LDL cholesterol in perspective with Ron Krauss, MD - Diet Doctor Podcast
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- Опубликовано: 30 июн 2024
- LDL cholesterol is one of the most controversial topics in the low carb world. On the one hand, conventional teaching is that elevated LDL is dangerous and needs to be lowered. On the other hand, otherwise healthy individuals following a low carb lifestyle have not been represented in our available data. How do we reconcile what to do?
Dr. Ron Krauss helps us understand the nuances beyond LDL-C and how we can use all the available data to help us better understand what we know and do not know about cholesterol, including LDL, HDL, triglycerides and Lp(a).
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Wow, he is a REAL expert with an in-depth knowledge of the subject and he chooses his words carefully, which is rare these days.
Yes chose was too carefully. Close this monotone baritone voice, I have to rewind a few times to get what hes saying.
Thank god for experienced drs like this experienced one. He could easily just say "my work is done here - Ive been in this field xx yrs -some one else please take on this challenge". Instead he is swimming against the current of many years to help those of us, who are probably a large percentage, are much younger than he, who dont have his experience and knowledge. Thank you Dr Krauss for your service! I hope you see this comment.
You might notice also that Mr. Krauss says many times that we just do not know the finer details of many aspects of his research ...
Thank you so much for a clear presentation. Your questions to Dr. Krauss and the exchange of information between the two of you just simply amazing.
Dr Krauss needs to narrate books and films!
For my own self, high triglycerides is a proxy for SDLDL. Test LDLP, start intervention, then wait until TG goes down well below 100. Retest LDLP to see if improves. No point in expensive test until TG changes.
Best channel in the nutrition space. Keep up the great work.
Very informative interview! Professor Krauss is a serious researcher.
It is 3 years now. I wonder if Ron Krauss has done any study on high responders.
I never get tired of watching this video. I hope this gentleman has younger peers and mentees that will continue and flush out more of the body of work this man has created.
Dr Krauss is a Giant in the field of sorting out all the confusion and misinformation surrounding the risk of Cholesterol. He pioneered the techniques that enable us to measure lipoprotein number, size and character, taught us all what really causes heart disease (Particle count and size distribution) and he deserves a Nobel Prize. You can take what this incredible physician says to the bank. You'll live longer if you do. Thank you Dr. Krauss!!!!
Great conversation - this in conjunction with the Peter Attia more recently has been very useful for my understanding. Awesome.
Great inteview, Thanks a lot for the highly esteemed doctor for taking the time to share his knowledge.
Great interview! Thank you!
Thank you both!! What a great interview.
Excellent interview! Thank you! Wow! The more we know - the more we don’t know. One thing for certain - we need to know more than we do😉👍
Wow! Just watched this entire interview a second time in one year. Still excellent!! Learned some more. Thank you both 👍👏
Super useful and informative. Thank you.
Fantastic information and great sound in this vid
Would be interested in his thoughts on Vitamin C status as a LP(a) risk factor.
That was an awesome interview!
After reading "The clot thickens" by Malcolm Kendrick, it seems to me that Ron Krauss (who definitely moved the Overton Window) may now be a bit behind the latest thinking. Kendrick makes a good case as to why atherosclerosis is not a build-up of LDL, as Krauss states.
Great interview! Sounds like the science is just not there yet for those of us with slightly raised LDL. Given the side affects of Statins seems a risk either way.
LP(a) can go up with high carb intake 37:34 in some people. They don't have a good way to know from genetic testing who those people are. It seems clear to me that if you have a lot of LP(a) you should try lchf.
@@iss8504You are assuming that the person is not doing some version of low carb. How do you know if he is doing high carb? Low carb is not just what the current "keto diet" declares of under 20g. Low carb can be under 60g or even up to 100 carbs. I prefer under 60. LDL can shoot up from a heavy switch to predominately carnivore and yet all my other markers - all of them - continue to be just fine, normal range. Frustrating as I do not want to go back on statins.
FORMER NIH OFFICIAL!! WORDS FROM THE INSIDE OF “THE GARDEN PATH” as Dr. Krauss puts it. I’m just now crawling out of a 30-year rabbit-hole journey through Statin use and subsequent Type II diabetes diagnosis. I don’t recall ever hearing about the LDL particle size measurement/identification.
I had come to accept my high number with LDL until I was denied life insurance recently. Now I just don’t know.
