5 ms·

> "More LDL over time means more heart disease." ... in the Standard American Diet. Dr Paul Mason's video "The truth about high cholesterol"[1] at 9:40 he cite

> "More LDL over time means more heart disease." ... in the Standard American Diet. Dr Paul Mason's video "The truth about high cholesterol"[1] at 9:40 he cites a study showing that increasing levels of "light buoyant undamaged LDL" do not correlate with increased heart disease risk over 15 years and 11,000 subjects. Then at 10:20 shows study results that increased levels of oxidised, damaged, small, dense LDL do correlate with increased heart disease. IIRC it's damaged by oxidation, glycation, plant phytosterol cholesterol-mimics (driven by increased seed oil consumption) and involved with disruption to lipid rafts which some medications cause, e.g. statins and anti-psychotics. That talk is 1 of 3, they are here: [1] The Truth about high cholesterol: https://www.youtube.com/watch?v=rdgS3PuSuyg https://www.youtube.com/watch?v=rdgS3PuSuyg "can we tell if we have normal or damaged LDL? Yes" Part 2: The shady truth about statins: https://www.youtube.com/watch?v=I7r4j1u42V8& https://www.youtube.com/watch?v=I7r4j1u42V8& (studies showing they do lower cholesterol, and that doesn't lower the risk of heart disease). Part 3: "Hard science on the real cause of heart disease - why you should avoid seed oils" - https://www.youtube.com/watch?v=-xCr3mvFCHM https://www.youtube.com/watch?v=-xCr3mvFCHM [2] A comment I've made before about his views on saturated fats generally: https://news.ycombinator.com/item?id=32966148 https://news.ycombinator.com/item?id=32966148 linking to his talk "Saturated Fat is not dangerous" - https://www.youtube.com/watch?v=NUY_SDhxf4k https://www.youtube.com/watch?v=NUY_SDhxf4k "Why your doctor thinks cholesterol is bad" - https://www.youtube.com/watch?v=j-nq60_oEIc https://www.youtube.com/watch?v=j-nq60_oEIc

