Some people follow a ketogenic diet seeking to lose weight, feel more energised, or gain control over their eating habits. Others may turn to this diet in an effort to treat their epilepsy, bipolar disorder, or diabetes. Regardless of their reasoning for adopting this eating pattern, a key question remains: can high LDL cholesterol levels on a ketogenic diet be safe? In Episode #311, I’m joined by Dr William Cromwell, MD and Dave Feldman to explore this question. :point_down: Visit The Proof website for the full show notes and supporting studies. :point_down: Dr William Cromwell is a lipidologist with over 35 years of clinical practice experience. Since 1990, Dr Cromwell’s practice has specialised in managing lipid and lipoprotein disorders. He has authored over two dozen peer-reviewed papers and book chapters on evaluating and managing lipoprotein disorders and lipoprotein analytics. Dave Feldman is a software and platform engineer, an entrepreneur, and founder of the Citizen Science Foundation. His life took a radical turn on seeing his cholesterol skyrocket after adopting a ketogenic diet, leading him to research lipidology. Through a series of self-experiments and partnering with formal researchers, he has since published the "Lipid Energy Model" which may explain this phenomenon. Connect with Dr William Cromwell: - Twitter/X (personal): /lipoprotein - Twitter/X (Precision Health Reports): / precisehlthrpt - LinkedIn (personal): /wcromwellmd - LinkedIn (Precision Health Reports): / precisionhealthreports - Facebook: / precisionhealthreports - Instagram: / precisehlthrpt - Website (personal): - Website (Precision Health Reports): Connect with Dave Feldman: - Twitter/X: / realdavefeldman - YouTube: / @realdavefeldman - Instagram: / realdavefeldman - Citizen Science Foundation: - Own Your Labs: - Cholesterol Code: We covered: 00:00 Intro 01:54 Dr. William Cromwell: Background as a Lipidologist and LDL Research 05:34 Dave Feldman's Ketogenic Diet and Elevated LDL Experience 12:30 Unpacking the Lipid Hypothesis and Cardiovascular Risk 20:40 The history and evolution of the lipid hypothesis 23:39 The role of apoB lipoproteins in atherosclerosis 31:59 Factors beyond apoB involved in atherosclerosis and mortality risk 41:43 The complexity of interpreting mortality data in the context of apoB 44:00 Macrophages and the process of atherosclerosis 52:57 Beyond ApoB: Metabolic Vulnerability, Inflammation and Mortality Risk 1:10:35 Transcytosis: A New Perspective on LDL Movement and Atherosclerosis 1:17:33 Exploring Low Cholesterol Impacts and Genetic Disorders 1:22:30 Macrophage Function and Phenotype Across Different ApoB Drivers 1:31:41 Defining Lean Mass Hyper Responders in the Context of a Ketogenic Diet 1:38:00 Investigating PCSK9 and Its Effects on Healthspan 1:44:18 Assessing cardiovascular risk in lean mass hyper-responders 2:02:19 Statin safety, adverse effects, and patient reluctance 2:11:10 Ketogenic Diets and Elevated LDL: Risks and Benefits in the Absence of Long-Term Data 2:18:40 Insulin Resistance, ApoB, and Cardiovascular Risk: Challenges in Assessment and Imaging 2:33:06 Lean Mass Hyper-Responder Study: Design, Recruitment, and Eligibility Criteria 3:05:15 Outro Enjoy, friends. 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Aired: May 11, 2025
