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.

*Expert Featured:*
Dr. Matthew Budoff

*Resources Mentioned:*
Plaque Begets Plaque, ApoB Does Not

*CMEs Mentioned:*
_Managing Major Mental Illness with Dietary Change: The New Science of Hope_

_Brain Energy: The Metabolic Theory of Mental Illness_

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

*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?

[sdjohnston]

So awesome to see you getting the word out about this and letting the public know.

[GrahamEdward]

3 habits that changed my health forever:
1.A cleaner diet
2.Reading book Rethinking Health Secrets
3.Stopped eating excess sugar

[deryck]

It is amazing that the research has to be done and pushed for by concerned citizens. The institutionalized science and medicine is so bias and has lost its way in the myriad of corporate America.

[Pondgurl]

Great interview! Thank you, Dr Scherer for asking great questions.

[Khadija-uuvm]

Great video, thank you, Doc. Whenever I hear the word "statins", I become cautious...

[lesworks]

I'm an LMHR pre keto. As a retired fit, RD, I wouldn't take statins for my High LDLs & ApoBs, yet high HDL and low Tryglcerides, low insulin and low HSCRP, clean/zero CAC and Carotid scans. I wish doctors were up to date with this. Thank you for this conversation 🎉

[janalderton]

This is the way that science and medicine progresses. I look forward to more data. Stay Curious!

[Aviation_Professional]

Appreciate the study and the interview

[atolman]

Are his eyebrows for real? That’s awesome!!

[mrc-xy]

He lost me as soon as he said that he treats individuals without concern for their diets! He is still part of the problem! He is only concerned with towing the official medical paradigm of pharmaceuticals over everything else! Statins have some terrible side effects and yet their NNT is 200. I’m sticking with my whole food, low carb diet free of alcohol, sugar and seed oils.

[rebopdeluxe]

Regarding people who were on the keto diet and had high levels of plaque, this was probably caused by the years of eating badly before starting a keto lifestyle 🤔

[davidzip]

I think this paper has a good chance of being retracted. Certainly peer review seems to have failed and the reputational risk for the journal is simply too great. He anticipated that the plaque progression would be around seven because of the healthy population in the study. It was 18.8. Now he says oh that’s less than I expected. Because of course he did. It is not normal for a study not to even mention the primary outcome of the study. Not normal because it’s unethical. The plaque progression for everyone was similar to someone with type two diabetes.

[magncity]

Good video! Was disappointed that you didn’t tie in the CIMT tests that are popular that also look at arterial soft plaque

[ccamire]

Great work and presentation. Finally LDL theory is crumbling

[jesseshaver]

All this study implies is that very high ldl and extremely high ldl both have lots of plaque progression lmao

[txc]

Bret great as usual and Dr. Budoff exhibited a very good analysis and what and hw an open-minded, non-biased person conducts ones self when given data that might not fit into current dogma ... My cap is off to him and the MM web site...

[ellapenrapiti]

For over forty years there's been a great deal of blind fixation on cholesterol as the cause of heart disease. There are a multiple factors contributing to the the cause of heart dieseases. Diabetes and stress are far more important factors than raised cholesterol. Cholesterol is an essential fat for the brain. Statins do more harm than raised cholesterol.

[coffeemachtspass]

Will this study change treatments?

No, treatments are chosen based upon expected revenue.

Look at how many meta-analyses and umbrella reviews conclude that saturated fat has no importance for heart disease. Yet, the American Academy of Nutrition and Dietetics continues to harp on it as if it were still 1983.

Cholesterol has been the world’s most profitable waste of time ever.

[alainsauvage]

The actual data in the study talked about do not match the claims made here. Further, most of the comments below and some of those in the video largely ignore the fact that candidates were chosen specifically because they were a supposed phenotype - 'lean mass hyper responders'. Therefore the conclusions do not necessarily apply to the general population. At great peril follow this advice!

[Bbarfo]

The statin studies used relative risk analysis, not absolute risk analysis. The absolute risk analysis shows that a statin will provide a 1% benefit over the course of use. Robert Lufkin authored a book in 2024 entitled, "Lies I Taught in Medical School." Dr. Lufkin taught at USC and UCLA medical schools and in his book Dr. Lufkin explains the studies and the flawed science associated with statins.