The Cholesterol Code (2026) | Full Movie | Documentary | Health

Heart disease is still the single leading cause of death. The number one killer, the number one killer in the US. We're spending so much money, and yet the outcomes are all worse. Heart disease has become the most frequent cause of death. Cardiovascular ailments continue to take American lives.

You can reduce the risk of heart attack. Eat a diet low in cholesterol and saturated fats. We're still taught that high-fat diets cause heart disease because they raise LDL cholesterol. We would talk about cholesterol being bad. Higher cholesterol going to clog your veins. Is that what we should be focusing on the most? And I think no, it absolutely is not. The only reason to focus on cholesterol is because we have drugs. There's no other reason. More drugs, more illnesses. And it's not working. It's a broad failure of the medical system. I think it's just the paradigm is wrong. You go to the medical literature, it's all on flimsy data based off of a sick population. Cholesterol was not a good predictor of who's going to have a heart attack.

Now is our chance. This one study could change everything. These people could finally help us crack the code. I'm sorry. That's not ethical. Incredibly reckless. No regard for human life. I feel like I've underestimated the wind that's in front of us. If we think high LDL in everybody is equally concerning, if that's wrong, then we've been wrong for a very long time.

All over the world, people are looking for ways to live a healthier life free from medication and disease. I have traveled so many places to get some of these stories from people like me. People who suffered sometimes for decades with chronic illness and then, in what seems like a miracle, a simple change in diet turns it all around. My symptoms all improve dramatically. Many people lowering or getting off medication, finding relief from pain. It really did change my life. It literally felt like the lights had come on. They have hope again, life again.

So many people have found their solution in a ketogenic diet. I was surprised at first that just changing my diet had such a night and day effect on my mental health. There's new hope for the reversal of mental illness. It's almost like a different existence. The resolution of eating disorders. I'd never been able to go that long without eating or without like obsessing about it and thinking about it. The reversal of type 2 diabetes and safe management of type 1. His diabetes is completely under control. It just looks healthy. Every day is just a better day. There is hope. And that is what I want everyone to know. That was my story, and it's a story I've seen tens of thousands of times. I wish the story ended here.

A new report from the American Heart Association is shedding light on the risks associated with some popular eating plans. The problem is, modern medicine believes that ketogenic diets can also kill us. These diets that were very low in carbohydrates raise the risk for bad cholesterol, and that is a risk factor for heart disease. If you have that much fat, the bad cholesterol goes up, increasing your risk of heart problems. There's an assumption that if someone starts a ketogenic diet, automatically you increase your risk of heart disease. And that really is unfounded. Most people on keto see little change in their cholesterol. But surprisingly, it's the leanest, healthiest individuals who can see their levels go up a lot. The cholesterol went through the roof. My LDL is way up. Was the highest I've seen it. I was in the best shape I'd ever been in. Yet one lab number was saying that this was bad. I just knew how good I felt when I was low carb. But I did freak out a little. I was really afraid. I was really scared.

Modern medicine believes there's no debate. These people are a heart attack waiting to happen. Our LDL cholesterol causes heart disease and stroke. LDL cholesterol is causative without a doubt. LDL causes heart disease without question. You will have more heart attacks and more strokes. A lot of times, LDL is described as though it is the disease. If you have high LDL, it's as good as if you already have heart disease, or at least that it's right around the corner. But what if modern medicine is wrong? You like to see your heart on three dimensions. What if this isn't a medical problem, but a scientific opportunity? We have the anterior descending artery here. Why not just go ahead and study these folks? That's one of the fascinating things about Dave. He's an outsider who came in and is starting to sort of upend medicine.

My story began when I saw my own cholesterol skyrocket on this diet. And I became obsessed with finding out why. But I'm not a medical professional. I've gathered hundreds of blood tests and I track everything I consume. But I don't work for a lab. I've authored peer-reviewed papers to share these discoveries. With that, Dave, please come and tell us more about it. And now I'm spearheading a highly controversial research study with a team of doctors and PhDs across multiple institutions. But I'm not a trained researcher. I'm an engineer chasing this medical mystery around the world and seeking an answer for the countless individuals who rely on ketogenic diets for their health. I need for what they're experiencing to tell the story for us. And that's what's exciting, getting to see how different each of the locations are, but yet how common a phenomenon is. This isn't to say the ketogenic diet is a panacea. It's not for everyone. It's not certainly not for every medical condition, but for some medical conditions and for some individuals, it seems to be a lifeline. And yet, they have this one problem. They see this extraordinary increase in their LDL cholesterol. Why not just go ahead and find out, are they at a higher risk? He's throwing strikes. We really need to have an answer, not just for the adults, but also for the children who might have a medical reason to be on a very low carbohydrate diet. And they deserve it from us.

Worldwide, the leading causes of death are chronic diseases. You already know these well: heart disease, stroke, type 2 diabetes, Alzheimer's, and kidney disease. A key driver of most chronic diseases is chronically elevated insulin. And a major contributor to chronically elevated insulin is the overconsumption of sugar and refined carbohydrates. Ketogenic diets, often referred to as keto, restrict carbohydrates to less than 5% of daily calories. They include high amounts of healthy fats and a moderate amount of protein. Studies on keto diets show that they can reduce insulin, normalize blood sugar, promote weight loss, and restore metabolic health. And yet, every physician I've met on this journey was taught that keto diets cause high cholesterol. And high cholesterol causes the number one killer, heart disease. Just cholesterol is bad. It causes heart disease. We would talk about cholesterol being bad. Higher cholesterol going to clog your veins. The assumption was just, well, everyone knows that cholesterol is a problem. Enough said.

But what is cholesterol? Cholesterol is an essential molecule found in every cell in the human body. We cannot live without it. In fact, whatever cholesterol we don't get from the foods we eat, our liver will make on its own. And the liver is not alone. Nearly every cell in the human body can synthesize cholesterol. Cholesterol is essential for building your cell membranes. It also helps your liver make bile, which is needed to digest the foods you eat. Cholesterol also plays a starring role in the central nervous system, ensuring your brain communicates well with your body. It also helps synthesize vitamin D, which supports your immune system, and sex hormones like testosterone and estrogen. So, if every cell in our bodies needs cholesterol and we can't live without it, how did it become the villain of modern medicine? Well, here's an interesting fact. Most studies that show an association between elevated cholesterol and heart disease are looking at general populations who are, let's face it, generally unhealthy. There was a recent study that showed 93% of the American population has suboptimal metabolic health. 93%. So then the question becomes, well, would that same evidence translate to a metabolically healthy population or a population who's in ketosis? And we don't have that evidence, right? That population has not been studied. What if we back out high insulin? What if we back out obesity, diabetes, pre-diabetes? What if we take a look at healthy people and see if cholesterol matters the same? What if high cholesterol in healthy people on a keto diet is telling us a different story?

This is the kind of thing I like to be eating. Or this. Now, you might be like, "Huh, how many photos of food do you have?" Good question. About, I don't know, this many. I've been pretty much a nerd my whole life. And I liked playing with Legos. I liked reading comic books. I liked playing video games. I liked playing around with programs and writing little games for myself and my friends. I like building things. I remember I really impressed my dad one time because I built a transmission for a Lego car, and it was it was fun. Just the building and constructing of things is enjoyable. But here's one of the things about all engineers: we actually spend more time taking things apart. I've been taking photographs of my food and a lot of these metrics for coming on to eight years and a couple months. I just always make sure that my hand was in the shot, but usually I'd have like my fist nearby so you can get a sense of volume.

