Insulin resistance makes LDL 'stickier,' increasing cardiac risk, while individuals who are insulin sensitive show no increase in cardiac risk with higher LDL levels.

“Physicians should be taught to interpret LDL within the context of metabolic health and insulin sensitivity.”

“what did he find he found that as you go up an LDL number according to the Framingham data if your HDL is high there is no increase in cardiac risk but as you go up an LDL number with a low HDL there is an increase in cardiac risk”

“the take-home message here for people which we will continue to elaborate on in this podcast is that LDL cannot be interpreted in a vacuum if we really look at the studies it's not clear that there's a linear directly correlated relationship between LDL level and the incidence of coronary disease there's another risk multiplier the context is everything and that context is insulin resistance”

“insulin resistance is the spark that lights the fire of cardiovascular disease and so people with lipodystrophy I wonder what their LDL is to tell you the truth I wonder if they looked at lipid panels and people with Lipa Disher they have I don't know the answer but I'm sure they have it but what's so interesting is I believe you and I have talked about this that people with lipodystrophy right look ripped very insulin resistant below that aggressive cardiovascular disease because it's insulin resistance that really is the determining factor in whether we develop this atherosclerosis cure disease process”

“if you look at LDL in relation to cardiovascular disease incidents on an observational level that Association changes massively depending whether you are insulin resistant AKA metabolically broken or not”

“when you stratify data regarding ldl low density lipoprotein and cardiovascular disease risk by any metric that looks at insulin sensitivity and or insulin resistance you get a very different picture this is what everyone is missing it drives me crazy”

“and as i'll show you later in this podcast when you stratify ldl versus heart disease risk by a third variable that is correlated with insulin resistance and or insulin sensitivity you see a very different relationship emerge whereas there's essentially no correlation between ldl level and cardiovascular disease”

“i think that ldl is a very poor predictor of cardiovascular risk and as i will talk about in a moment i think that the context by which you are viewing that ldl is the most important piece of it and that elevated quote unquote ldl is not necessarily a problem if you are insulin sensitive though many in the lipid space will provide study after study to say look there's a very strong relationship between ldl and cardiovascular disease and then they will leave out the studies that show that that relationship between ldl and cardiovascular disease is attenuated massively in people who are insulin sensitive”

“one way you can tell that you're insulin sensitive one proxy is a high hdl and low triglycerides i talked about this on the joe rogan experience a couple years ago i showed framingham study data looking at different levels of hdl as a stratification for ldl and cardiovascular risk what you saw was that people with the highest levels of hdl had essentially no relationship between ldl cholesterol and cardiovascular risk hdl in that situation was a proxy for insulin sensitivity or low hcl being a proxy for insulin resistance”

“furthermore I don't believe that quote unquote elevated LDL is a risk factor for increased levels of cardiovascular disease if I or you or a human is insulin sensitive”

“but the thing that I think is most important is your context, how metabolically healthy you are, how insulin sensitive you are. I don't think LDL matters that much if you are insulin sensitive”

“there's a lot of medical evidence that if you are insulin sensitive and you can ask say that with a low fasting insulin elevated or I would say robust levels of HDL low triglycerides and you know good blood pressure low fasting insulin but in that situation elevated LDL quote unquote elevated LDL is not a risk factor for cardiovascular disease there's literature to show that”

“because someone with a slightly higher LDL who is insulin sensitive does not increase their risk of cardiovascular disease”

“we have so much better predictors insulin sensitivity which is a little bit technical but that metric is a much better predictor of cardiovascular health and or risk of future disease”

“if you do not have insulin resistance there is essentially no correlation between LDL and cardiovascular disease”

“if you stratify the relationship between LDL and cardiovascular disease by any metric that reflects insulin sense activity you see this you see this exact pattern that LDL is no longer correlated with cardiovascular disease”

“if you do not have insulin resistance there is essentially no correlation between LDL and cardiovascular disease”

“I think we should be focusing on LP little a which is a much better risk factor oxidized LDL in the arterial wall and most importantly insulin sensitivity”

“if you are looking at LDL as the wrong risk factor or there are other more important risk factors I think it's important to point those things out to people and so when I hear arguments like the totality of the evidence I'm reminded of the way that vegans think about plant-based studies and meat studies and if you look at the totality of evidence for vegetables versus meat for humans you can draw conclusions that I think are false which is that meat is bad for humans that meat is associated with decreased longevity that meat is associated with increased incidence of cardiovascular disease when if you look at the details you arrive at different conclusions”

“when I look at the details of LDL in connection with cardiovascular disease what I find is that there are many instances that are important not just a few but there are many instances that are important to consider where LDL cholesterol does not associate with cardiovascular disease”

“if you do not have insulin resistance there is essentially no correlation between LDL and cardiovascular disease okay”

“if you look at the Framingham study there's been subsequent analyses where they stratified that relationship between LDL cholesterol and cardiovascular disease by HDL which is a metric that may give us some indication of insulin sensitivity and and the relationship between LDL and and uh cardiovascular disease essentially disappears”

“in any situation in which LDL cholesterol versus cardiovascular disease is stratified by a metric that gives you any indication of insulin resistance you see the relationship between LDL cholesterol and cardiovascular disease essentially vanish”

“if you do not have insulin resistance there is essentially no correlation between LDL and cardiovascular disease”

“the clear path forward here is get insulin sensitive you want to be metabolically healthy focus on that rather than lowering your LDL that's the most important piece of this equation metabolic Health insulin resistance this is the Crux upon which LDL and cardiovascular risk is based”

“what we see in humans who are insulin sensitive is that the relationship between LDL cholesterol Andor apob and cardiovascular disease essentially vanishes in some studies like the Framingham cohort there is a very weak connection between LDL and cardiovascular disease even in the most insulin sensitive people but it is much much lower than what happens in people who are insulin resistant so clearly insulin resistance is driving the majority of that connection between LDL cholesterol and cardiovascular disease”