Original subtitles

Downloaded from YTS.BZ

Official YIFY movies site: YTS.BZ

Heart disease,

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

if you 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 is gonna 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 gonna 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 improved 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.

He 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.

It was the highest I've seen it.

I was in the best I've 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.

Straight out, LDL cholesterol

causes heart disease and stroke.

LDL cholesterol is causative, without a doubt.

LDL causes heart disease, without question.

You'll 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?

Would you like to see your heart

in three dimensions?

What if this isn't a medical problem

but a scientific opportunity?

Well, 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 tracked everything I consume.

But I don't work for a lab.

I've authored peer-reviewed papers

to share these discoveries.

Well, then, 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 the phenomenon is.

This isn't to say the Ketogenic diet is a panacea.

It's not for everyone.

It's 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.

91.

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 over-consumption 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 diseases.

We would talk about cholesterol being bad.

Higher cholesterol are gonna clog your veins.

The assumption was just, well, everyone knows

that the cholesterol is the 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

'cause I built a transmission for a Lego car.

And it was fun.

Just the building and the 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 lot of these metrics

for coming on to eight years in a couple of months.

I'd just always be sure that my hand was in the shot,

but usually I'd have, like, my fist nearby

so you could 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,

that maybe somebody who spent their entire life in medicine,

than 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 pounds, 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'd 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 hundred points.

And suddenly a lot of my fear became fascination.

I knew, I knew right then, there's way more to this 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, 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 gotta check this out.

You've gotta 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 his laptop.

You know, like, "Look at it."

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.

Yeah, I'm sure I came off as, 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 we think about lipids and lipoproteins

is on the order of months.

Now here's Dave who comes along

with his end of one 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, nutrition.

I wanna 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 LDL-

Dave Feldman is someone you'd wanna have on too.

Dave Feldman, who's been a guest on the podcast-

I respect Dave Feldman.

Dave Feldman, who's been on the podcast.

I mentioned a guy named Dave Feldman and 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 experienced 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 improved and there's 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.

Alison?

Hi.

Hello.

How are you?

Come on in.

I've landed in Pennsburg, 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.

I'm gonna start with that.

He's very, very active.

Do a full windup, all right?

You could go slow, slow with the windup.

He turned 10 last April

and he played with 11 and 12 year olds.

And some of those 12 year olds

actually were almost 13 year olds.

And he didn't miss a beat.

Like, I think I can do like 50 miles per hour,

like, right-handed.

I sure (indistinct) 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 .5 units of R 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,

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,

I think it was over 300 milligrams per deciliter.

But he didn't like being on that rollercoaster.

That rollercoaster of glucose gets too high,

you need insulin, but then it can get too low and you have

the hypoglycemic effect. - Correct.

If I was living, like, that high carb diet,

like, I would have to take a lot of insulin,

it'd bring me up and then when I started low 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 or 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.

When I got diabetes, my parents were told

that my lifespan would be 30 years from the onset.

So I'd live 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 it's connection with heart disease.

The connection with heart disease was very profound.

Gary Taubes is an investigative science journalist

who has researched the history and treatment of diabetes.

By the 1960s, the research is 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 (chuckles).

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.

So 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 10th 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.

He sent it out to journals,

got very nice rejection letters back then

saying this is a good idea, but you're not a typical person

and nobody else is ever gonna wanna 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, "Ahhh, we're doing everything right.

Why is this happening?"

He's like, "Calm down.

It's okay.

Like, breathe."

Timeout.

Of course Johnny's parents and his medical team

are freaked out.

His LDL cholesterol isn't just high,

it's 640 milligrams 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 like 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 test 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 continued 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 in my blog

where I named this profile Lean Mass Hyper Responder.

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 Hyper Responders?

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, 400, 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 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-

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'd eat anything,

to really not being 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.

So that was the point at which I started finagling

with lifestyle and particularly diet.

And you know the punch the 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

the Ketogenic diet had on my life.

Within a few days, I was feeling remarkably better.

My energy was back.

My symptoms all improved dramatically,

and 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.

We're gonna 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 gonna develop

the Lean Mass Hyper Responder phenotype.

And eventually he did.

And on my first lipid panel,

which was taken very shortly

after I started a Ketogenic diet,

my LDL jumps 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 into 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 looked back on my lipid panel,

I'm like, "Well, 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, like, 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. Adrian Soto-Mota and many others,

and we begin publishing papers together.

True science is human being 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 wanna pursue.

And if people get defensive about that question,

that's a question you really wanna pursue.

We are presented with this opportunity,

this scientific opportunity that's never existed before,

where we actually pulled off

getting this one variable of interest, LDL, all by itself.

It's scientific manna

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 crazy.

So this is just a general example?

Yes, this is somebody who has severe atherosclerosis.

Dr. Matthew Budoff

is a cardiologist and researcher.

He's 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. Budoff 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.

And my boss told me back in 1991

this is gonna be the mammogram of the heart,

that we're gonna 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 atherosclerosis.

In the early 1990s,

Dr. Arthur Agatston, Dr. Budoff,

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 under-utilized.

A more advanced scan known as a CT angiogram

adds contrast dye injected into the blood of the patient.

This allows researchers like Dr. Budoff

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 a hundred Lean Mass Hyper Responders

who rely on Keto diets for their health

and who see extraordinary increases

in their LDL cholesterol?

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, as 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 Ketogenic diet.

We don't have big pharma here to fund the trial.

So I decided to try something different.

I had 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.

Yeah, so for me, this was a first.

