Examining the Heart Risks of Ketogenic Diets and LDL Cholesterol

In this solo episode, I unpack the controversial new KETO-CTA study and why its conclusions about cholesterol, ApoB, and ketogenic diets aren’t as clear as they seem.

We break down what the study really found, how it was communicated, and what it means if you (or someone you care about) is following a high-fat, low-carb diet with elevated LDL-C.

With expert commentary from Dr. Alan Flanagan, we explore:

• Who Lean Mass Hyper-Responders (LMHRs) are
• Why the study isn’t actually a “trial”
• The missing data on plaque progression and what was left out
• What non-calcified plaque volume (NCPV) tells us
• Whether this study really challenges ApoB’s role in heart disease
• Why communication matters and how headlines can mislead
• What this means for keto diets, cardiovascular risk, and informed decisions

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• 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)

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Simon Hill, MSc, BSc (Hons)

• Creator of theproof.com
• Host of The Proof with Simon Hill
• Author of The Proof is in the Plants

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