling me I am going to die if I don’t go on statins… please help me fell better … Patricia
Hi Patricia –
That’s a panel I wouldn’t mind having… 🙂
It looks like you’re a borderline Lean Mass Hyper-responder. AKA Someone who is on the leaner side and/or active, and running on fat. Perhaps it would help you to do a bit more research on all sides and see for yourself if you think it’s something to worry about, or if so what sort of action you might want to take (even if that is no action).
We have a couple posts here with some information you might find helpful, including this one regarding risk, and this one regarding what the research shows about women in particular.
We also have the Lean Mass Hyper-responder facebook group filled with people with similar results who share all sorts of information, which I’ve found really helpful.
Hi Siobhan, I came across Dave’s videos on YT today and am interested if you know much about high cholesterol generally? I’m in the overweight BMI category, even though I weight lift. Because of a health condition with a general level of fatigue I tend to exercise for a while gently and then have to stop and restart later. However, whilst my total cholesterol and LDL (calculation) is high (7.6 and 5.2 mmol/l) my HDL is good and my trigylcerides low. My ratios have been in the best category each measurement too, although there is some room for improvement. I had slightly better ratios on keto. My HS-CRP has been very low too. My consultant thinks I might have a genetic condition although I tested negative for the usual suspects, but this, of course, doesn’t mean there isn’t a genetic cause affecting a biochemical pathway.
So my consultant is worried, my ratios aren’t worrying me and then I read something about ‘residue cholesterol’ (I’m struggling to recall the name of it) , but that seemed to be cause for some concern. Some study reports suggets LDL isn’t correlated with heart health and some healthcare professionals insist it is. Due to the possibility of misrepresentation of figures and false reporting I am still struggling with the question, “What is my risk?” I’d be grateful for any thoughts you guys might have. Please feel free to contact me on my email- I don’t have any social media. Cheers, Rich.
Hi Rich, it’s hard to comment without the actual numbers. Could you post your full panel (HDL, triglycerides, LDL, and total cholesterol)? LDL only says part of the story, as far as the research I’ve read, and the surrounding context (indicated by other markers) can help see what the context is. 🙂
What does Dr. Nadolsky think about the consistent lowering of triglycerides and raising of HDL when carbohydrates are restricted?
What level of LDL negates a good TG/HDL ratio?
What are the differences between lipoproteins and cholesterol?
I understand that lipoproteins are transport for water insolvable trigs and cholesterol.
When measured in blood – how they measure total cholesterol and triglycerides if they cannot just float in blood?
Do all LDLs carry the same load of cholesterol?
If Dave’s energy model is correct and VLDLs deliver trigs to muscle cells for energy then what exactly is the role of cholesterol?
Can it be that all those LDLs are empty of cholesterol because they have just deliverd trigs?
And what exactly “clogs” the arteries – cholesterol or LDLs themselves?
Thank you!
Does Dr. N’s explanation of how the lipid system works differ from Dave’s? How? What is Dr. N’s thoughts about why so many people in the US are obese? Are blood lipid levels and cardio-vascular health affected by what we eat? Which foods and how? How does fat in diet and carbohydrates in the diet affect atherosclerosis and build up of plaque? What diet does he prescribe to help obese people lose weight? What diet does Dr. N recommend to help people improve their blood lipids, to raise HDL and lower Triglycerides? Does his diet advice work for patients who follow it? How does he measure it? How do blood lipids of a person on LCHF diet differ from a person on a vegetarian diet with increased carbohydrates? Does he always think it necessary to reduce TC if above 200? How can very low TC affect health? What health advice does he give if TC is high by his standard but HDL is high and Triglycerides are low? Does he ever prescribe statins for men who have not had a CV event? ever for women? why or why not? Under what conditions would he prescribe a statin? What does he think about the study that showed all cause mortality in women is inversely correlated with reduction in TC? How might statins create health problems in women? in men? Does he advise his patients about unintended side effects of statins? What does Dr. N think about the AIP index as predictor of vascular disease? What about Remnant Cholesterol to HDL as an indicator? So many questions! Thank you!
What is “best practice” in evaluating the desirability of statin therapy and weighing likely benefit versus potential adverse side effects such as myalgia, myopathy, and increased risk of diabetes?
