Is high cholesterol on a keto diet always a problem? | Dave Feldman and William Cromwell, Md

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Apr 29, 2024

Dave Feldman and Dr. William Cromwell dive deep into the safety of high cholesterol on a keto diet. They discuss the lipid hypothesis, ApoB's role in atherosclerosis, interpreting mortality data, and the complexities of plaque formation. The conversation challenges traditional views on lipidology, explores biomarkers, gut health supplements, and macrophage involvement. They also touch on longevity habits, research design for hyper-responders, managing high cholesterol levels, and analyzing plaque risk in different diet contexts.

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Introduction

00:00 • 3min

Discussion on Cholesterol Metabolism, Lipidology, and Heart Disease

03:07 • 4min

Evolution of Understanding Atherosclerosis and Cholesterol in Vascular Disease

06:45 • 2min

Exploring Cholesterol Changes on a Ketogenic Diet

08:22 • 18min

Understanding Atherogenic Potential of Apo B in Atherosclerosis Risk

26:28 • 18min

Exploring Biomarkers and Gut Health Supplements

44:29 • 5min

Understanding the Dynamics of Atherosclerosis

49:16 • 9min

Exploring APOB and Cardiovascular Risk

58:40 • 18min

Understanding Trans-cytosis and APOB Particles

01:16:16 • 21min

Exploring Longevity Habits and Cholesterol Markers

01:37:25 • 3min

Evolving Hypotheses on Lipid Levels and Cardiovascular Risk

01:40:03 • 10min

Research Design and Cardiovascular Risk in Hyper-Responders

01:50:24 • 6min

Managing High Cholesterol Levels on a Ketogenic Diet

01:56:24 • 21min

Managing High Cholesterol Levels on a Keto Diet

02:17:50 • 2min

Understanding Plaque Formation Risk in Different Diet Contexts

02:19:52 • 23min

Analyzing High Cholesterol Levels on a Ketogenic Diet

02:42:49 • 13min

Challenges of Studying Metabolically Healthy Individuals and High LDL in Keto Diet Research

02:56:17 • 16min

Exploring Comprehensive Health Risk Assessment and Informed Patient Conversations

03:11:52 • 3min

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 conditions such as epilepsy, bipolar disorder, diabetes and inflammatory diseases. Regardless of their reasoning for adopting this eating pattern, a key question remains: is there ever an instance where having high LDL cholesterol levels on a ketogenic diet can be safe? In Episode #311, I’m joined by Dr William Cromwell, MD and Dave Feldman to explore this question.

In this discussion, Dr William Cromwell and Dave Feldman share their professional opinions on whether high cholesterol on a keto diet is a problem. We investigate where their opinions align and where they differ, where Dave’s hypotheses diverge from the norm, and what we do and don’t know with the available evidence. We also explore the significance of ApoB, lifespan and healthspan considerations, research Dave is currently conducting, and much more.

Specifically, we discuss:

Intro (00:00)
Dr. William Cromwell: Background as a Lipidologist and LDL Research (01:54)
Dave Feldman's Ketogenic Diet and Elevated LDL Experience (05:34)
Unpacking the Lipid Hypothesis and Cardiovascular Risk (12:30)
The history and evolution of the lipid hypothesis (20:40)
The role of apoB lipoproteins in atherosclerosis (23:39)
Factors beyond apoB involved in atherosclerosis and mortality risk (31:59)
The complexity of interpreting mortality data in the context of apoB (41:40)
Macrophages and the process of atherosclerosis (44:00)
Beyond ApoB: Metabolic Vulnerability, Inflammation and Mortality Risk (52:57)
Transcytosis: A New Perspective on LDL Movement and Atherosclerosis (1:10:36)
Exploring Low Cholesterol Impacts and Genetic Disorders (1:17:30)
Macrophage function and phenotype in the context of different drivers of high apoB (1:22:30)
Defining Lean Mass Hyper-responders in the Context of a Ketogenic Diet (1:31:40)
Investigating PCSK9 and Its Effects on Healthspan (1:38:00)
Assessing cardiovascular risk in lean mass hyper-responders (1:43:50)
Statin safety, adverse effects, and patient reluctance (2:01:54)
Ketogenic Diets and Elevated LDL: Balancing Individual Risks and Benefits in the Absence of Long-term Data (2:10:40)
Insulin Resistance, ApoB, and Cardiovascular Risk: Navigating the Challenges in Assessment and Imaging (2:18:12)
Lean Mass Hyper-responder Study: Design, Recruitment, and Eligibility Criteria (2:32:45)
Closing Perspectives on Research and Dietary Options (3:04:47)
Outro (3:06:42)

Connect with Dr William Cromwell: Twitter/X, LinkedIn, and https://www.mylipid.com/. Discover more of his work with Precision Health Reports: Twitter/X, LinkedIn, Facebook, Instagram, and at https://precisionhealthreports.com/.

Connect with Dave Feldman: Twitter/X, YouTube, and Instagram, and discover more of his work at https://citizensciencefoundation.org/, https://ownyourlabs.com/, and https://cholesterolcode.com/.

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