You’ve probably heard the claim: “If you’re lean and metabolically healthy, high LDL doesn’t matter.” In low-carb circles, it’s more than a claim, it’s a permission slip to eat as much butter and bacon as you like. But is that confidence backed by science?
In this solo episode, I break down the much-discussed KETO-CTA study that aimed to assess cardiovascular risk in lean individuals following a long-term ketogenic diet. With commentary from Dr. Alan Flanagan, who co-authored a formal critique of the study, we examine the actual data and how it was presented.
What we cover:
- Who are Lean Mass Hyper-Responders (LMHRs) and why they were studied
- What the KETO-CTA study actually measured and why calling it a “trial” is misleading
- The significance of Non-Calcified Plaque Volume (NCPV) and Percent Atheroma Volume (PAV)
- Why the primary outcome data was omitted from the published paper and why that matters
- ApoB levels and plaque progression: what the study showed and what it didn’t
- The role of exploratory vs. pre-registered outcomes in research
- Problems with media coverage and misleading headlines
- How this study compares to others using similar imaging methods
- Why the average subject showed plaque growth 4x faster than expected
- What this means for people on a ketogenic diet with elevated ApoB
- The importance of responsible science communication
Whether you follow keto, are concerned about your LDL, or just want clarity on cardiovascular risk, this episode cuts through the noise.
- Intro: Can You Be “Healthy” with Sky-High LDL on Keto? (00:00)
- What the Keto CTA Study Was Trying to Prove (01:36)
- The Problem: This Wasn’t Actually a Clinical Trial (03:57)
- APOB Focused, But Not Pre-Registered: Red Flag #1 (07:58)
- Real Plaque Progression Numbers: 4x Faster Than Healthy Controls (09:16)
- So… Does ApoB Matter or Not? (17:50)
- How the Study Was Communicated to the Public (26:03)
- What the Headlines Should Actually Say (37:05)
- Final Thoughts from Dr. Carvallo and Dr. Flanagan (38:06)
- Key Takeaways (40:37)
Resources and Links:
- Dr. Alan Flanagan: Instagram | Alinea Nutrition
- My episode on optimal ApoB targets with Dr. Thomas Dayspring
- Plaque Begets Plaque, ApoB Does Not: Longitudinal Data From the KETO-CTA Trial
- Association of Cardiovascular Disease Risk Factor Burden With Progression of Coronary Atherosclerosis Assessed by Serial Coronary Computed Tomographic Angiography
- Reply: Keto CTA Study
- Lean Mass Hyper-Responders See Rapid Plaque Progression
- Abstract 4139340: Atherosclerotic Plaque Progresses Over Time in Healthy Individuals Without MACE, Risk Factors, or Interventions
Connect with Simon:
- Instagram: @simonhill
- Newsletter: theproof.com/newsletter
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