The Peter Attia Drive #19 - Dave Feldman: stress testing the lipid energy model
Oct 8, 2018
03:10:16
Peter's Initial Framing And Skepticism Of Feldman Model
- Peter frames Feldman's position: Feldman argues LDL rises on low‑carb result from altered energy metabolism and lipoprotein trafficking, skeptical that LDL causally drives atherosclerosis.
- Peter states he entered conversation skeptical and left more unconvinced by Feldman's model.
Defining The Lean Mass Hyper‑Responder Phenotype
- 'Lean Mass Hyper‑Responder' phenotype: lean, athletic, low‑triglyceride, very high HDL and paradoxically very high LDL/LDL‑P after adopting low‑carb/high‑fat diets.
- Feldman sees pattern across many self‑reported cases and seeks mechanistic explanations.
Run Sterol And Particle Tests Before Diet Changes
- Get advanced lipoprotein and sterol panels before starting a low‑carb diet to understand baseline LDL‑P, synthesis (desmosterol), and absorption (phytosterols).
- These measures help distinguish whether LDL rises stem from synthesis, absorption, triglyceride cargo, or clearance changes.
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Introduction
00:00 • 2min
The Diagnosis of Low Carbohydrate Heart Disease
01:44 • 2min
The Biggest Problem of the Week, Part 2
03:34 • 4min
The Lean Mass Hyper Response
07:33 • 2min
The Probability of a Low Carbohydrate Diet Is the New Once
09:54 • 4min
Dopon Clestral
13:57 • 3min
How to Move Eldio Calestra and Elderio Particles Up and Down Without Medication or Supplements
17:26 • 3min
Do You Have a Particle Count Test Before You Start a Low Carb Diet?
20:01 • 2min
How to Measure Callestral Synthesis in the Body
22:21 • 6min
I'm on a Low Carb Diet, and I'm a Hyperabsorber, I Must Be Taking More Collestral
27:57 • 3min
Type 2 Diabetes
30:29 • 3min
Lippo Proteins Are a Boat.
33:47 • 1min
The Lippo Proteins in the Blood Stream Are a Central Regulator of Energy
35:14 • 5min
Is It a O C Three or an Ao E?
39:58 • 3min
Is It a Po B 100 Liper Protin?
42:31 • 2min
Are the LDL Particles Really for Energy Delivery?
44:15 • 3min
Lean Mass Hyper Responders - What Are They?
47:20 • 1min
Type 2 Diabetes - What's the Problem?
48:49 • 2min
Atheros Grosis
51:18 • 6min
The Role of L D L in the Antioxident Defense System
56:52 • 2min
Is the HDL Particle an Important Part of the Menological Role?
58:29 • 2min
The Multi Purpose Value of a Vehicle
01:00:24 • 2min
Does Inhibiting PCS K9 Make a Difference?
01:02:39 • 3min
The Zero Eldiel Hypothesis
01:05:48 • 4min
Is the Colesteral a Vaccine?
01:09:58 • 2min
I've Had More Than I Would Like
01:11:53 • 4min
Is It Possible to Have a Higher Level of Atheros Grosis?
01:15:49 • 2min
Deficiency of D Receptors on the Endothelial Cell Causes Hyperclestralemia
01:17:37 • 3min
Is There a Difference Between Hard Inpoints and Soft in Points?
01:20:33 • 2min
Is Death the Only Outcome of Athroscerotic Hornary Disease?
01:22:14 • 4min
Is Indecision a Decision?
01:26:35 • 1min
A New Patient on a Low Carb Diet
01:28:04 • 2min
Is This a Traglis Ride?
01:30:14 • 2min
Is There a Risk of Inflammation?
01:32:16 • 5min
Is There a Greater Gradient of Receptor Mediate Endosytosis for Repairant Growth?
01:37:19 • 2min
Is There a Difference in El D Ll C?
01:39:01 • 3min
I'll Add It Two to Your in but You're Not Going to Have
01:42:28 • 2min
The Poor Man's Version of a Remains
01:44:06 • 2min
Callestra - Is There a Remaining Collestra?
01:45:46 • 3min
Is Ld L Clustral a Better Predictor of Cardiovascular Disease?
01:48:23 • 2min
What Is the Bottom Line of This Study?
01:50:43 • 2min
Is Non H D L Clestra More Predictive Than L D L Collestra?
01:52:33 • 2min
The Indogenous Trigliceride Pool
01:54:14 • 4min
Is Full Body Lypolysis Getting Released?
