Heart of the Matter: Higher LDL on Keto Does NOT Mean More Plaque.

[@quirkyqs]

Nick, this is fascinating. I’m a physician and have always been curious about the biochemistry on metabolic health. I was on a ketogenic diet in college (about 12-13 years ago before keto was mainstream) based on papers I had read. I was lean and my LDL was also the highest it had ever been, which spooked me. I knew LDL was correlated with heart disease but was curious how it would affect me…obviously I didn’t get a CTA of my coronaries…and stopped the keto diet from fear. Not to mention, the biochemistry and what we learn in medical school support the “badness” of LDL with its coorelation with heart disease. So learning about your work is so exciting as it addressed a question I had about leanness, ketogenic diet, LDL, and heart disease. Preliminary, yes, but we can learn so much still ❤️!

[@KenDBerryMD]

Bravo! Chipping away at that paradigm…

[@makaisenki]

Less of a paradigm and more of a secret society pyramid hidden in plain sight. My phrase I've been using for a year now is "If you don't use it, it will abuse you" LDL is an example of this. I believe it circulates not being used until it over stays its welcome, gets oxidized and then becomes an issue. Since keto/carnivore uses lipids as energy, we use it therefore we are not abused by it.

[@nicknorwitzPhD]

Doritos? Fritos? Be specific

[@benstepanek2808]

​​@@nicknorwitzPhDsun chips? Sorry, but it seemed perfect for a corny suggestion.

[@PestControlPapito]

@@nicknorwitzPhDlmfao

[@PestControlPapito]

@@nicknorwitzPhDNick, don’t hate me if I seem obtuse, but given who you’re responding to, what are your thoughts on the carnivore lifestyle. 80-90% carnivore over here though I did try the keto brick based on your recommendation. Obviously, all low carb eating is connected but do you have any opinions given you expertise in the field?

[@fjsa_2471]

53 yo here, close to LMHR, been on keto for about 4 years. Had a CCTA done recently, no evidence of soft/calcified plaque. Go Nick and Dave, your work is important. Also, just wanted to say that your videos are a joy to watch (minus occasional minor editing issues). You don't use unnecessary words and don't waste time. For my rational/logical brain it's a huge plus. Thank you Nick.

[@jaymehatfield9540]

I agree yt must be at work here. Nick, I have followed you and Dave since 2023 when you announced that your study results were going to be announced in Feb-Mar 2024. Thankyou thankyou for your work. Brilliance in America, so RARE. Nick Norwitz! Go Nick go!!

[@mikecf1]

I have been following Dave since wayyyyyyyy back in the day. His work, and yours along with him, are incredible, and what scientists should strive for. Thank you.

[@nicknorwitzPhD]

Thank you 🙏🏻

[@llenhu7537]

Nick- I’m 53, Asian female, have between 350-400 total cholesterol all my life, since I was a teenager. Recently went on carnivore last 6 months and cholesterol is the same, LDL 250, HDL 94 and Tri is 42. My CAC score is 0. Feel pretty darn good, even with a cholesterol that high for almost 40 years. Would be happy to be a part of any of your studies or trials.

[@janissquirell5072]

👍

[@nicknorwitzPhD]

Functional tests are telling…

[@Kjuken69]

The thing is that you don't messure your cholesterol levels, you never do, the nr you messure are irrelevant, the important thing is that your cells get the cholesterol they need! The brain makes it's own cholesterol, many of the cells in the body can make it's own cholesterol, but that's a hard process so the liver does most of the job. But if we eat food that contains more cholesterol, the liver should downgrade. It's a complex system perfected for 100 000 thousends of years. A new book is coming out soon called, your freind cholesterol! It should be sold to the whole pharmaceutical industry and every doctor and cardiologist in the world!

[@llenhu7537]

@@Kjuken69 interesting. Thanks for your insight. I’ll watch for that book.

[@ExtaTer]

Do a CIMT test. The standard CAC score does not measure soft plaque (not calcified). This study uses some modified CAC that supposedly measures the soft plaque too but I don't think this is available with the standard CAC.

[@roy204crossfit]

You guys are doing such an astounding job, both in research and communicating the preliminary results. I can't wait to see you guys get more data over the years. I hope you get the recognition you deserve for this work, which will affect so many.

[@nicknorwitzPhD]

Thank you so much! The research is important and a blast… and communicating it with all of you is a superb pleasure

[@eric1richards]

I don't pay a lot of attention to my LDL numbers in my blood work. It usually hovers around 99-105. Instead, I tend to focus on fasting insulin and HbA1c. I have been keto for about a year with great results. Down from 210-170lbs. I am very happy with how I have responded to a ketogenic diet. Love your channel!

[@Ozzie-n8t]

This is an issue for people with BMI less than 25, which is why they are called “lean mass”. The mechanism does not apply in your case, because yourBMI is still higher. If you become lean, you could possibly start to develop skyrocketing LDL, as some people have done.

[@thewrightoknow]

I am a LMHR living in the UK and my DR is always pushing me to take Statins. Great presentation and much appreciated. I am going to send or present this video to my Dr. Blessings!

[@phoenixaz8431]

High cholesterol is not associated with heart disease, plaque is. However, statins may work partially by reducing inflammation, but il also comes with a host of problems including sexual and cognitive. It depletes the body of CoQ10. The problem is not LDL per se but small, dense particles of it. If the majority of your LDL is not those particles, you're fine. Quoting ''Small dense LDL is the most *atherogenic* subtype of LDL, which means that it is more likely to leave fatty deposits in the blood. Having fatty deposits in the blood means that a person may be at higher risk of developing certain conditions, such as: heart disease. obesity.'' Athero-genic=tending to promote the formation of fatty plaques in the arteries.

[@JaneDr-x1z]

A really great, clear and thoughtful explanation of the study so far. Thank you! It's such a privilege to have cutting edge research developments available to anyone who's interested.

[@colinvankeith4814]

Thanks Nick, Dave and everybody that made this happen. Just so you know, I have forwarded this study to my doctor and posted on my Facebook.❤

[@nicknorwitzPhD]

Thanks for sharing!

[@truthseeker9701]

Nick… YT must be suppressing your show. There is zero reason why you shouldn’t have at least 1M subs by now! Thank you and keep up the good work!

[@Jojo-o6o6w]

I can almost 100% assure you they are.

[@nicknorwitzPhD]

Appreciate it. Unfortunately for me, the enthusiasm of my audience doesn't multiply ... although I count you as 10 viewers for this response

[@homomorphic]

​​@@nicknorwitzPhD it will multiply. I know you're doing this because you want to help save the country (this is one of the most significant national security threats we face) so hopefully that will sustain your persistence. Google "Nutrition: The national security threat no one is talking about"

[@RC-qf3mp]

@@truthseeker9701 too many woke vegans at YT/Google. Don’t even mention the trans issue. If Nick changed his pronouns they’d promote him more.