Why do you do this? I wanted to track all my food so that I had the data to match with the blood work I do, and I have a perfect record of everything I've consumed. How many photos has Dave taken of you versus food? Well, I think if anybody looked through their phone, they'd think that something was very, very off because there are far more pictures of his food. His food and his fist. I even have a lot of gestures. While the hand enclosed is what's showing up shot after shot, I actually have some things like this gesture. What this means is I decided to start eating two hot dogs without a bun. But an open hand means that I stopped. And that's because these hot dogs were gross. Being the engineer geek that he is, he just has a different way of thinking than maybe somebody who spent their entire life in medicine, than what how they would think in their thought process. The more I could take things apart and see how they worked on the inside, the more I became fascinated. And nowhere did I become more fascinated than with code, with programming. As early as I can remember, I loved software. Eventually, I'd be writing my own code, starting businesses, and building platforms with teams of engineers. I love technology, and technology loved me back, but it came at a cost. Like my fellow developers, my diet was terrible, and my blood work was showing higher and higher glucose levels, suggesting I was developing diabetes, like most of my family. Finally, in 2015, I decided to do something about it. The low-carb diet was steadily rising in popularity, especially for treating diabetes, which made a lot of sense to me. And when I cut back on carbohydrates, it worked. Not only did my blood sugar come down, I dropped 30 lbs. My energy levels increased. My sleep improved. My running improved. Everything got better except one thing. One thing that could not be ignored. I remember that day like it was yesterday. I remember it because that one 8 1/2 by 11 piece of paper completely changed my life. I just kept looking at those labs, completely mystified. I kind of wanted a second opinion. Maybe it was a lab error. So, why not just get my blood work all over again? In the meantime, I'm trying to learn everything I can about cholesterol, but I have no background in medicine or research. So, I just get frustrated and then depressed. And my appetite had fallen off. But I kept thinking, that's actually a good thing. If my appetite's fallen off, guess what? I'm eating less fat, and especially less saturated fat. Because if I'm eating less saturated fat, my LDL should drop, right? But that's not what happened. Not at all. The second test was two weeks later. Instead of dropping, my LDL jumped up a lot. It climbed another 100 points. And suddenly, a lot of my fear became fascination. I knew, I knew right then, there's way more to the story. It's not as simple as it's just fat or saturated fat, because this was literally the first experiment that I didn't even intend to do. Yet, I was doing it. I was finding out that the thing that I was told was driving up my cholesterol, it couldn't have been all there was to the story. There had to be more. And at that point, it turned into a full obsession. So, I started taking pictures of my food all the time, and that allowed me to have a tighter record of where my food matched with my lipid levels, because at the same time, I'm getting constant blood tests and tracking my cholesterol, then comparing it to my food intake. So, I could actually see these changes in real time. And the very first pattern that emerged was this inversion pattern. My baseline LDL is still high on keto, but get this: my numbers can swing dramatically based on what I eat on a daily basis, and not the way we might think. When I consumed less food on keto, including less saturated fat, my LDL jumped higher. When I consumed more, my LDL dropped. That was the first signal. The first signal was, "Wait, wait, wait. These levels are super dynamic. All I need to do is track my food, take a higher frequency of these tests, and then see if that feedback gives me meaningful information." And it did. It was giving me meaningful information in real time. In just the span of a few months, I was already wanting to go to the next low-carb conference and knock on their doors and say, "Look guys, you've got to check this out. You've got to look at this." It's my very first low-carb conference, and I brought my laptop with me, which had the data in it, and it had the graphs. The thing was that it was our very first event, and I was spinning like a top, and he kept getting in my face with this laptop, you know, like, and I was saying, "Yeah, Dave, thanks." But, you know, no, no, no. Like, he was so passionate about it. And all I had was eight blood tests at that time, but it showed this inversion pattern, and I started talking to them about what I thought it might be. And they all looked at me like I was an alien. But the most astounding thing to me was everybody was coming to me saying, "Have you met that gentleman who's walking around with a laptop and he's got this graph and he's showing everybody you can adjust your LDL and your cholesterol by what you eat on a daily basis?" I'm sure I came off as a, you know, a bit kooky. Regardless, though, it didn't change how passionate I was about making sure that they could understand just how dynamic these levels were. The usual way we think about lipids and lipoproteins is on the order of months. Now, here's Dave who comes along with his NF1 experiment and says, in a matter of days, I can radically change my cholesterol. We've not talked about that in lipidology. If anybody has any questions, feel free to post them here in the chat. The more I shared my discoveries, the more people started paying attention. Dave is a software engineer who got ridiculously interested in self-experimentation and nutrition. I want to thank Dave Feldman, an engineer who came into this field. Dave Feldman, I think it's extraordinary that we've got an engineer. Dave Feldman noticed that when he went on a low-carb diet, his. Dave Feldman is someone you'd want to have on, too. Dave Feldman, who's been a guest on the podcast. I respect Dave Feldman. Dave Feldman, who's been on podcasts. I mentioned a guy named Dave Feldman. He was. And Dave Feldman is an engineer who stumbled onto this mystery. And that's how it all started. They all thought I was a little crazy, which maybe I am, because I put my engineering career on hold and jumped full-time into the world of science. It's fascinating because now I'm connected with all these people who experience the same thing I did. It's like they're echoing back the same story where they feel like they found the fountain of youth. All these things improve, and there's even a lot of people who are getting medical benefits from dropping their carbohydrates way down. But you've got this one thing, this one thing I have to know. I have to know if this is a problem, because it's the only one. It's the only one I can see. Allison. Hi. Hello. How are you? Come on. I've landed in Pittsburgh, Pennsylvania to meet 10-year-old Johnny. Hey. Tell me a little bit about Johnny. What kind of kid is he? So, Johnny is all boy. We'll start with that. He's very, very active. Do a full wind-up. All right, you could go slow. Slow with the wind-up. He turned 10 last April and he played with 11 and 12-year-olds. And some of the 12-year-olds actually were almost 13-year-olds. And he didn't miss a beat. Like, I think I can throw like 50 miles per hour. Like, I'm right-handed. I'm sure I can have a lot of 12-year-olds, too. Last year, Johnny was diagnosed with type 1 diabetes. His condition requires vigilant blood sugar monitoring and insulin therapy. This is 0.5 units of our insulin. He'll get this right before he eats breakfast. Insulin injections are crucial for individuals with type 1 diabetes because their bodies don't produce insulin, a hormone needed to regulate blood sugar. There you go. Without insulin, glucose builds up in the bloodstream to dangerously high levels. Injections of insulin unlock the cells, allowing them to absorb glucose properly, keeping blood glucose levels normal. But the amount of insulin Johnny requires is greatly affected by the foods he eats. Type 1 diabetes, the mantra has always been, eat whatever you want, eat your carbs, and cover it with insulin. Your child will still be able to eat all of his or her favorite foods. Because with type 1 diabetes, the risk of too low of insulin is as great as too high of insulin. And that's unfortunately why in the long run, they tend to do pretty poorly because the treatment guidelines are very lax about how aggressive to be. I can have a cupcake and get insulin for it and be okay. That's what they kept saying. Feed him what he wants. We'll dose you, dose accordingly. So, I have pictures of him like in the hospital bed with his IVs, and he's shoveling pancakes covered in syrup. That's the highest his blood sugar has been since we knew he had type 1 diabetes. The last night in the hospital under their care, it was, I think it was over 300 milligrams per deciliter. But he didn't like being on that roller coaster. That roller coaster of glucose gets too high, you need insulin, but then it can get too low, and you have the hypoglycemic corrective effect. If I was living like that high-carb diet, like I would have to take a lot of insulin, it would burn me up, and then my start carb, it got perfect. So, we buy our eggs from a local farm. The entire family went keto, cutting out simple carbohydrates like bread, pasta, cereal, and sugary sweets. So Johnny, at 10 years old, hardly requiring any insulin because he's on a keto diet, his path is going to be much clearer, much smoother, and much better controlled than the alternative. Fewer carbs on his plate means less glucose in his bloodstream, making Johnny less reliant on injected insulin. An hour and a half after breakfast, and he's sitting at 78, which is pretty healthy blood glucose for a child, for anybody. So, I keep our extra insulin in this fridge. We get it every month, and I just put it away. Before the discovery of insulin, a diagnosis of type 1 diabetes was a death sentence. Children with the disease became emaciated and slowly starved to death. When insulin was discovered in the 1920s, it revolutionized the treatment of type 1. But dosing insulin was a new frontier, and there were no tools like blood glucose meters to monitor the results. In the old days, individuals were being given what I call industrial doses of insulin. Richard Bernstein is a pioneer in the realm of diabetes care. Born in 1934, he developed type 1 at the age of 11. How old are you, Dr. Bernstein? 89. 89. When I got diabetes, my parents were told that my lifespan would be 30 years from the onset. So I lived to be 41. Wow. Many of Bernstein's contemporaries would die young. Early insulin therapy was a miracle cure, but young patients on high insulin doses developed early atherosclerosis. Most died from heart attacks and strokes within 20 or 30 years of starting therapy. So, one of the things that's emerged with insulin therapy for type 1 diabetics is its connection with heart disease. The connection with heart disease was very profound. By the 1960s, our researchers saying insulin itself in high doses is atherogenic. It causes atherosclerosis. Bernstein was determined to avoid those complications. Okay, this is the first blood sugar meter. It was used in emergency rooms to tell the drunks from the diabetics at night when the labs were closed. Originally trained as an engineer, Bernstein hacked the bulky monitor so he could run it off batteries, carry it with him, and continuously track his blood sugar. And he becomes the very first person in the world to start measuring his blood sugar at home multiple times a day. I was the only one in the world who was checking his blood sugar all day long. Literally patient number one for blood sugar monitoring, and he comes up with this idea that he calls the law of small numbers, which is the way physicists and engineers think: that small inputs have predictable effects. So if he keeps the input, the carbs, small, he can keep the insulin doses small. And now he could kind of keep everything under control. I finally had normal blood sugars. I walked into this taking 200 units of insulin, and today I take about 20 units, about a tenth of what I was taking then. Bernstein went back to school in his 40s to become a medical doctor. Adding MD after his name would open more doors for publishing his discoveries in medical journals. But even so, letters of rejection. Sent it out to journals, got very nice rejection letters back then saying, "This is a good idea, but the you're not a typical person, and nobody else is ever going to want to monitor their blood sugar five times a day." So Bernstein's revelation that you can control the disease with small doses of insulin and control blood sugar almost perfectly without carbohydrates would be left behind. Wow. It just seems so straightforward, though. If carbohydrates are what gets converted to glucose in our body, and if you've got a condition where you have difficulty regulating it, why not just have less carbohydrates? Well, there's something that's now called the cholesterol myth. Okay, so remember how in the early years of insulin therapy, people with type 1 diabetes were dying young from heart attacks and strokes? At the time, some researchers blamed it on high doses of insulin, but other researchers blamed it on high cholesterol. Dr. Bernstein calls this the cholesterol myth because he observed that reducing insulin reduces diabetic complications like heart disease. When did you first find out that Johnny had something going on with his cholesterol? That was at his one-year labs. And this brings us back to Johnny. Johnny's insulin is under control, and he's thriving. But like so many I've met who are very lean and athletic and go low carb, Johnny's cholesterol went through the roof. I was hysterical. I called my husband. I was just like, "We're doing everything right. Why is this happening?" He's like, "Calm down. It's okay. Like, breathe." Time out. Of course, Johnny's parents and his medical team are freaked out. His LDL cholesterol isn't just high. It's 640 mg per deciliter. That's well over six times the recommended level. Johnny's cholesterol is on par with kids who have a rare genetic disease. It's called familial hypercholesterolemia, or FH. FH impairs the absorption of LDL cholesterol, causing a massive buildup in the bloodstream. In its rarest form, FH can cause heart attacks and death in young children. This condition is often marked by fatty deposits on the skin and is considered the strongest case for the hypothesis that LDL cholesterol independently causes heart disease. But it's unclear how much of the risk is related to the genetic disease itself. Regardless, the association between LDL cholesterol and heart disease in this condition is a major reason why Johnny's medical team is so concerned. So, now the difficult question: How do you know for sure if you're doing the right thing for Johnny? I feel sometimes just looking at him, he looks so much healthier than any other kid his own age. I know that's kind of naive to think that nothing wrong is going on inside, but I tell you that all the time. He just looks healthy. I'm hoping that maybe one day there'll be a doctor that can help us, you know, at least with what we should do, the proper tests to get done to make sure that everything is okay with him.

