Dave Feldman: stress testing the lipid energy model

**Peter Attia** (0:04)
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All right, on to today's guest. Now, this is gonna be a slightly longer introduction than normal apologies in advance. If you positively, absolutely don't wanna hear it, just skip ahead, I don't know, five minutes or so. If you're a low-carb enthusiast, you've undoubtedly heard about Dave Feldman and his cholesterol drop protocol and his take on what he calls lean-mass hyper responders or people who go on ketogenic or low-carbohydrate diets see a very high LDL cholesterol and or LDL particle number. You've probably also heard that Dave is somewhat skeptical of the LDL is causal paradigm or thinking in atherosclerosis. So you're probably gonna understand that out of the gate, Dave and I don't really see eye to eye on the genesis of heart disease. We go right into the conversation, assuming people know the background. And the reason for that is I knew that this was gonna be a long enough discussion anyway, and I'd already heard Dave on a number of other podcasts present his model and his observations. So I thought rather than recapitulate those things here, we would link to those previous shows of which there are at least two or three, including a couple of presentations on YouTube, so that you can kind of watch those if you're not already familiar with Dave's hypotheses. I do recommend that you familiarize yourself with these because as I said, I didn't really make the time in this episode for Dave to go into the depth that he would normally go into. And again, that wasn't out of any reason other than I knew that we were gonna have enough to talk about without that and I didn't wanna reproduce or recreate the wheel, so to speak. Now, I believe Dave is putting up a companion blog post for this episode. So if you head on over to his site, which is cholesterolcode.com, he will undoubtedly have his own links and show notes and that will probably on some level overlap with what we do, but also probably provide some new information.
Now, we've got a kind of a special treat on this as well, which is Tom Dayspring, who if you don't know who Tom is, you certainly will by the next week or so, because Tom is kind of my foremost lipid mentors. And I wanted him to make sure that anything that Dave and I said that wasn't accurate was sort of corrected. So he's actually taken a look at the transcript of this, which we usually pull together for our episodes. And he's kind of weighed in with some commentary, mostly clarifying and elaborating on some technical stuff, but even as I said, correcting any mistakes that we've made. So hopefully Tom's clarifications to the transcript will be valuable to those who want to kind of get on the next level of detail. The show notes will have lots of links to graphics that help conceptualize some of these topics we get into. I mean, a lot of the time that Dave and I were talking, we were looking at diagrams and pointing things out. And so we hope to reproduce that for you. Now, before jumping into this episode, I do wanna provide my summary and synthesis of where I've landed in my own mind when all was said and done. I think I came into this with a point of view, and I think I left with a slightly different point of view. And I think that it's actually kind of hard maybe to follow the logic in my mind as I go through the episode. So I thought in the days after we recorded this, which was in July this year, 2018, that I would sort of just put my thoughts down and sort of crystallize them. So again, kind of an unusual thing to do, but I do think that this is a complicated enough topic that it's helpful. Ultimately, I am not convinced by Dave's model. And again, truthfully, I came into this maybe 20% thinking that there was a chance I would find the argument convincing, but I left with that number being a lot less. And I'll explain why. There are basically three reasons. The first is Dave was unable to explain to me the mass balance, meaning how does one account for the greater amount of cholesterol in and the greater number of the LDL particles.