Study Shocks Cardiologists: LDL Didn’t Predict Plaque

What if everything we thought we knew about cholesterol and heart disease risk… doesn’t apply to everyone?

In this episode, world-renowned cardiologist Dr. Matthew Budoff unpacks the results of a landmark one-year study tracking 100 lean, metabolically healthy individuals on a ketogenic diet with *extremely* elevated LDL levels.

Dr. Budoff is the Program Director, Director of Cardiac CT, and the endowed chair of preventive cardiology at The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center.

In this interview, Dr. Scher and Dr. Budoff further break down the results of his new publication, which used advanced imaging to demonstrate that LDL cholesterol and ApoB levels are not associated with plaque progression in Lean-Mass Hyper Responders following a ketogenic diet.

???? Surprising insights:

- Elevated LDL and ApoB did *not* predict plaque progression
- Some participants with LDLs over 500 showed no plaque at all
- A few participants even experienced plaque regression
- Existing plaque—not LDL-C or ApoB—did predict plaque accumulation in this population

Dr. Budoff explains what these results mean for clinicians, for patients using ketogenic therapy as a medical intervention, and for the broader conversation around cardiovascular disease risk.

“It is important that clinicians, along with the general public, are made aware that personalized, data-driven approaches to assessing risk should be considered based on individual conditions,” said Dr. Budoff. “The existence of this phenotype suggests that alternative markers or tests should be used to establish metabolic health in some cases.”

???? These exciting new findings are featured in Dave Feldman and Jen Isenhart’s upcoming documentary, The Cholesterol Code, the story of how a software engineer conducts a groundbreaking study on an unusual group of people—lean, healthy individuals whose doctors are convinced they’ll die young. Real stories of healing with ketogenic diets provide a blueprint for using food as powerful medicine.

Visit cholesterolcodemovie.com to learn more about the film and to be the first to hear about private screenings and the general release in the fall.

*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

Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/

*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.

*Timestamps:*
0:00 - Introduction to Dr. Matthew Budoff and his new study on the effects of high LDL-c in metabolically healthy individuals.
2:03 - What were the main findings of Dr. Budoff’s study? What is ApoB? Did LDL-c and ApoB correlate to increased plaque?
5:49 - If someone has plaque in their arteries should they take measures to reduce risk of progression (whether on keto or not)? Does being in ketosis put someone at a higher risk if they already have plaque in their arteries?
8:41 - Was it a surprise to Dr. Budoff to see multiple study participants have a reduction in plaque at the end of the study, despite the high LDL-c?
10:58 - Will this study change the way cardiologists treat these type of patients?
13:48 - How does Dr. Budoff look at a CT angiogram to determine what is a safer level of plaque and not a concern?
15:25 - How have Dr. Budoff’s papers on the subject been received? Has he gotten pushback?