Here's an important point. Johnny doesn't have genetic FH. He wasn't born with these levels. Like me, he only started to see high cholesterol when he went on a ketogenic diet to manage his diabetes. He also has minimal body fat and is extremely lean and athletic. And high LDL cholesterol wasn't the only thing we had in common. We also had high HDL cholesterol, often referred to as the good cholesterol, and low triglycerides, a measure of fat in the blood. High HDL cholesterol and low triglycerides are markers of good metabolic health and are associated with a low risk of cardiovascular disease. I continue to see this triad of high LDL cholesterol alongside high HDL cholesterol and low triglycerides in other lean, metabolically healthy people on a keto diet. Finally, in 2017, I wrote an article on my blog where I named this profile "lean mass hyperresponder." The responses were staggering. Hundreds of people, then thousands of people from different countries all around the world. Identifying this phenotype proved a major breakthrough. But the big unanswered question remains: Will these high levels of LDL cholesterol cause plaque to build up in their arteries? Or is there something different about lean mass hyperresponders? For that matter, is there something more they can tell us about cholesterol and its role in heart disease? You know, when you see your LDL come back in the 300s, 400s, 500s, and you're a medically literate person, the reaction always is, like, I can just— It's the facial expression. It's the double-take. Like, is this— Is this an error? What's going on here? This is something that you only see, especially levels in the 500s, in very rare genetic conditions. This is the famous building that there are all the pictures of. But Nick Norwitz is a medical student at Harvard. He first noticed his LDL spiking when he got his blood work back after starting a ketogenic diet. Nick went keto to treat his ulcerative colitis, an inflammatory bowel disease that causes ulcers in the gut. Symptoms of ulcerative colitis include severe abdominal pain and intestinal bleeding. Basically, I went from having absolutely no dietary restrictions. In fact, I was known as the guy who would basically be the garbage disposal. I did anything to really not be able to eat much of anything without having negative reactions. I think the scariest thing about his ulcerative colitis, for me at least, was seeing him lose weight. I mean, he lost a dramatic amount of weight. He lost about 20% of his body weight, and he's already, you know, a very lean young man. Over the course of two years, Nick went from athletic and energetic to dangerously thin, going in and out of the hospital. He was so sick and weak he considered dropping out of medical school. At the lowest point of his illness, he ended up in a palliative care ward, surrounded by dying patients. Yeah, it was a little bit terrifying. Um, so that was the point at which I started finagling with lifestyle and particularly diet. And, you know, the punch line to the story was I eventually tried keto out of a large degree of desperation and zero expectation. And my life changed like that. It was shocking to see what a potent effect a ketogenic diet had on my life. Within a few days, I was feeling remarkably better. My energy was back. My symptoms all improved dramatically, but my inflammatory markers had dropped to completely normal. I think they dropped like sixfold within a week. So, you know, that was a light bulb moment for me. Even then, I was a little bit anxious, you know, that it wouldn't hold, but it's been over four years, and it's holding. Going to leave a little bit on there. It really has changed my life, and I think given me the life back that I was hoping for. Nick is interesting because he got into keto because it became the one thing he could do to help his symptoms with ulcerative colitis. And that ironically is what would ultimately lead him to me because, given how lean and how fit he is, that meant he was likely going to develop the lean mass hyperresponder phenotype. And eventually, he did. And on my first lipid panel, which was taken very shortly after I started the ketogenic diet, my LDL had jumped well over threefold. It had gone from around 90 to well over 300. Subsequent tests found that it went up even higher. It's peaked at the mid-500s. Nick dove into the medical literature, but he found few answers as to why he would experience such a hyper response in his cholesterol. So, he did what any modern medical student would do: he hit the internet. And it wasn't long before I got on the trail of this quirky engineer in Nevada who had put up a blog post about this phenotype in which people who are lean and athletic go low carb, and their LDL goes through the roof, their HDL also goes up, and the triglycerides drop. And I look back at my lipid panel, and I'm like, well, this—this is me. Isn't it just striking how little curiosity there really is for at least wanting to get under the hood and understand this better? When you have a question, a really authentic question, and you're told it's off-limits, at least for me, it makes you a lot more hungry to go after that question. The idea that this is a scientific taboo, but actually also a legitimate scientific question, is very enticing for both of us, combined with the fact that it actually has the potential to help a lot of people. So, Nick and I teamed up along with Dr. Adrienne Sodamod and many others, and we began publishing papers together. True science is human beings exercising their curiosity and poking things to see what happens and then trying to make sense of it. That's true science. When you keep poking at that question and there's no good answer, that's the question you want to pursue. And if people get defensive about that question, that's the question you really want to pursue. We are presented with this opportunity, this scientific opportunity that's never existed before, where we've actually pulled off getting this one variable of interest, LDL, all by itself. This is—it's scientific mana that you could actually get the variable of interest all by itself at super high levels alongside low cardiovascular risk. Yeah, it's a natural experiment. And yet, there's so much controversy just in our pursuing research on this, which to me baffles me. It's just—it's crazy. So, this is just a general example. Yes. It's just somebody who has severe atherosclerosis. Dr. Matthew Budof is a cardiologist and researcher. He has conducted hundreds of clinical trials and published over 1,500 peer-reviewed papers on his findings. This is the left artery. Dark means that there's soft plaque. White means there's calcified plaque. You can see dark and white. So, this person has just a lot of atherosclerosis. Dr. Budof uses high-resolution computerized X-rays to produce detailed 3D images from inside the body. And we can take a look at the individual arteries and compare it and contrast it to the last study we just saw that had severe disease. This is the right coronary. Nice, smooth, big pipes, and no disease seen. So, I started working with cardiac CT early in my career in the early '90s. My boss told me back in 1991, "This is going to be the mammogram of the heart. That we're going to do these scans in middle-aged people, see who has plaque and who does not, who needs treatment and who does not, and base everything on that, just like we do a mammogram for breast cancer." Yeah, we called it the mammogram of the heart. And we knew it reflected the total amount of arterial sclerosis. In the early 1990s, Dr. Arthur Agston, Dr. Budof, and their cardiology colleagues rallied around a brand new X-ray machine. For the first time, it was ultra-fast enough to take clear images of a live beating human heart. And it froze the motion of the heart. So, for the first time, you could actually see the heart. It showed that there was a lot more coronary calcium in people with coronary disease versus those without. But the high price and radiation exposure of ultra-fast scanners made adoption slow. Fast forward 30 years, and both the price and exposure have come down dramatically. Yet still, coronary calcium scans are underutilized. A more advanced scan known as a CT angio adds contrast dye injected into the blood of the patient. This allows researchers like Dr. Budof to see both the calcified and soft plaque for a more complete picture of their heart disease risk. And then we can rotate around to the right side of the heart and measure the right coronary artery through here. And then this is the right coronary artery with a moderate to severe stenosis. It gets narrow and then opens back up like an hourglass. That's a stenosis. This person will probably need to get a stent or bypass surgery at some point. CT angiography is great because beyond looking at something like a marker like LDL, you're actually looking at the physical presence of the disease itself, for that matter, whether it's there at all. And this gave me an idea. What if we recruit 100 lean mass hyperresponders who rely on keto diets for their health and who see extraordinary increases in their LDL cholesterol, and we just scan their hearts? We just go ahead and look inside to find out, do they have plaque in their arteries? Honestly, I mean, when as a just a reflex, as a preventive cardiologist, somebody walks into my office with an LDL of 250 or 300, I'm looking for the prescription pad. So, why not just study them, look inside, and see? The plan is simple. We scan everybody at the beginning of the study, and then a year later, we do a follow-up scan. Then, we can do a comparison between the two. There's only one catch: there's no money without industry, and there's not an industry for a ketogenic diet. We don't have big pharma here to fund the trial. So, I decided to try something different. I have officially announced the Citizen Science Foundation, and I was a little scared. Honestly, I didn't know how much money we would get or wouldn't get. Yes, if you could donate any amount helps. As that study announcement was made, I was heartened to see that tens of thousands of dollars were coming in. I went ahead and said, "Look, but what I really want is $200,000." At $200,000, that would give me $2,000 per lean mass hyperresponder, which is what I figured I would need for the study idea I had in mind. Hi guys, I am humbled to say the least to share this news that once our contributor pool reaches $100,000, there's an anonymous donor that has made clear that they will be matching it dollar for dollar. They will be contributing a $100,000 match. We did it. We managed to crowdfund a clinical study, and that just doesn't happen these days. That's just not something you see. And thank goodness, because now we're really getting the data. We're just making it happen ourselves. And who better to lead the study than one of the pioneers in high-resolution heart imaging, Dr. Matthew Budof himself? I think this is remarkable. I think it's a wonderful model. I think you can answer a lot of great questions, and I think crowdfunding has done wonderful things outside of science. I'm not aware of too many models of it funding scientific studies, but though we now need crowdfunding to answer some of these clinical questions about diet. So, it's happening. The fully funded lean mass hyperresponder study is a go. All 100 participants will be evaluated here at the Lquist Institute's Cardiac Wellness Center in Southern California. Frank Caputo traveled all the way from New York to participate. I enrolled for it. They picked me for it. How are you today? Not good. How are you? I'm good. Scan day. And I'm hoping that this changes the science going forward. Back home, Frank works as a landscaper. He started keto five years ago. I do work a very physical job. Have a lot of inflammation throughout my days. I needed a change. So, I challenged myself to try this diet out. Immediately, I started feeling better. Frank qualified for the study because after he started keto, his LDL cholesterol spiked. LDL was, last we checked, it was about 238. Prior to being on the diet, it was at about 73. So, it is what they consider a hyper response to the diet, the LDL. Frank's other blood work all looks good. His blood glucose and triglycerides are low, and his HDL is high, which are all indicators of excellent metabolic health. As a participant in the study, Frank must test his ketone levels daily. This number is proof that Frank is keeping his carbs low and maintaining his keto diet. And this is the extent of the fat-burning mode that I'm in right now. Along with blood work, Frank will undergo two CT angiograms, one at the beginning of the study and another one year later. The images taken here could change our entire understanding of ketogenic diets, cholesterol, and heart health. I'm hoping this changes the medical protocol where instead of them immediately putting you on a statin for the rest of your life because they see a high LDL, they're sending you for a heart scan and they're seeing if there's any calcium that's built up in your arteries. Very soon, Frank and 99 others will help us find some answers.

