Transcription
Hey, it's Mike here, and today a new keto heart plaque study has just come out. And I will say my predictions from one year ago were wrong. But forget me anyway, because we have a massive onslaught of levelheaded doctors responding and saying, "Hey, they were hiding data from this study, not disclosing it, and really spinning a subsequent narrative that is deceptive." Incredibly reckless, in my opinion; no regard for human life. That is among the most deceptive examples of misreporting of data I've ever seen. The rate of progression of non-calcified plaque for these individuals in the keto CTA study is incredibly concerning. The fact that it wasn't reported correctly is incredibly concerning, in my opinion. This is a gross manipulation of data. I'm sorry, but this study is an absolute joke, and really this story is rife with scandal, even between the authors, where some seem to be going around the other one's back. All right, well, he's not allowed to do that, and then people are having to just squeeze the actual data out of these authors, which is wild. I've never seen this before, and then it's also really just a master class in grifting, in terms of how they're spinning this study; not just in terms of mainstream media, but also in terms of, of course, like carnivore influencers. They're talking to this new study. It's literally going viral. It's about cholesterol and heart disease. LDL did not predict plaque progression. Now help me and make sure this post goes far and wide so that people can start waking up. Now, as someone who's been following the study, I was not expecting this much drama, but let's just go, all right, now to the study itself, which they are calling the keto trial. Keto being ketogenic diet, and CTA being the type of heart imaging that they did, and trial being completely inaccurate. They multiple times called it a trial, even a prospective trial, but those are all misrepresentations. This is a prospective cohort study, which is an observational study. There's no intervention here; not a trial. I'm also going around boasting that it was published in the Journal of the American College of Cardiology Advances, though, because that is sort of a newer subjournal from 2022, which sort of explains how some of these sketchy things slipped through. I'm not a huge fan of impact factor, which is a measure of a journal's influence, but this one is at around a two, which is the lowest of any of the JACC's journals. Just published a paper this morning in the Journal of the American College of Cardiology Advances that's going to create huge waves, I promise you that. And I love how they're like, "We published in the Journal of the American College of Cardiology Advances; they absolutely love us over at the Journal of the American College of Cardiology Advances."
And for those of you who have been following this, yes, this is that lean mass hyperresponder study where they have people on a keto diet, super high-fat, and if they are skinny, it seems sometimes their LDL just skyrockets; not even as a direct result of saturated fat, just macronutrients. So they had 100 people, and their LDL, or bad cholesterol, was an average of about 250, which is quite high. And we're talking about less than 100 being the conventional cutoff for optimal. Yet they did not have a control group to compare to, which is standard for perspective cohort studies. And in terms of the primary outcome that they reported that they were looking for on the study, they were supposed to be looking for changes in soft plaques of the heart. But to the results, weirdly, no figures on plaque changes were actually given. Hm, thankfully, after a bunch of pressure from the online community, the first author of the paper actually tweeted that there was an 18.8 cubic mm increase in soft plaques in that keto group. It's almost like they didn't want to report the main finding because it wasn't flattering. Other point is that me and many others initially missed that this is actually a median number, meaning a middle number, that 18.8, and it's not an average, which, you know, is okay in the sense that some other studies do that, but a lot of studies, large studies like the paradigm study, use the mean or average figure. And this is a bit convenient because they have some right-skewed data, which in every case we're going to have a mean or average that's higher than the median. So it almost certainly pushes that average change in plaque figure to over 20. And since we are seeing some comparisons to studies that use a mean, I thought, hey, let's see what AI might guess. I mean, this is data after all; let's see what it can do. So initially uploaded the graph to ChatGPT and was like, using visuals only, what is your estimate here? And it estimated 30 cubic millimeters over that year. But then I was like, hey, this red line represents the median, and that median change is 18.8, and I was like, okay, with that information I would put it more at like 24 to 26, which is, yeah, quite large. Then I was like, let's compare to Gemini, and initially they're like, yeah, it's between 20 and 50, and then I was like, hey, that red line is actually the median line. It refined it to between 40 and 55. So take that as you will, but the question is how bad is this result really? And a doctor named Anna Borick actually went ahead and compared this keto CTA figure to various other studies on this chart, and I will say some are using median, some are using mean. For example, that haunted all study on some higher-risk people appears to be using mean, and my guess is the keto CTA is right about where that one is, or higher even. And then we have another study that used median, and we can see a 17 times worse rate of plaque progression in the keto group compared to them, healthy group.
