Dr Ford Brewer - PrevMed High Cholesterol DOES NOT Clog arteries (if you are doing THIS) ft. Dave Feldman - Ford Brewer MD MPH (PrevMed Health)
Aug 24, 2025
In this engaging discussion, Dave Feldman, an engineer and expert on cardiovascular health, challenges conventional beliefs about cholesterol. He introduces the concept of lean mass hyper-responders and their surprising cholesterol profiles on ketogenic diets. The conversation highlights how LDL levels don't necessarily lead to plaque formation, emphasizing the need for a nuanced view of metabolic health. They also touch on the importance of calcium scoring, the effects of stress on fat accumulation, and the drawbacks of traditional health metrics like BMI.
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Baseline Plaque Predicts Future Plaque
- In the Keto CTA trial baseline plaque predicted future plaque while ApoB/LDL did not correlate with one-year plaque progression.
- This suggests pre-existing plaque status is a stronger predictor than current ApoB in this metabolically healthy cohort.
LDL/ApoB Not Linked To One-Year Progression
- Across multiple stratifications there was no correlation between LDL/ApoB levels and plaque progression in this cohort.
- The data challenge the simplistic hypothesis that higher ApoB directly drives short-term plaque growth in metabolically healthy LMHRs.
Definition And Typical Context Of LMHRs
- Dave defines lean mass hyper-responders (LMHR) as LDL≥200, HDL≥80 and triglycerides≤70, typically lean and metabolically healthy.
- He links the phenotype commonly to ketogenic dieting but notes it can arise from any low hepatic glycogen state.