[@i.ehrenfest349]

@@RC-qf3mpgive me a break man

[@MichaelWDietrich]

I'm not lean at all ( BMI 34 though rapidly decreasing weight trough low-carb diet), but my bloodwork has shown the same triangle since I went low-carb and controlling my keto status. I've got bloodwork from before where ldl and hdl were in the recomended corridor. First Keto bloodwork from only 3 Months into keto shows nearly doubled ldl and 25% + in hdl where tryclycerides stay low or even dcreased (a not realy significant) bit. This (quaterly measured) trend stayed for the following bloodworks. Though not so dramatic (no doubling of LDL anymore ;-) but still slightly rising LDL while at the same time losing more weight. If I wasn't convinced that Low-Carb and keto had already done a lot of wonders to my health, that LDL-Values would have scared the hell out of me. Glad to find your study.

[@patl3854]

I am in similar situation, only I am female, older, and on keto/low carb for about 5 years. I was quite overweight, lost weight, and everything was great except LDL. Statins are worse than useless; they are harmful and the studies supporting their use are biased. Dr. Nortin Hadler's books on how we are all over-tested and over-treated are excellent. I especially appreciate his book: Rethinking Aging: Growing Old and Living Well in an Overtreated Society. For the younger folks: The Last Well Person, and Worried Sick.

[@MichaelWDietrich]

@@patl3854 It depends a bit on what you mean by "older" (I'm 60 and my doctor didn't even dare to offer me a statin prescription - because he knows my lifestyle). But in fact, according to the manufacturers, statins are contraindicated for people over 70. Because "the side effects outweigh" the "possible positive" effects. On the other hand, various studies show that statins can indeed reduce total cholesterol and LDL. BUT: the really important values ​​ - number of LDL particles and - amount of particularly harmful LDL

[@nikoscaldera]

As long as your triglycerides to HDL ratio is less than 2 you are on the safe side

[@phoenixaz8431]

Is there is no scenario in which someone's triglycerides/HDL ratio is less than 2, but who has high LDL, chiefly small dense LDL (the most atherogenic subtype)?

[@Ozzie-n8t]

@@phoenixaz8431A study in 2003 found no clear reason to test for LDL fractions to more accurately assess cardiovascular risk. Perhaps there have been other studies showing that it really is only SD-LDL that is associated with arterial plaques. You should have a CT angiogram to assess the full extent of any coronary artery plaque you may have.

[@ericbolz]

I wish you would talk about ApoB more. I'm a LMHR with high ApoB and with increasing calcium score. I'd like to understand my risk better. And please talk more about Saturated fats.

[@WowzaGuy]

I would love to hear more about this as well.

[@younutre]

I have to admit that I can consider myself a "hater" in your videos. But this is mainly due to the way some topics are approached, which I disagree with. However, in this video I have to congratulate you, because you were extremely clear about the nuances and the specific application relative to the studied population. If this theory is proven, it will definitely be a milestone and I'm rooting for this to happen. A hug.

[@nicknorwitzPhD]

A hug returned. I mess with haters. I love constructive critiques.

[@jonmackay_TSD]

I love this interaction between the two of you. I wish we could handle our politics this way. You both made my day!

[@davidherr6793]

Me too

[@nickyoung798]

15:03 💯

[@LyingEyes-t3m]

@@jonmackay_TSDyep someone had to admit they were wrong

[@efsmiley1995]

I'm LMHR. Keto for 8yrs. Last measured: triglycerides 52, HDL 98, LDL 160. 18.5 bmi. This study is reassuring and fascinating. So looking forward to more studies to come. How exciting for you! How exciting for all of us! Curiosity is key!!

[@GoneCarnivore]

That's a low LDL. you eating carbs?

[@laurengianna9944]

Sadly I won’t get another CTA because of radiation. I’ll stick to sono. Had a CAC and maybe I’ll do another in a year. CIMT said I was low risk and I’m 57 and a former smoker. But they found a nodule on my thyroid 😫. Had uterine cancer in 2019 total hysterectomy so now I’m worried 🥲. Love the work Nick and Dave do 🙌🏼. On carnivore since December 2023. Feel amazing!

[@chensally3]

Dave and Nick have helped me to decide whether to take LDL lowering drug. My LDL went up to 235 after a year of low carb diet. I fit the LMHR profile perfectly. Now I am comfortable in my decision not to angst over my high LDL Your podcasts have given me a better understanding how lipids work in our bodies. Thanks very much!!

[@theketovorian]

Glad to hear I’m a normal, happy LMHR. Thank you for all you do!!!

[@debjordan4399]

My LDL at last test in Feb 2024 was 353, CAC score "0". Age 73 female. Not a LMHR. Carnivore 99% over 4 years. Protein 110 grams max. In 2005 my LDL calculated was 138, HDL 65, trigs 83.

[@nicknorwitzPhD]

Happy to hear about your functional testing. We had quite a few cardiac imaging experts and clinicians on the team, all of whom would be reassured by a 0 CAC at 73 in general. Of course, the duration of time with LMHR phenotype may be of relevance too.

[@lukasholly5517]

​​@@nicknorwitzPhDmine is 200 , metabolic markers are fine, diet mostly carnivorous-ketogenic based on high quality local organic foods, age 18 male

[@dacisky]

My ldl 225 ,cac score 7. Doctor pitching a fit. Lean mass hyper responder here.

[@BeefNEggs057]

@@dacisky Just say no to being a lab rat. PCSK9 are not ready for humans. You are the lab rat if you let them inject you.

[@BeefNEggs057]

@@lukasholly5517 Sounds lowish to me. Must be eating a decent amount of carbs.

[@dacisky]

This blows mw away. Last year,I started loosing weight,backstory is I'd been hflc for 0 years,I lost around 10 pounds and as my weight went down,my ldl went up...Last summer two Doctors went beserk,as you can well imagine,telling me I HAD to take a statin,or "the shot". As you can guess,I refused both and stayed on keto,sometimes going off keto and doing carnivora. About 4 months ago,whatever was screwing intermittently stopped,my lympth nodes shrank and I started gaining weight. Last month,all blood tests normal. I did not ask about my ch markers cause I just did not want to deal with another lecture,but none of that was mentioned...Anyway,this video gives me real hope that what I'm doing is what I need to be doing for myself. Anyway,wonderful video!!!

[@nicknorwitzPhD]

I'm glad you enjoyed the video. I'd caution you to take our caveats about these data being preliminary seriously and talk with doctors. However, it's important that you find the right doctors for you. If you don't feel you're being listened to... that's a problem.

[@homomorphic]

I echo Nick. I am extremely hopeful about this data, but I continue to moderate my LMHR triad with healthy carbs (whole fruit) to keep my LDL below 200 just in case. The science is great, but it's your health so if I were you I'd try to strike a balance and get the best numbers you can all around.

[@Damudean]

@@homomorphicbut we don’t have numbers for low carb health population

[@homomorphic]

@@Damudean we do and: 200 150 40 Is not in the current dataset. I would say those numbers are definitely LMHR, but they aren't given the current parameters as the LDL is below 225.

[@cathiemcginnis3997]

​@@nicknorwitzPhDI honestly think I can say that most of us are not being listened to.

[@thestrongcarnivoress]

I am a LMHR. LDL 500, BMI 22. Previously BMI was 35. HDL/Trig ratio 0.8. I had my CT angiogram to get my CAC. Zero scores across all measures. Cardiologist scratching his head. Carnivore since Feb 2022. Prior to that Keto from Dec 2020. Never sick anymore.

