Benefits of lipids testing

[Mrpb]

Request: Please use this thread for serious discussion.

I just noticed some comments in the previous thread about a Cochrane review that may lead to misinterpretations.

The review found that: "General health checks probably have little or no effect on cardiovascular mortality".

This does not mean that there's no point in getting your lipids tested if you're eating 12 eggs per day. The review included extremely little people who ate 12 eggs per day, if any and they didn't say it never has benefits.

The review also mentions 3 systematic reviews that have found that general health checks can have beneficial effects on markers such as blood pressure and cholesterol.

Another Cochrane review reported that:
There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors.
https://www.cochranelibrary.com/cdsr...0411.pub2/full

General advice by CDC is to get your lipids tested every 5 years or more frequent if you have CVD risk factors.

Cholesterol should be checked starting early in life—even children and adolescents should have their cholesterol checked.

Cholesterol testing should be done

Every 5 years for people age 20 or older who are at low risk for cardiovascular disease.

More frequently than every 5 years for people with cardiovascular disease risk factors.

https://www.cdc.gov/cholesterol/checked.htm

[EiFit91]

Request: Please use this thread for serious discussion.

I just noticed some comments in the previous thread about a Cochrane review that may lead to misinterpretations.

The review found that: "General health checks probably have little or no effect on cardiovascular mortality".

This does not mean that there's no point in getting your lipids tested if you're eating 12 eggs per day. The review included extremely little people who ate 12 eggs per day, if any and they didn't say it never has benefits.

The review also mentions 3 systematic reviews that have found that general health checks can have beneficial effects on markers such as blood pressure and cholesterol.

Another Cochrane review reported that:
There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors.
https://www.cochranelibrary.com/cdsr...0411.pub2/full

General advice by CDC is to get your lipids tested every 5 years or more frequent if you have CVD risk factors.



https://www.cdc.gov/cholesterol/checked.htm

I think it's useful to distinguish between the individual/practical perspective and the public health/health economics/academic perspective.

For an healthy individual with no prior family history of CVD considering whether or not to get tested I would say it's up to you. There's no clear evidence for substantial benefits but not for any downsides either. For individuals with reasons to worry (prior family history of CVD or other CVD risk factors) or individuals eating an extreme diet (12 eggs/day would fall under that) I would favor erring on the side of caution and get tested. This is because there may be benefits on mortality outcomes in these subpopulations that are difficult to pick up in a general systematic review.

From a public health/health economics/academic perspective, given the available evidence I think we probably shouldn't recommend healthy individuals to do these general health checks, unless it's something they pay for out of their own pockets (this point will apply more in european welfare states than in the US I guess).

[ManwittaPlan]

This is why I always recommend blood work, especially a lipid profile which you can get for 20 bucks at any quest location.

Not sure for those of you outside the USA.

[EiFit91]

Another point concerning the science debate part of this.

Although eggs increase LDL, that may not necessarily imply a link between eggs and heart disease/mortality risk. This would be the case only if there is a deterministic relationship between LDL and CVD risk. LDL is a good predictor of the latter, but that doesn't by itself imply that egg consumption/dietary cholesterol intake raises your CVD risk. This is why I feel it is important to look at epidemiological evidence in addition to randomized trials.

One potential mechanism through which eggs may increase overall LDL and still not lead to higher CVD risk: There are subclasses of LDL, and eggs have been shown to shift individuals from LDL pattern B to LDL pattern A. Some have argued that LDL pattern B is a better predictor of CVD risk than overall LDL levels. It is also worth mentioning that the majority of people suffering from a heart attack don't have dangerously high LDL levels.

Sources:

https://academic.oup.com/jn/article/147/3/323/4669740
https://pubs.rsc.org/en/content/arti...oQh6hFd3qL5U0A
https://www.health.harvard.edu/heart...-heart-disease

[Mrpb]

https://academic.oup.com/jn/article/147/3/323/4669740
https://pubs.rsc.org/en/content/arti...oQh6hFd3qL5U0A

I was wondering when you were going to post the Fernandez study. She's received hundreds of thousands of dollars from the Egg Nutrition Board, which she usually doesn't disclose. Any study she publishes is favourable for eggs.