KempyKolibri 2y ago
The problem with the “lbLDL is harmless” argument is that, while it was an interesting theory ten years ago, we have very strong evidence this is not the case now. I could go through exactly why people thought this is the case, and why the hypothesis turned out to be wrong, but this paper does a better job than I could: https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 Paul Mason is a renowned spreader of misinformation on this topic (and many others). My favourite moment of his is when he tried to teach a clinical research scientist that the lipid hypothesis was false, and in doing so revealed that his entire argument against the lipid hypothesis was based on an undergraduate-level misreading of a study, after which he just ran away from the conversation instead of admitting he was wrong. Absolute chef’s kiss moment, enjoy: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46
- jodrellblank 2y ago
  > but this paper does a better job than I could: https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 Since I don't have the knowledge to read this, why is this review better than the multiple review papers Dr Mason cites in the videos I linked? > Absolute chef’s kiss moment, enjoy: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46 This just says "it is so" and a page of numbers; X won't let me read the thread because I have no account, so... what is so? What intervention? What outcome is it showing? And how are they doing a six year study measuring people's daily energy intake down to 0.2 of a Calorie?
  - KempyKolibri 2y ago
    Because Mason’s making a number of flawed assumptions based on a misunderstanding of what drives atherosclerosis risk. The important factor js number of ApoB tagged lipoproteins (ApoB) and not mass of cholesterol within those lipoproteins. There is significant collinearity between these two things, but in ~30% of individuals there is discordance, which can create this illusion of “lbLDL is harmless”. This is because a given individual with the same amount of lbLDL-c as someone else’s sdLDL-c (that is, mass of cholesterol in both), the person with the same mass of sdLDL-c will have more ApoB tagged lipoproteins and therefore more risk. But when we stop using LDL-c as the measure, and use ApoB, which is what lipidologists now recommend, then the risk from large and small LDL particles is more or less the same. That is, one particle of sdLDL carries about the same risk as one particle of lbLDL. If you’d like something more consumable, lipidologist William Cromwell covers the topic very well in this video: https://youtu.be/kplh30RmYo8?si=WvDMwG-Z82voxDMp https://youtu.be/kplh30RmYo8?si=WvDMwG-Z82voxDMp It’s not hard to make an X account, but ok. I can link to the individual posts so you can have a laugh: Mason said the entirety of the lipid hypothesis was challenged by the fact that those randomised to reduced fat diets had a higher risk of dying in the 2006 WHI RCT: https://x.com/drpaulmason/status/1335411781557075968?s=46 https://x.com/drpaulmason/status/1335411781557075968?s=46 It was pointed out to him that the lipid hypothesis is about P:S ratio, not total fat reduction: https://x.com/avibittmd/status/1335470882987323392?s=46 https://x.com/avibittmd/status/1335470882987323392?s=46 Avi explained the criteria a study would need to meet to challenge the LH: https://x.com/avibittmd/status/1335475024854192129?s=46 https://x.com/avibittmd/status/1335475024854192129?s=46 There’s some back and forth, eventually Mason says the rebuttal that WHI failed to significantly reduce serum cholesterol/was a failed intervention because it targeted total fat doesn’t make sense because the intervention arm of the WHI reduced their serum cholesterol by 30%,so clearly the intervention was significant according to the LH: https://x.com/drpaulmason/status/1335488114534481920?s=46 https://x.com/drpaulmason/status/1335488114534481920?s=46 Avi asks him what he’s talking about, the serum cholesterol between intervention and control was basically the same, showing the table in the study: https://x.com/avibittmd/status/1335488453417562112?s=46 https://x.com/avibittmd/status/1335488453417562112?s=46 Avi suggests he might have confused serum cholesterol with dietary cholesterol: https://x.com/avibittmd/status/1335489121486299138?s=46 https://x.com/avibittmd/status/1335489121486299138?s=46 They share the table from the study that confirms this: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46 And then Paul, previously so headstrong and sure he was nailing everyone on this one, just peaces out from the conversation (or runs away, if you were to be less generous). His entire argument against the lipid argument was based on misreading dietary cholesterol as serum cholesterol. So good. No one should take him seriously, he’s either purposefully deceptive or completely incompetent at reading the evidence. Don’t see why anyone interested in reaching the truth should be interested in his arguments in either case.
tanseydavid 2y ago
>> oxidised, damaged, small, dense LDL I am so confused. What on earth is a " dense Low-Density-Lipid" ? Please help me understand whether or not this is an oxymoron?
- KempyKolibri 2y ago
  It’s a fair point, I’ve never even thought about that. I think it’s just something that’s awkwardly come about because there was an early broad categorisation of lipoproteins by density, and then there a subsequent need to divide those species even further by density. I tried to come up with a corollary but the best I have is “jumbo shrimp”. Sigh.
- jodrellblank 2y ago
  I don't know what it is chemically, but why is that naming confusing? Some tortoises are in the family Giant Tortoise. Within that group some are smaller than others. A "small giant tortoise" is not so confusing? A video card can be mid-range. It can also be upper-mid-range or lower-mid-range. I assume similar of LDL; within the group "LDL" there is some variation in size and density; the smaller denser parts of the range have properties which make them worth talking about as a sub-group. It's a term people use, e.g. "Small Dense Low‐Density Lipoprotein Cholesterol Is the Most Atherogenic Lipoprotein Parameter in the Prospective Framingham Offspring Study" - Hiroaki Ikezaki MD, Elise Lim PhD, L. Adrienne Cupples PhD, Ching‐Ti Liu PhD, Bela F. Asztalos PhD, and Ernst J. Schaefer MD; Journal of the American Heart Association - https://www.ahajournals.org/doi/10.1161/JAHA.120.019140 https://www.ahajournals.org/doi/10.1161/JAHA.120.019140

KempyKolibri 2y ago

The problem with the “lbLDL is harmless” argument is that, while it was an interesting theory ten years ago, we have very strong evidence this is not the case now. I could go through exactly why people thought this is the case, and why the hypothesis turned out to be wrong, but this paper does a better job than I could: https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 Paul Mason is a renowned spreader of misinformation on this topic (and many others). My favourite moment of his is when he tried to teach a clinical research scientist that the lipid hypothesis was false, and in doing so revealed that his entire argument against the lipid hypothesis was based on an undergraduate-level misreading of a study, after which he just ran away from the conversation instead of admitting he was wrong. Absolute chef’s kiss moment, enjoy: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46