[@larrywong7834]

My Aunt and my Mom had CAC=0 appx at age 65'ish. Believe they do well in their age 90's. They eat healthy. Not much fats. Eat Good Carbs. Tho one is pre Diabetic. One has Hba1c under 6. How old are you???? Believe under age 50 average peoples don't have much CAC. If not zero.

[@lindamorristx]

My total cholesterol is over 600 since going carnivore. HDL is 72, Trig is 158, LDL is 350. Female 73 and 120# feeling great.

[@thalesnemo2841]

One should aim to get the triglycerides to HDL < 2.0 mg/dl 158 triglycerides means from my readings that your daily dose of carbohydrates is too high . Aim for less than 100 grams total carbs per day . Also see the triglycerides to glucose

[@DF-by7gy]

Great content Nick. Thank you for sharing this information with us.

[@nicknorwitzPhD]

My pleasure!

[@emmezero]

Dall'Italia:spero che questi dati si diffondano e vengano letti in fretta dai medici di base .Grazie

[@KendraWilhelm]

Thank you SO much for sharing this video. I'm 36 years young, lean, and with my latest numbers at 87 HDL, 238 LDL, & 66 TG after trying (mainly) Carnivore/Keto for just a few months, this matters to me. I still have SO many questions and concerns about other numbers, particle #'s, Lipo little a, LipoB, etc. but this video finally gives me some slight hope that I MAY not be heading straight for a heart attack without crazy interventions. I am meeting with a lipid specialist next week for my first "specialist" consultation, but I love that I'll have this information (and questions) to go in to that meeting with.

[@ClovettCC]

I’m going keto to see if it helps with mental health issues. I’m also doing keto to see if it will have synergy with psilocybin use for ADHD and social anxiety. Thanks for the vid!

[@diversifiedcollectibles9242]

Keto for 8 months and it 100% has helped tremendously with my anxiety, mental clarity, bloating etc. You are going to love it. 25 grams or less of carbs a day works well for me. Some days a little more. Good Luck!

[@D4rkBl4de]

Checkout the books of Dr Chris Palmer and Georgia Ede. Fantastic resources

[@ClovettCC]

@@D4rkBl4de I’ve heard Chris Palmer on KZbin a lot, but I’ll probably check out the Brain Energy book too. Will have to check out Georgia Ede!

[@ClovettCC]

@@diversifiedcollectibles9242 glad it worked for you, and thanks for the good luck!

[@jaeLAX23]

Congratulations!!! Great work from everyone on the paper.

[@nicknorwitzPhD]

Thanks so much!

[@karenturner1784]

Thank you, Nick. This video answered my specific questions about numbers. My LDL went to 300 after losing 50 pounds on a low carb diet, and most of the info I could find talked about an LDL of 190 being high. Thank for sharing about the 500+ LDL. 😊

[@nicknorwitzPhD]

I wouldn't take this as "reassurance" per se, but the Lipid Energy Model (see Cholesterol and Lipid playlist) can give insight into the mechanistic explanation. Your case is not atypical: LDL rise after weight loss on low-carb. These data are as good as they could look, but they are preliminary.

[@kenpumford754]

Great work Nick, and company! The word is gradually getting out. I'm a LMHR since going keto 2 years ago. I shared a plethora of research with my PCP in advance of this year's physical, including the Oreo cookie trial, because I knew we'd be discussing why I'd stopped taking a statin. Backed by CAC scores of zero in tests this year and 6 years prior, he didn't press me on statins.

[@alvinKKHills]

Nick, thanks so much for the wonderful work, keep it up and we promise and continue to stay curious 😊

[@nicknorwitzPhD]

More to come! #StayCurious!

[@tonderaigomo1707]

Amazing Channel. Amazing content. Amazing quality of presentation! Keep it going, NICK!!

[@nicknorwitzPhD]

Thank you! Will do! 😍

[@talchemerinsky7809]

WOW! This is fascinating and I'm so happy I found this information! I already watched all your videos and interviews related to your study and it's been only 3 days since my blood work. I got my results and honestly, I was shocked (but not worried at all!), as I never had these numbers: LDL 380, HDL 125, Tri 40. I'm strict carnivore since February 2024. I'm 167cm, 54kg and keep losing weight. I am metabolic healthy and do resistance training 4-6x a week. Would be happy to be a part of any of your studies or trials.

[@JesseStarks]

Congratulations on making it this far. It's so fun to watch you guys meticulously reveal this story.

[@nicknorwitzPhD]

Thanks for joining in the journey

[@-fred]

Glad you summed this all up with a call for open minds. Exciting ideas and data; pinhole view into what there is to know.

[@firstchoicefarm7767]

You teased me again! I thought you were announcing the publication of the longitudinal study. My curiosity is killing me more than my LMHR status.

[@nicknorwitzPhD]

HAHA! Good way to go. Sadly, things are moving a bit glacially w/r/t the longitudinal publication... but it (and much more!) are coming. We will also have a juicy carnivore publication just next week.

[@firstchoicefarm7767]

@@nicknorwitzPhD I will do my best to help global warming along to move the glacier then...

[@Mindafter60beyond-wp2lx]

Brilliant explanation Nick!

[@nicknorwitzPhD]

Thank you :)

[@Roberto-cg2gr]

Hope LMHR will include Kraft insulin assay test in comparison with APOB

[@jonathansamaroo5777]

Finished. Alternative title: "Statin manufacturers hate this one study"

[@otallono]

they don't care because they know 99% of the population doesn't know about it and wouldn't believe it if they heard about it.

[@larrywong7834]

Have you seen all the huge soft plaque in both the LMHR cohort and MiHeart cohort. TPS score, total plaque score in both the same.

[@alquinn8576]

he better be careful; might get Boeinged

[@machdoctor]

This research is fantastic, but I hope you plan on expanding your research to include individuals outside of this phenotype. In my case, I started a low-carb diet in order to control/reverse pre-diabetes. I don't quite make the LMHR cutoffs but I do have the triad of low triglycerides, high HDL and high LDL. I'm also pretty lean, with a BMI

[@LongHaulHealing]

I’m dealing with same LP(a) under 10 LDL HDL high Trigs 48 but APOB 148 5 months strict carnivore went up from 123 in two months

[@davidinmemphis]

Same. ApoB is 174, lp(a) of 167...

[@machdoctor]

@@LongHaulHealing @davidinmemphis Do you have any metabolic conditions? What does your doctor say and what are you going to do?

[@machdoctor]

@@davidinmemphis Do you have any metabolic conditions? What does your doctor say and what are you going to do?

[@LongHaulHealing]

@@machdoctor docs say statins . I’m metabolically healthy . Going to keep doing what makes me feel good !

[@jeffvazquez6394]

That certainly chips away at the prevailing HIGH LDL = Cardio Vascular Disease. Thanks Nick!

[@stevenburky9980]

7 percent body fat here; 18.7 BMI; triglycerides 50; 52 years old; sub-elite runner; ran 10 miles at 8:08 per mile yesterday; lean af....Been eating a high fat reduced carb diet years now and just keep losing body fat despite eating high saturated fat daily. I also eat little sugar. Been wondering for years if my high fat/high cholesterol diet is causing arterial plaque. I definitely needed this video. Thanks!

