20 years ago, when this study started, it was still considered bleeding edge science to even consider that (or a proxy, particle size), and they recorded all of the wrong values
A quick glance through the paper does not indicate they measured particle size. It also seems they may have measured LDL/HDL/TG fraction, but then did nothing with it (which basically puts this paper at the technological level of the 1950s).
Neither total cholesterol nor LDL/HDL/TG fractions can accurately predict mortality, but particle size can. LDL-P et al tests are quickly becoming the norm as younger doctors enter the field, and their education is more up to date than their older peers.
There is a 6 hour lipid series in YouTube where they go into the details: https://youtu.be/5iGl3iPZDis?si=fzL6zmX-iqkF7wF-
I noticed heart disease was called out as a co-morbidity to high cholesterol. A lot of cardiovascular disease is caused by excess LDL cholesterol.
https://my.clevelandclinic.org/health/articles/11920-cholest...
In the discussion section of the paper, the authors write:
"The current cholesterol guidelines are heavily based on heart disease risk and recommend a TC range of <200 mg/dL as desirable. TC range <200 mg/dL, however, may not be necessarily a sign of good health when other diseases are considered. The diseases associated with lower TC levels and potential mechanisms have not been conclusively identified."
Time to eat more cheeseburgers?
Low cholesterol (hypocholesterolemia) is commonly observed in critically ill patients. This could be driving the correlation and doesn't mean that if you lower your cholesterol you will increase your risk of dying.
Regarding your 'low-impact' comment I have a few thoughts. 1. Although this is a large study, they do not find any world shocking new insights that are otherwise found in other studies. Cholesterol phenotypes are very well studied. Changing a guideline is usually not done based on a study of a single population. 2. They do not account for medication usage which confounds results. 3. They do not find a causal relationship between cholesterol and mortality, only provide an association.
>Although cholesterol is protective against oxidative and cytolytic damage, the chronic free radical exposure will oxidize it. During the low cholesterol turnover of hypothyroidism, the oxidized variants of cholesterol will accumulate, so cholesterol loses its protective functions.
>In the healthy organism, cholesterol is constantly being synthesized, and constantly converted into steroid hormones, and, in the liver, into the bile salts that are secreted to emulsify fats in the intestine. Thyroid hormone and vitamin A are used in the process of converting cholesterol into pregnenolone, the immediate precursor of progesterone and DHEA. Anything that interfered with these processes would be disastrous for the organism. The supply of cholesterol, thyroid and vitamin A must always be adequate for the production of steroid hormones and bile salts. When stress suppresses thyroid activity, increased cholesterol probably compensates to some extent by permitting more progesterone to be synthesized.
>In very young people, the metabolic rate is very high, and the rapid conversion of cholesterol into pregnenolone, DHEA, and progesterone usually keeps the level of cholesterol in the blood low. In the 1930s, a rise in the concentration of cholesterol was considered to be one of the most reliable ways to diagnose hypothyroidism (1936 Yearbook of Neurology, Psychiatry, and Endocrinology, E.L. Sevringhaus, editor, Chicago, p. 533). With aging, the metabolic rate declines, and the increase of cholesterol with aging is probably a spontaneous regulatory process, supporting the synthesis of the protective steroids, especially the neurosteroids in the brain and retina.
"Dr. Paul Mason — Why your doctor thinks cholesterol is bad"
https://youtu.be/j-nq60_oEIc?si=KX9MFMrC43NDJtVy
Then maybe follow up with "The shady truth about statins"
https://youtu.be/I7r4j1u42V8?si=QHxg7UDQFcBkMt2p
---
tl;dr: total cholesterol is a terrible health metric on its own, and depending on your diet, it might be both associated with shorter lifespan, or longevity. More valid diagnostic tools are available, but far too expensive for the GP office. And statins simply reduce this useless figure in a vacuum, but are not correlated at all with improved health.
Yeah you've got HDL, LDL and Triglycerides, LDL should be low (L) and HDL high (H) - that's my mental shortcut for it. Triglycerides should be low as well, but not too low. That's the one that has a specific bandwidth. A high HDL and low LDL could have the same TC as a low HDL and high LDL.
I have no idea why anyone worth their salt would look at the total cholesterol value without a breakdown of the _types_ of cholesterol. It's a meaningless number.
(I ask because my labs routinely show very low triglycerides - generally in the 65-70mg/dL range - which I've been told is a very good sign for heart health.)
In short, triglycerides should always be low, whatever your diet. Cholesterol depends on your diet: if lower carb, it is necessarily high, and is positively correlated with longevity. In higher carb, it means you are eating a lot of sugar w/ fat, which is terrible for your arteries and mitochondria, causing long term atherosclerosis and systemic metabolic syndrome.