And to Dr. Gil Carvalho, who frankly did the best response here, even interviewing one of the doctors, we'll cover more in a bit. He says this: So I looked for other studies where the participants are also not taking statins, which is more uh, it's a more interesting comparison, right? More apples to apples. I found one with fairly healthy individuals, for Western standards anyway. This cohort is called Nature CT. Their age was identical to the keto group, 55 years old average, and this Nature CT study was conducted by the same institute as at UCLA, overseen by Dr. Budoff as well, and they use the same technology as a keto study. So I asked Dr. Budoff about this. He agreed that this Nature CT study is a good comparator. They report that the progression of soft plaque was 4.9 cubic millimeters annual median compared to that 18.8 in the keto population; 3.8-fold faster progression of soft plaque in the keto group compared to a population of Westerners that is reasonably healthy without a ton of risk factors. So yeah, we're talking about nearly four times the progression of a healthy population in the US, which is a population that eats a standard American diet and is likely going to die from heart disease anyway. All right, now for a quick break with something that has actually been changing my life, and that is today's sponsor, Cove Pure, which is an awesome tabletop water purifier, reverse osmosis unit that also heats and cools water and remineralizes it and more. It's got its PCB filter as well as that RO filter, and it removes up to 99.9% of impurities, which is great. So the water out of this guy is delicious, and that's one thing, but it has a total dissolved solids meter on it for the filtered and unfiltered water, and my raw Iowa crappy water that is hard was at 999. Yes, this reads the unfiltered water, and then it shows you the filtered version, which is down to 57. And over 500 is like, hey, you shouldn't drink that; over 1,000 is considered unacceptable. So yeah, another thing that this filters out is PFAS, those forever chemicals, and water is a pretty big exposure point for those, which are hormone disrupting; you really don't want them. And going to the Environmental Working Group's water database, I can see that nearby counties in Iowa are just loaded with random nasty toxins, and the radium levels in my county in particular are 43 times higher than the Environmental Working Group's cutoff. Thankfully, a lot of radium is removed with reverse osmosis, because it uh, you know, may or may not fuel some cancer. And if you want to try one of these, you can scan the QR code on screen or just go to co-pure.com/micthevegan for a whopping 200 bucks off.
All right, let's get back to it, and this is very telling because we're talking about a group that's averaged age 55 that at baseline started at about 40 cubic millimeters of plaque volume. That means within 1 year they had an increase of nearly half of their lifetime plaque over 55 years, which to me shows that this diet is leading to new rapid acceleration of heart disease. This is where I have to flat out just say that I was wrong, because I did a video on this a year ago when they presented their baseline data, and we already had quite a bit of drama around it. Dr. Spencer Nadolski, who we'll cover again in a second, said, you know, I was part of the board of the study initially, but I had to leave due to like ethical concerns. So with that little bit of mistrust and how this study was funded by a community of people that generally deny the connection between LDL and heart disease, I thought there's going to be no progression in plaque, no matter what; they're going to fudge the data, do whatever they need to not have that progression. But if you're somebody that follows these authors or heard about this study through low-carb channels, I was right in that there was no plaque finding, cuz they completely hid it. The way this study in general and these results have been communicated to the public on social media is a great example of how not to do science communication. Here's an example: one of the authors on a Facebook group, and as Dr. Brad Stanfield, who I think is again another neutral doctor on this topic, said, so you have to pixel peep; you have to try and figure out based on this trend line how much has the non-calcified plaque progressed. So we we don't know, and that's a massive red flag. Every single study should be publishing their primary outcome in written form along with the statistical analysis. And this is where the author responsible for doing these scans, Dr. Budoff, comes in, because he was making his rounds on, you know, low-carb social media, etc., until he decided to go on Gil's show, Nutrition Made Simple, which was clearly a mistake because Gil is neutral on this topic. Here they are. But when I asked Dr. Budoff about this number, he essentially disavowed it. I don't even know where those numbers come from, because I'm looking at the paper and I'm looking at the raw data, and I don't see 42% or or 18.8 mm cubed. Yeah, those are not in the those are not in the currently available version. That's what I'm asking. Okay, your your author on Twitter said it was 18.8 when people kept asking what's the primary outcome change. All right, well, he's not allowed to do that, and I'm not on social media to to debate or or or answer those queries, but my statistician does the math, and my statistician hasn't released a number that's in in public. I I I don't have the final draft yet. We are literally working on it; um, we're waiting for the proofs. We don't even have the proofs yet.