[@lpg12338]

Have you thought about having a carotid intima-media thickness or coronary artery calcium (CAC) scoring performed?

[@stevenburky9980]

@@lpg12338 I'm kind of new to this discussion. I didn't realize until reading comments and watching the video that a non-invasive test was possible, if one is.

[@lpg12338]

@@stevenburky9980 No problem, the two that I posted, plus this one are pretty good to have performed, they are not expensive and along with a blood test, would give you a good idea about your general health, ankle-brachial index (ABI) test. Good Luck! 👍

[@timh-c7186]

​@@stevenburky9980 you may enjoy The Widowmaker film on Ivor Cummins YT channel . They made a movie to promote people having a CAC score done

[@chrisavetrano]

Thank you and Dave for all your work! Carry on!

[@nicknorwitzPhD]

We will!

[@FleshyInterloper]

Another thought provoking presentation

[@milantoth2045]

Excellent review, thanks 🙏

[@nicknorwitzPhD]

Very welcome

[@cattleprods911]

In the decades-long avalanche of well-funded cholesterol junk science and statin pill pimping, you (and your network) are a breath of fresh air. THANK you sir, keep it up! :)

[@nicknorwitzPhD]

Well I might not entirely endorse your description of the existing data, I will accept the breath of fresh air compliment 😉

[@LVQ-so5th]

LMHRs have very high LDLc values on a keto diet. An interesting questions would be, what happens to these people on a high-carb, low fat diet? Will they have a unique response to an anti-keto diet? I ate the latter diet and had a heart attack in my 40s. I had high triglycerides, low HDL, and Pattern B smLDL, but normal LDLc. Ron Kraus's research identified this as an atherogenic triad. When I switched to a keto diet, I became a near-LMHR (with Pattern A).

[@KakashiBallZ]

Was there any information ApoB levels, as it's been shown to have a positive correlation to plaque growth?

[@livmo2351]

So happy to hear about this new research. My husband and I started carnivore in January. My bloodwork is consistent with the LMHR. My LDL increased to 309 (I’m 55yo 5’0 102lbs HDL 121, Triglycerides 74 total 438). My husband’s LDL and overall cholesterol decreased (he’s 5’8 217lbs) so I believe we also fit the model of the inverse relationship of change in LDL as related to BMI. He has lost 33lbs and I lost 13lbs in 8 months.

[@nicknorwitzPhD]

Sounds like you two squarely fit to the data re LMHR and the Lipid Energy Model. Of course, please take the caveats in the video seriously. Thanks for listening and learning

[@HakuCell]

Simon HIll once said that the main function of LDL particles is to actually carry triglycerides, which is fat for fuel. so it makes sense that in the absence of carbs, we need to use much more fat as fuel, hence more LDL particles. and if we re-introduce carbs (like oreos), we need less LDL particles in circulation. however, why are these higher LDL-C levels not leading to more atherosclerosis? that i don't know, it's very surprising.

[@tomgoff7887]

Good question but this is over just five years. Also who was screened out from participating? Further, did the greater body fat in the comparator group explain why their results were no better than the LMHR group?

[@KeithRobertson57]

You’ve answered your own question 😉 Higher LDL does not cause heart disease. It’s the Seed Oils 😮

[@tomgoff7887]

@@KeithRobertson57 Unfortunately, the evidence clearly shows that LDL is causal for atherosclerotic cardiovascular disease. If it is only seed oils that cause cardiovascular disease, then how do we explain the fact that in 1909 heart disease and strokes combined together were the leading cause of death in the US? Crisco didn't appear until 1911.

[@nicknorwitzPhD]

Have you listened to our pods with Simon. Between me and Dave I think it’s 8.5 hours of listening 😂

[@Kjuken69]

Because it is not a chance in hell that ldl cause plaque build up (plaque is rapid blood cloting, in exposed areas) when the artreries don't heal properly. They consist of very little ldl compered to other things that float in the blood stream! Like fibrin and macrophages. The result of cloting is an arterie disease, and have nothing to do with ldl or the cargo cholesterol esters!

[@faricus27]

Hi Nick, thank you for this mega-important research. I truly believe that current lipidology models are flawed and need re-evaluation. I have a Mission meter at home and am trying to understand how I react to different fats. I think I am a LMHR, but I manage to keep my LDL at the 120-150 range by consuming the minimum amount possible of plant sterols (avocado, chocolate, plant/seed oils, nuts, even broccoli, berries and other plants), which, by the looks of it, somehow recognised as LDL-C in my body. It would be extremely interesting to learn the level of plant sterols in the cohort that you monitor or are going to monitor next time.

[@mishaspektor]

20 years on keto. I’m a hyper responder. High LDL high HDL low triglycerides. My coronary arteries are 80% pluqued. This month I have to do a heart surgery. If I’m lucky stenting will be enough. If not, I will go to bypass surgery. For years, I’ve been preaching the same. Now I’m not so sure. I blame TRT and other PED‘s I’ve been abusing for about 10 years. But seems like cholesterol played an important role here. Sorry to tell that guys. I’m only 46.

[@fihimsadiq8779]

PEDs affect how your body regulates lipids and also causes inflammation. Did you check your c reactive protein when doing blood tests?

[@thehappyfellow5500]

​@@fihimsadiq8779 for sure the PED's played a role but the keto was also not protective. A lot of people take PED's for longer and don't have these issues. I hope he pulls through.

[@Pp-wn2gn]

The PED'S caused the damage to your arteries. The cholesterol was only trying to repair. You would have the blockage even with low LDL

[@larrywong7834]

Best Results for your surgery. Thank you for sharing. I've too have thoughts on the saturated fats. Dad had Triple Bypass at age 52. Uncle had Stroke at 53. Many CHD History in our family tree. GrandMother died heart attack age 40's. Trying to Self Learn I followed a Plaque Tracking site for like 10 years that emphasized low Carb High Fat, Keto.. Two things perk my ears up. And made me Think. Like my Skin, my Life is on the Line So my choice of knowledge is critical and important. I can't just make or take assumptions. One observation that sticks to me. President Bill Clinton has couple MI's or Heart Surgeries early in his Life. So he became Vegan. The LowCarb community said that was Bad. And they worried for Bill of his choice. Many paleo's critized his new adopted "Healthy Heart" program. Bill Clinton looks awesome now. Lean. Healthy. Strong. Young. Guess he has been Vegan for near 20 years now. Observation #2 was at that Heart Plaque Tracking site. A member went high extreme Paleo for 2-3 years. And Proudly Boast of the extreme low carb, Tons of sat fats LifeStyle the member adopted. After about 3 years Paleo the member posted that a quadruple/Triple Bypass was needed. So for me I had to be careful of what I adopt to achieve Heart Artery Health. When At age 51appx my LAD artery was 70% occluded. I have done like 7 CT Angio heart scans. I'm age 73 now. No heart Surgeries. No Heart attacks. Knock on Wood. I keep Saturated Fats intake low. 20 grams a day is likely.