My simplified understanding is that coronary artery disease is caused by endothelial damage that is repaired/patched by LDL cholesterol, resulting in plaque in the arteries. Common medical practice is to reduce LDL, thus reducing the ability to have plaque. Wouldn’t the better approach be to address the endothelial damage? Doesn’t endothelial damage point to a broader metabolic system problem? It seems that a ketogenic diet reduces inflammation, and I infer it would reduce endothelial damage. This diet also has been known to cause increased LDL. If the endothelial damage is addressed, then the increased LDL should not be a cause for concern.
I compare this to trying to make my house childproof for fires. I know a fire needs an ignition source, a fuel source and oxygen. The house alone is a fuel source, so I can’t address that. Removing oxygen from the house will have unintended consequences. As a result, I address the ignition sources by removing matches, lighters and candles.
I feel that the medical community is taking the oxygen removal approach when it comes to heart disease. They are so focused on the LDL, that they are missing the bigger picture. I would like Dr. Spencer Nadolsky’s thoughts on this.
Agree! (I suspect you’ve been reading Malcolm Kendrick). To take it one step further, it appears to be damaged LDL that causes problems which fully formed LDL doesn’t. And what’s more the factors that damage the LDLs may also be the factors that damage the endothelium. Eliminate the damaging factors or eliminate the LDL, I know what I’d go for.
I have been on a Keto diet for 2 years now due to a severe Borrelia infection that no antibiotics could get rid of. The diet has been working fine and most of my symptoms are gone, but recently I did a lipid panel test to see how my values are. My values are; Trig 70 mg/dl, HDL 54,1 mg/dl and LDL 131,5 mg/dl.I also found out that my Thyroid is a bit low activity as my TSH is 5,2 mE/L and my CRP levels was a bit high (19 mg/L) which indicate that i have some inflammation going on. This could be residual infections from my borrelia but i don’t really know. My question is does these two indicators affect my lipid panel? My guess was that I would fit the LMHR group and was a bit surprised of the outcome. I am 65 years of age, well trained and do regular HIIT training and is quit lean.
If there’s something causing inflammation, this could impact your lipid panel – however, this is usually reflected by lower than usual HDL, and high triglycerides which I don’t see here (although I’m not sure what your HDL usually is). Did you happen to do HIIT in the days leading in to the blood test? CRP is a finicky marker than can react to a wide variety of causes of inflammation, including exercise.
The other thing is TSH alone often misses a lot of context of thyroid markers, from what I hear – usually I see recommendations to get T3, T4, and reverse T3 as well.
I did not do HIIT the day before the blood test. The T4 values was 15 pmool/L and is within range (12-22). What I recall i had a high CRP when my physical status was really bad due to my borrelia and now the CRP is almost the same. Since two week Im doing carnivore diet to see if my values will improve.
Okay! Sounds like a plan, hopefully carnivore helps and/or it was something else entirely. I look forward to hearing back on the results.
Could be the thyroid. I had the opposite problem – hyperthyroid – which paradoxically (!) knocked my LDL down exactly as much as a statin.
When overtreated (ie. hypothyroid) the LDL went up. Not sure of the pathways involved.
Dr. Spenser stated “saturated fat ingestion results in downregulation of LDL receptor activity” therefore that is a reason that saturated fat results in increased LDL-P levels. Please provide a reference for that mechanism?
How much value does the Doctor or Dave place on a zero score on the coronary calcium scan? My triglycerides have been slashed and HDL significantly improved along with higher LDL on the LCHF diet. I do not want to take statins and my doctor suggested a scan. It came back with a zero former at 58 years young.
Hi I have a question about anabolic steroids and cholesterol. Why do AAS raise LDL and lower HDL? Is this or can this be a serious issue given you are eating a healthy diet?
Hi Scott, we can’t really comment much on medication/etc because we don’t really get enough data to see any patterns there. In addition, I haven’t read much on this in the research (granted I haven’t specifically looked for it). I can ask Dave if he knows of anything regarding it though.
Is there a resource to provide to a physician to explain why total cholesterol and LDL are not the markers they should be looking at but rather the Trig/HDL ratio?
Hi Holly,
Although we personally consider ourselves “cautiously optimistic” in regards to high LDL when paired with high HDL and low triglycerides, we do not claim certainty on this and acknowledge it is still being investigated (including via the Lean Mass Hyper-responder study upcoming, which will hopefully provide additional information into the profile). We think everyone should look at the available information and decide for themselves what their stance, and of course discuss their viewpoint with their health care team. If you’ve already explored the topic, it may help to provide your opinion and some resources you used to come to it to discuss with your doctor. If wanting to discuss the energy model, we do have this newer post for health care professionals, introducing them to the topic of hyper-responders and lean mass hyper-responders and the lipid triad.