To sum up what was covered in that interview, Dr. Budoff essentially says that the study was released before he even signed off on it, before his statistician signed off on it, and that it wasn't even the final version of the paper, somehow being published. Additionally, that they were about to release another version that actually had the plaque numbers in it; that the author releasing this on Twitter was absolutely not okay. Like, there's just so much drama here. Like, are they even talking? But one thing I will say, it does appear that that number is accurate, just generally looking at the chart. You can tell it's roughly 20. But to the surprise of not anybody, since that interview, Gil mentioned in his comment section that the authors issued a statement shared on social media that the study will not be revised. It appears no changes will be made, and that the version currently available and discussed in this video will be the final version. After all, we don't even have the proofs yet, meaning no plaque numbers in a study whose primary outcome was plaque change. Now one thing that I haven't seen anybody do, and that is just think, okay, what would these plaque numbers mean a few years down the road? Generally with heart disease, as people age, we're kind of flat; nothing's really happening. They start to get heart disease, and then it accelerates much faster. And while participants in the study were certainly on different places on that curve, we're seeing people that are not diagnosed with heart disease; they're kind of starting on that slower, lower slope, which is almost certainly going to accelerate to a higher slope. But let's be generous and just say that it's a linear progression, and we can look to 5 years out, and we're seeing a plus 94 cubic millimeter increase in plaque volume, which brings us to 134. And of course, real fast, from a linear perspective again, in about 10 years they're going to be at plus 188 cubic millimeters, and then they're on average 20 years out, why not? We're talking about a chronic disease of their group is going to be over 400.
All right, now I want to talk about the media and social media spin here, because right away again we were seeing like Fox News articles like this saying, "Hey, LDL is fine." The authors, like Nick Norwitz, going on Steak and Buttergal, who's a carnivore influencer, and really saying, you know, everything is good, not mentioning the plaque progression. And this is where I have to applaud them for being just so good at spinning this, because what they did when they didn't find a nice primary outcome that they like, they just completely pivoted to some secondary outcomes that they could again spin to seem like high LDL in this group was fine. And the one that I've seen pushed out there the most is this idea that there was no correlation between LDL and plaque progression in these people. Oh my god, here he is on Steak and Butter Gal. I got the inside scoop from Dr. Nick Norwitz at Harvard. Let's ask him what he has to say. Thanks for asking, Bella. The findings are tremendously fascinating. When we ask the question, well, what predicts the progression of coronary artery disease? There's always going to be some older population. The answer was that LDL cholesterol and apoB, even at these crazy high levels, some patients with LDLs of 500 LDL and apoB did not predict plaque progression. I couldn't help but immediately notice that she's like, here's Nick at Harvard, like as if he's in some Harvard lab, you know, in a study done by some Harvard research wing. Nope, yeah, he went to Harvard in the past, but this is in no way like sanctioned by Harvard. And we will get to the funding of this in a bit, but yeah, he also went on Metabolic Mind, the low-carb channel I've covered in the past, and and said a similar thing. But I don't actually think—correct me if I'm wrong—has anybody online contended the conclusion that LDL and apoB are not correlated with plaque progression in the study? I don't think that's even been a point of contention. And for those that aren't aware, APOB is the main atherogenic component of LDL and some other particles as well, so it's just another metric of an atherogenic particle. This brings me back to Dr. Spencer Nadolski, the one who was originally involved in this study and then pieced out when we saw that things were sketchy. Spencer and others jointly stated that this study was not designed or powered to find a relationship here with LDL and plaque. Yeah, we're talking about an observational study of 100 people, which, yeah, if it was a randomized control trial with some control group, double-blind, all that stuff, maybe we could see a result. But again, observational study, you know, the type where we're usually seeing 1,000, 10,000, 500,000 people. And there are some little red flags here and there because you can see a hints of a relationship. The study says, yeah, LDL lifetime exposure was associated statistically significantly with plaque, but then they adjusted for coronary artery calcium, and boom, it disappeared. Also finding that age itself lost significance with plaque progression, which should be a huge red flag in terms of just what the study can pick up, cuz that's like the main plaque association. So it shows a weakness of the study or that they weirdly over-adjusted for CAC, which is coronary artery calcium score. So yeah, I don't really trust these people with a black box of data; what outcomes they're going to come up with.
