If you have elevated fasting glucose or a family history of type 2 diabetes, proactively research and implement strategies to manage blood glucose levels rather than just monitoring.
Actively seek out information and perspectives that challenge your existing beliefs from every side, rather than staying within an echo chamber, to foster a more complete understanding.
Approach scientific inquiry with skepticism and prioritize the pursuit of truth over advocacy for a particular viewpoint or diet, as this fosters genuine understanding.
When evaluating scientific literature, especially in complex fields like lipidology, recognize that the quality and depth of evidence can vary significantly, and avoid applying the same dismissive lens used for less robust fields like past dietary guidelines.
To gain the deepest and most accurate understanding of complex scientific topics, seek out and engage with the leading experts in that specific field, who may not be found in popular online forums or general conferences.
Recognize that population-level health data can obscure individual nuances; seek personalized advice to understand what specific health strategies are most relevant and beneficial for your unique situation.
When pursuing longevity, consider both increasing lifespan (delaying death) and improving healthspan (quality of life), as patients often prioritize the latter.
Understand that choosing not to act or decide on a course of action is itself a decision, with its own set of consequences and implications.
Understand that atherosclerosis is driven by multiple factors (lipoproteins, endothelial damage, inflammation), and improving any single risk factor like blood pressure or smoking cessation can lead to better cardiac outcomes.
Understand that LDL is a necessary, though not sufficient, factor for atherosclerosis development; without LDL over a lifetime, there would be little to no atherosclerosis.
Clearly define your health concerns, such as reducing cardiovascular disease risk, and consider potential trade-offs, like whether interventions might increase the risk of other conditions like cancer or neurodegenerative disease.
Be wary of confirmation bias in health and diet, recognizing that even beneficial interventions can have downsides or not be universally optimal, and avoid overly simplistic ‘black and white’ thinking.
When new research emerges, integrate it thoughtfully into the existing body of scientific knowledge to refine understanding, rather than immediately dismissing decades of established data.
Recognize and acknowledge personal knowledge gaps, and actively pursue learning and information to fill them as quickly as possible.
For individuals on a ketogenic diet experiencing a ‘hyper-response’ with very high LDL, replacing saturated fats with monounsaturated fats (e.g., olive oil, macadamia nuts) may significantly lower LDL without changing total fat intake.
Before starting a low-carb diet, get a particle count test to establish a baseline, as this can help in understanding subsequent changes in lipid profiles.
Obtain a sterol panel (measuring desmosterol for synthesis and phytosterols for absorption) at baseline to understand the underlying drivers of LDL particle number.
For lean mass hyper-responders, consider that increased endogenous cholesterol synthesis, rather than just energy trafficking, may be the primary driver of their elevated LDL levels.
Experiment with carbohydrate intake, as increasing net carbs to a certain threshold (e.g., around 90g/day for 3 days for one individual) may lead to a substantial drop in LDL-C for some individuals.
Caloric deprivation (fasting) and fat deprivation appear to be general principles that lead to a reduction in LDL levels.
Be aware that while statins do not cause Alzheimer’s disease, they can slightly increase the risk of diabetes in a susceptible subset of patients over time, emphasizing the need for individualized assessment of medication side effects.
Understand that the primary purpose of the LDL particle is to transport cholesterol, including its role in reverse cholesterol transport from the periphery back to the liver.
Appreciate that HDL particles play critical roles not only in reverse cholesterol transport but also in immune function, carrying immunoglobulins and other proteins.
Appreciate the liver’s central and robust role as the body’s ’energostat,’ constantly sensing and regulating circulating energy and metabolites, likely through ATP levels.
Recognize that chylomicrons primarily deliver fat-based energy from the gut, while HDL particles are generally involved in support operations not directly related to energy delivery.
Understand that the normal half-life of an LDL particle is about a day, but it can be pathologically extended by factors like ApoC3, increasing residence time.
Understand that ApoC3 levels tend to correlate with insulin, meaning hyperinsulinemia (e.g., in type 2 diabetes) can increase the residence time of VLDL and LDL particles, potentially increasing their burden.
Stay informed about emerging therapeutic targets in lipid management, such as antisense oligonucleotides aimed at impairing ApoC3, which could impact lipoprotein residence time.
Recognize that Carotid Intima-Media Thickness (CIMT) and Coronary Artery Calcium (CAC) scores are indicators of advanced atherosclerotic disease, not early biomarkers of risk, and should be interpreted accordingly.
When evaluating health risks and interventions, consider not only the risk of death but also the potential impact of events like heart attacks or procedures on long-term quality of life and functional capacity.
Understand that many biological phenomena and their effects are not linear, meaning that increasing or decreasing a factor may have different outcomes at different levels.
When dealing with novel or unusual health phenotypes, share all observed symptoms and remain open to the possibility of as-yet-undetermined risks, even with cautious optimism.
When making healthcare decisions, differentiate between the efficacy of a treatment and its cost or value, recognizing that the latter often involves individual or insurance-based decisions.
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