If you are APOE4 your liver will suck up more dietary fat from cholomicron remnants and thus be less able to suck up (clear) circulating LDL resulting in too many SDLDL. That's me. Trying to see if eating less fat helps. Working with my doctor Nadir Ali on this.
Any updates on this effort?
Talk about walking the tight rope between true fact and bullshit. AGAIN...Bret Sher delivers "THE INTEVIEW". This is the best informative podcast on the web about nutrition!
Very happy you were able to talk to Dr. Krauss. He's obviously a very intelligent and influential guy and surprisingly agreeable.
Mostly for my own benefit I'm giving him a thumbs down just so I don't watch his video again. I think what he shows is how easily you can Target a group of people through genetics and bad dietary advice. Scary.
I am a diabetic with high triglycerides. I just started intermittant fasting and my sugar readings and a1c have gone down. I expect that lLDL will be up. time to live and forget these numbers!!!!
Vary interesting Dr.Krauss. thanks for your research.
YES! Always learn something important frm Dr Kraus!
Unfortunately unless you live near the ocean, wild-caught fish is too expensive. Our stores are filled with farm-raised fish which is toxic (look on RUclips if you’re not aware of this issue). Also, glyphosate is toxic and used on many of our crops. This is also a big issue which must be addressed.
Sardines, Mackerel?
@@jerseyjim9092 … Herring?
@@asarcadyn2414 not sure ive ever tried them or noticed them on my store shelves but they also look like a good option.
@@jerseyjim9092 I can get them freshly filleted as I live near the North Sea (Jutland, DK) but they are also great smoked and canned as kippers, which you can probably get anywhere. All three small fish are powerhouses of nutrients and have pretty much zero toxins.
@@asarcadyn2414 do they taste similar to sardines or other fish or do they have their own unique taste?
Dr. Krauss does a great disservice to all people by not reversing the AHA nutrition recommendations regarding carbohydrates and fat. There are no excuses that are acceptable to making this change.
AHA is funded in large part by the pharmaceutical companies (Abbott, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Merck and Pfizer to name some of them) and the food industry, which pay from $5,490 to $7,500 per product to gain the "heart-check mark" imprimatur from the AHA, renewable, at a price, every year. ("Huffpost" February 15, 2014) That's why they don't change their recommendations. Dr. Krauss is/was on their payroll.
so this was extremely informative
that in the context of genetic variation, the LDL particle number is extremely important, and perhaps a statin is appropriate in general
In the context of metabolically healthy individuals, again, LDL markers need to be considered in an individualistic manner.
Think I can take away from this that
LDL particle number matters - as generally, the standard tests are capturing the "smaller dense/ arthrogenic particles" in this instance...
However, in the context where a metabolically healthy individual with no family hx/ genetic hx having a high particle count - may need a further review into the subsets of those particles to review true artherogenicity.
A novel subset being -- in the context of a Low carb high fat diet (very low carb 5-50g/ day), where this picture may show elevated LDL-c which can be usually comprised mainly of large LDL particles, along with high HDL and low TGs, there may not be an elevation of risk..however, if there is a famhx/genetic component here - quantifying that risk or lack there of matters using more detailed testing, usually unknown to the general practitioner.
Dr. Krauss it would be beneficial in studying the negative effects of statins to look at dementia precipitation as a result of taking statins. My wife was on statins for 2 months and she started to have a noticeable dementia related to very short term events - she was not recalling things that she did only hours previous.
This happened to me 6 months ago. I'd only been taking statins a few months when my memory deteriorated. I was putting myself in danger - windows left wide open at night, forgot about food in the oven etc. I stopped taking them when I googled side effects. Thankfully I'm now back to normal.
He said in this interview one of his current appointments from the NIH is working on the adverse effects of statins.
It would be interesting to hear what Malcolm Kendrick thought about the explanation of LDL particles and arterial plaques presented here. As I understand it, LDL is not taken into the artery wall, but what is seen as plaque-included LDL is actually products of a clot. Link here: ruclips.net/video/8wkxp-l2c68/видео.html
I would suggest being very careful about using "Subtitles/closed captions". They are not always correct. For example, at 29.33 the closed caption uses the word "assistance" when the spoken word is "resistance". And, a few seconds earlier, "worthy" for "were these".
How many have their life shorten from this cholesterol scare.
And the whole fat scare that is been going on in the last 50 years.
