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Short Summary: Heart health and the ketogenic diet, with expert insights from a cardiologist and researcher.

About the guest: Matthew Budoff, MD, is a preventive cardiologist and professor of medicine at UCLA School of Medicine.

Note: Podcast episodes are fully available to paid subscribers on the M&M Substack and everyone on YouTube. Partial versions are available elsewhere. Transcript and other information on Substack.

Episode Summary: Dr. Matthew Budoff discusses cholesterol, heart disease, and his study on the ketogenic diet’s impact on lean, metabolically healthy individuals with high LDL cholesterol. He explains LDL, HDL, and triglycerides, debunking myths about their direct link to heart disease, and emphasizes the importance of coronary calcium scans to assess plaque buildup. Budoff also covers statins, dietary cholesterol, and personalized heart health strategies.

Key Takeaways:

• LDL cholesterol is not a definitive predictor of heart disease; plaque buildup, assessed via coronary calcium scans, is a better indicator.
• Lean metabolically healthy people on a ketogenic diet may have high LDL without increased plaque progression after one year.
• Coronary calcium scans, costing ~$100, are recommended for men around age 40 and women around 45-50 to evaluate heart disease risk.
• Statins effectively lower LDL and can reverse soft plaque, but may be overprescribed for those without plaque buildup.
• Dietary cholesterol has minimal impact on blood cholesterol, as the liver produces ~85% of it.
• Ketogenic diet can aid weight loss & diabetes control but may cause high LDL in some lean individuals, known as lean mass hyper-responders.
• Plaque progression depends more on existing plaque than LDL levels in metabolically healthy ketogenic diet followers.
• Heart health varies widely due to genetics and other unknown factors, underscoring the need for personalized assessments.

Related episode:

• M&M #158: Ketosis & Ketogenic Diet: Brain & Mental Health, Metabolism, Diet & Exercise, Cancer, Diabetes | Dominic D'Agostino

*Not medical advice.

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