When someone's LDL cholesterol hits 574 mg/dL, doctors typically expect the worst. But what if everything we think we know about cholesterol and heart disease risk is incomplete?

In this episode, I sit down with researchers Nick Norwitz, Adrian Soto-Mota, and Dave Feldman to discuss their groundbreaking study on lean mass hyperresponders - a rare population who develop extremely high LDL cholesterol on ketogenic diets despite being lean, fit, and metabolically healthy. Their recent paper "Plaque Begets Plaque, ApoB Does Not" challenges conventional wisdom by showing that in this unique population, neither LDL cholesterol nor ApoB levels predicted plaque progression over one year of follow-up. Instead, existing plaque was the strongest predictor of future plaque growth. We explore the proposed lipid energy model that may explain why some people's cholesterol skyrockets on keto, discuss the limitations and implications of their findings, and examine what this means for personalized cardiovascular risk assessment. This conversation touches on fundamental questions about causality in medicine, the importance of studying outlier populations, and why a one-size-fits-all approach to cholesterol management may be missing crucial nuances.

🌐Links in this video

Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not https://pubmed.ncbi.nlm.nih.gov/40192608/

Citizen Science Foundation https://citizensciencefoundation.org/

Nick's home page https://www.nicknorwitz.com/

On X

Nick Nowitz https://x.com/nicknorwitz

Dave Feldman https://x.com/realDaveFeldman

Adrian Soto-Mota https://x.com/AdrianSotoMota

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