[@MarkThomasMedia]

Troll checkers on please

[@JakMang]

This front is moving ahead nicely. We need to start studying normal keto people with high HDL, low TG, lower LDL and not so lean against these coronary risks.

[@bettykramos1802]

Love the t shirt! Just ordered one 👍🏼

[@nicknorwitzPhD]

Glad you like it!

[@LockFarm]

This is indeed interesting stuff, congratulations on getting the study this far! A couple of criticisms/questions would be: 1. A trial of N=100 seems relatively small for generalising about atherosclerosis, and 5 years is still relatively short 2. I'm under the impression that there is a threshold (around 80mg/dl) for LDL that marks the point at which we might expect progressive atherosclerosis to start to occur. Since both groups were significantly above that level, would any difference between them be negligible anyway? I.e. how linear is the response to LDL levels in the general population. 3. There continues to be a danger in the communication of this research that results that apply to a specific phenotype (that is not particularly representative of the population in general) might be applied to the wider population. Since this feeds into the "statins are a trick of big pharma" conspiracy theorists, there is potential for misuse of your research to beat a very different drum. 4. There are a whole bunch of questions about comparisons between the two groups in the trial - almost by definition a group that sticks to Keto for five years is much more aware of their body, and likely to have different exercise and activity routines as a consequence. 5. Similarly, the types of fat being ingested are known to have effects on plaque formation, so there are a lot more questions around diet composition beyond simple carbohydrate/protein balance.. None of these questions should take away from the hard work and interesting science that you're doing here, but as you say, there are a lot more questions to be answered...

[@nicknorwitzPhD]

(1) n-value isn't nearly as important as the question and methods. And 4.7 years is longer than many trials looking at plaque (2) Two words: dose response... idk where you got the 80 mg/dl threshold, but 123 mg/dl and 272 mg/dl are two very different "highs" (3) We communicate the research with appropriate caveats. There will always be those who seek confirmation bias, on both sides. The alternative is to shield the public from data. I don't like that alternative. We will continue to do our best to communicate responsibly. (4) Addressed in the video. Please watch again. (5) Please feel free to elaborate. Please cite studies, for example, showing dietary saturated fat promotes plaque development independent of changes on ApoB/LDL

[@llicit1833]

Another issue I've seen raised is that plaque accumulates first in the arterial wall, and only after a long time does it appear in the lumen. And the lumen is where the imaging used in the study is looking for plaque. Not sure how valid that criticism though

[@alz.7716]

Thank you for this.

[@nicknorwitzPhD]

You're welcome

[@Lea-k2c]

My LDL was always around 170-190, HDL and triglycerides normal. I didn’t want to take prescribed Statins and decided to ask doctor to check more advanced panel; lipoprotein(a) is 225, Apo-A1 175 and Apo-B 105. Doc was shocked. I am and always was on a skinny side, not sick, don’t take any meds. My ANA is +140 but no autoimmune disease was found. 4 years ago cardiologist said my arteries have plaques and I need Statins. Last year he said I have CAD after I did scan for very mild Bronchiectasis. He insists on Statins. I am not taking them all these years. My bad numbers stay the same. Carnivore made me even more skinny but didn’t reflect on cholesterol. Should I listen to doctor and take Statins? Should I be scared of heart attack?

[@MareBlz]

Dr. Nick, are you familiar with Lipoprotein Phenotyping? I had this test (through my chiropractor) a couple years back and I have Type 11A (2A). I’ve been told this is FH. My Kaiser doc took a look at it and messaged me that it’s an older test and I have Fredrickson 11A. She said it’s not a test for FH. I have high LDL (301). From what I’ve read very briefly, it’s something to do with the receptors. My cholesterol literally doubled when I went keto 5 yrs ago. No meds for it. I’ve been following Dave since then and more recently, you also. Not asking for medical advice, just some direction or knowledge about this factor. I appreciate all you men are doing in this field. Thank you so much for Any insight!! I’m 58, and have Hashimoto’s btw.

[@TOMGARVEYtheKETOCOOK]

Very intriguing and I`m very interested in learning more!

[@nicknorwitzPhD]

You and me both!

[@donbrown7694]

Thank you for this great work! My doctor never saw anyone in his clinic with my HbA1c (type one diabetic) but the only concern of his is to lower my cholesterol…

[@Montenegro651]

Well done Nick! Leaving this here for them rithms.

[@nicknorwitzPhD]

Thanks

[@Ozzie-n8t]

When the risks of high LDL are discussed, there doesn’t seem to be a discussion or analysis based on FRACTIONS of LDL, given there are many assertions that it is only the SMALL DENSE LDL that is of concern regarding the etiology of CHD. Have there been many new findings since the 2003 article in JCEM by Sacks + Campios, which concluded that “LDL subclass measurement does not add independent information to that conferred generically by the LDL concentration…”

[@JamesBogashDC]

Two comments...first, it's generally accepted that oxLDL is the problem, so higher LDL should not = oxLDL in the presence of a healthier lifestyle (you mentioned metabolically healthy--which is unfortunately a rare unicorn these days). Second, just having seen this video and briefly looking through the study, I didn't see specifics on the other macros in the diet. Keto is all about the fats, but many think that this means lots of bacon and cheese instead of macadamias nuts and avocados - this can certainly make a difference in outcomes.

[@misilen24]

Hi guys. You should do CT FFR AI to. I had this done in Swedish trial instead of having a coronary invasive FFR. This gives a good answer to the question - if there is plaque but how big is the restriction in the flow. Since I have no symptoms I had very little motivation to risk the life qualty I have today.

[@whitGGG]

LMHR here.. I appreciate your channel so much! Too bad conventional medical doctors don’t bother to read these studies.

[@kristaG73]

They’re burned out from working for insurance companies (who have relationships with pharmaceutical companies). They go home and they’re dead. It’s not surprising.

[@nicknorwitzPhD]

We are making them ;) ...

[@glenntimberlake2413]

This is a great series of questions and significant contrasting data.

[@nicknorwitzPhD]

glad you enjoyed the video

[@QuintonDolan]

Wasn’t high LDL supposed to be an observable marker for an increased risk of arterial plaque accumulation, not necessarily the single underlying mechanism for this accumulate. It appears there should be more than one accompanying condition that the subject must also exhibit for the arterial wall to be susceptible for plaque to accumulate in the first place. In the absence of these conditions is LDL a meaningful metric?

[@cokeiceeeee]

best comment with the only question that truly matters

[@ExtaTer]

I would like to see how the plaque changes over time in the keto group vs the regular diet group.

[@jaro6985]

Yeah, this would be useful.

[@nicknorwitzPhD]

Longitudinal study analysis underway. All data collected. Can't say more other than "stay tuned"

[@ExtaTer]

@@nicknorwitzPhD The question is why this was not done already. The change in plaque score with time is of greater interest than what the plaque score is at a time point.

[@jaro6985]

@@ExtaTer It takes more time and effort to do that.

[@ExtaTer]

@@jaro6985 No it doesn't. If they checked the patients plaque initially with the same method, they should have the change but they don't show it??? If they haven't checked the plaque initially, it begs the question why, cause that is basic statistics. Repeated measures is better than independent samples analysis.