To understand how LDL cholesterol can jump so high so fast, you need to understand what happens inside the body when you restrict carbohydrates. The human body has what you might call a hybrid energy system. We can use glucose for fuel, which comes from sugar, starches, and simple carbohydrates. And our bodies can run on fat. When your primary fuel is fat, you enter a unique metabolic state called ketosis. A variety of eating patterns can induce ketosis, including carnivore, omnivore, vegetarian, and there's even plant-based keto. The key to keto is restricting carbohydrates. Carbohydrate restriction drops glucose stores in the liver and shifts energy demand over to using more fat for fuel. So, if we're eating high carbs, we're using glucose for energy. If we're eating low carb and we're in ketosis, all of a sudden, our body switches, and we're burning predominantly fat or fatty acids to create energy. But here's the thing, and this explains a lot. Glucose is soluble, like this table sugar. It mixes easily in the blood because the blood is water-based. But shipping fat around in the bloodstream is an extremely difficult problem to solve. Why? Well, you know how oil and water don't mix. It's the exact same thing with fat in the blood. Like this oil, fat will clump together. It doesn't mix well with the blood. So, how does the body solve this challenge? Well, the body makes these little containers to ship lipids through the bloodstream. They're a bit like submarines, and the lipids are effectively the cargo that rides inside. Altogether, they're a complex of lipids and proteins appropriately called lipoproteins. Never heard of a lipoprotein? Well, actually, you probably have. The most legendary is called LDL, short for low-density lipoprotein. And here's where we see the connection to cholesterol. Because the fat we burn for energy is just one kind of lipid that rides inside lipoproteins. There are other lipids that catch a ride as well, such as fat-soluble vitamins A, D, E, and K. And yes, the most famous lipid that rides shares with fat around the body is, you guessed it, cholesterol. And that brings us back to the keto diet. When we're fueled more by fat than glucose, it makes a lot of sense why we would need to ship more of this fat around in the blood inside these lipoproteins. More lipoproteins circulating in the blood means more cholesterol in circulation as well. To be sure, this is a high-level, simplified explanation, but it's the basic premise for what we call the lipid energy model, and it's the phenomenon we believe we're seeing often in lean people on a very low-carb diet. Okay, but are there any studies supporting this? Randomized controlled trials are considered the gold standard in research. In a broad analysis of 41 RCTs that included people on low-carb and keto diets, we see indeed the leanness of participants proved strongly predictive of the change in their LDL cholesterol. The leaner they were, the more likely and higher their LDL cholesterol would go. Conversely, those with higher body mass were more likely to see their LDL stay the same or even decrease on a low-carb diet. This could explain why most people on keto do not see an increase in LDL cholesterol because most people adopt the diet to lose weight. So, they start out at a higher body mass. But in recent years, we are recognizing the power of keto for treating all kinds of medical conditions, including mental health. For these reasons, we're seeing more lean and normal-weight people switching over to keto. And it's when lean people go on these very low carbohydrate diets that we can see their cholesterol levels rise a lot. Hello. Hi, Robin. How are you? I'm very well, thanks. How are you? Good. Good. Robin is a mom, a wife, and a woman who suffered from the debilitating depression of bipolar disorder. I was basically comatose all day long. I set an alarm in the morning to wake up and take the kids to school, go home, go back to bed, set an alarm to remember to wake up to get them. Bipolar disorder is a mental health condition characterized by severe mood swings that include manic highs followed by depressive lows. Everything was just gray. There was no joy in life. And I'm doing all of this during a time where my children are little. Like, I should be sitting on the floor with them and playing with whatever toys they're playing with. But instead, I'm just kind of perched on a couch and just watching. Like, I can see life is happening, but I'm not participating in that life. It would become a decade-long struggle. Robin cycled through numerous doctors and various medications, drugs that sedated her and caused weight gain, making it difficult to do daily tasks and help raise a family. What are some of your earliest memories of your mom? To be honest, I don't have.