I'm in that subset that cannot follow those dietary guidelines without negative effects. Insulin resistance.
Thank you... Not what I hoped to hear re: Lp(a) but sobering opinions from a giant in lipidology.
I have been following keto since March of this year. I have had high triglycerides for a very long time. I had a heart attack in 2014. I have since brought them down, quite a bit. I had blood work done in April they were 191, following l.c. low fat, down from 347. I just had blood work yesterday. My triglycerides are 289 now! I've been watching as many videos as I can find, advocating keto. Can someone please, explain to me how eating higher fat is supposed to be better? Clearly, this has been found not good, for me.
Cutting down or eliminating sugar or carbohydrate from your diet, while eating high fats will increase your HDL and lower your Triglycerides. Also don't snack between your regular meals. Don't eat out of habits. Eat until you are full twice a day only. Your blood test may show high LDL, with high HDL and low Triglycerides. But do look at the particle sizes of your LDL. If the small density LDL falls within the good range, you are fine even with very high large density LDL particles. Don't let your uninformed Doctor tell you that you are going to have a stroke or die from a sudden heart attack if you are not taking a statin drug to lower your total cholesterol. That blood test showing your total cholesterol out of range may have to do with that LDL reading having lumped together the small density LDL (bad) and the large density LDL (not as bad).
@@HKships4TeresaTeng2 and no vegetable oils
Mt grandfather, father, physically fit cousin died of heartattacks in their fifties,, so now I have a clue, thank you
Dr. Bret Scher: "Is the benefit of statins that great?" It's time for ALL doctors to stop promoting (harmful) lies from big pharmas?
Good stuff
So is it the proportion of SDLDL or the absolute number that constitutes risk? I have a lot of SDLDL but have a lot of big'uns too.
great interview. Hard to believe most doctors continue to use HDL/LDL test to establish risk.
Bottom line: American medical association and heart association monopoly needs Congress attention to break up. The medical profession owes us a huge apology, return our money, and move forward to get help from physicists and engineers on how to analyze data and determine causality. Physicians need the help of their own fellow doctors: psychiatrists! Your loyalty to errors and ignoring data is criminally insane.
So if you eat too much carb. or carbs with fat, the LDL goes stale and oxidizes?
Seed oils and a lot of refined carbs
Checking peoples insulin levels is a much better indication of heart disease than checking for sugar. The insulin can be rising for years responding to high sugar levels, keeping them in check but still the high insulin would have prevented years of heart disease from an insulin test.
My glucose levels are in the normal range so I would say my insulin levels are ok (even without having that tested). Then I guess, based on what you stated, that heart disease is not indicated by those factors. But some of my lipid panel readings were a bit off. Hmm....
@@David_144 Everytime your insulin rises in the presence of high glucose over time this makes the insulin less effective….it takes more and more insulin to pull down the glucose. The rising of insulin and high levels of insulin will let you know about heart disease before the glucose becomes a problem. By the time glucose is staying high because the insulin is no longer responding effectively there has been years of heart disease. It is high glucose not fat that causes heart disease. The prolong abuse of intake of carbs renders the insulin ineffective and that is when people are diagnosed as pre-diabetic or diabetic. But the high levels of insulin is harmful to the body as well but the body is trying to keep you alive from the damage of sugar but causing the insulin to have to be elevated is harmful to the body as well.
@@DarleneDeSilva My glucose levels are always good, not being or staying high so I guess I have no insulin problems and am not in danger of heart disease. Is my interpretation correct?
@@David_144 many people have glucose levels that are good because the insulin has worked so hard pulling it out of the blood stream but storing it as fat. By the time the glucose levels go up, you have had years of fat build up in the arteries.
@@DarleneDeSilva Got it -thank you! Well at least I have not had any insulin resistance symptoms
He is so cool....
My LPa always says
I can’t get my dr to move beyond the standard cholesterol tests. I did get a CAC scan in 2019 and my score was 67 and repeated the scan again this year with a score of 49 and I’m 56. I eliminated all vegetable and seed oils and keep my insulin and glucose levels low.
CRP, heart inflamation, Trigl. HDL, if those numbers are within their range it is more likely your LDL its majority would be "fluffy" particle good ones. if you have high Trigl. low HDL more likely your glucose, LDL are high LDL with the wrong crowd, small oxidized particles which are a problem. watchout. there is a test for LDL as well as HDL breakdown. try intermittent fasting. Listen to Dr. Jason Fung or Paul Mason better yet Dr. Nadir. they are "Open eyes" to what we have been misled.