It's all in the videos I've linked.
LDL = TC – (HDL + TG/5)
It’s not even a real measured amount, it’s a very rough middle-school-level formula, but people freak out about fluctuations of this number.
My recollection is that Koreans have a pretty healthy diet of meat and vegetables. It might be that they have higher HDL? So total is high, but they generally have a better ratio.
Cholesterol is a specific molecule, there is only one type, just like there is only one type of ethanol. (Modulo any isomers)
The "differences" (LDL, HDL) are essentially different types of "bucket" used by the body to transport the molecules through the bloodstream.
Those videos I linked contain dozens of research papers and data for you to cross-reference, but given your snarky one-line dismissal with no further elaboration, I don't think there's any intelligent discussion to be had here.
Tiny studies of very limited demographics, studies with questionable premises (like this one), in vitro being generalised to in vivo, conclusions that say "This effect could go either way" turned into "Don't ever..." advice, and so on.
This isn't anti-vax nonsense on YouTube. These are medical papers in mainstream medical journals which define medical policy.
Of course "poor" does not mean "worthless" so there's often still some signal in the noise.
But "you should lower your cholesterol" is a perfect example of bad research leading to bad messaging.
The science actually says you should manage LDL, HDL, triglycerides, and blood sugar and keep all of them in their healthy ranges.
Some doctors will tell you that, but many won't - because many don't even know.
There's no intelligent discussion to be had because the Keto “science” has been proven wrong repeatedly. At this point, I don't think it's worthy of respect, actually. And don't get me wrong, I don't want censorship or anything of the kind. People believing that crap will eventually realize that it hurts them, whereas a small minority will double down.
The problem with the Keto “science”, and its arguments, is that the goal posts are moved, much like anything non-falsifiable, and the studies that are supposedly in their favor are cherry-picked, or misinterpreted. Whereas, they dismiss studies or reviews that prove them wrong, even if high quality (e.g., RCT, pre-registered), based on non-scientific grounds (e.g., not long enough, use of the wrong proxy markers, etc.). What's ironic is that we do have year-long, high-quality studies on nutrition. Diabetes and cardiovascular disease are understood fairly well, but they rarely attack those. They are also full of double standards, crying “conflict of interest” from the “sugar and oil industry”, while not observing the conflict of interest in their backyard, including the conflict of interest from those peddling the nonsense.
And all the nonsense they spew on cholesterol is accompanied by a conspiracy theory involving Ancel Keys and his limited selection of countries to study. They conveniently ignore the facts that a selection had to be made post-world-war, as few countries had data available, and those studies are pretty good, actually, and his findings were replicated. Keto and conspiracy theories go hand in hand.
When I made the comparison with anti-vaxxing or homeopathy, it's quite a literal comparison. They have conferences and are “science”-based too.
And it's not a conspiracy theory to question the fact that since we introduced low-fat dieting, obesity has gone from being a circus attraction to common place. "We're eating too much" does not explain it either, and you just need to have read a couple papers after 1995 to see this is exactly where mainstream science is going. Calling it a conspiracy theory is not scientific rebuttal.
Again, there is no discussion to be had where there's dogma, and painting everything with the same brush, and certainly not on a forum comment.
Not nearly as many, unless you consider "unpublished people posting videos on youtube" to be "in particle physics." There is a meaningful difference between scientific communities that are centered in universities and wellness communities that are happy to include every influencer with enough followers on tiktok.
I don't really know about keto, but the problem as widely understood with obesity is calories, not just calories from fat. And the easiest way to onboard calories without realising is to snack on sugary food and drinks.
Also, your point relies on the idea that the population is doing low-fat dieting. They may not be in the first place.
The only sensible diet I know of is the No S diet[0], which is so simple (and free) that it fits into the hover title of its web page.
Yes, "thermodynamics". But we are not a simple furnace (which is by the way the very thing used to calculate the calories in food. A furnace). We are a complex machine with thousands of chemical pathways, feedback loops, some more efficient than others. You do not eat pure energy, you eat organic matter that is chemically turned into multiple forms of energy.
Nothing has been a better ally to the obesity epidemic than CICO (calories in, calories out)
I doubt that's true. The availability of Mars Bars and magic food diets (Fat is bad! No, now carbs are bad!) are more likely culprits. People don't fail to lose weight if they count calories. People fail to stick to their diets if they count calories, because it's a joyless activity; biology divorced from psychology.
The "it's less fat than cheese" isn't a calorie thing. You seem to be mixing things up.