And then we also have Dr. IDs who responded directly to this point. Of course, it wasn't the average LDL was 254 milligrams per deciliter. You won't find an association between LDL and plaque if everyone has sky-high LDL. That finding is meaningless without a low LDL control group because it lacks the variability and exposure to detect a dose-response relationship. It's like trying to find a difference in lung cancer rates between those who smoke 50 versus 60 cigarettes a day. No matter how you try to spin it, the fact is these lean people with sky-high LDL following a keto diet develop plaque several times faster than healthy people and at similar if not worse rates than metabolically unhealthy people. But yeah, to Dr. IDs's point, if we did have people that were down in the lower, under 100, even in the vegan range of 50 to 70, we would have had a much more dramatic contrast, and maybe it could have statistically found something. Because yes, in other studies looking at the same imaging technique, we do see that LDL, as it increases, is correlated with higher plaque volume. We can look at this graphic that Dr. Anam Borick put together, and it really illustrates it and frames it well. You can see how they just isolated a clump of the distribution of real people and said, "Look, no association, guys." And this is where we get to another secondary outcome that they sort of pulled out and ran with to make the study look good. Most exhibited no or minimal progression of coronary artery disease. And I think I'll let Dr. McGowan, who has a great response to this video overall, respond first, as when you look at their graphs, which we have to do because they wouldn't give us numbers for the primary outcome, we see that about 95% or more of the participants had progression in NCPV, i.e., the primary outcome of the study. So to report that most people had stable plaque when clearly this wasn't the case, that is incredibly deceptive. But it just blows my mind to see an author of the study going out and completely ignoring the four times higher than healthy average plaque progression and saying, "Hey, we had some people that were fine." Well, it's the case that if we're looking to any of these studies and we decide to just chop up the group in weird arbitrary ways, then you're going to get people that look like they're doing fine. The same thing could happen again—keep using this example—but for lung cancer and smoking. Oh yeah, 50% of the people in this one-year study didn't see a progression in lung disease; therefore, smoking's fine. And I would add that you could probably defend diabetes plaque progression the same way, saying diabetes doesn't increase plaque because look, in this study with people who have diabetes, we can slice a portion of that population that didn't see an increase in plaque progression, which would be a ridiculous argument to make. And weirdly, later I found that Nadulski had made the exact same comparison, letting people actually vote on whether it would be healthy to be diabetic for plaque. Pause to read. We have to again think about that sigmoidal curve of heart disease where we have these people who are starting off largely with nothing, and you're slamming them with LDL, and yeah, disease might not be sprouting in all of them in one year, but down the line I think we can imagine how this chart would look, is that as soon as there's any injury, whether it's from an infection or oxidative stress of aging or whatever, they start to get that plaque, and then boom, they shoot up in that more exponential fashion. So in terms of super high LDL, I can't help but think of this very obvious analogy where you're maybe like a fireman in a fireproof suit who has to run through a field of razor blades, that is life, where it's cutting tiny holes in your suit. Would you rather have people shooting at you with flamethrowers or holding up lighters to you? Because that's essentially what's going on, because as soon as you get that first cut from a razor blade due to whatever it was in your life, you don't want to be gassed with the flamethrower; you don't want to be gassed with 250 or higher LDL. You want to be down to