What are LMHRs (LEAN MASS Hyper-Responders)? | Dave Feldman, Drs. Nick Norwitz & Dominic D’Agostino

[@loradouglas]

I am one of those people that Dom refers to as "having the features of a LMHR, but are sort of borderline." I would not consider myself lean. I have a BMI of 27, however on a low carb diet, with high HDL and low Trigs, but high LDL. To keep my PCP and Cardiologist from freaking out, I am on 80 mg of Atorvastatin. I am a 69 yo female and do have plague and 4 stints from a previous highly inflammatory SAD diet and metabolic syndrome. I've been Keto since 2017. I am following your research. Keep up the good work!

[@kenadams5504]

If your bmi goes under 25 , your lipids will probably qualify as a true lmhr .I'm 23.5 bmi and ' qualify '. My Doc recommended a statin , but I got a cac score of zero hard plaque , so declined the statin . I'm gonna get a cac annually just to see what, (if anything ), happens .

[@ssa8479]

I'm a very ordinary 65-year-old male, and find it hard to believe I may be a LMHR. Sure I do pushups, squats and light weights, and walk a lot every day, but I'm not particularly athletic and gave up my gym membership when COVID began. I follow a low carb lifestyle, keep carbs mostly below 20 grams but indulge in homemade chocolate cake on family birthdays. I have a BMI of 19 (135 lb / 61kg), total cholesterol 553, LDL 474 (large or Pattern A, according to the NMR Lipoprofile), HDL 86, trig 56, VLDL too low to be measured, Lp(a) 18, HS-CRP 0.95 and insulin of 6.7. The LabCorp test results said the ApoB (at 256) was high, and it took some research to learn that high TC (or LDL) also means a high ApoB.

[@oglelaura]

I love the point Nick makes at the very end. I feel his frustration because there is so much ego in medicine. But when it's you with skin in the game, and you reach out to researchers who could help, and they pretty much write off your ideas, well, frustration is inevitable.

[@kelseyhargrove5862]

Dr Robert Lustig talks about how there are 2 types of LDL cholesterol that contributes to a standard cholesterol test: small dense and large buoyant. When you eat meat you are going to produce more large buoyant, but it is metabolically neutral and not harmful. However if you consume sugar and carbohydrates your small dense cholesterol (and uric acid) will increase and it is what actually causes heart disease. So anyone going on a keto diet will see their cholesterol increase because the test lumps both cholesterols together. It would be a great experiment to look at just the small dense LDL.

[@rebeccabrown1124]

Yes! That test is called an NMR Lipoprofile (Nuclear Magnetic Resonance) and a person can even have it done without their Dr ordering it (insurances aren't paying for it yet). I just had mine drawn and am waiting on results, because my last 13 months of keto/carnivore has put me in what looks like the LMHR category, too. I used RequestATest and went in to a LabCorp lab to have it drawn.

[@michaelcariello6233]

Great discussion. So glad that Dom brought up the disagreement between experts. Dom is correct in that keto people whether expert or laymen live in severe echo chamber. When such glaring disagreements exist between experts it must be addressed head on as opposed to having battles and talking past one another on social media.

[@nataliajimenez1870]

Well, the whole Oreo test is showing that LMHRs may have alternative treatments for lowering LDL without statins. The slight addition of carbs and the resulting fall of LDL had been published already in a series of case studies from Dr Tro's patients and also Dave Feldman had played with the addition of carbs from sweet potatoes.

[@6789uiop]

I was mystified when my LDL was very high since going keto in 2012. Been following dave and Dominick shortly after. I finally came to the conclusion, after seeing yet another Dayspring vid, that I have too many NEIMANN-PICK C1-LIKE 1 receptors, or too few ATP Binding Cassette Transporter G5 / G8 receptors on the enterocyte area of my intestinal lumen.

[@CashMoneyMoore]

Really cool discussion, thank you Dom for bringing some interesting questions.

[@godblessusall7696]

71 year old female, BMI 25, CAC score zero. Always had normal cholesterol till dropping 50 pounds on low carb, ketogenic diet 2 years ago. I exercise very little. Currently, LDL 159, Triglycerides 63, HDL 73. Is there a study using folks like me? I worry that the CAC will worsen given the last 3 years of low carb but higher fat, given my increasing LDL.

[@ssa8479]

I'm learning not to worry about the higher total and LDL levels. Your trigs and HDL are excellent. If you can, get an NMR Lipoprofile; it will show if your LDL is mostly the large buoyant "pattern A" that's harmless.