A lot of them. Like I would ask her to play with me and she would just sit in her bed and she wouldn't get up. There was a lot of tears, a lot of crying, a lot of uncertainty, but for me, a lot of, "I don't know how to stop this." And it was miserable. It was absolutely heartbreaking.

Nearly a billion people on the planet now have a psychiatric condition serious enough that it interferes with their daily life. This startling increase in mental health disorders coincides with the rapid decline in the quality of our diet. For the past 75 years, we've thought of mental health conditions as chemical imbalances in the brain to be treated with medications. But the field of psychiatry is experiencing a transformation in how it views these conditions. Recognizing that most mental disorders may in fact be metabolic disorders affecting the brain.

"There's a very strong connection between metabolic and mental health, just as there is a very strong connection between metabolic health and just about every aspect of health."

Dr. Georgia Eid and a growing group of psychiatrists say that ketogenic metabolic therapy, which is structured around a keto diet, offers promising new hope.

"And for some people, it can be life-changing."

Dr. Chris Palmer, a Harvard psychiatrist, says the ketogenic diet can work even when medications fail.

"It doesn't work for everyone. But I think the thing that has been really disruptive and quite exciting is that the ketogenic diet can sometimes have dramatic benefits for people with bipolar disorder, schizophrenia."

There's still some debate on exactly how a keto diet improves brain function, but one prominent theory points to the change in fuel sources. High consumption of sugar and refined carbohydrates can flood the body with so much glucose that it causes an energy overload, making cells malfunction throughout the body and causing cells in the brain to malfunction, too. A keto diet switches the body over to burning mostly fat for fuel. A portion of this fat is converted to ketones. Even in the midst of a glucose-induced energy crisis, ketones can fuel the brain.

"I think that may be responsible for this phenomenon that we often see in patients who begin a ketogenic diet. Sometimes in as little as 3 days, people will say things like, 'I feel like my brain, uh, you know, the lights just switched on.' A revelation."

"I just felt amazing. My energy is through the roof. I'd never felt like that before."

"Everything was in color and sounded amazing."

You get the picture. And get this. In 2022, scientists in France used a ketogenic diet with 28 patients who had been hospitalized for severe bipolar disorder, major depression, or schizophrenia. In less than a year, nearly half of the participants achieved full clinical remission. That means they no longer meet the criteria for mental illness. And that is so exciting and powerful because our existing treatments right now usually don't restore people's health.

"You know, doctors who've been treating bipolar disorder, schizophrenia, major depression for years and decades have said they never thought they would see complete remission with nutrition alone."

In addition to his work as a cardiologist and lipidologist, Dr. Brett Sher is the medical director at Metabolic Mind, a nonprofit organization that promotes metabolic therapies to improve mental health.

"But what I've seen in the past year and a half by being the director of Metabolic Mind is stories left and right of people completely putting their bipolar disorder into remission with a ketogenic lifestyle. And that's remarkable, the way it has changed their lives, the way it's changed their families' lives."

"It's almost like a different existence. I don't even know how to describe it."

After a 5-year struggle with treatment-resistant bipolar disorder that left him homeless and wandering the streets of Los Angeles, out of desperation, Matt Bizooki tried ketogenic therapy. He says it healed his brain.

"Not only did my mood stabilize, but everything just fell into place. So, I could play chess again. I could work full-time. I was exercising and I was lifting weights and I had energy and everything seemed to fall into place when I went on keto."

"People have no idea that what they eat can cause mental illness."

Eric Rogers suffered from severe depression and thoughts of suicide. He adopted a keto diet to address his pre-diabetes. Not only did his metabolic health improve, his depression faded away.

"I felt it initially fairly quickly, but it's just been a continual gradual improvement to where, yeah, the last seven years. Um, no mood issues at all."

"Like, kind of blown away that I just don't really experience symptoms anymore."

Lauren Kennedy struggled with schizoaffective disorder for more than a decade. It's a serious mental health condition that combines the psychosis of schizophrenia with the mood disorders of bipolar. But earlier this year, she began working with her psychiatrist to implement ketogenic therapy.

"I have been using medical ketogenic therapy to treat my schizoaffective disorder over the last 5 months. And honestly, I'm kind of blown away by how effective it has been in eradicating my symptoms. I have thoroughly documented this process on my YouTube channel, Living Well with Schizophrenia, if you want to learn more about my experience."

"I think I already feel fine on 10 milligrams. So, kind of planning to try going completely off."

"People who have schizophrenia usually have lifelong disorders. They have lifelong suffering. Any treatment that can reduce symptoms or even put symptoms into remission is a godsend."

You may have noticed the name of our channel has changed. It's gone from Living Well with Schizophrenia to now Living Well After Schizophrenia.

"I don't struggle with my symptoms of schizophrenia anymore. And so I hope that setting an example that it is possible can be seen as a new kind of beacon of hope for people who may be experiencing similar challenges or illnesses. Um, let's go with red."

"This is where it gets interesting."

"Because I had no indication, no idea, no information at the time to let me know that mental health could be affected in any way, shape, or form by diet."

Ironically, it was the desire to lower her cholesterol that led Robin to try a keto diet. Within 6 months, Robin dropped 50 lbs. At first, her cholesterol levels trended downward and something remarkable happened to her mood.

"I said to Matt, 'I think my mental health is getting better.'"

"There was a joy in her that I hadn't seen in a very, very long time."

"I felt excitement and I just said, 'You know what? I need to see if I can live my life without this medication.' We went to the doctor. We told them what was going on and she agreed and said, 'Yes, let's titrate you off your medications.' So, that's exactly what we did. And I have not been on any mental health medications ever since."

"Wow."

Robin achieved full remission. She no longer suffers from bipolar and it's holding. It's been seven years now. Robin has reconnected with her children and is healing her relationships.

"Before life was gray, now it's full of color. That joy that I knew existed, I now feel. I just look forward to everything that is in the mold."

"That's totally a miss."

"Cuz this is what it's supposed to be. This is what our life is supposed to be. There's hope and it just takes one little change."

"You did a good job throwing axes."

"Thank you."

But now that Robin has regained her mental health, she has also become more and more lean.

"Well, that's where the irony starts. I started this whole process of eating low carb to drop my cholesterol and then suddenly my cholesterol starts shooting up."

Robin saw her LDL cholesterol climb to 360. Suddenly she faced a very real and difficult decision. Should she abandon a diet that has given her her life back?

"Modern lipidology says abandon the diet quickly. You know, this is the worst thing that could ever happen to you. And yet we see so many people improving their lives, improving their metabolic health, improving their mental health, and abandoning it could lead to some potentially really negative outcomes. So, it's tough to figure out what to do."

"Robin, it's so good to see you again. How are you?"

"I'm doing really well. How are you?"

Robin turned to Dr. Tro Collagian. He specializes in low carb nutrition.

"Of course, you being the great doctor that you are, you asked me, um, would I go on a statin? And I refused. But instead of being like all the other doctors and considering me a non-compliant patient, you worked with me on, uh, some ways that we could try to get around that."

"We saw your famous Wonderbread study and we knew of other people in my clinic who had improved their cholesterol by adding back carbohydrates."

What Dr. Tro just mentioned is a key premise of the lipid energy model. I demonstrated this in my most popular experiment. I called it the white bread experiment. In it, I lowered my cholesterol more than 200 points in a week by adding white bread to my otherwise keto diet. The experiment reveals just how tightly linked cholesterol is to metabolism. Many people who eat keto have replicated variations of this experiment. It can dramatically and swiftly affect cholesterol levels. And any simple carbohydrate will work. It can be white bread, sweet potato, or...

5 months ago, I started an experiment to see which would lower my cholesterol more, statin therapy or Oreo cookies. Nick made the provocative choice of adding 12 Oreo cookies per day, about 100 g of carbs, to his otherwise low carb keto diet. He compared that to 6 weeks of high-intensity statin therapy. The results are stunning. The addition of Oreo cookies was twice as effective at lowering Nick's LDL in less than half the amount of time. But why? Well, remember, according to the lipid energy model, the main driver of LDL cholesterol in people on keto diets is a drop in glucose stores in the liver. This shifts energy demand toward using mostly fat-based fuel. But even a small reintroduction of carbohydrates can refill those glucose stores. And when glucose is easily available, it dramatically drops the need to ship fat fuel in the blood, resulting in a sudden and significant drop in LDL cholesterol.

