The Drive with Peter Attia — Dave Feldman

On: Stress testing the lipid energy model.

Episode: 19

Date: October 2018

Key Subjects:

  • Lean Mass Hyper-Responder (LMHR):
    • Athletic, lean, low carb (and high fat).
    • High levels of LDL-C and LDL-P.
    • High levels of HDL-C.
    • Low levels of TG.
  • Feldman Thesis:
    • LMHR have high rate of VLDL secretion.
    • Needed to deliver the TG to cells for energy.
    • Under these conditions, high LDL-C (or LDL-P) may not be a bad thing.
  • Attia response:
    • Feldman Thesis doesn’t explain how or why cholesterol goes up.
      • If cholesterol doesn’t go up, the increased number of VLDL particles (needed to carry around the fat) should be cholesterol depleted, but they are not.
      • So why is the cholesterol mass higher and where does it come from.
    • Reasons that cholesterol goes up:
      • More synthesized.
      • More reabsorbed.
      • Less cleared.
    • Counter thesis:
      • Higher intake of saturated fat results in higher cholesterol because it activates some cholesterol synthesis pathway (or prevents cholesterol clearance – see Cholesterol write-up)
      • Can be avoided by replacing saturated fats with MUFA.
  • Both agree:
    • LDL-C is one of three necessary ingredients for increased CVD risk (other two: oxidation / inflammation, damaged endothelial walls).
    • Importance of testing oxidized LDL.
    • Lipoproteins are energy delivery system for much more than cholesterol and TG (phospholipids, etc.).

Key Takeaways:

  • Measure oxidized LDL to check for level of inflamed particles.
  • Get sterol panel to understand how much cholesterol you synthesize and reabsorb.

Worth Listening:

Feldman thesis is a helpful reminder that lipoproteins are necessary as (energy) delivery system of more than just cholesterol to cells.

An interesting perspective, but Attia’s core thesis seems more convincing: high LDL-P is bad over time specifically for increased risk of CVD in the presence of inflammation and damaged arterial walls.


Leave a Reply