Here's some criticism on her earlier work: https://nutritionfacts.org/2016/04/2...lesterol-size/

I'll post more later.

[Mrpb]

This is why I feel it is important to look at epidemiological evidence in addition to randomized trials.

That would be nice but in my opinion you need higher quality epidemiology. For example the PURE study. It was done in the lay public (who generally are poor in recalling what they ate). They had to answer a questionnaire once at the beginning of the study. Then CVD events were tracked for ~7 years.

Compare that to this Harvard study. The followed health professionals. They had to fill out a questionnaire every year. They were followed for 20 years.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706003/

Goes to show there can be large differences in the quality of the study.

It is also worth mentioning that the majority of people suffering from a heart attack don't have dangerously high LDL levels.

I'd say that's an argument in favour of keeping LDL as low as possible. You can look up how effective lowering LDL in general is for reducing CVD events.

That doesn't mean that other metrics can offer more insight, but the support for plain LDL as a risk factor is pretty compelling imo.

https://academic.oup.com/eurheartj/a.../1/111/5556353

[ManwittaPlan]

Some info for you lads

https://www.marksdailyapple.com/the-...o-know-part-1/

Hard to argue with a guy pushing 70 that lives his kind of lifestyle and has helped many. Enjoy!

[Mrpb]

Ah yeah Mark Sisson, the paleo advocate.

This is why we have science, so we don't need to rely on anecdotes.

[Silencespeaks]

Oh I thought lipid panel was standard recommendation annually? I’ve always gotten it standard annually with my annual physical. Without requesting it but the doctors just always include it.

Anyway I think it’s good to check annually for everyone. Main benefit is that it provides early flags that you have to change your diet and increase exercise if your values are off. It’s a flag that you need a lifestyle change. So that is good for people.

[TolerantLactose]

Ah yeah Mark Sisson, the paleo advocate.

This is why we have science, so we don't need to rely on anecdotes.

I haven't paid much attention to him lately but he includes whey in his diet which shows he's not dogmatic about things.

[AdamWW]

Ah yeah Mark Sisson, the paleo advocate.

This is why we have science, so we don't need to rely on anecdotes.

But he's old... he hasn't even died yet... he's a master at staying alive!

[Mrpb]

I haven't paid much attention to him lately but he includes whey in his diet which shows he's not dogmatic about things.

Only if it's Primal Blueprint whey of $49.95 per 1.85 lb tub

https://www.primalblueprint.com/coll...s/whey-protein

(for those unaware those are his own supplements)

[EiFit91]

I was wondering when you were going to post the Fernandez study. She's received hundreds of thousands of dollars from the Egg Nutrition Board, which she usually doesn't disclose. Any study she publishes is favourable for eggs.

Here's some criticism on her earlier work: https://nutritionfacts.org/2016/04/2...lesterol-size/

I'll post more later.

I don't know who is funded by who, and I wasn't previously aware of the Fernandez study. I would certainly be worried if a replication of the Fernandez study fails to arrive at similar conclusions. The only reason why I linked to it was as part of an argument that you cannot necessarily infer directly from a) a link between LDL and CVD risk and b) a link between egg consumption and LDL to c) a link between eggs and CVD risk. The subclass thing was just to provide an example of a possible mechanism.

The study that showed that subclass B is a better predictor of CVD risk than total LDL was not coauthored by Fernandez (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874513/). It was also published after the Journal of Nutrition study. The only part of my argument above that relies directly on the Fernandez study (where it says that Diana M DiMarco did the data collection) is the part about eggs shifting LDL from subclass B to subclass A.

[Mrpb]

I don't know who is funded by who, and I wasn't previously aware of the Fernandez study. I would certainly be worried if a replication of the Fernandez study fails to arrive at similar conclusions. The only reason why I linked to it was as part of an argument that you cannot necessarily infer directly from a) a link between LDL and CVD risk and b) a link between egg consumption and LDL to c) a link between eggs and CVD risk. The subclass thing was just to provide an example of a possible mechanism.