So did it work for Robin?

"So, every day, actually, the very first meal of my day was one sweet potato."

For 3 months, Robin added one sweet potato per day to her baseline keto diet.

"Lo and behold, the numbers are all trending downwards where they're supposed to trend downward. And we're seeing success. But the first thing that happens to me when I wake up in the morning, and this is a big sign to me, it's like a blaring neon blinking sign, is I can't wait to go back to bed. I said, 'I think my depression's coming back.'"

Dr. Trow and Robin tried scaling back the dose, cutting down to half a sweet potato per day, then a quarter, but still her symptoms of depression lingered.

"It was not getting better. Even that quarter of a sweet potato, I was not in a good mental state. My family was very aware of what was going on and they were telling me, 'Mom, it's hard to be around you. Mom, you're angry again.' It wasn't worth it to me to drop that number and ruin the relationships that I was really very new to forming with my family members."

"So, we eventually just stopped."

Robin's experience speaks to a larger issue. For many people, the keto diet is a lifeline and adding back carbohydrates is simply not an option.

"What's important to me is my overall health and the relationships that I'm trying to rebuild with my children. And I can't do that if I'm eating that way. I've lived that life. I know what that life feels like. And I never want to go back."

"So to be coming from the outside, raise money for a study like that to pursue a question that you're just curious in. It's I'm trying to think of a word more powerful than admirable, but it's incredibly admirable."

"Today, today's the day we're going to Lquist. So this is it. He's swimming upstream and he's had to scrap and fight just to get a couple hundred thousand to do these studies. Today we get to see the first 100 heart scans from the study. It's taken 7 years to get to this point. Big day for Dave."

"It's truly a passion project for him. It's something that he feels very strongly about. This is not about money or fame or fortune or anything like that. It has always been about helping other people."

"Kind of nervous, man. It's been so long to come up to this exact moment. You know what I mean?"

"So, Dr. Budof, our hundred baselines are here, right?"

"Um, so let's let's look."

"Sure. So, um, just going through the the population that we studied, you can see a pretty nice spectrum going from about 200 LDL all the way up to somebody who looks like they're approaching about 600 mg per deciliter. So, this is kind of the big money shot. More than half had zero plaque. 53% had absolutely no plaque detectable. The vast majority of either no or minimal atherosclerosis."

"I just couldn't believe my eyes. The total plaque score can go from zero to a maximum of 45. And yet everyone in the study is a nine or below. Not one person even made it to 10."

"This is actually this is really good, right?"

"Yeah. Oh, staying staying zero is still the predominant number and the median is still zero for the overall cohort even as we trended higher in in age. This is big. The average age of our participants is 55. At 55 years old, it's very common to see plaque developing in the arteries. And yet, most of our participants have no visible plaque on these initial scans. Add to that, they've been keto for an average of 4.7 years. That's almost half a decade at these sky-high levels of LDL cholesterol."

"Yeah. No, I think this is uh uh really really uh incredible data. I think the uh expectations when we see LDL cholesterol of 200, 300, 500, 600 is that the coronaries are going to be coated in plaque, that there's going to be a lot of blockages that we're going to be thinking about. Should we be calling the cardiac surgeon for bypass surgery? And that's not what we saw."

"I just really appreciate this, Matt. Like I there's literally epileptics that write me and severe type 1 diabetics. And you know, the first time I'm hearing a toddler, her parents are considering getting her brain surgery. She's and she was thriving on a ketogenic diet, but the pediatrician was pushing back and saying, 'Well, there's no point if she's going to like have a heart attack in 10 years.' I want to be able to give her that answer from our data."

"We will we will give them the answer."

"Yeah. So thanks thanks to you and your team and and everybody."

"That's great. And we just pursue whatever wherever the science takes us and we we you know come in with open minds and and try to try to see which which way the the you know the the science uh pushes us."

"Yeah. Here we are, London town. It's a lot of low carbers here, and that means, of course, a number of them are going to have some high cholesterol."

We've traveled all the way across the pond to London, England to meet with members of the Public Health Collaborative. The PHC is a nonprofit health organization that advocates for the use of low carb and keto to reverse metabolic disorders like type 2 diabetes. Sam Felam is the president and he's been closely following our research.

"The LDL issue really one of the biggest objections to to implementing low carb in all aspects whether it be cardiovascular disease or type 2 diabetes and everything else in between. So Dave's work is is vital in overcoming that. So I'm really excited about it."

"Why do you travel all over the world to meet these people in person?"

"I think there's just no substitute like really coming to meet people directly. You get to know their story directly."

While we're here, we'll actually be chatting with Dr. Jennwin.

"How are you?"

"Pretty good."

"I'm just so excited to finally be discussing this with her. And of course, she has extraordinarily high levels of LDL. You don't just have high cholesterol, you have what I think many would consider extremely high cholesterol."

"Mhm."

"I myself was very surprised that her levels were up there at around 600 and she is voluntarily having it at those levels in order to work with her food addiction."

"I'm a I'm a carb addict."

"If I up my carbohydrate, I lose all balance with my diet and um I would I start overeating and then and then putting on weight."

"She's exactly the kind of person who drives me to continue this research. I'm sure many colleagues would say, 'Why not just go ahead and bring the carbs up a little bit? That can bring the cholesterol down a lot more. Why wouldn't you consider that?'"

"What I've learned like you through self-experimentation is that I'm better when I when I keep the carbs really low. And I think that's that's why my cholesterol's gone up over the years because there's a nice balance between feeling well mentally, not doing that sort of weight cycling. It's just that sort of stability is so invaluable to me. That mental stability. Um, I might not even swap that if you told me that that I'm I'm going out earlier. I might I might even keep that."

Dr. Jen follows a nearly 100% animal-based diet with fresh eggs from her own chickens and grass-fed lamb from a pasture just down the road. She's been eating this way for more than a decade.

"You're eating a lot of these livestock, predominantly meat-based diet."

"Yeah."

"It's resulting in you having high cholesterol. And this, as natural as it feels, must therefore be killing you, right?"

"Yeah. No. No."

"So, you know, I feel better physically and mentally at 59 than I did in my 20s when I was eating a high sugar, high processed food diet."

Dr. Jen is not alone. New research is bringing to light the benefits of keto for a variety of eating disorders.

"And there was kind of this constant like battle, you know, like I felt like I was standing on the sidelines of my own life. like I couldn't really participate, you know, cuz I always had like all these all these thoughts running through my head."

Michelle Hearn was just 12 years old when she was diagnosed with anorexia nervosa, a potentially deadly eating disorder. She suffered from constant racing thoughts about food, but struggled to eat. She became so thin her parents sent her to an inpatient care facility where the medical team put her on an IV feeding tube and force-fed her foods that would help her gain weight.

"The number one ingredients of two feeding formulas are maltodextrin, soy protein, corn syrup, canola oil. These are really highly inflammatory ingredients. And so, you know, you're taking somebody who, you know, clearly had starved themselves for several months who super damaged GI and immediately dripping, you know, all of this sugar and oil in their system while having them eat the standard American diet. You know, we were eating cereals and breads and pastas, the food pyramid. The focus of treatment always seems to be about the weight. Eat your shakes. Eat your chocolate shakes and your chocolate cake and your cookies and and I mean it's a real thing that people aren't able to leave an inpatient treatment center until they eat their cookies."

"It didn't take long for I had all kinds of problems in the facility. I had severe anxiety. Um, you know, depressed. I I was like shaking. I had massive GI issues, diarrhea, then constipation, lots of pain, and, you know, you're often told like it's in your head, you know, it's in your head."

"It was a it was a very it was a very difficult time."

Michelle eventually gained enough weight to check out of the care facility, but she struggled with anxiety and nutrition throughout adolescence and into adulthood, even contemplating suicide for a time. Then out of sheer desperation, she tried a low carb, high animal protein diet.

"In a matter of weeks, her anxiety around food started clearing up."

"If you're thinking about eating disorders as a purely like a psychiatric illness, like you can't ask somebody with a dysfunctional relationship with food to eliminate a food group or give up a food group. Like that in theory, like makes sense."

"But what I want people to understand and what I'd want more dietitians and medical professionals to understand is anorexia is not just a psychiatric illness. It has a metabolic component to it, you know, and that's the one thing that we've missed. I mean, anorexia has the highest mortality rate of any psychiatric disorder. So if people can eat in a way, you know, that provides their body with all the nourishment they need and they feel calm and they can participate in their life, I would say that's that's not restrictive. That's freedom."

"And I think a lot of food acts would stay the same. It's it's really priceless that freedom from cravings and compulsions to eat, which I've suffered."

