Study: Is LDL cholesterol associated with long-term mortality among primary prevention adults?

(Bob M) #1

This is a study of LDL as an indicator of mortality:

Primary prevention = prevention before onset of heart disease.

As an aside, I saw this posted by someone on Threads. He said if you have higher triglycerides, you should endeavor to lower them. Now, I’ve always thought of the trig/HDL ratio (which the study likes) as being an indicator of what you’re eating/your metabolism.

But once you start saying you might need to lower trigs if they are high, to me, this means trigs are CAUSAL in heart disease. Under what mechanism are triglycerides causal? That is, how does having high trigs cause heart disease? Anyone have any theories? (Because I don’t.)

(Edith) #2

I just listened to a fascinating podcast about mitochondrial disfunction. It’s quite long but fascinating throughout.

According to Dr. Means, she makes a case that most (maybe all) chronic disease can be blamed on mitochondrial disfunction. High triglycerides are carbohydrate converted into fat. The mitochondria aren’t functioning efficiently enough to process all the energy coursing through our blood streams. The cells become resistant to insulin to protect themselves from taking in more energy than they can convert to ATP, thus keeping the fat floating around instead of being used.

There was a LOT of information covered in the podcast. I know I’m really not paraphrasing it correctly, but that was the gist. I plan on listening to that it again, so more of the info will stick.

(Joey) #3

@ctviggen The key word here may be “association” as contrasted with causality. Higher serum LDL levels may well be in response to inflammation - not its root cause (akin to firetrucks arriving at fires).

As for serum triglycerides, they are clearly higher on a high carb WOE and very quickly come down after cutting out the carbs. This is simply a clinical fact, not a hypothesis.

The extent to which higher trigs are associated with poor health outcomes or actually a cause of poor outcomes is an interesting but separate question. Wish I knew more about the underlying mechanisms to say with any confidence.

Lower trigs on low-carb might be a reflection of the mitochondria better able to utilize them (therefore lower circulating levels) - or not. Then again, circulating trigs might also have some adverse health causation effects. Or, it might all be inter-related as a homeostatic system. :man_shrugging:

Dr. Thomas Seyfried and his team at Boston College have done a deep dive into this same theory of mitochondrial dysfunction in the context of cancer. His genetic research strongly supports the notion that damaged mitochondria (fermentation vs aerobic processes in energy production) are behind tumor growth vs suppression.

I’ve found his written papers/books and online presentations on this topic to be highly compelling (strongly recommend checking them out if you haven’t already). Spoiler: it’s all about the mitochondria.

(Bob M) #4

@VirginiaEdie Thank you. I’ve added that to my podcast list.

@SomeGuy I’m hesitant to say much about these types of studies, since they just look at what happens with people as compared to doing anything. But to the extent that my cardiologist is telling me I should be on a statin with an LDL of 130 and a CAC score of zero, at least this study says that my “normal” LDL doesn’t seem too dangerous.

What Edith says from the podcast sounds reasonable. Your cells aren’t taking in the trigs, because they can’t. Thus, high trigs are an indicator of a problem, but might not be the problem itself.

Unlike those darn LDL BBs that are just waiting to get inside your arteries and cause trouble. :wink:

(Joey) #5

Kind of interesting the range of medical opinions out there … my wife and I have LDLs well into the 200s and our internist thinks our overall lipid profiles are just fine (with HDLs 90-100+ and trigs 50-60). No statins offered.

(Geoffrey) #6

There have been enough studies out there to show that high (relative term) LDLc is not associated with with cardiovascular disease as the medical community would like us to believe. I lost my fear of my LDL after listening to several cardiologists that proclaimed the uselessness of statins and the all cause mortality of those who are on them with low LDL.
At last count mine was at 190 and I’m perfectly fine with that and that’s exactly what I told my doctor when he insisted that I get on a statin.
Then there is the glaring evidence to show that the only reason that statins and LDL are even considered is because it’s a trillion dollar a year industry.
To quote Paul, “ The reason the medical profession worries so much about your LDL level is that studies have shown a very strong correlation between lowering your cholesterol by taking a statin and the annual pay bonuses of pharmaceutical company executives. (Cynical? Moi?)”