There is also food => inflammation change => body water gain/loss.
Also big pharma and big food won't be sponsoring it any time soon.
You can find many examples of people who cured what their doctors told them "uncurable illness" by following keto or carnivore diets.
You can find 105 pages of testemonials how keto/carnivore helped people:
Of course the entire field is dubious, and then there's the commercial interests.
This is to say, actual success stories are probably the best we've got. In my experience, carnivore is excellent, albeit very restrictive for many.
as opposed to starting at a hypothesis and accepting any result, and any future hypothesis and result modifies everything, the only question asked is whether it can be reproduced and how the reproduction went
unfalsifiable beliefs have no capability of doing that, or, as you say, the goal posts keep moving. its just a flawed place to start from
faith based belief systems are taking advantage of people that lack the mental faculties to understand that others aren't relying on beliefs, they're relying on reproducibility and acceptance of any outcome
And it basically says that cholesterol limits need shifting, because lowest all cause mortality is observed in a different band that expected. A higher one, to be precase.
But if you want to talk science, new studies don't disprove what was found before. That's not how science works.
The consensus is that LDL causes CVD (atherosclerosis). I dare say that causality was established. Here's it from “European Atherosclerosis Society”:
https://pubmed.ncbi.nlm.nih.gov/28444290/
Here's one of the largest studies correlating risk markers (n.b., ApoB is the protein from LDL particles):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
TC measurements, of which the TFA talks about, are already ignored, BTW, because it's not accurate. This study may as well be valid, and further investigation is needed.
That doesn't mean previous findings aren't valid, and if you have a high LDL, chances are high for you to die of CVD. And I'm mentioning LDL specifically because that's what the Keto community cares about, since eating saturated fat directly increases LDL, with many in the population being “hyper responders” with a high risk, actually. Therefore, people that advise others to eat all the saturated fat they want, with no statins treatment or other lifestyle choices that may help, probably have blood on their hands.
If I reduce my own ACM and increase risk of a heart attack at the same time, it still looks like a good trade-off.
However, one must not read too much into observational studies, either, as many times their interpretation isn't corroborated by stronger science. A good resource for laymen on how to read studies would be this one:
https://examine.com/guides/how-to-read-a-study/
Meanwhile, minimizing the risk of CVD, the leading cause of death worldwide, does seem like a good idea, no?
This is the problem of modern medicine in a beautiful shortcut. Everyone is concentrated on their own domain. Oncologists treat cancer, cardiologists treat CVD. Few pay attention to the survival of the whole body, which is what you actually want.
Reducing the risk of CVD only makes sense if you reduce all-cause mortality at the same time. A therapy that would protect your heart at the cost of, say, increasing cancer risk, would be almost criminal to administer.
Now I don't want to claim that this is what now happens. But 12 million people in the developed world is an enormous statistical set and there likely won't be any weird outliers dragging the total result into implausible values.
Reading quickly through, I also notice that the overall effect of cholesterol on mortality seems to go significantly down with increasing age, which is something that has already been observed.
I certainly wouldn't be so favorable towards contemporary medications and at the same time so dismissive towards the observational studies. Quite a lot of CVD mortality reduction since the 1960s comes from surgery (stents etc.), from reduced prevalence of smoking and from early treatment of high blood pressure. Anti-cholesterol drugs are pretty deep in the list of interventions by total efficiency.
I am not dismissive of observational studies. I am dismissive of the attitude of the public when reading observational studies.
Maybe. I read a bunch of papers on cholesterol and statins a few years ago, and my recollection of the results is roughly as follows. High LDL and high LDL:HDL ratio are consistently associated with higher risk of mortality from CVD, and this seems to be partly (but perhaps not entirely) causal. Statins can lower LDL and can improve this ratio, and for some groups of patients they seem to be an effective intervention for reducing risk of serious or fatal CVD.
However, in the studies I looked at, statin therapy was only demonstrated to reduce all-cause mortality in certain groups of patients who already have CVD, or who don't have CVD but have extremely high LDL (or maybe it was LDL:HDL ratio, don't remember). In groups with lower risk, the benefits were not as great and seemed to be outweighed by the side effects in terms of all-cause mortality, and given that some of the side effects are immediate I would guess that this is also true for quality of life.
This also meshes with the article's data that total cholesterol has a U-shaped relation to mortality. To the extent that this is causal, lowering total cholesterol with statin therapy may not be helpful unless it was really high to begin with.
So my takeaway was that statins are a useful class of drug for some people, but that in America they are probably also overprescribed. My research might have gotten the wrong answer though. Obviously do your own and/or listen to your doctor.