Both Dr. Jen and Michelle have dedicated their lives to helping others with eating disorders. Michelle as a registered dietician who supports ketogenic nutrition for treatment of anorexia and Dr. Jen in her practice as a psychologist.

"I'm dedicated now to this work around food addiction, educating people about that so that they understand that it's a real condition and helping them to to manage it."

But what about the cholesterol? Both women are hyperresponders. Soon, Dr. Jyn will visit her cardiologist to find out. Is she trading good health today for a heart attack tomorrow?

"I think one of the benefits of traveling and showing that this is everywhere and all ethnicities and and all ages and all genders that it's a phenomenon that needs to get looked at. I think when people can see that particularly when all kinds of people can see all kinds of people are affected that makes a difference."

"Okay. So, you recording? Th This is absolutely going to be one of the best days of my life. There's been a big development. Dr. Budof's team is preparing our study for submission to the American Heart Association. The goal is to present a summary of our research to the AHA's scientific sessions, one of the most important cardiology conferences in the world."

"Tomorrow. Yeah. tomorrow. Wow. Okay. So, this is really it."

"All the work, all of the push. This is the moment. I I wasn't just thinking it. I could feel it. This is it."

"This may be some of the most novel data in the field of cardiology in decades." Dr. Dr. Budov has prepared a comparison between 80 participants in our lean mass hyperresponder study and 80 from the Miami heart study, a separate study that includes many who are also metabolically healthy but have average levels of LDL cholesterol. For the first time ever, we'll see how the plaque levels in our group compare to a healthy matched control group.

"Are you excited about this data?"

"Yeah. No, I'm very excited. I'm looking forward to I'm pretty confident that we'll be able to present it as a late breaking clinical trial. Obviously, we have to wait to see what the American Heart says about it, but I think it's robust data. It's prospective. It was blinded. This is very exciting data and very, I think, very powerful data."

"This is a pivotal moment. Our data and this comparison have the potential to influence the world of cardiology. As much as I'd like to have been that protagonist who knew he was right all along, you don't know until it's right there staring back at you."

"Okay. All right. We got to disappoint. We've come to Philadelphia, Pennsylvania for the American Heart Association's annual conference. This is where cardiologists and lipidologists from all over the world come to learn the latest science. Except we've just learned our science won't be presented."

"I'm just beside myself. I just I I couldn't sleep. I couldn't get over that this was this was happening."

The American Heart Association has a long history of pushing back against low carb and keto. I suspected they might downplay our data, but honestly, I never expected this.

"I I can't think of a single better example of what we're up against, frankly, than the American Heart Association scientific sessions rejecting our abstract of 160 people, a groups of 80 compared with CT and geography. that gets rejected, but they're accepting a case report abstract on a single person who already had advanced heart disease, then having a heart attack and emphasizing that it's a lean mass hyperresponder. Why not at least accept both? I'm just I'm dumbfounded, honestly."

"Very disappointing, for sure. I thought it would be accepted at American Heart. uh um but you know we'll never know for sure what what what kept it from the meeting."

"Thank you very much. It's certainly a pleasure to be here with everybody."

Fortunately, it didn't take long before another cardiology conference recognized the value of this new and exciting research.

"So we undertook this study to look at this interesting population of patients who go on a carbohydrate restricted ketogenic diet and end up with a very high LDL cholesterol. The lean mass hyperresponders had an LDL of 272 milligrams per deciliter. And when we compared them to patients with more normal LDLs, LDL mean LDL of 123, there was no difference in coronary plaque burden."

"It's incredible. When you compare the two groups, there is no statistically significant difference in total plaque score. In fact, ours are trending slightly better. In spite of having sky-high levels of LDL cholesterol, the lean mass hyperresponder group has essentially the same low level of plaque. But I'll just conclude by saying there was no correlation in this study between LDL cholesterol and plaque burden. So with that, I'll stop and thank you all very much."

"That was fantastic. Was that was I don't know how much more I could have liked it and the response from the audience was kind of what I was expecting. We are seeing these people in clinical practice and it makes us feel very uncomfortable when somebody walks in with this. So would you recommend that we're supposed to just ignore the LDL and not treat them if they walk in?"

"No. No. So I would say get a calcium score. If we have great data that a calcium score of zero does not induce long-term risk, I would say get a calcium score."

"Going as fast as I can, George. I promise. Huge amount of interest. rapid fire questions."

"They had to cut off the questions because there were just so many."

"I think it was eye opening for a lot of people."

"Yeah, this is it. I mean, we're cross the dot of the line now."

"Wow, what a revelation. Earth shaking in the world of of health."

"Will the findings of a new study make us rethink everything we know about LDL cholesterol?"

"The video I posted is already up to 100,000 views. I don't think I've ever had this anything this viral."

"The data that I've been talking about is finally in."

"Even after four years, most of these people do not have a progression of atherosclerosis."

"And that's also getting a little spicy. A number of people are giving push back, too."

"So, a lot of people now feeling that it's okay to chug endless amounts of saturated fat and increase your LDL to 500."

"So, the research that Dave is doing with Dr. Budof and others is absolutely groundbreaking because medicine has never looked at this in this way."

"Whatever it shows, we need to know what is going on in this particular patient population and then that will hopefully lead to more research and more experience and more research and more experience and that's how science progresses. That's how medicine progresses."

"It's new territory like the territory I was aiming to get to. When it comes to risk factors for heart disease, is it possible that we've been missing the forest for the trees? Is it possible that we've been hyperfocused on LDL cholesterol when the major culprit is chronically high insulin?"

Our processed food culture provides an overabundance of refined carbohydrates and sugar. The blood sugar spikes caused by overconsuming these foods wreak havoc on our metabolism. This causes our bodies to release ever higher amounts of insulin. Chronically high insulin is a major risk factor for heart disease. Take a look at this analysis of one of the largest and longest health studies ever conducted. The Women's Health Initiative examined more than 160,000 women over a period of more than 20 years. This analysis found the condition with the greatest risk factor for heart disease is type 2 diabetes. People with type 2 increase their risk of developing heart disease by more than 10-fold. Those with metabolic syndrome, which is a cluster of metabolic disorders, have more than six-fold greater risk. The biological marker with the highest risk factor for heart disease is insulin resistance. Insulin resistance occurs in people who have chronically high levels of insulin like in type 2 diabetes. No other marker even comes close. By comparison, elevated LDL is associated with a very small increased risk.

"Insulin resistance is responsible not just for diabetes and heart disease, but all chronic diseases of the West. And if you're not measuring insulin levels, you're missing the boat. Yet insulin is rarely tested, even though insulin resistance has the strongest association with the biggest killer. What is routinely tested in physician offices all around the world, cholesterol."

There have been lots of theories about why the focus on LDL and one is because we have a drug that we can give that is easy, you know, quote unquote easy to take, easy to give, easy for the doctors as opposed to lifestyle changes, which is what improves metabolic health, which takes more time to talk about, which is for many people harder than taking a pill. I mean, that's really where the focus should be.

But unfortunately, I think our modern-day medicine is not very good at addressing lifestyle interventions as opposed to pharmaceutical interventions.

The final data is finally here and I'm driving to meet Dr. Budaf. I've waited 8 years for this moment. Dr. Budof is ready to show me a comparison between the first and the final set of scans.

"Take a look."

"It's hard to even describe how much effort it took to get to this very moment."

"All right, one more try."

"It's definitely been a roller coaster of seven, however many years it's been. He just keeps pushing through all of the ups and downs and the days where he just feels like he wants to just give it up and move on to something else. He always just looks towards the people that he's helping."

"All right, Dave. Sorry."

"No worries."

"Promise this should work. All right. A lot of people can come up with a hypothesis, but what he's done is he's followed it through. For someone with no medical training, no medical degrees, no research training to have partnered and built this amazing team to contribute to the medical literature is substantial and really deserves notice and would be remarkable for any, you know, seasoned researcher. But he's an engineer. He's completely on the outside and he's created all this and we're in business."

"All right, so here's the data. So this is a sum of all of the vessels and the severity of the plaque. Overall very very uh excellent data with about 90% of patients showing no change over the course of a full year."

"Wow. The data is better than I ever expected. 90% of our participants show little to no change in plaque. That means most people who started with zero plaque a year ago stayed at zero. vast majority 90% plus are are in that range of no progression which is which is a great great place to be."

Overall remarkable results but there are a few outliers. Six people showed significant plaque progression but even then the numbers don't line up the way modern medicine would predict. There is no correlation between the levels of LDL cholesterol and the progression of plaque. In fact, some people with the highest LDL cholesterol developed no plaque at all. And take a look at this. Six people actually show regression.