[@melissagrogan9895]

I am a LMHR and frankly I find it unsettling. Not sure what I should do about it.

[@PhilHugo]

Like if you want to see before the end of 2024 an epic debate between Layne Norton and Nic, that will help all of us who are LMHR.

[@whitGGG]

I’m a LMHR and when I cut carbs I cannot function & my brain fog goes through the roof. By carbs I mean bananas, berries & other fruits.

[@NutritionPolice]

You're a non-keto LMHR? Never heard of that.. What is your diet, generally speaking?

[@wesleyroseiv]

You got a sugar addiction

[@bml4646]

I had the same phenomenon, all numbers got better but LDL & TC were at an all time high on keto. I’ve added some carbs back and reduced saturated fats, not sure what to make of everything.

[@speedyswede5585]

By adding back carbs did you gain weight and did your A1C increase (albeit it takes 3 months average to move A1C).

[@bml4646]

@@speedyswede5585 so I don’t know yet since I’m just now testing how carbs will change my numbers, and won’t get labs done for a couple months unfortunately. A1C is 5.2 now, and no weight gain yet.

[@jessical989]

How’s that working out for you? I’m in the same situation in keto with similar numbers and thinking of adding back in some carbs as well

[@bml4646]

So after adding carbs back, I gained some weight back - which I needed to. Keto made me lose way too much and doesn’t work for me, I would still lose weight despite taking more protein than I weighed. All my numbers remained good, A1C, trigs, even my HDL spiked to 61…and I’ve never been higher than 52 there. Finally, my LDL and TC reduced moderately, like 155 to 140. For me I’ll stay with some carbs in the diet.

[@jessical989]

@@bml4646 so your LDL was 155 on keto and the lowered a bit to 140? I think I’m going to also add back in some fruits to be around 50-70g carbs for now, and cut back on saturated fat. My doctor suggested Mediterranean keto, which would be even more restrictive, so I think I’ll just do a version of Mediterranean lower carb

[@TheTarasom]

Great podcast , great questions . I have very high cholesterol , over 500 , and being without any symptoms lost February in emergency I had a triple bypass. At that time the doctor told me the three arteries were over 80% plugged now I don't know if it's the truth or not I had the bypass regardless. Before the surgery from year 2000 to 2015 I was very low ketogenic diet and from 2015 to even now full carnivore. Also I have exercised all my life and I still do. Tere ratio between HDL and triglycerides always have been very good and yet I still got in trouble. I'm stunned confused but I still refuse to take statins. Recently I reintroduced a little bit of carbs in form of fruits and fermented vegetables. 1 I want to thank you all of you for everything that you are doing for all of us.

[@iorch82]

Well, you're the text book example that all these claims by the low carb / keto / carnivore influencers is to be taken with a pinch of salt. Just take the statins.

[@gray45374]

Great minds, great discussion.

[@nicolelaurentLMHC]

I wonder how many people don't meet the triglyceride criteria (I know it's loose) for LMHR because they like French Press coffee instead of filtered.

[@Natural.PharmD]

Great talk! I am a LMHR after going low-carb While recovering from environmental illnesses. I have always been active with a low LDL until I changed my diet. it drastically increased when my LFTs rose while detoxing - my LFTs have now normalized & LDL is still significantly elevated. I believe Stephanie Seneff mentioned in a podcast the rise in LDL could be due to an inability to sulfate it. I am conducting my own N=1 experiment to see if I can move my LDL as I continue to focus on quantum health and decreasing deuterium in my body and enhance sulfation

[@robyn3349]

Super discussion!

[@aew234]

Is there any relation of Lpa and LMHR

[@petercyr3508]

My 71 YO wife on carnivore meets LMHR criteria, but she is not lean. She has lots of healthy fat cells in her hips and thighs which are actually protective. Last Tg 73 HDL 73 LDL 220 insulin 5.6 A1C 5.4. You guys need to rethink the "lean" aspect of this.

[@punchkitten874]

LOL 🤣🤣🤣 if your wife is on carnivore, she sure ain't been on it for long! There isn't any "protective" "healthy" fat - the only protective fat is visceral, which forms when you continuously eat crap foods. Your wife is cannot fit the criteria for LMHR if she is not healthy when the measurements are made. She is definitely not an LMHR if she retains unhealthy fats. She is DEFINITELY not on the carnivore diet if she can't lose that weight. Reported your post for misinformation. Try again pal 🤣🤣🤣

[@davidzee641]

What a wonderful bet. Hey we’re gonna do a study with people with very high LDL who have been so for 4.7 years and, oh by the way, we are going to exclude everyone with elevated CAC from our study. Would you like to bet that the people we didn’t exclude don’t have elevated CAC. Because that is what you did in the current study.

