Is Current Thinking Around Cholesterol Outdated? What You Need to Know About Heart Health and The Root Cause of Plaque Build Up with David Feldman
Apr 9, 2025
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David Feldman, a software engineer and founder of the Citizen Science Foundation, delves into the complexities of cholesterol and heart health. He challenges the traditional views linking elevated LDL to heart disease, presenting surprising findings on plaque progression and metabolic health. Feldman emphasizes the importance of advanced imaging techniques and personalized testing, while advocating for a holistic understanding of cardiovascular risks. His groundbreaking research calls for a re-evaluation of current health strategies, promoting innovative approaches based on real science.
Dave Feldman's personal experience with elevated LDL while on a ketogenic diet prompted a decade-long exploration of cholesterol and heart health.
The Lipid Energy Model proposes that high LDL levels may reflect healthy fat metabolism rather than poor health, challenging traditional cholesterol views.
Current debates emphasize the importance of differentiating between types of LDL particles in assessing cardiovascular risk, suggesting quality over quantity.
Imaging techniques, such as CAC scans, are vital for evaluating cardiovascular risk and plaque progression beyond standard lipid panels.
Deep dives
Dave's Journey into Nutrition and Health
Dave transitioned from a career as a software engineer to focusing on nutrition and heart health after experiencing unexpected increases in his cholesterol levels while on a ketogenic diet. Despite feeling great after adopting this diet and achieving personal fitness records, his LDL cholesterol skyrocketed while his family's levels remained normal. This alarming change prompted a decade-long commitment to understanding the relationship between diet, cholesterol, and heart health. His personal journey has driven him to pursue research that examines the impact of various diets on cardiovascular health.
Understanding Cholesterol Markers
Key cholesterol markers include total cholesterol, LDL cholesterol (often referred to as 'bad' cholesterol), HDL cholesterol ('good' cholesterol), and triglycerides, which measure fat in the blood. Doctors typically focus on LDL levels, with guidelines recommending total cholesterol to be below 200 mg/dL and LDL below 100 mg/dL. Dave's experience illustrates that his LDL levels rose to 250 mg/dL on the ketogenic diet, raising concerns despite his perceived health benefits. This situation highlights the complexities of interpreting lipid panels for cardiovascular health, especially in those on specific diets.
Conventional Views on Heart Disease and Cholesterol
Conventional medicine views high LDL cholesterol as a significant risk factor for heart disease, advocating for lower cholesterol levels to minimize risk. Organizations assert that lowering cholesterol improves heart health, often equating high LDL levels with high risk. This perspective draws parallels to smoking-related diseases, emphasizing that increased risk is a population trend rather than an individual certainty. Most dietary advice stems from these traditional views about the danger associated with high cholesterol, which can lead to misconceptions about dietary fats.
Emerging Perspectives from the Low-Carb Community
The low-carb community has highlighted the importance of understanding the type of LDL particles rather than just their quantity, differentiating between large, fluffy LDL particles (considered less harmful) and small, dense ones (more atherogenic). This perspective, gained from advanced testing like nuclear magnetic resonance (NMR), has led some low-carbers to disregard LDL concerns if they had predominantly larger particles. Yet, debates persist over what constitutes an acceptable level of LDL. This nuance represents a shift towards examining individual biometrics in conjunction with broader cholesterol discussions.
The Lipid Energy Model and Metabolic Health
Dave and his colleagues have proposed the Lipid Energy Model, suggesting that elevated LDL levels may be a consequence of healthy fat metabolism rather than an indication of poor health. In this model, the body efficiently utilizes fat for energy, resulting in higher levels of lipoproteins to transport that fat. The model challenges traditional views by positing that higher levels of LDL may not be inherently harmful if metabolic health is maintained. This insight suggests that those on low-carb or ketogenic diets may not face the cardiovascular risks commonly associated with high LDL if they are metabolically healthy.
Understanding Plaque Formation and Progression
Plaque formation in arteries is a complex process often attributed to a combination of two main hypotheses: response to injury and response to retention. Injury to the vascular endothelium can trigger inflammatory responses leading to plaque buildup, while retention suggests that cholesterol particles accumulate and incite similar results nearby. The progression of plaque may be predictable based on its existing presence. However, data from recent studies show that the presence of high LDL levels may not necessarily correlate with plaque progression in metabolically healthy individuals.
The Importance of Imaging in Cardiovascular Health
Imaging, including coronary artery calcium (CAC) scans and CT angiograms, is emphasized as a critical tool for assessing cardiovascular risk. These imaging techniques provide insights into existing plaque and associated heart disease risks that basic blood work can't reveal. The data collected offers a more qualitative understanding of cardiovascular health and informs decisions about lifestyle changes or medical interventions. Regular imaging could guide individuals towards better heart health and prompt early interventions when necessary.
The Role of the Citizen Science Foundation
The Citizen Science Foundation aims to advance research in cardiovascular health and the impact of dietary protocols by focusing on populations who are metabolically healthy yet have high LDL levels. Funded largely through community donations, the foundation seeks to explore the implications of these findings through targeted studies. The foundation's efforts aim to fill gaps in existing research by investigating the relationships between fat metabolism and heart health, emphasizing the need for bold and innovative studies in this area. Support from the community is essential for accomplishing these research goals and driving future studies.
Traditionally, elevated LDL has been directly linked to a higher risk of cardiovascular disease. But today’s guest is on a mission to dig deeper. He’s raising both awareness and funding to explore the true relationship between LDL, ApoB, and heart disease—challenging long-held beliefs in the process. He joins us to share the results of his team’s groundbreaking study.
Today on The Dhru Purohit Show, Dhru sits down with Dave Feldman to discuss his team’s landmark study on LDL cholesterol and its implications for cardiovascular health. Dave shares the personal journey that led him to fund this research and what it means for how we approach and treat heart disease. He breaks down the surprising findings on how plaque progression really occurs—and the key questions that still need answers in future studies. Dave also outlines the most effective tests to assess your risk, along with how to interpret your scores based on age.
Dave Feldman is a software and platform engineer, entrepreneur, and founder of the Citizen Science Foundation. His life took a radical turn upon seeing his cholesterol skyrocket after adopting a ketogenic diet, and he became obsessed with understanding why this is common with those who are likewise leaner and more metabolically healthy. Through a series of self-experiments and partnering with formal researchers, he has since published the “Lipid Energy Model,” which may explain this phenomenon.
In this episode, Dhru and Dave dive into:
Dave’s mission and journey to pursue answers (00:30)
What mainstream medicine believes about high cholesterol (4:20)
The keto and carnivore view on cholesterol (6:00)
Dave's perspective and his groundbreaking research (7:45)
Why Dave’s research matters and its implications for cardiovascular disease prevention (15:57)
The factors that led to starting and releasing the study (18:23)
The surprising results of plaque progression (28:42)
What the results mean on a broad scale and how to configure the right type of diet (35:32)
Appropriate testing and optimal score ranges (45:32)
Factors that contribute to plaque progression (53:32)
Injury to cells and arterial lining—and what prevents repair (1:00:32)
The likely responses to the landmark study (1:23:47)
Advice on ApoB based on large-scale metabolic health concerns (1:38:32)
Critical takeaways (1:42:22)
Where to follow Dave and learn about his upcoming movie (1:45:32)
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