The study that showed that subclass B is a better predictor of CVD risk than total LDL was not coauthored by Fernandez (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874513/). It was also published after the Journal of Nutrition study. The only part of my argument above that relies directly on the Fernandez study (where it says that Diana M DiMarco did the data collection) is the part about eggs shifting LDL from subclass B to subclass A.

Fernandez and DiMarco all work for the same department of the University of Connecticut. They've been receiving a lot of money from the Egg Board and every study I've seen from them is favourable for eggs. This doesn't mean that I dismis the study entirely, but I do recommend caution with their interpretations. For example: the change in total LDL and large LDL (>25%) is quite notable with increased egg consumption. I'm not sure whether lipid experts with current knowledge would agree that the changes they reported were favourable. I have strong doubts.

[ManwittaPlan]

Science evolves

I would take the word of someone who produces results rather than random studies that are contradicted

When they are, some will claim funded by the cereal industry, the egg industry etc

Look for the persons health and quality of life and how they’ve been able to transform others

Results are everything

[Mrpb]

When they are, some will claim funded by the cereal industry, the egg industry etc

Just to be clear: Just the funding doesn't disqualify a study. But it makes it way more likely that they report favourable outcomes. That's why you need to pay extra attention to the design, the data and interpretations.

[AdamWW]

Results are everything

Results are everything in the right context, yes.

However, it is not a good approach to assume (A) causes (B) when it comes to human biology.

The fact that someone who is old and fit eats a particular diet, follows a particular training protocol, etc, doesn't mean that any one variable is the cause of success.

In fact, most people who live long using fringe approaches to training and diet do so in spite of their methods, not because of them.

This is why science and studies are important: they attempt to remove the noise and individual variabilities to provide repeatable, predictable outcomes.

A great example would be Flex Wheeler... he has arguably some of the BEST genetics for bodybuilding known to anyone, and yet his training style was horribly lazy compared to most people who would otherwise see little progress on such an approach.

He did not get huge and impressive because of his training, it was based on his genetics and his personal response to drugs. And yet, HE had results.

So, actually, we CAN argue against results in many many cases.

Imagine if he, or many others who claim they're seeing great results due to one thing or another, actually followed the science; for all we know they'd be 5, 10, 20% better than they even are now.

[Mrpb]

https://thelogicofscience.com/2016/0...lly-worthless/

[EiFit91]

I'd say that's an argument in favour of keeping LDL as low as possible. You can look up how effective lowering LDL in general is for reducing CVD events.

https://academic.oup.com/eurheartj/a.../1/111/5556353

This assumes that there is an effect of lowering LDL even within the "normal" range. Has that been shown? In that case, wouldn't that imply that current guidelines should be revised?

[air2fakie]

I want to be Chairman of the Egg Board.

[Mrpb]

This assumes that there is an effect of lowering LDL even within the "normal" range. Has that been shown?

I think so:
https://jamanetwork.com/journals/jam...rticle/2695047
https://bmcmedicine.biomedcentral.co...16-020-01792-7

I don't think we looked at this meta yet. 55 RCTs and they found a stronger effect than Weggemans.
https://pubmed.ncbi.nlm.nih.gov/30596814/

[AdamWW]

[img]https://i.imgur.com/aJ7ITkS.png[img]

https://thelogicofscience.com/2016/0...lly-worthless/

If only the body was a closed system ;o)

[ManwittaPlan]

Just to be clear: Just the funding doesn't disqualify a study. But it makes it way more likely that they report favourable outcomes. That's why you need to pay extra attention to the design, the data and interpretations.

Fact or non fact?

“ The sine qua non of atherosclerosis is the presence of sterols (cholesterol or phytosterol) in arterial wall macro****es. Sterols are delivered to the arterial wall by the penetration of the endothelium by an apoB-containing lipoprotein, which transport the sterols. In other words, unless an apoB-containing lipoprotein particle violates the border created by an endothelium cell and the layer it protects, the media layer, there is no way atherogenesis occurs.”