that tiny little flame of 50 to 70 LDL if possible, but definitely under 100. And this is where Nick said something that I just had to laugh at on Metabolic Mind. Has the message been it is safe to be a lean mass hyperresponder, um, as demonstrated by this study? I mean, I think that's probably one of the concerns that some people think they are hearing or others are saying. So with you as an individual, I mean, is that what you interpret from the study? For me as an individual, I think I take the data within the context of my own case. My case is I have a zero um plaque score on coronary CT angiography. Dude, this guy is in his 20s; he is a young dude. The amount of people that are going to have plaque progression after a few years on high LDL is low, but the fact that he also just has to get scans to make sure that his heart isn't clogging on his diet should be enough to kind of tell you that it's not the best diet out there. And again with the smoking here, where it's like, okay, if he was smoking, where only 10% of people who smoke end up getting lung cancer, someone in their 20s saying, look, I smoke, I don't have lung disease; smoking doesn't cause lung cancer or lung disease; look at me, you know, like, come on. And this is where I want to just give a little bit of information about the funding of the study. This was done by the Citizen Science Foundation, and I believe it was started by Dave Feldman, one of the co-authors who has the Cholesterol Code website, which is really a cholesterol denial website, denying the connection between LDL cholesterol and heart disease. And what this organization and Nick on social media does as well is they really have a following of people that really don't want high LDL to cause heart disease. They're carnivore, they're keto, they're low-carb in some way, and their LDL is too damn high, and their doctor's like, "You should do something about this," and they're like, "I don't want to; tell me some good news about my bad habits." Which makes me think, how would this same group react if vegans got together and crowdfunded a study and found that there was like increased plaque on this vegan diet and then just like completely ignored it and only reported weird secondary outcomes? And that's a standard that I think everybody should constantly—that's like how I constantly think of everything—like if a claim that I'm making was also made by carnivore people, how would I feel about it? Bill also touches around the concern of this community as well, to a year or two ago when the study was not even published, wasn't even running, just hyping this to the public continuously, constantly dog whistling that it's okay to have sky-high cholesterol, ignore your doctor, abandon medical treatments. Incredibly reckless, in my opinion; no regard for human life. That I'm going to keep the weird analogies going by modifying that old blind man elephant analogy, in the sense that it's like these low-carb people, based off the information they're given, are blind people just touching the leg of an elephant and seeing a tree and going, this is just a harmless tree, but little do they know it's an elephant that's about to trample them. And that's what all of these more neutral doctors are trying to shout at them. But no hate to elephants; they're not obviously going to trample you, but that's just an analogy. Dr. Brad Stanfield also brings up the human aspect of this from his practice, and I again see this in the clinic where people are under the impression that if they're on a keto diet or they're a so-called lean mass hyperresponder, if they have high LDL cholesterol levels, that they don't necessarily need to
Ich mache mir Sorgen deswegen, aufgrund einiger Forschungsarbeiten und Kommentare zu Studien wie dieser. Oftmals komme ich nicht wirklich weiter, weil diese Einflüsse schon viel länger verfolgt werden, verglichen mit einer 15-minütigen Beratung, die ich als Hausarzt mit dem Patienten vor mir habe. Das lässt mich fragen: Wissen sie wirklich, welchen Schaden sie anrichten? Wenn man tiefer gräbt, findet man so etwas wie leicht verklausulierte Warnungen, wie diese hier. Und wir sind auch ziemlich klar, wie zum Beispiel wenn Sie mein Video sehen, sage ich ganz deutlich: Bedeutet das, dass Lean-Mass-Hyperresponder immun gegen Herz-Kreislauf-Erkrankungen sind? Nein, das bedeutet es nicht. Oh, nun, das gilt nicht für diese gesunden Lean-Mass-Hyperresponder, zu denen Sie wahrscheinlich gehören. Eine solche Einstellung halte ich für wirklich unverantwortlich. Ich glaube fest daran, dass es Menschen geben wird, die negative Herz-Kreislauf-Erkrankungen als Folge von hohem LDL erleiden werden, während sie einfach ins Krankenhaus gehen und glauben, dass es einen magischen Lean-Mass-Hyperresponder gibt, der durch sein LDL eine Herzerkrankungs-Unverwundbarkeit besitzt.