jodrellblank 2y ago
> but this paper does a better job than I could: https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 https://pmc.ncbi.nlm.nih.gov/articles/PMC7369156 Since I don't have the knowledge to read this, why is this review better than the multiple review papers Dr Mason cites in the videos I linked? > Absolute chef’s kiss moment, enjoy: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46 This just says "it is so" and a page of numbers; X won't let me read the thread because I have no account, so... what is so? What intervention? What outcome is it showing? And how are they doing a six year study measuring people's daily energy intake down to 0.2 of a Calorie?
- KempyKolibri 2y ago
  Because Mason’s making a number of flawed assumptions based on a misunderstanding of what drives atherosclerosis risk. The important factor js number of ApoB tagged lipoproteins (ApoB) and not mass of cholesterol within those lipoproteins. There is significant collinearity between these two things, but in ~30% of individuals there is discordance, which can create this illusion of “lbLDL is harmless”. This is because a given individual with the same amount of lbLDL-c as someone else’s sdLDL-c (that is, mass of cholesterol in both), the person with the same mass of sdLDL-c will have more ApoB tagged lipoproteins and therefore more risk. But when we stop using LDL-c as the measure, and use ApoB, which is what lipidologists now recommend, then the risk from large and small LDL particles is more or less the same. That is, one particle of sdLDL carries about the same risk as one particle of lbLDL. If you’d like something more consumable, lipidologist William Cromwell covers the topic very well in this video: https://youtu.be/kplh30RmYo8?si=WvDMwG-Z82voxDMp https://youtu.be/kplh30RmYo8?si=WvDMwG-Z82voxDMp It’s not hard to make an X account, but ok. I can link to the individual posts so you can have a laugh: Mason said the entirety of the lipid hypothesis was challenged by the fact that those randomised to reduced fat diets had a higher risk of dying in the 2006 WHI RCT: https://x.com/drpaulmason/status/1335411781557075968?s=46 https://x.com/drpaulmason/status/1335411781557075968?s=46 It was pointed out to him that the lipid hypothesis is about P:S ratio, not total fat reduction: https://x.com/avibittmd/status/1335470882987323392?s=46 https://x.com/avibittmd/status/1335470882987323392?s=46 Avi explained the criteria a study would need to meet to challenge the LH: https://x.com/avibittmd/status/1335475024854192129?s=46 https://x.com/avibittmd/status/1335475024854192129?s=46 There’s some back and forth, eventually Mason says the rebuttal that WHI failed to significantly reduce serum cholesterol/was a failed intervention because it targeted total fat doesn’t make sense because the intervention arm of the WHI reduced their serum cholesterol by 30%,so clearly the intervention was significant according to the LH: https://x.com/drpaulmason/status/1335488114534481920?s=46 https://x.com/drpaulmason/status/1335488114534481920?s=46 Avi asks him what he’s talking about, the serum cholesterol between intervention and control was basically the same, showing the table in the study: https://x.com/avibittmd/status/1335488453417562112?s=46 https://x.com/avibittmd/status/1335488453417562112?s=46 Avi suggests he might have confused serum cholesterol with dietary cholesterol: https://x.com/avibittmd/status/1335489121486299138?s=46 https://x.com/avibittmd/status/1335489121486299138?s=46 They share the table from the study that confirms this: https://x.com/avibittmd/status/1335491375073271808?s=46 https://x.com/avibittmd/status/1335491375073271808?s=46 And then Paul, previously so headstrong and sure he was nailing everyone on this one, just peaces out from the conversation (or runs away, if you were to be less generous). His entire argument against the lipid argument was based on misreading dietary cholesterol as serum cholesterol. So good. No one should take him seriously, he’s either purposefully deceptive or completely incompetent at reading the evidence. Don’t see why anyone interested in reaching the truth should be interested in his arguments in either case.

tanseydavid 2y ago

>> oxidised, damaged, small, dense LDL I am so confused. What on earth is a " dense Low-Density-Lipid" ? Please help me understand whether or not this is an oxymoron?

KempyKolibri 2y ago
It’s a fair point, I’ve never even thought about that. I think it’s just something that’s awkwardly come about because there was an early broad categorisation of lipoproteins by density, and then there a subsequent need to divide those species even further by density. I tried to come up with a corollary but the best I have is “jumbo shrimp”. Sigh.
jodrellblank 2y ago
I don't know what it is chemically, but why is that naming confusing? Some tortoises are in the family Giant Tortoise. Within that group some are smaller than others. A "small giant tortoise" is not so confusing? A video card can be mid-range. It can also be upper-mid-range or lower-mid-range. I assume similar of LDL; within the group "LDL" there is some variation in size and density; the smaller denser parts of the range have properties which make them worth talking about as a sub-group. It's a term people use, e.g. "Small Dense Low‐Density Lipoprotein Cholesterol Is the Most Atherogenic Lipoprotein Parameter in the Prospective Framingham Offspring Study" - Hiroaki Ikezaki MD, Elise Lim PhD, L. Adrienne Cupples PhD, Ching‐Ti Liu PhD, Bela F. Asztalos PhD, and Ernst J. Schaefer MD; Journal of the American Heart Association - https://www.ahajournals.org/doi/10.1161/JAHA.120.019140 https://www.ahajournals.org/doi/10.1161/JAHA.120.019140