[@DanzeMusic]

Interesting video! I started doing keto around the same time with my friend who is 17 yrs younger. His LDL level elevated drastically after 1-2 yr, but for me, my LDL level never elevated, in fact it decreased a little. Anyway, after a more detailed lipid profile test, it was found that his LDL-P level was quite low. My LDL level has never been high all my life, even when I was eating lots of rubbish like high sugar/carbs/seed oils. I suspect maybe it was due to my body’s inability to metabolize fructose (according to tests). None of my siblings were overweight, and so was my mom who ate all day with 0 exercises, but was still able to stay very slim. However, not being able to metabolize fructose is like a double edge sword, it kept me from getting overweight, but at the same time, it gave me blood sugar spikes that elevated for hours from consuming fructose, much worse than glucose. It makes me wonder if fructose is the cause for high LDL in a lot of people.

[@johnk6578]

I went carnivore, so no fructose, and my ldl-c jumped to 624 at month 6.

[@user-oq8cm6ej3u]

@@johnk6578 You din't consume fructose, what about glucose? That's why I said: 'It makes me wonder if fructose is the cause for high LDL in a lot of people.' ie: younger people who are not doing Keto. I'm not normal because I cannot metabolise fructose.

[@johnk6578]

@@user-oq8cm6ej3u- - strict carnivore = essentially zero carbs, so no glucose. Ignoring “expert” opinions on cholesterol, all of my blood markers are now at a super healthy level.

[@davidinmemphis]

Nick, the language used throughout the video and paper (though it hints to the correlation in paragraph 1) is "LDL", but I'm assuming in this cohort that increased LDL means increased ApoB as well? What about lp(a)? I never hear much about ApoB and lp(a) and how they track with the LMHR model. Have I missed this discussion somewhere?

[@thehappyfellow5500]

They showed the data on apoB in a video but it's not in the study for some reason...

[@williamhightower4940]

I have been moving to what one might call Keto after 10 years of pricking my finger to monitor my diabetes. I learned over that time what raises my blood sugar. In my push to finally get off weight to prove that I can loose weight without weekly injections I started moving toward keto, with a 18day stay in the Hospital that caused me to really get motivated to get the weight off. I listened to my heart doctor, and read about the keto friendly south beach diet. It's like Keto light. I ended up more carb restricted, not quite carnivore. It's working, A1C looks normal. I was able to get off one diabetes med. But, my triglycerides and LDL went way up. My HDL really didn't move much, actually is below "normal". This is my Puzzle. I played over and over in my head what my doctors said. They are concerned about the triglycerides and LDL but they want me to continue with my diet. I have lost around a 100lbs and probably could loose another 100 to get to a healthier weight. I'll see my 2 doctors in 6 months, and hopefully I'll have lost another 24-30lb or so. One question I do have is what is the minimum dose of Oreos for lowering LDL and maybe Triglycerides? I know silly question, it is counter to me trying to put my Diabetes into remission. Sorry I don't know to have a short comment in this side of KZbin.

[@olafstorbeck4777]

I'm not a physician, so take it with a couple pinches of salt: To readjust a metabolism after decades of derangement needs time. Definitely don't ad the Oreos. The raise the Triglycerides and lower the HDL. If you need another 100 pound to loose and you lost already the same amount, keep going. HDL would rise with exercise, but if you are 100 pound overweight, be careful with your joints, swimming would be great if possible. I did also intermediate fasting, e.g. omad. I'm mid-fifties, was on overweight (barely not obese) and had HBA1C on 5.9, so insulin resistant and not yet pre-diabetic. I lost 35 pounds. But to restore insulin sensitivity and get a healthy metabolism takes probably years. I for myself decided that I keep track of Trig/HDL-C being low and ignore LDL-C on a LCHF. Oh, just another trick. If you can effort it, use a continuous glucose monitor for a month or so and journal your food and exercise. I found funny effects. One day I was trailrunning for 10 km (7 miles or so) in a 24h fasted state and my blood glucose went slightly up. Afterwards I had a keto feast (steak, prawns, broccoli, salad, a bit of red wine) and while eating my blood sugar went down. Especially if you are still loosing weight, you need to consider that you are in catabolism, that fat lost is kind of part of your diet

[@johnk6578]

For what it’s worth, I’m about 8 months into carnivore and my trigs did not start going down until after I leaned up. My ldl-c peaked at 624 and is also now trending down. Last measured at 543. I’m testing monthly

[@williamhightower4940]

@@johnk6578 good to hear. I got the impression from my primary care doctor was that when I get down to a healthy weight we may be able to ween off of the statins. I kind of figured it was part of the weight loss. I am staying the course.

[@williamhightower4940]

@olafstorbeck4777 Thanks, the oreo remark was kind of tongue in cheek. No way I could enjoy anything with that much sugar. I suspected the LDL issues was part of the weight loss. kind of figured the fat has to mobilize to get used. HDL I suspect that is genetic, all I ever was able to lower it with a very low fat diet and exercise. This is the most successful at loosing weight of all the diets I tried. It will be interesting in 6 months with another 25-30lb off. I expect i have another year and a half to get to a healthy weight. I will stay keto once I get there. I walk more and move more at work for most of my exercise. Knees are not so good, but way better than last Thanksgiving. Thanksgiving 2023, I was rushed from immediate care to the Hospital, before I left the hospital I pretty much had a doctor for every organ. I am 58 now. Wish I discovered this a long time ago. Take care fellow traveler, I am staying the course.

[@Robert-vv6tz]

Nick, As a 70 year old with existing coronary artery disease from a "previous lifetime" of bad health habits, now mostly carnivore for 5 years and my labs are solidly in the LMHR range, I'm delighted to get at least some suggestion I may not be killing myself by following this diet. My cardiologist is in flipout mode and has me on repatha. I'd rather not take it but I need further evidence to make an informed decision. Please continue to bring forth any relevant data as it becomes available. Thank you for the important role you play.

[@nicknorwitzPhD]

"but I need further evidence to make an informed decision" - this is a wise and reasonable decision. We are doing our best to move the data along and appreciate you learning with us along the way.

[@WowzaGuy]

I think it’s important for everyone watching this to understand that thia data is specifically for the lean mass hyper responder phenotype. One can’t infer the same impact on plaque for those who are NOT LMHR.

[@kristydickerson6171]

There are other risk factors to consider, Lp(a) and ApoB. What of those folks? Please include these things in your videos.

[@jarednordstrom6041]

I appreciate studies that offer evidence contrary to the "preponderance." It offers opportunities for more research, learning, and understanding! The beauty of medicine and science!

Great information. My LDL was "high" on carnivore when lowering my A1C and fasting glucose.

[@CoyoteWindRanch]

I actually just hit your parameters for LMHR last week. Dr almost had a heart attack but my Trig/HDL ratio is .84. She was a bit confused. . . .