"We did see six people with regression."

"So, six people had less plaque."

"This is incredibly exciting. Six people had less plaque at the end of one year. At these levels of LDL cholesterol, that's unheard of. For years, I've wondered if that's even possible. We wouldn't expect it and if we did that would be a new learning that we try to understand."

"If you saw regression with LDL levels in the 230 range that that better be front page news because that would be remarkable."

To independently confirm these findings, we sent the same scans to an outside group for a separate analysis. Heart flow is one of the most thoroughly validated platforms in cardiovascular research. Their results broadly match Dr. Budof's semiquantitative and quantitative analyses. The median change in plaque volume remains low. And look at this. Heart flow shows more than 30 participants with regression. Plaque regression has been visually verified by Dr. Budof's team directly. Multiple participants have less plaque in their second scan. people like Mark, Craig, Kathleen, and Lyall. In spite of high LDL cholesterol, all four of you actually saw regression.

"How did that make you feel?"

"That was refreshing news."

"Thrilled, of course. Over the moon for myself."

"I was happy."

"I'm happy with it cuz I I love the keto diet and I want to stay on it."

"Do you feel this study will affect clinical care?"

"I do. I think for those patients with a a hyper respponse of LDL in the setting of a ketogenic diet, I think that this should have a a change in management. I can't imagine even a cardiologist who would say this is this is inappropriate to let you be on this diet. This is something that should be interesting to everyone. Even if that only applies to one patient, you still have to ask the question, well, what the heck is going on?"

"Okay, Jen. So, you had your um CT scan."

For decades, doctors viewed LDL cholesterol as the go-to marker for heart disease.

"Obviously, this was done because your cholesterol is massively high."

But today, cardiologists can now see a much clearer picture of your risk with high resolution heart scans.

"There's no calcium in there, and there's actually no plaque either. You see, there's nothing."

"Sure enough, Dr. Dr. Jin Unwin has no detectable plaque."

"Two negative calcium scores 5 years apart whilst continuing your current lifestyle with a cholesterol of 751 milligrams per deciliter and you've got no coronary artery disease. So you don't need statins."

"Thank you very much."

"All right."

"Yeah."

"So it kind of flies in the face of what you'd think should happen and what the GP thought would happen."

"And the fact that I've been doing this for for 10 years and there are still no symptoms and I'm an older person. Um, I guess I guess I'd take that as reassuring."

"All those vessels look really open and excellent. Lots of blood flow to all of your heart here."

"right?"

Despite what Nick is learning in medical school about the consequences of high cholesterol, his heart scan is clean.

"My LDL has been over 500 for years, and my coronary arteries are absolutely perfect. I definitely think Nick is going to help with shifting the paradigm because he has extremely high levels of LDL. He's getting scanned. He's turning that around and putting it into the literature. I think nothing quite hits home for people like other people who are sharing their own experience and especially their own data."

Johnny and his parents finally found a doctor who supports keto in the management of type 1 diabetes.

"The type 1 diabetics that manage their disease with a low carb approach or ketogenic approach in general I've seen faring significantly better along every metric every metric."

Dr. Bal Manan is also keeping a close eye on Johnny's heart.

"We're just going through slices of his his heart and we see that it's all completely clean. I think it brings us a little bit of, you know, peace with the situation just knowing that his heart is okay and we're just keep an eye on it."

"Okay, Robin. So, we're going to review here your CAC."

Adding back carbohydrates brought down Robin's cholesterol, but it also brought back her symptoms of bipolar. She's choosing instead to stay keto and monitor her heart.

"And each of your arteries are completely clean. There's no evidence of any calcified plaques there."

"It was a a huge relief to get that back. And it's a zero. There's nothing going on in there."

"Nothing beats the physical detection of the disease itself."

"No. If there was a medicine that was found that would have helped me with my bipolar disorder, I may not have ever gone down this path. There wasn't one, and here I am. If the CAC had been zero, I wouldn't feel a need to take lipid lowering medicine, but it wasn't zero."

Eric reversed suicidal depression and metabolic syndrome with keto, but he fears that for many prior years, his standard American diet caused damage. Eric's coronary artery scan did show moderate calcification. And the doctors I talked to said, "Take the medicine and if you tolerate it, um, it's hedging your bets. You're doing everything you can with lifestyle, but let's let's hedge your bets and and lower your LDL a little bit. And as long as it's asymptomatic lowering, no side effects, uh, I'm I'm good with that."

Eric plans to remain keto for his mental and metabolic health and take cholesterol-lowering medication for the foreseeable future. Many experts in the low carb community agree with this approach.

"If they think they're a lean mass hyperresponder and they have a lot of plaque, you treat them in a non-healthy environment. I think people still need to be very cautious about LDL. And for those patients who have metabolic disease, coronary artery disease, I still believe that lowering LDL is very important in in that context of of heart disease or or or lack of metabolic health."

Almost every doctor we've interviewed for this documentary has a similar position to doctors Aguguston and Budaf for this exact situation. They say if you have high LDL cholesterol and poor metabolic health or existing heart disease, you may want to consider taking steps to lower your LDL cholesterol. But they also agree metabolic disease itself is a far greater risk to heart health. There's just no comparison. We should look at a lot of different things as doctors, but if you back out metabolic syndrome and you look at just cholesterol in the absence of disease, in the absence of family history, it's like it almost doesn't matter.

"And what about me?"

"Well, remember earlier when Dr. Budof showed this heart scan?"

"This is the left anterior descending. Nice smooth big pipe and no disease scene. So this is a nice clean study."

"Yeah, that was me."

"It's very simple. If you have a patient who has lean mass hyper respponder, their LDL is very high, is just to get a calcium score. If the score is zero, we have great evidence that there's no short-term risk to having high LDL cholesterol and you may be able to derive the benefits of of the ketogenic diet without the harms of the high cholesterol."

"Wow, isn't it beautiful? We are at the office of Dr. Bernstein. Okay, give a little knock. We can't wait to meet him."

"One of you is Johnny."

"You Johnny."

"I want to thank him for all of his teachings, my son's health, and for getting us off the roller coaster that we were on. Thank you so much."

"I have to tell you why I feel such inspiration from him. He was an engineer, but the medical establishment wasn't listening to him until he became a doctor. So, he was willing to go the extra mile to bring this solution to so many amazing folks like yourself."

"We're so incredibly honored to be here to be able to say thank you in person. And so I hope that I can bring the other part of the solution."

"It takes somebody with completely fresh eyes but some scientific background in Dave's case engineering that would take this and run with it and not be influenced by the more traditional medical community. I would compare him to Richard Bernstein because he was an engineer who got into medicine at a new way of thinking to now running a major study and a very important study that would never have happened if his if his cholesterol hadn't gone up."

For decades, modern medicine has assumed high cholesterol on a low carb diet is dangerous for everyone.

Today, new data is showing us that the story is much more nuanced, offering new hope to countless people who rely on keto for their health.

"If they want to do it, that's smarter than not doing it. I I recommend being healthy and then not healthy."

"For me, it was the difference between having a life and no quality of life. From being able to pursue a career in medicine and not being able to pursue a career in medicine. People need to understand what they eat affects everything in their body."

"It's so hard in our current food environment to stay on this low carb journey. So, we need to all support each other or have the right information."

"I hope doctors won't tell their patients who feel good for the first time in 20 years that they need to stop doing keto because their LDL is 20 points higher. That's insane. I've seen what a ketogenic diet can do. I want people to be given this as an option initially because it's hard to be hopeless. I want that message to get out there."

"Hi everybody. Welcome to Bless Success Stories."

"People are now coming out of the woodwork sharing their stories. So yeah, I I think there is a paradigm shift happening, but we're at the very beginning of it. And I can't wait to see what happens next because the way this can improve people's lives. Truth seeking is not just science. It's actually a part of human nature."

"And I'm thankful for how many people have put in their own elbow grease to just help us get to the answer."

"I'll take the side of science every time."

"That's where the data led you."

"That's the That's the answer the data gave us. And that's the the answer that I I see in front of me. And if we do another study and you know can prove something different or or supplement that then then the message may change over time. But that's got to be led by the science and the outcomes not not by our personal beliefs. And I think a lot of times in even in medicine it's personal beliefs that that rule the rule the moment. And that might just be the human flaw in all of this."

In the end, no one can take ownership of your health like you can.

"We got this."

For me, that meant digging deeper into the science. And if there's anything I can now say from experience, it's that the science is never settled.