Dave Feldman Profile picture
Sep 28, 2018 50 tweets 18 min read Twitter logo Read on Twitter
1/ Finally getting around to watching the @joerogan podcast with @drjkahn and @chriskresser. I’ll be tweeting occasionally responses into this thread....
2/ at around 13:30: @chriskresser “Back in the 13th century you had Frances Bacon who said for something to be scientific it has to be independently measurable, and falsifiable, and then accurate and valid.”...
3/ “... If you’re sitting there eating an apple. And I’m watching you do that. I can observe you’re eating the apple, I can measure how much is the apple you eat, and I can confirm or refute that you were eating the apple...”
4/ “... if you tell me that you were eating the apple 15 years ago, or 10 years ago, I obviously can’t observe that, I obviously can’t measure it, and I obviously can’t confirm or refute it.”...
5/ and this, my friends, is why I — Dave Feldman — literally take a picture of every last thing I ingest with either a scale or my hand in the picture for a volume reference. I can tell you with perfect clarity anything ate on any day in the last 2.75 years.
6/ OH MAN! --
@chriskresser "Let's step back a little bit... total mortality is the most important endpoint we should be talking about..." WHOA!!! Who do you know, dear reader, who pounds the All-Cause Mortality Drum every single day? (Hint: )
7/ "If an intervention reduces the risk of a heart attack and increases the risk of cancer, I'm not happy with that. In fact, I'd rather go out with a heart attack in my sleep."
8/ "So you need to consider total mortality."
Thaaaaaaaaank you, @chriskresser. I've been feeling so lonely on this seemingly All Too Obvious Crusade.
9/ Okay, so I'm here at 43:20 and things are getting intriguing with @drjkahn's cholesterol discussion. While I'm sure many will be interested in my critiques here, I'm going to call out Joel for what I feel has been a very professional and respectful performance thus far...
10/ I realize I'll get a lot of flack for this as many of followers and #lchf/#keto friends as, like me, may disagree quite a bit with @drjkahn -- you should all know just how much I appreciate constructive, open debate and I think Joel has exemplified that well to this point...
11/ So there's a long stretch here where there's some conflating of "saturated fat and cholesterol" with heart disease which I always try to avoid myself. Discussion of saturated fat = CHD should be separated from cholesterol = CHD to better discuss the evidence independently...
12/ With regard to "more saturated fat = more serum cholesterol", I think this is *generally* true for many, all things being equal. But I don't believe it is due to higher overall dietary absorption of it comparatively. I believe it's more VLDL-TG trafficking (see blog)...
13/ With regard to "every major health organization" and "100 years of research" -- I obviously have an enormous bias given how much I'm demonstrating (and now @siobhan_huggins, @tigriscraig and 100s of followers) the dynamism of the lipid system...
14/ To put it bluntly... well... I'm going to refrain from what I want to say...
15/ @drjkahn "I'll give you a classic study. If you hold sugar the same and increase dietary saturated fat, heart disease rockets. If you can hold saturated fat the same and increase sugar in these manipulations CHD doesn't increase." I'm interested... linkage, @drjkahn?
16/ Hey! @chriskresser debuts "Hyper-responder" at 53:42!
17/ Okay, everything @chriskresser says starting at 1:01:37 is absolutely fantastic and well worth a listen with regard to observational studies and randomized control, bradford hill criteria, and replication.
18/ Ahhhh... the SNPs and MRs arrive at 1:09:40... @drjkahn mentions the study of nine -- but that's actually a tiny fraction of the total known to impact LDL cholesterol.
19/ @chriskresser : "These RCTs are not short term, many of them go up to two years in length. If we're going to see changes in lipids, we're going to see them within a few weeks and certainly within a few months." <--- proof @chriskresser hasn't seen my work yet!
20/ Future @chriskresser : "We'll be seeing these changes in a few days... " 💪💪💪
21/ Per my earlier point, as @chriskresser states here: "The other problem is they were using cholesterol as a proxy marker. They weren't looking at -- did people eat saturated fat and die more. They looked at -- did saturated fat increase cholesterol."...
22/ @drjkahn "Saturated fat lowers LDL receptors in the liver..." at 1:16:20
... @drjkahn, can you link?
23/ From @drjkahn : "I'm not hear to actually negate the data... I'm looking at people walking into Wendy's, and Hardy's, and McDonalds, and hospital cafeterias, and gas stations -- that's what we need to shut down and we'll make a major difference..."
24/ ..."If all we're left with is Chris's diet, Joe's diet, and Joel's diet, we're going to have an amazing country. Then you can decide what you want."
25/ @chriskresser : "And let me clarify something too, I'm not just talking about biomarkers. Biomarkers are important. But I'm the one who was arguing to look at total mortality as the most important endpoint. And mortality from any of these other diseases." Thank. You. Chris.