On a statin?
Spoke of a result of a N=1 result where someone was able to dramatically effect Lp(a) with lifestyle intervention. What was the intervention ? Diet? Please specify?
N is sample size. So what he's saying there is that if you keep reducing the population size that you look at, the measurements become less and less useful till you reach N=1. Which is just a sample of 1
Is lp little a same as pattern b cholesterol?
Isn't it true that blockages are not associated with events? 18:00
Krauss may like to be more progressive, but he seems content to simply agree when Scher says what NEEDS to be said.
Why does no one talk about lipoprotein a? That is known to be a risk factor but is rarely measures and never discussed.
If statins only lower big particles that aren’t even harmful then what’s the point?
Seems like cholesterol is too complicated to control for benefits
so what statins target particle size ? Until that is worked out is it not best to avoid a high fat/cholesterol diet ? I am all for a sausage muffin if a pill with no side effects can wipe out the bad effects. Hey, if eggs only give me a harmless fluffy ldl I will eat up. This sounds like wild speculation here.
I'm surprised that, at the time of this podcast being uploaded (Dec. 2018), Dr. Krauss is still referring to "whole" grains (whole-schmole or otherwise) as a healthier form of carbohydrate. We, as humans, have no business consuming the seeds of grasses. Grains/wheat, etc. are extremely inflammatory to our bodies, and thanks to Big Food and Agribiz, there is virtually no such thing as a naturally occurring "whole grain" left on the planet, anyway. Additionally, in some cases, their conversion to glucose in our blood is as high, or higher, than table sugar. WARNING: Eat grains at your own risk!
Did you not even make it 10mins in? He covers that.
@@kant12 , I had to stop listening at minute 13:00. I have a vast amount of reading and podcasts/vids to keep up with. If you are telling me that I will learn current information about grains by watching the rest of this vid, then I will.
@@DonyaLane He doesn't go into details but he points out that there is a lot of confusion over the topic and that only certain kinds have the needed fibers to slow the digestion process enough.
Ron Krauss: godfather of lipids
There's no better diet than naturally raised and processed foods
Creative protein
With so much genetic testing available.. is there a benefit to know if one has a single (hetero) or two (homo) copies of the familial hypercholesterolemia (FH) gene variation?
I understand small LDL particles and lp(a) tend to have longer residence-time, and so measuring the number of particles (either by LDL-P or APO(b)) is a better CVD metric since small particles are usually the ones proliferating.. however, what does a good lipid panel look like? For example, what does Dr. Krauss like to see for ApoB/ApoA1?
Also, would have loved to have heard his thoughts on niacin. it seems to move all the numbers in the right direction.. preferentially lowering small LDL particles, lp(a), and triglycerides, while raising HDL-C.. yet is it actually effective in reducing CVD mortality? For example, perhaps its raising HDL without using APOA1? And unlike PCSK9 inhibitors that inhibit the PCSK9 protein from killing the livers LDL uptake receptors, perhaps Niacin lowers LDL via some other mechanism?
(BTW, there's an interesting Niacin book that talks about the work by Abram Hoffer.. suggesting niacin can help with everything from CVD to bipolar and schizophrenia disorders!)
What about the role of Vitamin K2? Does calcification happen independent of cholesterol oxidation/inflammation/rupture.. i.e does adequate K2 levels only prevent atherosclerosis that was caused by calcium deposits.. not by cholesterol deposits?
Finally, regarding the balancing act of whether or not to prescribe statins due to its upside in high risk patients, versus the side effects (muscle damage, diabetes) for those not in high-risk.. what about dementia? Isn't there also a danger in reducing ApoB and lp(a) so low that you block (Bloch pathway) in the Cerebral Spinal Fluid that converts desmosterol into cholesterol?
1.) The diagnosis of FH is phenotypic, not genotypic. There are thousands of mutations. You'd drive yourself nuts trying to hunt for them all.
2.) Dr. Peter Attia says that for general prevention and longevity, he targets LDL-P for 1000 (or lower). For the purpose of trying to prevent a second heart attack (or in the presence of objectively confirmed heart disease, e.g. >0 CAC score), his target for LDL-P is 600 (or lower).