[@MarkHorswill]

Excellent talk. Ty. My wife is a LMHR. She went from a total cholesterol of 7 mmol/L to 16mmol/L upon starting 95% carni/low oxalate diet a yr ago. Since leaner folk might be more likely to eat high oxalate foods such as spinach salads and green smoothies, she would like to see prior oxalate consumption explored as a potential contributing factor to the LMHR phenotype. Over the past year on 95% carni / low ox, she has been constantly expelling calcium ox crystals via urine, nails, eyes and skin. She has just started to develop cholesterol deposits under her eyes (xanthelasma). Is it possible to do an analysis on the LMHR group using prior ox consumption as a variable? Or even better, CHANGE in oxalate consumption (a potential measure of oxalate dumping) when they switched to low carb (ie she went from 2000 mg to 70 mg of oxalate consumption /day when she went low carb. Oxalate dumping causes intense inflammation. Inflammation is one potential cause of CVD is it not? She appreciates your continued hard work in this area.

[@edl653]

Engineer here. In short there are two fueling modes of the human body, ketone (fat) and carbohydrates centric at the two extremes. LDL's impact on the body is different at each end. As fat (LDL) is the primary fuel during ketosis, it makes sense that there will be more LDL and a corresponding rabid burning/turnover of that fat. Those different paradigms seem obvious to me. So, what needs to be determined are the in between responses by the body. For example, comparing 70% Fat/ 10% Carb/ 20% Protein versus 50% Fat/ 30% Carb/20% Protein versus 30% Fat/ 55% Carb/20% Protein. For the Carb a factor is naked carbs (which we already know is bad) versus Whole food Carbs. For Fats, Saturated fats (which I suspect are unhealthier the more Carbs, but not so much during ketosis) versus Poly-Monounsaturated fats. - Simple non-medical/molecular biology language I think most should understand. 😇 Good video.

[@clinhart]

Engineer here, too. I am aware of at least 4 types of fuel for cells, and all of those fuels can be transported by blood: These are glucose, ketones, cholesterol and glutamine. So, there is quite some redundancy in that system. If one type of fuel is inhibited or not economical due to diet, the other types of fuel will probably be elevated. Which explains higher LDL on a ketogenic diet for some people. Other people's bodies may prefer to produce more ketones for example to replace glucose. I am currently temporarily testing a cholesterol-lowering drug ( ezetimib ), and preliminary results indicate that my glucose level is elevated and ketones are still quite high but a bit lower than without the drug. The drug seems to also inhibit conversion of fat to ketones by blocking a receptor that cells need to get fat into the cell. Which indicates that the body replaces LDL and ketones by glucose from gluconeogenesis. Possibly, glutamine is also elevated, but I cannot measure that. The connection of those 4 internal fuels to food also have several pathways and degree of freedom: Some amino acids can be converted to glucose. (gluconeogenesis from protein) Some amino acids can be converted to ketones. (ketogenecis from protein) The amino acid glutamine can be used directly. (is converted to glutamate at some point, possibly in the receiving cell (?) ) The glycerin component of triglyceride fat can be converted to glucose. (gluconeogenesis from fat) Fatty acids can be converted to ketones. (ketogenesis from fat) Fat can be used to build cholesterol. (together with protein I guess) Glucose and fructose can be converted to fat. ( for storage ) All of this is more redundancy than most mission critical computer systems have. Which is awesome.

[@RechtmanDon]

Just shared this vid and your PDF paper with a Shenzhen, China WeChat medical group.

[@nicknorwitzPhD]

Thanks 🙏🏻

[@mbrochh82]

Here is a ChatGPT summary: - The data presented are pivotal but preliminary and cannot be ignored. - The study, published in Jack Advances, investigates the effects of carbohydrate restriction on LDL cholesterol and atherosclerosis in lean mass hyperresponders on ketogenic diets. - 100 lean and metabolically healthy individuals on ketogenic diets were followed to measure plaque accumulation in their coronary vessels using state-of-the-art coronary CT angiography. - The keto group had significantly higher LDL levels (average 272 mg/dL) compared to a matched control group from the Miami heart cohort (average 123 mg/dL). - Despite high LDL levels, the keto group exhibited no increase in plaque compared to the control group. - There was no correlation between LDL cholesterol levels and total plaque measured by coronary CT angiography. - The subject with the highest LDL level (591 mg/dL) in the keto group had a zero plaque score. - The study raises questions about the absolute risk associated with high LDL cholesterol in metabolically healthy individuals on carbohydrate-restricted diets. - The lean mass hyperresponder phenotype shows a unique metabolic response to carbohydrate restriction, leading to high LDL, high HDL, and low triglycerides. - The study suggests that more research is needed to understand the mechanisms and risks associated with this phenotype. - The data are preliminary and will not change current guidelines immediately. - The study acknowledges that the lean mass hyperresponder group differed from the control group in non-LDL parameters like HDL, triglycerides, and BMI. - The study emphasizes the need for more research to understand the metabolic signature and underlying physiology of lean mass hyperresponders. - Main message: Despite high LDL levels, lean mass hyperresponders on ketogenic diets did not show increased plaque accumulation, challenging conventional wisdom and highlighting the need for further research.

[@larrywong7834]

Only one CT Angiogram were TAKEN by the Feldman/ Budoff LMHR studied peoples. ONLY upon reporting of CAC and Softplaque by LMHR's second scan will we know the effects of this High Fat Lifestyle. All we know now from the first Heart Scan by the n=100 LMHR is that appx 30 of them has very severe TPS total plaque score. Also the LMHR Study will not follow MACE(heart and stroke events) by the LMHR.

[@larrywong7834]

"Four-point MACE: cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for unstable angina."

[@larrywong7834]

From the LMHR Study. "The matched mean age was 55.5 years, with a mean LDL-C of 272 (maximum LDL-C of 591) mg/dl and a mean 4.7-year duration on a KETO. There was no significant difference in coronary plaque burden in the KETO group as compared to MiHeart controls (mean LDL 123 mg/dL): coronary artery calcium score (median 0 [IQR: 0-56]) vs (1 [IQR: 0-49]) (P = 0.520) CCTA total plaque score (0 [IQR: 0-2] vs [IQR: 0-4]) (P = 0.357). There was also no correlation between LDL-C level and CCTA coronary plaque." THIS SHOWS VERY CLEARLY that at the median====> 50% of age 55 Americans on the SAD standard american have no Heart Plaque. The LMHR n=100 did NO Better at the Median.

[@antoinetteqvistorff2270]

My doctors are now freaking me out about my super high HDL of 120. I have been told this is more dangerous than my high LDL of 194. I am a 62 year old female and very lean and active. My triglycerides are 57 and I have low inflammation markers.

[@jatf]

Interesting findings. I’m not an expert but I’m not metabolicly healthy and have had a CTA in my early 30s that showed no plaque. but an ultrasound on my neck showed I had mild to mid plaque in my carotid arteries. Should these LMHR participants have been tracked with carotid ultrasounds and other peripheral arteries where I’m told plaque develops first?

[@PhilHugo]

Brilliant content Nick, thanks for everything you guys do for the LMHR community

[@nicknorwitzPhD]

Than you Phil!