01:58:07 • 2min
Is the Liver the N Urgostat of the Body?
02:00:26 • 2min
Is the Liver a Synthetic Problem?
02:02:12 • 2min
Remainder Callesterall
02:03:50 • 2min
Is There an Increase in Ld L Colesteral?
02:05:25 • 2min
How Much Colesteral Is There in the Blood?
02:06:59 • 2min
Is He Deficient in Callestral?
02:08:42 • 2min
Why Wouldn't Ell D L C Be Higher?
02:10:55 • 2min
The Inversion Pattern Is What Shouldn't Have Happened When I Fasted for a Week?
02:13:05 • 2min
Do You Know How to Lower Ld Lc Numbers?
02:15:25 • 5min
Is There a Relationship Between Pufas and the E P A?
02:20:08 • 2min
The Long Term Tank of Storage in a Low Carb, High Fat Athletes
02:22:07 • 2min
Is Your Fat Intak as Sensitive as Yours?
02:24:17 • 2min
Is Ld Lp More Relevant Than Remaining Lipo Proteins?
02:26:43 • 3min
Is There a Food Pyramid in Athero Sclerosis?
02:29:42 • 2min
Is There a High Level of LPS in Cardy Vasco?
02:31:33 • 2min
Is L D L a Cause of Atherosclerosis?
02:33:09 • 2min
Is There Any Cell in a Person With F H That Functions Like a Normal Cell?
02:34:54 • 2min
Is It a T P Binding Caset Deficiency?
02:37:15 • 2min
Is Ld L Playing a Causal Role in Atheros Ceurosis?
02:38:49 • 2min
C I M T Is Even Worse Than Calcium Score?
02:40:37 • 2min
Collesteral Code, You Haven't Even Described It Correctly to Me to Day, Right?
02:42:24 • 2min
Is He Making More Collesteral?
02:44:18 • 2min
Is There a Difference Between v L D L and Vl P Little a Cllester?
02:46:00 • 2min
Is There a Good Reason to Have High LDL?
02:48:15 • 4min
Do You Want to Stratify for Hd L Ld, Ih H Dl, Po?
02:52:27 • 2min
I'm Not Going to Leave the Kindergarten Classroom Till I Can
02:54:06 • 2min
Do They Stratify by O B?
02:55:41 • 2min
L D L P Is More Accurate Than O B, Right?
02:57:28 • 2min
Do You Think H D L C Is a Useful Metric?
02:59:07 • 2min
Is the Libit Hypothesis Proved?
03:01:13 • 2min
Is There a Null Hypothesis?
03:02:46 • 3min
Why I'm a Knuckle Head, I've Don't Know What to Do With Low Carbohydrates
03:05:24 • 2min
A Very Good Interview, Dave!
03:07:14 • 2min
Forward Slash Podcast
03:08:45 • 2min
In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.
We discuss:
- Peter's synthesis of Dave's energy model [5:00];
- Dave's journey from software engineer to cholesterol enthusiast [15:00];
- Standard blood panels, sterol panels, and what moves the needle when it comes to particle numbers [18:30];
- Hyper-responders [20:00];
- Lipoprotein transport [33:45];
- The lean mass hyper-responder phenotype [47:30];
- The progression of atherosclerosis, CAC, and CIMT [52:30];
- Testing for oxidized LDL [55:30];
- All-cause mortality and clinical endpoints [1:01:15];
- What does "LDL as causal" mean? [1:05:15];
- Dave's low carb cholesterol challenge and drug & genetic study qualifications [1:13:15];
- If all other markers are in an healthy range, but LDL-P is high, is the patient at risk? A couple of case studies, and a self-experiment [1:27:30];
- Peter's three-day exercise and ketosis experiment [1:41:00];
- What are remnant lipoproteins? [1:45:00];
- What might cause lean mass hyper-responders to have higher LDL particle numbers? [1:53:30];
- A case study from Dave of a lean mass hyper-responder [1:56:30];
- Mass balance and cholesterol flux [2:05:30];
- Can a higher degree of cholesterol explain the lean mass hyper-responder phenotype? [2:10:00];
- Peter's LDL during his keto-fast-keto experiment [2:13:30];
- Does substituting saturated fats with monounsaturated fats lower LDL-P and LDL-C? [2:15:45];
- Dave's carb-swap experiments [2:22:15];
- Dave's carotid intima-media thickness tests [2:41:15];
- Looking for studies that stratify for high HDL-C and low TG alongside low and high LDL-C [2:53:00]; and
- More
Learn more at www.PeterAttiaMD.com