There’s been a lot of buzz—and confusion—about the new Keto-CTA study, examining plaque progression in Lean Mass Hyper-Responders (LMHRs).

Much of the social media debate has centered on whether high LDL on keto is safe or dangerous, driven largely by how to interpret the supplemental table comparing this study to others on LDL and plaque progression.

In this episode of the Metabolic Mind Podcast, we sit down with Dr. Matthew Budoff, a world-renowned cardiologist, cardiac CT researcher, and the study's lead investigator, to discuss the the supplemental table, what the plaque markers mean, and how this fits into the discussion of high- vs -low-risk plaque progression.

In this episode, we cover:

✅ What PAV (Percent Atheroma Volume) is, what it actually measures, and why it matters

✅ Why a 50% increase in plaque may sound scary, but can be deceiving

✅ The difference between “treatment-naive” and “treated” participants

✅ What the Miami Heart Study comparison reveals about keto, LDL, and plaque

✅ Why LDL alone may not tell the whole story about heart disease risk

✅ How some high-risk individuals may still benefit from statins and other therapies

This study doesn’t answer whether keto causes heart disease or not. Instead, it shows that high LDL on a ketogenic diet is not a reliable predictor of plaque progression across all individuals. What is predictive? The presence of existing plaque.

💡 Key takeaway: Relying on surrogate markers of heart disease, like LDL and ApoB, is not the best way to assess heart disease risk in all populations.

If you're concerned about how elevated LDL may be affecting your heart health, the best next step is to speak with your doctor about cardiac imaging to directly assess plaque and gain a clearer picture of your individual risk.

Expert Featured:

• Dr. Matthew Budoff
• X: https://x.com/budoffmd?lang=en
• https://lundquist.org/matthew-budoff-md

Resources Mentioned:

Plaque Begets Plaque, ApoB Does Not

• https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686

CMEs Mentioned:

Managing Major Mental Illness with Dietary Change: The New Science of Hope

• https://www.mycme.com/courses/managing-major-mental-illness-with-dietary-change-9616

Brain Energy: The Metabolic Theory of Mental Illness

• https://www.mycme.com/courses/brain-energy-the-metabolic-theory-of-mental-illness-9615

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About us:Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.