I don't know what the ultimate answers are, but the arguments skeptical of the COVID [mRNA] vaccines-that-proffer-neither-immunity-nor-any-lasting-protection are on completely different grounds than what was previously called "anti-vax", being against vaccines that do provide lasting immunity. The use of the term "anti-vax" should not be used in such a confusing way, it would be like insisting on labelling a well known and safe anti-viral as "horse dewormer".
People weren’t disputing that ivermectin is generally safe. They were arguing that it’s not going to help you with Covid unless you have parasites like worms.
There is a real cost of lives when people eschew current best medicinal knowledge for homeopathic blog recommendations, like how Steve Jobs died of a preventable pancreatic cancer because he thought he just needed to eat fruit.
you don't know what you are talking about. from the NIH:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539925/
Ivermectin is an FDA-approved broad-spectrum antiparasitic agent with demonstrated antiviral activity against a number of DNA and RNA viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
And a very qualified statement at that. Barely a sentence later ...
Despite this promise, the antiviral activity of ivermectin has not been consistently proven in vivo.
By "demonstrated antiviral activity" they specifically mean that in places such as Brazil (and elsewhere) large spectrum courses of Ivermectin are positively correlated and associated with reduced viral activity (fewer sick and fewer dead from influezenza, covid, etc).
Does that mean that Ivermectin "kills" (or harms) COVID directly?
Nope.
It does mean (or rather strongly implies) that in places with relatively wide spread parasites in water, etc treating parasites improves community health.
Fewer parasites, better immune systems, nore people can fight off the effects of the flu, COVID, etc.
Who'd have thought, hey?
The excoriation and censorship of ivermectin before a study showed the confounding parasite idea, and the subsequent coming out of the woodwork to embrace that study, served to increase the sense that it was not about truth and research, but about only allowing certain messaging.
Given that evidence... the advice given to you by doctors is literally in the same class as homeopathy and anti-vaxxing.
Not exactly. Medical personell is (in general) not the research branch of science, but practitioners. They follow clinical guidelines and treatment procedures, and there's a delay to be expected before new results are evaluated and established. In contrast to homeopathy and anti-vaxxing, the system is designed to be able to catch up eventually (though usually not as fast as one could wish for).
Prior to this study it wasn't known. There was literally zero studies as comprehensive as this one. So it looks like they made a guideline up out of thin air.
Additionally I don't understand what kind of genius doesn't trust a YouTube channel providing more up to date and accurate information over doctors who you yourself admit are presenting false bullshit because of a delay?
Looks like logic isn't being employed here. It's just blind trust in established industries you were taught to trust as a child. How does a "name" of a YouTube channel in any way shape or form associate or correlate with correctness or accuracy? Don't answer, we all know it's typical human bias at play here. I prefer to call it human genius.
I'm not saying completely trust a YouTube channel. But don't deride that channel just because of its name and definitely don't trust doctors. Hippocratic oath my ass you see enough doctors you'll see not only is the science dangerously incomplete but they care about money more than your health. So a lot of doctors actually fucking straight up lie to you. It's common af. Genius.
I should go out and eat some ribs, and pump it up to target 220.
Low cholesterol (hypocholesterolemia) is commonly observed in critically ill patients. This could be driving the correlation and doesn't mean that if you lower your cholesterol you will increase your risk of dying.
There's evidence for another phenotype called lean mass hyper responder. Basically you can eat white bread and cheap sausage for a week, that will cut your cholesterol in half. But you'll feel horrible. Also glycerides will go up.
For other health reasons I stopped working out and eventually started eating junk food .
My chelesterol got cut in half !
The trick to read scientific papers is that unless you're in that specific field, skimming doesn't work. You have to read sentence by sentence and sometimes stop and look up terms you don't understand for the whole to make sense.
This sentence is an EVEN easier read and is more suitable candidate for an abstract.
Interesting though, seems that from a total cholesterol level of 200 to 229 mg/dL (or a bit lower optimal range for the youngest age groups), raising the level causes increased mortality, but below that level, raising it decreases mortality even more than raising from a high level increased it, so it seems like ‘cholesterol == bad’ is wrong, having really low levels (it seems) can be much worse than having high levels.
The second bit seems to say that increases from the high range were worse (increased mortality rates more) for younger people and but the effect decreased pretty linearly as you go up through the age groups, but the positive effect of increasing from a low level was pretty consistent for each age group, except for the youngest and oldest group.
I think sex will get me before age does.
They should have done the study based on gender, rather than sex. This study is discriminatory against trans people so its inherently anti-trans.