Lean Mass Hyper-Responders

High LDL in Fit People on a Low-Carb Diet

Is LDL cholesterol the best way to measure and predict heart disease?

New research suggests "no!" or perhaps, "It depends!"

Context matters. Any single measure cannot contain the context of any individuals situation.

This video is before the study results were known.

Nick Norwitz (27 minutes)

Published by: Nick Norwitz - 6 May 2024

For Dr. Norwitz, ketogenic therapy has been life-changing, placing his inflammatory bowel disease into remission and allowing him to remain off medications. With no evidence of coronary plaque on CTA, he believes that continuing his ketogenic lifestyle without lipid-lowering medications is the right path for him.

Dave Feldman interviewed by Bret Scher (46 minutes)

Published by: Metabolic Mind - 9 Apr 2025

Dave Feldman is an engineer turned citizen scientist who has devoted his life to understanding a phenomenon that some individuals around the world are experiencing: a robust increase in LDL cholesterol while on a ketogenic diet.

Dave’s past research has identified a unique phenotype dubbed Lean Mass Hyper-Responders (LMHRs). LMHRs respond to ketogenic therapy with a metabolic profile that includes elevated LDL-C and ApoB levels with otherwise healthy metabolic markers, including low triglycerides, high HDL, low blood pressure, low insulin resistance, and low BMI.

In Dave’s most recent publication, what most doctors would consider dangerously high LDL levels in LMHRs did not correlate with an increased risk of heart disease.

In this video, Dr. Bret Scher sits down with Dave Feldman to discuss this groundbreaking study and its implications for ketogenic therapy and cardiology.

Key Takeaways:

LMHRs on a long-term ketogenic diet who show elevated LDL can show robust metabolic health
LDL-C and ApoB were not linked to plaque progression in LMHRs
Existing plaque did predict future plaque accumulation in LMHRs
Individualized approaches to cardiovascular risk assessment are crucial to serve this group better.

Nick Norwitz interviewed by Bret Scher (16 minutes)

Published by: Metabolic Mind - 16 April, 2025

The Keto-CTA study examining Lean Mass Hyper-Responders (LMHRs), LDL cholesterol levels, and coronary plaque progression has quickly become a hot topic of discussion across scientific and social media communities.

In this interview, we speak with Dr. Nick Norwitz—one of the study’s co-authors and a LMHR himself—who helps unpack some of the swirling debates and clarify misconceptions that have surfaced online.

Dr. Norwitz shares a personal perspective: he himself is a LMHR, with LDL cholesterol levels exceeding 500 mg/dL. That fact alone has placed him at the center of the controversy. Yet, as he thoughtfully explains, “I have more reason than anyone to not get this wrong.”

A central question in this conversation: Are LMHRs inherently protected from cardiovascular disease? Dr. Norwitz emphasizes that the answer is not one-size-fits-all. Due to the diversity within the LMHR phenotype, individual context matters.

Key topics include:

Interpreting the KETO CTA study from a personalized perspective
Coronary CT angiography and assessing true cardiovascular risk Plaque progression in the Keto-CTA study
Addressing biases
The need for rigorous science and individualized patient-centered care
New papers with more data are in the works

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