(Bob M) #7

OK, so I’m listening to the podcast from above. Most of the info is good, but Huberman says he believes that the body follows the CICO model and believes that the body follows certain laws (forget their names). I don’t believe in either of those.

She lists 7 important metrics, which I think are important. She then blasts through multiple other metrics, including fasting insulin and GGT, and others I couldn’t catch, and then that’s it. They don’t discuss them.

He keeps talking about Peter Attia, said he’s had Attia on 3 times. I do not hold a high opinion of Attia. My opinion of him is low, very very low. So, I have a hard time continuing to listen.

Anyway, then one of the things she starts taking about is probiotics and fiber. Ugh…as someone who avoids fiber because it leads to issues. Can some people eat fiber and could it be helpful for them? I’m sure that’s true. I’m just not one of those folks. Some fiber, sure. Too much, and all heck breaks loose (or sadly doesn’t break loose). And then probiotics…could they be helpful? Maybe? I’ve taken probiotics many times. Not sure there’s a benefit I could find, even when combining with prebiotics.

I do think protecting the mitochondria is good.

(Geoffrey) #8

I took digestive enzymes for a couple of weeks and all I got from them was a severe case of constipation.

(You've tried everything else; why not try bacon?) #9

Lower trigs on a low-carb diet are a direct reflection of the lack of carbohydrate in the diet. Studies using radio-labelled foods have demonstrated that our triglyceride levels are dietary glucose (carbohydrate) that has been converted into fat in the liver and is now being sent to the adipocytes for storage.

(Joey) #10

Is a “direct reflection” a correlation or a cause? :thinking:

(KM) #11

I’d say simply causal, it’s just the natural order of things. I.e. fewer carbs = fewer trigs. That is, it’s not some complex biochemistry, just math. Buying fewer apples to make applesauce = less applesauce.

But I’m mostly still asleep, maybe I’m missing something. What would you propose as a correlation but not causation?

(You've tried everything else; why not try bacon?) #12

:rofl::rofl: In this case, it’s causal. Eating less carbohyrdate directly lowers triglycerides. But the causality is one-way: lowering the triglyceride level with drugs does not cause lower dietary carbohydrate intake. :rofl::rofl:

You’re not missing a thing, except that Joey was joking, lol! :grin:

(Joey) #13

@PaulL @kib1 A bit of a gentle jibe … “direct reflection” was an interesting choice of words, successfully avoiding either of those contentious “c” words. :wink:

(Bob M) #14

OK, I just wish Huberman would shut up about his own opinions and instead let the interviewee speak. Let us know what they think. I already know that Huberman is concerned about ApoB, believes that the body is (somehow) in tune with the laws of thermodynamics, and likes cold therapy and I forget what else he went on a soliloquy to discuss. It’s like: “here are all my thoughts on this area; what do you think?”

And they are both talking about studies of the number of steps people get, without once mentioning the idea of the healthy user effect. They state that people who walk after eating have lower blood sugar and insulin response. But what does this mean for me?

I don’t have much data here at work, but look at Nov. 21st:

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That’s what my blood sugar looks like every day when I eat low carb. You can’t tell when I ate. If that’s the case, would walking do anything for me?

And they were going on about eating spinach every day to raise your GLP-1 inhibitor levels. I am not going to do this. 1) I don’t like spinach. 2) What happens with oxalates? 3) Plants like this cause me issues.

Do I think that protecting and improving the endothelium is good? Yes. I just wish she was on someone else’s podcast.

(You've tried everything else; why not try bacon?) #15

That is so true of so many YouTubers. (I’m looking at you, Ken Berry!)

Thank God for the fast-forward feature! :pray:

(Edith) #16

This one covers a lot of how important it is to get out in the sun, but it’s a shorter podcast and doesn’t get into nearly as much detail as the Huberman one. I guess you have to take the good with the bad. I stopped listening to the Peak Human podcast because Brian Sanders started interjecting himself and his politics way too much.

There is also this one, but I haven’t listened to it, yet.

(Bob M) #17

I agree with you about Peak Human too. Although he’s better at asking more questions.

It seems like the longer you are on the air, the more “knowledge” you get and the more you want to talk while not asking enough questions.