3.) Dr. Thomas Daysping (a lipidologist and Dr. Peter Attia's mentor on this subject) says that niacin is worse than useless. Don't prescribe it and don't take it--in pharmacological doses, anyway!
4.) Calcified plaques are stable, and as long as the disease is stable, the patient is safe. There's no good reason to want to try and decalcify the plaques. That said, you want to ensure adequate intake of vitamin K2--along with the other fat-soluble vitamins, because they're necessary for good health.
5.) Statins have no effect on dementia; they're neither protective, nor do they increase risk. There's no danger of driving down LDL too low. However, if you're concerned about inhibiting cholesterol synthesis within the CNS, you can use Crestor (rosuvastatin); it's water-soluble, so it stays mostly in the liver.
If you need references for anything, you're welcome to ask in your reply.
@@Nmethyltransferase
Thanks!
For #2, do you happen to know how this corresponds to ApoB100? Not many labs offer an affordable LDL-P (NMR) test, so the poor-man's proxy of ApoB would be the more practical test for me.
For #3, could you point me to what data Dr. Dayspring is referring to? Aside from the flushing discomfort, I haven't been able to find how it's harmful.. especially considering how vitamin B3 (in the form of NR) seems to be so in vogue these days!
Finally regarding #5, I understand that unlike PCSK9, statins (ex. Atorvastatin) work by inhibiting HMG-CoA reductase (the first step in cholesterol synthesis).. however, I can't remember where I read it, but I thought the connection with dementia is complex, and it has not been ruled out as a possible contributing factor on why the rate of AD incidence is outpacing the increase in lifespan rate.
@@bennguyen1313
National Lipid Association and American Heart Association guidelines say 100 mg/dL of ApoB100 for prevention of a first heart attack or stroke; 80 mg/dL for prevention after a second heart attack or equally high risk. I don't know if those numbers are "optimal." And I don't know how they correspond to LDL-P.
peterattiamd.com/tomdayspring4/
That episode should answer all of your relevant questions. If you want the show notes, you'll have to pay for a membership. I'd only do that if I actually like Dr. Attia's content and want the show notes for other episodes of the podcast as well. A nominal donation for a month gets you access to the show notes of all the podcasts. Or you can use your Google-fu to try and look up the studies they mention.
I'll just add that if you don't trust statins, I doubt any amount of data will convince you that they're worth it. I think your best bet is to go to a cardiologist and see if they can twist your insurance company's arm and get them to pay for a PCSK9 inhibitor. Prolonged fasting (5 days water fasting in a row, every month) and donating blood as often as you can might also help. Fiber (up to 100 grams a day), Welchol, Zetia, finofibrate, amla--or some combination of those, with or without the lifestyle changes and/or PCSK9 inhibitors might help you get to your target.
I need your help! Keto 2 years. High LDL-P low dense LDL APOb 178 VLDL 11 triglycerides 90, HDL 49 age 63.
You can find the full guide to cholesterol on our website.
www.dietdoctor.com/low-carb/cholesterol-basics
--Kristin
I am always wary of medical experts who carry excess belly fat. Understanding of lipids has moved on from when this was recorded.
I do not see a healthy, robust and fit man. Quite the contrary in fact.
It’s funny that nobody actually knows what’s the best dietary approach or what can eliminate oxidized LDL.
Ummmm, avoid processed carbs and seed oils? Eat clean?
I love the information and expertise of Dr K but what a dichotomy. Obese expert guest, lean healthy host. Makes me scratch my head a bit. Physician heal thyself.
On the wide shots: either Ron is a giant or the diet doctor is a hobbit. Can't figure it out!
Smokers voice ?
maybe more because he looks almost 7 feet tall
@@DolceArdore ... and Bret still looked half his size. ;)
Old man voice?
@@Arjeebee With that big chair Bret was sitting in, it looked like an Alice in Wonderland set.
Ron Krauss needs a cardiologist & dietician himself !!!!
He is a part of the problem, the NIH. He still recommends statins when there is little gain and more harm!
He was instrumental in the current USDA food guidelines!
Ford Brewer recommends low doses of statins because of their anti inflammatory effects, not because they may lower ldl. For some people it may be beneficial.
Rx Statins are missing the point, the problem is not cholesterol but high insulin levels & triglycerides concurrent with Low HDL. Platelet Aggregate factors ARE THE CONCERN.