Wait he said it doesnât matter, because LDL and apoB is whatâs important (according to Peter), but you seem satisfied with âbright redâ LDL and 100 apoB?
âI just donât see a reason to have an ApoB ever north of 60 milligrams per deciliter.â
âPeter Attia
Yes you have repeated that point and it has been debunked every time with reference to genetic and mendelian randomization studies. Showing benefits in âlow riskâ patients, because a âlow riskâ patient is just someone who hasnât had a long exposure to above optimal apoB. Because age (time) is de facto strongest contributor to risk.
That article is just hilarious. Completely ignoring the totality of evidence including mendelian randomization. Itâs like a time capsule to a time before these new methods.
Are you going to keep cherry picking?
You have not yet mustered a response to the mendelian randomization and genetic studies.
Historically, before Rapa and Keto, it was in the 180 area. Thatâs LDL. And my Trigs were high too, like 145. I just wasnât worried about it because I believed I was bulletproof. Little misguided there. My diet included lots of junk, also some good.
I took a CAC and it was 285, so went on keto and lost 25 lbs. Itâs still gone after 2 years⌠When I increased my dosage of Rapa the lipids went so high my doctor insisted on statin and I even got a few doses of Rapatha (I think, is that the one you inject?) The statin didnât really agree and I was worried about the side effects. I have a lot of pain anyway and didnât need any more. So I quit those and reduced the Rapa and rode it out. Next year CAC was 323. I was worried, so went on 1200 garlic extract and increased my niacin until I could take 3 grams a day.
This brings it down to only a little above 140, which is what Lustgarten says is optimal for all cause mortality. Iâm 62 and I can run 2 miles in about 17 minutes. I do that and weights 3 times a week and my work is pretty physical too.
The only reason I considered a statin and tried it for awhile is because I trust Chris Masterjohn, and I know heâs smarter than me. Otherwise I think LDL is doing important work and should be left alone. I know itâs correlated with ASCVD, and lowering it may slow the progression, but I donât think itâs the cause. I like treating the cause and the LDL should go down by itself. Thatâs not what Iâm doing, but thatâs what Iâm aiming for.
Improved diet (keto)
improved microbiome (I take all the biotics, including post)
exercise
improved hygiene (oral and skin, postbiotics take care of gut barrier)
I like your passion, but you should read Lustgartenâs free book if you havenât. Itâs called Microbial Burden, and what we can do to fight back. It really opened my eyes about whatâs going on. Itâs very short.
No, LDL causes heart disease as all of the randomized controlled trials and genetic studies show.
The higher your LDL is above optimal the more youâre increasing your own causal risk for heart attack. Even reducing LDL from 70 mg/dl to 30 mg/dl reduces events. Over a longer time period a higher reduction.
Thatâs the data. Thatâs reality. Itâs really simple.
The rest is just stories and storytelling.
These 8 life style factors seem reasonable. I like that it reduced all cause mortality, the only thing that really matters. There was 30 years of follow up. They included sleep which is a real positive. Iâd also like to see measures for chronic stress reduction and biomarkers of inflammation included.
Youâre linking an association study, you cannot say it âreduced all cause mortalityâ. âIt is associated with lower all cause mortalityâ is correct. That type of information I think can be found in health and fitness magazines. Itâs not groundbreaking or coming close to figuring out whatâs real.
Because rapamycin raises LDL and other lipids, people who are taking rapamycin now want to make the case that low LDL is not important, despite the facts. There may in fact be a âsweet spotâ for low LDL. But, studies showing that extremely low LDL levels increase all-cause mortality do not take into account all of the confounding variables. I am not an advocate of extremely low LDL levels, but I certainly think we should keep it in the normal range.
A recent article in the very prestigious journal JAMA by cardiologists at the University of California and editors of JAMA Internal Med. They discuss in detail the indications, benefits, and risks of statin usage in primary prevention.
In summary, when it comes to primary prevention of the low risk patient and the life time use of statins, the benefit/ risk ratio favors risk. Or, as they conclude, â time to curb our enthusiasm â.
Sheâs going in for the tests this Friday. The cardiologist was older and experienced. We should know more a few days after the tests are done. Hoping for the best.