Stephen S. Luther, MD

Healthy, fit and beautiful for life! Physician Owner & CEO Symbios Health, LLC.

[Camus @newstart_2024]

“Trust the science” is one of the most unscientific things you can say.

Dr. Aseem Malhotra said that bluntly in a Senate hearing. Medicine isn’t exact, it’s an applied, evolving field. The father of evidence-based medicine admitted 50% of what you learn in med school will be outdated or wrong within five years. Problem is, no one knows which half.

He pointed to John Ioannidis’ work: 20-50% of U.S. healthcare is wasteful, useless, or outright harmful. Root cause? Pharma funds and designs most trials, analyzes its own data, and bankrolls the regulators - 65% of FDA’s drug review budget and 86% of MHRA’s funding in the UK.

When the same industry that profits from new drugs controls the research pipeline and regulator budgets, exaggerated benefits and downplayed risks become the norm.

This isn’t conspiracy talk, it’s how the system is structured, and it explains why so many guidelines shift over time.

Real trust in medicine only comes from transparency, independent research, and humility, not slogans.

What’s one medical “truth” you’ve seen flip in your lifetime?

[Nick Norwitz MD PhD @nicknorwitz]

🚨New Paper: "Seven Years of 700 Cholesterol Without Coronary Atherosclerosis: A Lean Mass Hyper-Responder Case Report"

Link: https://t.co/5VnRpZlFdR

For the past 7 years, I’ve been running what is essentially a natural experiment in cholesterol and heart health.

During that time, I’ve largely lived with:

👉Total cholesterol around 700 mg/dl
👉LDL cholesterol between 500–600 mg/dL

I recently underwent advanced coronary CT angiography imaging with AI-guided analysis. This is not a CAC. It measures all plaque (soft + calcified), with expert interpretation and AI-guided analysis capable of quantifying plaque down to the cubic millimeter (mm3).

Now, to address the obvious question:

Am I too young for plaque?

In brief: No.

The clearest comparison is individuals with homozygous familial hypercholesterolemia, who often have similarly extreme LDL/ApoB levels and can develop advanced plaque as toddlers, and even heart attacks as early as age 8.

Also, nutrition influencers in their 30s have publicly shared quantified plaque scores from these same imaging technologies. In one recent case, a plant-based influencer in his thirties was found to have 61.3 mm³ of plaque despite having far lower lifetime LDL exposure. (He can identify himself if he so chooses.)

My case also isn’t a one-off.

There are many individuals like me, including older individuals with similar LDL-C and ApoB without any plaque.

The difference is that I’m an unusually well-characterized subject, with extensive metabolic data and health markers tracked over time. You can learn more at the newsletter or open-access paper, linked above.

The science of heart health is not settled. And cholesterol is not a simple story.

🚨 If you want to help spread the word...

Quote Tweet this post (or create an original post) including the article link with a thought. Academic papers are increasingly evaluated using attention metrics. Original posts from unique users are one way to increase these metrics and help ultimately increase its reach.

🚨 If you want to learn more, I'll include more learning resources below 👇

[Stephen S. Luther, MD @SLutherMD]

@BiggestComeback I suggest hand release push ups to ensure full ROM on the descent. Just did 40.

[Vinnie Tortorich @VinnieTortorich]

A 33-year-old cardiologist named Robert Atkins was overweight and couldn't lose the weight. Nothing was working.

Then he found a 1958 paper by Alfred Pennington — a DuPont company doctor who'd put the company's executives on unlimited meat and fat, zero carbs, and watched them lose weight without ever being hungry.

Atkins tried it on himself. Lost the weight. Put his patients on it. They lost weight too.

In 1972 he wrote Dr. Atkins' Diet Revolution — eat bacon, eggs, steak, butter. Cut the bread. 10 million copies.

The establishment lost its mind.

In 1973, the AMA Council on Foods and Nutrition published a formal takedown in JAMA calling his work "bizarre concepts of nutrition and dieting." Congress hauled him in. He was mocked in the press for the next 30 years.

Then the science caught up.

May 2003. New England Journal of Medicine. Two randomized trials.

HDL up 18% vs. 3%.
Triglycerides down 28% vs. 1%.
Weight loss at six months: greater on Atkins.
He was vindicated.
He died six weeks later.