Das bringt mich zum eigentlichen, größeren Bild: Metaanalysen, die wir zu Low-Carb-Diäten finden, zeigen bis zu 30 % erhöhte Gesamtmortalität. Und genau das ist die Art von Begründung, die dafür angeführt wird. Letztendlich ist so vieles an dieser Studie falsch, angefangen damit, dass ihr primäres Ergebnis scheinbar absichtlich nicht berichtet wurde, weil es eine schreckliche, besorgniserregende Zahl war. Zusätzlich fordern viele Ärzte eine vollständige Rücknahme. Wiederum Dr. Anabolic, und sie verwendet das Beispiel einer Studie, die speziell zurückgenommen wurde, weil sie nicht über ihr primäres Ergebnis berichtete, sondern bequem zu einem sekundären überging. Und dann das nachfolgende Spin, das mit diesen seltsamen sekundären Ergebnissen auftrat, wobei das völlig ignoriert wurde, was auf diesen Karnivor-Kanälen, Low-Carb-Kanälen und in den Mainstream-Medien passiert: „Oh, wissen Sie, diese Studie rechtfertigt LDL, was zum Teufel?“ Und dann der seltsame Mangel an Kommunikation zwischen den Autoren, wobei Bud Off sagt, dass sie mit der Veröffentlichung dieser Abbildung, die in der Studie hätte sein sollen, völlig falsch lagen, die sie dann der Studie hinzufügen wollten, die sie jetzt nicht mehr ändern wollen. Ja, Sie haben von verschiedenen Ärzten gehört, dass diese Keto-CTA-Studie, versuchen Sie es erneut, völlig daneben ist, ehrlich gesagt. Das Journal of the American College of Cardiology Advances muss dies ernsthaft überprüfen, sehen, was schief gelaufen ist, welche Aufsicht es gab, und mindestens muss es eine Corrigendum geben, das ist Latein für d.h./eine Korrektur. Und wirklich, das Journal of the American College of Cardiology selbst sollte eine direkte Presseerklärung herausgeben, die besagt, dass diese Studie in einem ihrer Journals von den Autoren auf unehrliche und unverantwortliche Weise absolut falsch dargestellt wurde.
Und in diesem Zusammenhang, wenn Sie Cove Pure ausprobieren möchten, etwas köstliches reines Wasser bekommen möchten, können Sie einfach diesen QR-Code scannen oder auf covepure.com/mike the vegan gehen. Und natürlich lassen Sie mich wissen, was Sie von diesem ganzen Drama unten denken, denn es gibt viel, und es gibt viele Punkte, die ich hier nicht einmal behandelt habe. Also lassen Sie mich diese wissen, und natürlich können Sie gerne liken, abonnieren, teilen, all das Gute, und ich sehe Sie im nächsten Video. Danke fürs Zuschauen.