[@lindafields3262]

Hey gentlemen, do you think insulin suppression cause this hyper lipid metabolism???? Is insulin suppression of 2 also the reason my blood sugars stay 110's on a carnivore diet.

[@UnknownUser-sc6jx]

I'm 38, 6 foot tall, about 77kgs BP 100/60 BPM of 40-60 at rest. total cholesterol of about 11 mmol/L triglycerides are about 40 mg/dl HDL 113 mg/dl zero CAC score. Before keto my total cholesterol was 3.7 mmol/L. If lipids were responsible for heart disease after half a decade should I have signs by now with such high cholesterol 🤔

[@martarico186]

I'm 19 bmi. 60 years old. Female. 6. A1C. 64 triglycerides. 545 ldl. Was 745 6 months ago. Tried to add a little carbs to my carnivore diet . 2.0 insulin. Walk 40 miles a week. 3 times / wk weight training ..Am I lean mass hyper responder? I have an ileostomy which makes eating fiber, carbs very challenging.

[@davidzee641]

What a wonderful bet. Hey we’re gonna do a study with people with very high LDL who have been so for 4.7 years and, oh by the way, we are going to exclude everyone with elevated CAC from our study. Would you like to bet that the people we didn’t exclude don’t have elevated CAC. Because that is what you did in the current study. I find it hilarious that they left out the most important confounding factor - exercise - and are lamely claiming that we can’t account for everything. 😂

[@Roberto-cg2gr]

Hope there will be a research comparing statin with vitamin K2 multidose for Atherosclerosis for 1 year in keto diet

[@vulcanorigan]

I am confused. I have been on low carb diet for 20 months, my NAFLD reversed after six months of low carb diet, but my lab’s results on 6/3 shocked me, cholesterol from 197 went up to 240, LDL from 92 went up to 140 , triglycerides remained low

[@punchkitten874]

Low triglycerides is the only important number from that broad test. LDL in your bloodstream is different sizes, and only the smallest size LDL is of concern. The test you took didn't check the sizes of the LDL. When the sizes of your LDL are checked, the test measures what percent of your LDL is what size. A healthy LDL size (the LDL you want to have) is large. Large LDL is considered harmless and there have been some studies suggesting it's cardio-protective. The demon LDL is the smallest size. Everyone has small LDL, but if your percentage of small LDL is high, that's an indication of a very serious problem that requires definite medical intervention. The usual test for LDL size is called an NMR LipoProfile. It can be covered by insurance if billed correctly. Also search KZbin for "carnivore lab results". There's a few good videos where folks on carnivore diets talk with supportive physicians about what the numbers all mean.

[@vulcanorigan]

Thanks so much for your explanation! It’s definitely relieved some of my stress. Next time I will see my doctor, hopefully she can order NMR Lipo Profile test for me 🙏

[@punchkitten874]

@@vulcanorigan You're welcome and good luck! Take notes to your doctor and expect to answer their questions. It's a relatively newer test that some may have not been in school for.

[@artindeedgallery93]

Very confusing and hard to understand.

[@Roberto-cg2gr]

Compare HOMA IR and LDL for LMHR

[@lemonz1769]

Really important data coming out of the work these two are doing. It’s unfortunate that they were argumentative and dismissive of questions that opposed their hypotheses. There are decades of scientific dogma that does not align with their hypothesis so it’s not only expected but important that other experts in the field try to poke holes in it. Calmly and clearly explaining both how their data explains this and stating where they don’t have sufficient evidence to support it (yet) is important. Being dismissive and argumentative is distracting and off putting.

[@lahmeSchnecke]

I would like to know if one could become a lmhf if he's none yet.

[@TheTarasom]

Forgot to add that I am very lean .!

[@matt-fn9gr]

Why rub ray peats name in the dirt when he’s dead

[@Roberto-cg2gr]

More citizens finance research on keto diet

[@UnknownUser-sc6jx]

It seems like this was a ambush interview very disrespectful " levels " needs to show some respect and stop ramming the lipid heart hypothesis down people necks 😑

[@jefforr439]

I think im a LMHR but.......my triglycerides are thru the roof also. I workout like crazy. I have little to no ketones in my blood. Ive lost 50lbs. Feel great. Im for sure below 10% BF. Are my triglycerides high bc im using them?