[ManwittaPlan]

I want to be Chairman of the Egg Board.

You’re looking at him

[desslok]

Just to be clear: Just the funding doesn't disqualify a study. But it makes it way more likely that they report favourable outcomes. That's why you need to pay extra attention to the design, the data and interpretations.

Even people that are interpreting the study will have different interpretations depending on how it does or doesn’t validate their beliefs and views or lifestyle. But that doesn’t change the fact that lipid panels are beneficial.

[EiFit91]

Results are everything in the right context, yes.

However, it is not a good approach to assume (A) causes (B) when it comes to human biology.

The fact that someone who is old and fit eats a particular diet, follows a particular training protocol, etc, doesn't mean that any one variable is the cause of success.

In fact, most people who live long using fringe approaches to training and diet do so in spite of their methods, not because of them.

This is why science and studies are important: they attempt to remove the noise and individual variabilities to provide repeatable, predictable outcomes.

A great example would be Flex Wheeler... he has arguably some of the BEST genetics for bodybuilding known to anyone, and yet his training style was horribly lazy compared to most people who would otherwise see little progress on such an approach.

He did not get huge and impressive because of his training, it was based on his genetics and his personal response to drugs. And yet, HE had results.

So, actually, we CAN argue against results in many many cases.

Imagine if he, or many others who claim they're seeing great results due to one thing or another, actually followed the science; for all we know they'd be 5, 10, 20% better than they even are now.

Great post (and Flex Wheeler is an excellent example btw). I'd only add that I wouldn't personally put 100% weight on science for adjusting my own training. Statistics applies to group averages and for most phenomena there is inter-individual variability in how well something works. So probably it's best to treat yourself as a N = 1 study and apply scientific principles to adjust one's training over time. If my lifts stall I may look to other experienced lifters for advice, or I may look at studies. And then I'll adjust based on how my own performance over time changes, ideally changing one factor at a time.

https://www.strongerbyscience.com/sc...d-application/

"When bro-science is making claims, they should be provisional – they should be humble. “I think this works,” or “lots of lifters have had success doing things this way,” are alright statements. “This is what works, I’m sure of it, and no pencil-necked geek in a labcoat can say otherwise,” is not acceptable."

Probably many professional bodybuilders have to an extent applied "scientific" principles to their training, without being aware that they have. But what works for them may not work well for others...

[ManwittaPlan]

Even people that are interpreting the study will have different interpretations depending on how it does or doesn’t validate their beliefs and views or lifestyle. But that doesn’t change the fact that lipid panels are beneficial.

Correct!

[Mrpb]

Fact or non fact?

“ The sine qua non of atherosclerosis is the presence of sterols (cholesterol or phytosterol) in arterial wall macro****es. Sterols are delivered to the arterial wall by the penetration of the endothelium by an apoB-containing lipoprotein, which transport the sterols. In other words, unless an apoB-containing lipoprotein particle violates the border created by an endothelium cell and the layer it protects, the media layer, there is no way atherogenesis occurs.”

Afaik that's mostly true. Here's a more in depth explanation: ahajournals.org/doi/full/10.1161/circulationaha.106.676890

Simple: https://drspencer.com/cholesterol-is-not-the-enemy/

[Mrpb]

I don't think we looked at this meta yet. 55 RCTs and they found a stronger effect than Weggemans.
https://pubmed.ncbi.nlm.nih.gov/30596814/

I have to admit, the Egg Board doesn't only fund research that's favourable to them.

Supported by the American Egg Board/Egg Nutrition Center (ENC). The ENC provided comments on early aspects of the study design. Interim
analyses and the final data were shared with the ENC prior to publication, but the ENC did not provide any comments.

[ManwittaPlan]

Afaik that's mostly true. Here's a more in depth explanation: ahajournals.org/doi/full/10.1161/circulationaha.106.676890

Simple: https://drspencer.com/cholesterol-is-not-the-enemy/

terrific, everyone can now safely eat steak and eggs!