73. How High Cholesterol Can Be Healthy, and Low Cholesterol Could be Harmful, with Dave Feldman.

Oct 5, 2020

Dave Feldman, a software scientist turned self-experimenter and founder of CholesterolCode, explores how cholesterol behaves in different metabolic contexts. He discusses lean mass hyper‑responders, why LDL alone can mislead, the role of LDL quality and oxidized phospholipids, and an energy model linking lipoproteins to fuel balance. Short experiments and novel assays feature heavily.

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INSIGHT

Bradford Hill Shows LDL Causality Is Not Straightforward

Bradford Hill criteria (consistency, specificity) question simple causality of LDL alone.
Dave Feldman contrasts FH children with lean mass hyper-responders to show different contexts and mechanisms may drive outcomes.

ANECDOTE

Paul's Very High LDL With Zero CAC

Paul Saladino measured total cholesterol 647 mg/dL and LDL 533 mg/dL yet had a coronary artery calcium (CAC) score of zero.
He highlights this personal N=1 to question whether high LDL alone produces rapid atherosclerosis like familial hypercholesterolemia does.

INSIGHT

Don't Evaluate LDL In Isolation

Single-lipid analyses (LDL alone) mislead; combination lipid data is needed.
Feldman proposes comparing LDL with HDL and triglycerides to distinguish atherogenic dyslipidemia from the 'lean mass hyperresponder' triad.

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If you are interested in lipids, you’ve probably heard of Dave Feldman and his work. If not, you’ve got some homework to do, and I think you’ll be amazed at what you find. Dave’s work can be found at cholesterolcode.com where he details his multiple, meticulous self-experimental projects. Prior to cholesterol adventures Dave was a senior software scientist and an engineer. He brings this “out of the box” thinking to the world of medicine and we are all better off for it.

He began a low-carb, high-fat diet in April 2015 and has since learned everything he could about it with special emphasis on cholesterol. He saw his own lipid numbers spike substantially after going on the diet and spotted a pattern in the lipid system that’s very similar to distributed objects in networks.

Time Stamps:

0:08:46 Podcast Begins

0:14:21 The Bradford Hill Criteria

0:15:29 Context matters in lipids

0:19:44 Carnivore MD's Lipid Panel

0:30:15 Why LDL can't be the root cause of CVD

0:35:57 Testing the Lipid Hypothesis

0:41:20 Why you can't look at LDL in a vacuum

0:47:38 High-density lipoprotein as a protective factor against coronary heart disease The Framingham study - The Framingham Study https://www.amjmed.com/article/0002-9343(77)90874-9/pdf

0:49:19 Metabolic health is what really matters

0:52:01 Premature Atherosclerosis Associated With Monogenic Insulin Resistance https://www.ahajournals.org/doi/10.1161/01.cir.103.18.2225?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

0:54:19 LDL quality is what actually matters

1:00:39 What's the root cause of oxidized LDL?

1:06:20 Why most LDL lab tests are bonk!

1:07:41 Dave's latest experiment results

1:16:12 Summary of Dave's Energy Model

1:21:21 The body holds onto and reuses cholesterol.

1:24:28 The vital importance of ample cholesterol

1:25:40 Fasting Increases Serum Total Cholesterol, LDL Cholesterol and Apolipoprotein B in Healthy, Nonobese Humans https://academic.oup.com/jn/article/129/11/2005/4721856

1:26:19 Brown Bears (Ursus arctos) Seem Resistant to Atherosclerosis Despite Highly Elevated Plasma Lipids during Hibernation and Active State https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439871/

1:28:40 Strong increase in hydroxy fatty acids derived from linoleic acid in human low-density lipoproteins of atherosclerotic patients