Today, ketogenic diets reverse type 2 diabetes. They treat drug-resistant epilepsy. The ADA lists low-carb among its evidence-based dietary options.

They called him a quack for 30 years. He was right the whole time.

No sugar. No grains.

[Bret Scher, MD @bschermd]

In metabolic health, the most dangerous words a clinician can say are 'the science is settled.'

Here are six debates that are very much not settled, and that affect every patient I see. 🧵

[Bret Scher, MD @bschermd]

1/ I kicked a hornets' nest. All I had to do was suggest we need to learn more about the relative contribution of LDL and ApoB to heart disease, and some parts of Twitter lost their minds. Let me bring this back into focus, although this might just kick the nest more. 🧵

[Tim Noakes @ProfTimNoakes]

Have you read our textbook https://t.co/YjAyVYic92 Andrew @ScottAppliedSci?
I'm guessing not. Because I would estimate that of the 60 authors not one began with any belief in the carb-restricted diet. We all just found that it was the only eating plan that cured our metabolic and other derangements resulting from our insulin resistance. Then we prescribed it for our patients and began to study the diet and publish research papers on what we found.
You see Andrew, that's how you discover real knowledge - even if, as in my case, it reversed what I had believed and promoted for more than 3 decades
Some of us (@FructoseNo and I) even went to court https://t.co/8e9MkYbsI5 to fight for the right to prescribe and promote this way of eating.
And you know what? We won.
We showed up the abysmal lack of evidence on which the (then) current dietary guidelines that you promote, are based.
That, dear sir, is our most powerful argument.
@bigfatsurprise @zoeharcombe @TheNoakesF @lowcarbGP

[DoctorTro @DoctorTro]

Do we need to eat carbs? No? Then why on earth do the dietary guidelines say that our daily diet should consist of AT LEAST 55% CARBS?! Thanks to Dr. Zoë Harcombe (@zoeharcombe) for joining us on the Low Carb MD Podcast to share her knowledge and insight.

[Jake Gilman @jakeglmn]

Harvard tracked 724 men for 80 years to figure out what makes you live longer.

They measured everything from income to IQ, and even genetics.

The #1 predictor of an early death? Had nothing to do with any of it...

Here's what they found (thread):

[Vala Afshar @ValaAfshar]

Do not use your energy to worry. Life is too short to worry about stupid things.

Have fun. Fall in love. Regret nothing and do not let people bring you down. 

Study, think, create and grow. Teach yourself and teach others. 

—Professor Richard Feynman

[Dr Shawn Baker 🥩 @SBakerMD]

As someone who is largely known for diet

It is my belief that exercise is incredibly important for healthy aging

A good diet can open the door, but to fully take advantage, you need to regularly push your bodies capacities

If you do not, then you will rapidly lose those capacities and decline far more rapidly than you’d like

Start as young as possible and never stop!

[Dr Shawn Baker 🥩 @SBakerMD]

Does reducing saturated fat prevent death or heart disease? According to randomized controlled trials, the answer is NO!!

https://t.co/7lSCHQ04xB

[Dr Shawn Baker 🥩 @SBakerMD]

If you prescribe weight loss drugs and don’t facilitate appropriate lifestyle modifications are you actually harming the patients long term?

[Stephen S. Luther, MD @SLutherMD]

@BenBikmanPhD We’ve chosen not to wait on the establishment to catch up, but have chosen to offer this care for our patients today at https://t.co/dLxyuUFy3C

[Robert Lufkin MD @robertlufkinmd]

https://t.co/Vr0k2NBaZD

[Tim Noakes @ProfTimNoakes]

Did your cardiologist tell you this as he rushed to prescribe the "life-saving" statins?

[Stephen S. Luther, MD @SLutherMD]

@CaryKelly11 St. Peter Stiftskulinarium

[Stephen S. Luther, MD @SLutherMD]

@ascarbs Excellent abstract. Very well said.

[Michael Eades, M.D.🏹 @DrEades]

True. Yet the elderly are the ones most worried about heart disease, because they are nearer the end of their days. Consequently, many of them are on cholesterol-lowering drugs, which may end up shortening their lives--the very thing they are taking the cholesterol-lowering drugs to prevent.

[Stephen S. Luther, MD @SLutherMD]

@BrianRoemmele 😂😂