---
title: 'High LDL Yet Clean Arteries: Study Analysis'
source: 'https://youtube.com/watch?v=bhHuOLE3ovc'
video_id: 'bhHuOLE3ovc'
date: 2026-08-10
duration_sec: 689
---

# High LDL Yet Clean Arteries: Study Analysis

> Source: [High LDL Yet Clean Arteries: Study Analysis](https://youtube.com/watch?v=bhHuOLE3ovc)

## Summary

This video analyzes a recent study that challenges the conventional wisdom linking high LDL cholesterol to coronary artery disease. The analysis, involving 80 individuals on a long-term ketogenic diet with high LDL, found no significant association between LDL levels and coronary artery calcification in metabolically healthy people.

### Key Points

- **Study Overview** [00:01] — A new analysis by Dave Feldman, Nick Norwitz, and Matthew Budoff finds that high LDL cholesterol is not associated with the degree of coronary artery calcification.
- **Keto Cohort** [00:29] — The study includes 80 individuals from a keto trial who had been on a low-carb diet for a median of 4.7 years and had LDL cholesterol levels greater than 190 mg/dL.
- **Methodology** [00:57] — Coronary CCTA (CT scan) was used to assess coronary artery calcification, approximating the severity of atherosclerosis. This was compared against the Miami Heart cohort.
- **Key Finding** [01:25] — There was no significant association between LDL cholesterol levels and coronary artery calcification in metabolically healthy individuals.
- **Lean Mass Hyperresponder Criteria** [02:09] — The phenotype is defined by LDL > 190 mg/dL, HDL > 60 mg/dL, and triglycerides < 80 mg/dL.
- **Study Design** [02:52] — 80 keto subjects were matched with 80 from the Miami Heart study for age, smoking, hypertension, and diabetes status, but the keto group had significantly higher LDL.
- **Baseline Characteristics** [06:13] — Keto group: LDL 272 mg/dL, HDL 90 mg/dL, triglycerides 64 mg/dL, BMI 22.5. Miami Heart: LDL 123 mg/dL, HDL 63 mg/dL, triglycerides 96 mg/dL, BMI 25.8.
- **Coronary Artery Calcium Scores** [07:17] — Median CAC score was 0 for keto subjects and 1 for Miami Heart subjects, showing no correlation with LDL levels.
- **Stenosis Score** [08:25] — No significant difference in stenosis (artery narrowing) scores between the groups.
- **Competing Theories** [09:09] — The 'continuous exposure hypothesis' suggests longer LDL exposure leads to more plaque, while the 'lean mass hyperresponder' theory posits that high LDL with high HDL and low triglycerides may not be harmful.
- **Conclusion** [10:03] — Carbohydrate restriction-induced LDL > 190 mg/dL over 4.7 years is not associated with greater plaque burden than a matched cohort with 149 mg/dL lower LDL.
- **Practical Advice** [10:56] — If LDL is high but HDL is high and triglycerides are low, without insulin resistance, it may not be a major concern. Work with an open-minded doctor and consider advanced lipoprotein testing.

### Conclusion

The study suggests that in metabolically healthy individuals, high LDL cholesterol from a ketogenic diet may not necessarily lead to coronary artery calcification, challenging traditional risk assessments.