26/ Aaaaaaahhhhhh...
..at 1:41:00 @drjkahn : "It takes a heretical conspiracy attitude to say, 'everybody's got it wrong for 60 years', 21 international societies have it wrong." -- while I've brushed off most of the appeals to authority to this point... this one was a biggie.
27/ Here we go -- big cholesterol gets the spotlight at 2:12:40...
28/ @drjkahn : "If you're lucky enough to be born with a low level of PCSK9, your cholesterol is lower, you have less disease, you live longer. That was part of the data I published in 2012..." Ah! I'm very interested in the "live longer" part of that statement...
29/ Alas, I have bloodwork in the morning (surprise!) and I need to head to bed soon. I'll have to pick up this epic debate tomorrow.
30/ I gotta say this before I pause this thread, @chriskresser up to this point (2:33:00) is crushing it. He's extremely prepared and very relaxed overall. His study recall is very impressive and he keeps making a great case for both strong RCT data and ACM. (But I'm biased, ofc)
31/ Resuming debate video. I have to expand on my earlier compliment of @drjkahn. While I think his first hour was very respectful/solid, I do feel there's a few points coming into the middle that were a bit less so (such as the loud sigh into the microphone)...
32/ Having been a parliamentary debater in high school & college, I probably provide a bit more leniency for interruptions than most. But negative exasperations are needless, non-constructive, and can risk coming off as emotional grandstanding.
33/ But that said, overall, I still think all three people in this room are doing extremely well at keeping this thing meaty and drilling down into the differences... (thus far)
34/ Okay... things get really interesting on the TMAO discussion that starts here: 2:35:26... @drjkahn brings it up, gets challenged by @chriskresser, and @joerogan continues follow up questions in an effort to clarify the argument...
35/ Dang -- I have to go get blood drawn and pause this again. This debate is really quite interesting, especially at this point in the video. (I half feel like I'm binge watching a @netflix docuseries)
36/ Back!... now where was I... oh yes, the TMAOs...
37/ @chriskresser summarizes this quite clearly, "If consuming food that raises your TMAO increased the risk of heart disease then you'd see people eating the most fish having the most heart attacks." in response to @drjkahn's position...
38/ @drjkahn backs up to point to multivariant, such as added o3 as potentially another confounder toward offsetting cardiovascular risk. But I think the reason @joerogan and @chriskresser are leaning on this so much is the magnitude of difference (20 fold?) is so pronounced...
39/ So we're left with the impression that either TMAO is not that big a deal, that the science is still too new and uncertain, or both. And the thing is, this seemed an unusual spot to argue the evidence was actually much stronger...
40/ Fish increases diabetes? I can honestly say I had never heard that asserted up to this point.
41/ @drjkahn "Jamie, you're bad man."
Jamie off-camera: "What did I do?"
😂 Props to Jamie for sticking up for himself.
42/ Waaaat? 🤨
@drjkahn : "You should be concerned that animal protein accelerates aging through mTor and IGF-1."
@joerogan : "Is that true? Has it been proven that animal protein accelerates aging?"
@drjkahn : "If he says 'no' then we should just stop."...
@joerogan : (Laughs) "Why?"
@drjkahn : "Because it's world class science. I mean..."
@joerogan : "But just because you say it doesn't mean it's true."
@chriskresser goes on to make a concession on what he's "open to the possibility for..." with regard to high levels of methionine in the absence of glycine, nutrients like b12, b6, and folate, "some of the animal studies suggest this can impact longevity..."...
@chriskresser explains this is why he advocates nose-to-tail to ensure the nutrition compliment.
46/ Are you kidding me??? This stretched up to the @BioLayne and @DominicDAgosti2 live discussion on @joerogan?
... Sorry, gonna have to pause again... (you understand)
47/ 3:36:45
@chriskresser : "All that you have said which I agree with... is that a plant or vegan-based kind of diet compared to a Standard American Diet will reverse markers of atherosclerosis."...
48/ So this is a tricky one because I think what Chris was trying to emphasize how a (nutritionally complete) plant-based diet is better for risk association regarding atherosclerosis in relative terms. If he's actually conceding plant-based = reverse athero, I'd want to talk...
49/ To the best of my knowledge-- and anyone feel free to correct me (like @drjkahn)-- all studies regarding #plantbased are neither RCT nor isolated to the removal of animal products only. Each one involved many lifestyle and diet changes unrelated to just being plant-based.
50/ @chriskresser at 3:37:40 mentions my dream study of having three groups: a control on a SAD diet, a #vegan diet, and a #nutrivore diet (I dig that new term). Would be tricky to execute in an objective way, of course. But it sure would give us some powerful data.

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