[@bastianfuentes8335]

Siempre pendiente Phil, eh? Un abrazo jajaj

[@allisonearley9944]

LMHR? I'm not lean. 5' 5" 150lbs. On carnivore diet and have lost weight, and still losing. HDL: 93, TRIG:66, VLDL:9, LDL:204! Everything has improved since May 2024, but LDL is still going up! Lipoprotein A: 27.1, Apolopoprotein B: 143 !! Not lean, but numbers look like LMHR. Why? Thinking maybe getting a CGM and adding some carbs to see what happens for next lipid tests. I'm lost.😮

[@stevelanghorn1407]

Just out of “curiosity” (!) did the Keto volunteers tend to be more generally healthier people than the Miami group? Did they comprise people who were “into” personal health and training? Does this mean that the applicabilty of this LMHR study runs the risk of being rather limited? I hope I’m totally wrong & that this advancing lipid science (thanks Nick, Dave & Dr Budoff!) will be significant for us all, irrespective of personal diet choices.

[@cokeiceeeee]

Yes almost 50% of the Miami group was overweight, while almost none of the keto cohort was.... anyone anyone at all

[@thehappyfellow5500]

The Miami group were overweight on average while LMHR were low-normal BMI. 'As LMHR subjects as a population are, typically, quite lean compared to the general population, perfect matching on BMI was not possible: mean BMI for the KETO group was 22.5 ± 2.7 kg/m2 as compared to 25.8 ± 3.6 kg/m2 for the MiHeart group. '

[@TezTezTezTezTez]

I'm lean, BMI 21 and I eat low carb, exercise 6 days a week, every week and my LDL sky rocketed to 273 - my triglycerides super low 0.5 and HDL up... so confused and my doctor wants me to go on statins Great content - subbed ❤

[@rollingstone3017]

Indeed, stay curious (and skeptical)🧐

[@nicknorwitzPhD]

🤓😉

[@brianadler67]

You and your team absolutely deserve a Nobel Prize. Is that a thing in medicine?

[@nicknorwitzPhD]

Yes… although I wouldn’t bank on it for my future. But you never know… with any luck I got another seven decades left. Let’s see how it goes.

[@chewiewins]

Not a believer yet that isolated raised LDL-C (with no metabolic disease) won't cause cardiovascular risks but certainly a promising study which is well explained. Curious how long does plaque (& indirectly calcification of arteries) takes to develop after how many years of elevated LDL-C? Maybe need more than 5 years? Time will tell.

[@larrywong7834]

My LAD Heart Artery went from 40% Blockage to 70% occlusion in appx 13 months. Confirmed by Serial CT Angiography done by Budoff. After the Heart scan Budoff then discussed my CAC and Soft Plaque occlusion results about an hour or so later. My next CT Angiography was done appx a year later. The LAD Blockage was reduced down to appx 45% Blockage. During that period I modified my Diet. Anyone that finds their LAD the widowmaker was 70% occluded would determine what they had to do.

[@chewiewins]

​@@larrywong7834 what was the modification? What was previous diet?

[@nicknorwitzPhD]

5 years is longer than many studies. Even 1 year is enough for prospectives studies (which the parent keto CCTA study is) using modern CCTAs. We aren’t measuring MACE/clinical outcomes.

[@chewiewins]

@@nicknorwitzPhD Agree it's looking good. I hope you and Dave can prove this as Keto would be a useful tool for many, and may be unique in CNS and cancer aid too. Thanks for replying @nicknorwitzPhD

[@larrywong7834]

@@nicknorwitzPhD Just wanted to inform you. That I have visited Harbor UCLA Torrence about 10 times if my old memory serves. Believe Budoff did CT Angio on my heart about 6-7 annuals. CAC even more times. My Scans are at the Harbor Facilities database. Budoff' s friend is my Cardiologist, now retired. I have done numeriou NMR's. And BHL particles study. apoE genetics. Inflammation markers. I firmly believe Knowledge is primary in the control of ones own severe CHD.

[@meg66]

Thank you for explaining this study in depth. I have one question. What about ApoB? Is apoB going to be elevated with the LDL or should ApoB be at "healthy" levels even in LMHR patients?

[@jobrown8146]

I doubt that we will ever know "for sure" but at least more evidence is being compiled. Thank you.

[@nicknorwitzPhD]

Yep 👍

[@christopherbrand5360]

You could use me as a paired control for your studies. My HDL and trigs consistently meet the LMHR criteria but with my WFPB diet my LDL-C is in the “healthy” range for the general population. My fasting insulin is typically low and I am very metabolic flexible - I easily enter ketosis. Pair me up with someone who gets lots of exercise (8-20 hours per week). I would be happy to get a couple of CT angiograms to help advance the science.

[@damens-xn9pu]

I do agree it is an interesting question. Not everyone is the same. What it will really come down to is whether or not these results will be the same in 10, 15, 20 years. What I dont get in your model is, why the fat that is lipolysed is turned into cholesterol instead of beta oxydation. Why is it not used for energy. Another question, did you try the carb thing on a vegan keto diet as well. In a previos video you only talk about meat and carb vs plant keto but not plant carb. As a vegan myself I would have found that interesting. I had a patient that tried lowering their ldl through a vegan diet though he was not lean and probably fh involved.

[@Roberto-cg2gr]

Atilla is still insisting results of Mendelian Randomization. Hope there will be a mendelian Randomization on Insulin sensitivity/resistance on all cause mortality

[@nicknorwitzPhD]

How relevant are MR to a population that has high LDL are response to a metabolic shift rather than genetics?

[@Roberto-cg2gr]

@@nicknorwitzPhD David Diamond presentation shows that even hyperlipidemia lives to 8 decades with low carb diet. No idea what is the accuracy of Mendelian Randomization Atilla is using as Justification for risk of high APOB

[@larrywong7834]

​@@Roberto-cg2grwow. A person doing low carb for 80 long years.

[@janvidezark]

Timestamp 10:29 illustrated that concept perfectly - thank you!

[@nicknorwitzPhD]

🙏🏻

[@hemantkhatod3979]

Apart from Just LDL, I am curious if their are data on other aspect of LDL such as partical size, number, small dense LDL, medium size LDL etc

[@stevemc2626]

Just curious, does Lp(a) play into any of this? It is my personal real concern. Were there any people in the study with high Lp(a)?

[@larrywong7834]

I have very high Lp(a). With 70% occlusion of my LAD artery via CT Angiogram about 20 years ago. Which a year later via CTA it was like 40-45% blockage. With a good heart healthy program correctly Individualized. The last 20 years I no MI, NO Stents, No heart operation. Knot on Wood. Yep. I never been able to bring my high Lp(a) level down.

[@stevemc2626]

@@larrywong7834 So what ‘heart healthy program’ did you do Larry? What did it consist of?

[@TeroCarni]

I am LMHR. I have also very much plague. I would like to believe that it is not because of my very very high LDL. You know what my doctors say. Statins are must they say..

[@AmazingFeynman]

As a skeptic, I have to say that this a nice result. Still lots more research to do to change the course of clinical guidelines. So if LDL-C is not a very good predictor of calcium score, what do you suggest? Have you considered ApoB? I’m someone who likes a good metric for predicting my future health and CVD risk. I found out I’m LMHR after accidentally going on keto for a week and got an LDL-C of 205, HDL of 60, TG of 57 at BMI of 22.6. But I was pretty anxious about those numbers so adopted a standard low saturated fat, high PUFA Mediterranean diet with complex carbohydrates. Shortly after I’m back at normal with LDL: 99, HDL: 46 and TG: 49.