## Transcript

cholesterol, but a new analysis finds that high LDL cholesterol is not associated with the degree of coronary artery calcification. This is a really interesting analysis by Dave Felman, uh Nick Norwitz, uh and Matthew Budof. I'll
here. I really want to go slow with this and break this down. Uh I'm sure Dave and Nick and other people have talked about this study uh at length, but this is a really interesting analysis because we have a cohort of 80 individuals. one
from the keto I think it's called the keto trial there's 80 individuals who had been doing a low carb diet for a minimum or median length of 4.7 years who have an LDL cholesterol level greater than 190 milligrams per
deciliter which is on the higher side most doctors would pretty much freak out you know and make sure that you leave their office with a statin and this analysis looked at using uh coronary CCTA this is a CT scan of the coronary
arteries to look at the coronary artery calcification which approximate the degree or severity of atherosclerosis or the plaque buildup in the coronary arteries and they looked at uh coronary artery CT scans from individuals in the
Miami heart cohort and I'll share with you the baseline characteristics shortly is if there was an independent association with high LDL cholesterol and the degree to coronary artery atherosclerosis and coronary artery
calcification and News flash, there was no significant association or correlation with the degree of LDL cholesterol and the degree of coronary artery calcification in metabolically healthy people. I want to
just emphasize that right out of the gate because in some people who are insulin resistant and type 2 diabetic, you know, we know that the metabolic mealu would exacerbate or worsen the propensity of that LDL to initiate the
atherosclerosis and lead to plaque buildup and possibly a major adverse cardiovascular event over time. But in this cohort or subset of metabolically triglycerides were low, their HDL cholesterol was over 60 milligrams per
deciliter. Uh these individuals uh and again the cut point for the sort of lean mass hyperresponder uh phenotype is an LDL cholesterol greater than 190 milligs per deciliter, an HDL greater than 60 milligs per deciliter, and triglycerides
less than 80 milligs per deciliter. And so, you know, we're comparing head-to-head uh here uh in the study, if I haven't yet mentioned it, is titled carbohydrate restriction induced elevations in LDL cholesterol and
This was published in the journal cardabolic. Uh there's the screenshot there. Uh here is the graphical abstract and we're going to dive into the weeds have to see, but here's a graphical abstract. As you can see here, we are
matching 80 individuals from the Miami heart study that generally don't have high LDL cholesterol. I think the median LDL was somewhere around 120 or 130 milligrams per deciliter. Not considered on the high side. Uh but uh in the keto
group, 80 individuals and they were we're comparing apples to apples, right? smoker in each group. They were age matched. you know, hypertension, no previous diagnosis or that was matched and and diabetes status was matched. And
apples, which which I like. And so, this study was really I think this analysis was well done. And you can see that there are significantly higher levels uh significantly higher in the keto cohort compared to the to the Miami heart
compared to the to the Miami heart cohort, but the plaque score was not significantly different. In fact, the Miami heart cohort had higher levels of that. But first, friends, thank you for being here. Hopefully, you're enjoying
are. And since we're talking about metabolic health, I just want to remind your metabolic health in 2025 and beyond. And that's bourberine. As you've for 3,000 years. It's one of the only natural products that you can actually
You know, sometimes we take supplements, we don't really know are they doing. You take magnesium, you're like, I hope it's doing something. With bourberine, you this with blood ketones or blood glucose. This product actually works.
That's why there's over three close to 350 reviews over at myioscience.com on the novel bourberine fasting accelerator using really high quality raw materials paired with pairing bourberine with alpha lipoic acid and biotin. Uh the
best way to use this is to take it before your last meal about 20 to 30 minutes before three capsules. And it can help curb food cravings so that start your fast. You don't need to, you know, mindlessly chew on snacks or hit
that. You can start your fast and have a better night's sleep. And you can also stomach. So, I would encourage you to check out what other people are saying over at myioscience.com on the novel Bourberine Fasting Accelerator. I'll put
that link in the description below and you can save with the code podcast at checkout. Okay, so let's dive into the baseline characteristics. I just want you to recognize this and anytime you see a study this is really important and
uh just for continuing education for many of you you know that when uh you from Harvard and Stanford and they say oh the plant-based diet is linked with that we always look at the baseline characteristics of the study
participants you know because then we can see if there's a healthy user bias or there's any other uh confounding factors that might influence whether or factors that might influence whether or not one cohort that that is supposedly
similar or different from another one. You know, we can see if there's elements of their lifestyle that confound the the the study results. And in this case, there there's the confounding variables like blood pressure, like age,
hypertension status, past smoking status are are equivalent, right? So, there's two past smokers in each group, hemoglobin A1C and and uh blood glucose and so forth. No significant differences between groups. But what is significant
here is the lipid markers, right? We have and this is what what I want to focus on. What makes this group different, these two groups different is the lipid markers. Uh you look here at LDL cholesterol in the keto group and
again there's 80 people in each one uh each cohort. The LDL cholesterol in the keto group is 272 milligs per deciliter. The LDL cholesterol in the Miami heart is just 123 milligs per deciliter. The HDL in contrast is almost 50% higher in
90 milligrams per deciliter versus just 63 milligs per deciliter in the Miami heart cohort. And the triglycerides are, you know, the same. They're about 45% lower in the keto group. The average triglyceride level here, the median was
64 milligrams per deciliter and it's 96 in the Miami heart cohort. Okay, so I interesting to note that the body mass index is quite lower in the keto group. 22.5 the BMI is versus uh 25.8 in the
Miami heart age and so forth. No differences here. Okay. So, let's look at the coronary artery calcium score from the uh CT scan. You can see here looking at there's no correlation, right? LDL is all over the place and it
doesn't strongly correlate with the degree of coronary artery calcification. So, I think that's important. So the median coronary artery calcium score was zero for the keto subjects and was one for the Miami heart subjects. Okay, not
that big of a deal but just you know there is a it was actually higher uh in the Miami heart subjects and remember their LDL cholesterol was about 50% lower. Uh so why is that? They say in the subset of the keto subjects meeting
all three stricter lean mass hyperponder criteria, the median coronary artery calcium score was zero for keto subjects and zero for matched Miami heart subjects. So I think that's uh very interesting. Now when we look at figure
one here, this is the plaque scores stratified for LDL cholesterol levels. Um in the keto uh you see that you see LDL cholesterol, you know, as we mentioned is about the median was like 190 milligrams per deciliter. Some
people had LDL cholesterol in the keto group going up to 600. That's insane. But again, you didn't see major outliers in the coronary artery calcium score. And when they looked at the what's called the stenosis score, so stenosis
is a way to it's a medical jargon term for the degree of narrowing or occlusion in the coronary arteries. Uh there was no significant difference in the stenosis store score. uh when you compare the the different groups and
there were no significant differences in the coronary artery calcium scores when what does this mean? I mean I think it's quite interesting. You know there's a share with you the the conclusions momentarily. A lot of competing theories
and you know the mainstream medical community has this idea known as the continuous exposure hypothesis. And that is it goes like this. the the longer that you're exposed to high levels of LDL cholesterol, the more likely that
you will develop coronary artery plaque and that will lead to stenosis and having a major adverse carvascular event. Um, so that's that's one theory. It's not necessarily proven. It's, you know, talked about in a lot of the
narrative reviews. Uh the other theory uh from the you know so-called lean mass hyperresponder camp Nick Norwood Dave Feldman and and others is that hey in metabolically healthy people if the LDL is high but it's matched by a high HCL
and a low triglycerides i.e. There are uh there's reason to believe there's high ketone uh utilization and fatty acid uh mobilization in the body, a greater reliance on fat oxidation,
therefore probably lower levels of oxidative stress and so so on that the LDL is not you know being modified or oxidized and contributing to the coronary artery calcification process. And so they say in conclusion, coronary
individuals with carbohydrate restriction induced LDL cholesterol levels greater than 190 milligrams per deciliter on a keto diet for mean of 4.7 years is not greater than a match cohort with 149 milligrams per deciliter lower
average LDL cholesterol. There is no association between LDL cholesterol and plaque burden in either cohort. That's a conclusion. So do? what you know and this may take
another decade or maybe two decades for the medical community to actually adopt this is you know if your LDL is high but your HDL is also high greater than at least 60 milligs per dilator and your triglycerides are low and you don't have
signs overt signs of insulin resistance or metabolic dysfunction should we really be worrying about the high LDL cholesterol uh it seems that the answer is probably not so I can't give you medical advice I just think that you
should work with a doctor who's a little bit more open-minded and does some advanced lipoprotein particle testing, metabolic health testing so that you can more confidently continue to eat in such a way that helps you stay lean,
energetic, metabolically fit, uh, and feeling good mentally, you know, and if in doing so your LDL creeps up a little bit, you know, is it that big of a deal? Should we really worry about it? In my opinion, probably not. Let me know what
my friends. I appreciate you watching all the way through.