I haven't worked with other crowdfunding studies.

But I knew I needed at least $50,000.

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 Hyper Responder,

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 a hundred thousand dollars,

there's an anonymous donor that has made clear

that they will be matching it dollar for dollar.

They will be contributing a hundred thousand dollar 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 Budoff 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 we now need crowdfunding

to answer some of these clinical questions about diet.

So it's happening.

The fully funded Lean Mass Hyper Responder Study is a go.

All 100 participants will be evaluated here,

at the Lundquist 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?

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, 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 ride-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

prove 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, Robyn, (laughs) how are you?

I'm very well, thanks.

How are you?

Good, good.

Robyn is a mom, a wife, and a woman who's 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

were 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.

Robyn 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.

I think 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, for them, 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 is 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 Ede

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

to the field 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 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 three days,

people will say things like,

"I feel like my brain,

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. Bret Scher 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 family's lives.

It's almost like a different existence.

I don't even know how to describe it.

After a five-year struggle

with treatment-resistant Bipolar disorder

that left him homeless

and wandering the streets of Los Angeles,

out of desperation, Matt Baszucki 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.

And 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, no mood issues at all.

Like, kind of blown away

that I just don't really experience symptoms anymore.

Lauren Kennedy

struggled with Schizo Affective 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 Schizo Affective Disorder

over the last five 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.

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 Robyn to try Keto diet.

Within six months, Robyn dropped 50 pounds.

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 and we told him 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.

Robyn achieved full remission.

She no longer suffers from Bipolar.

And it's holding.

It's been seven years now.

Robyn 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 bulls-eye.

That's totally a miss.

'Cause 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 Robyn 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.

Robyn 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.

Robyn, it's so good to see you again.

How are you?

I'm doing really well.

How are you?

Robyn turned to Dr. Tro Kalayjian.

He specializes in low carb nutrition.

Of course, you being the great doctor that you are,

you asked me, would I go on a statin, and I refused.

But instead of being like all the other doctors

and considering me a noncompliant patient,

you worked with me on some ways

that we could try to get around that.

We saw your famous Wonder Bread 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...

Five 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 a hundred grams of carbs

to his otherwise low carb Keto diet.

He compared that to six 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 Robyn?

So every day, actually, the very first meal of my day

was one sweet potato.

For three months,

Robyn 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 me on blinking sign,

is I can't wait to go back to bed.

I said, "I think my depression's coming back."

Dr. Tro and Robyn 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.

And so we eventually just stopped.

Robyn'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 am 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,

I'm trying to think of a word more powerful than admirable,

but it's incredibly admirable.

Today, today is the day.

We're going to Lundquist, so this is it.

He's swimming upstream.

And he's had to scrap and fight

just to get a couple hundred thousand dollars

to do these studies.

Today we get to see the first hundred heart scans

from the study.

It's taken seven 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.

I'm kind of nervous, man. It's been so long to come up

to this exact moment (indistinct).

So, Dr. Budoff, our hundred baselines are here, right?

So let's look.

Sure.

So just going through 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 milligrams 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 have either no

or minimal atherosclerosis.

I just couldn't believe my eyes.

The total plaque score can go from 0 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.

Staying zero is still the predominant number

and the median is still zero for the overall cohort,

even as we trended higher 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 really, really incredible data.

I think the expectations

when we see LDL cholesterol

of 200, 300, 500, 600

is that the coronaries are gonna be coated in plaque,

that there's gonna be a lot of blockages,

that we're gonna 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, 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.

And she was thriving on a Ketogenic diet.

The pediatrician was pushing back and saying,

"Well, there's no point

if she's gonna, like, have a heart attack in 10 years.

I wanna be able to give her that answer from our data.

We will, we will give 'em the answer.

Yeah.

So thanks.

Thanks to you, and your team, and everybody.

That's great.

And we just pursue wherever the science takes us.

And we, you know, come in with open minds

and try to see which way the,

you know, the science pushes us.

Yeah.

Here we are, London town.

There's a lot of low carbers here.

And that means, of course, a number of 'em

are gonna 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 Feltham is the president

and he's been closely following our research.

The LDL issue, really one of the biggest objections

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 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. Jen Unwin.

Jen.

Welcome.

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.

Mm-hmm.

I myself was very surprised

that her levels were up there, at around 600.

And she's voluntarily having it at those levels

in order to work with her food addiction.

I'm a carb addict.

If I up my carbohydrate, I lose all balance with my diet

and I start overeating 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

if 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 keep the carbs really low.

And I think 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.

I might not even swap that if you told me

that I'm going out earlier.

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.

Then there was kind of this constant, like, battle.

You know, I felt like I was standing

on the sidelines of my own life.

Like, I couldn't really participate, you know?

'Cause I always had, like, all these thoughts

running through my head.

Michelle Hurn 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 tube formulas

are maltodextrin, soy protein, corn syrup, canola oil,

these really highly inflammatory ingredients.

And so, you know, you're taking somebody

who, you know, clearly had starved themselves

for several months, 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.

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, you know, depressed.

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 very difficult time.

Michelle eventually gained enough weight

to check out at 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 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 dieticians

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 not restrictive.

That's freedom.

And I think a lot of food addicts would stay the same.

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 learn to manage it.

But what about the cholesterol?

Both women are Hyper Responders.

Soon, Dr. Jen 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,

in all ethnicities, and in 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're recording?

This is absolutely gonna be one of the best days of my life.

There's been a big development.

Dr. Budoff'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 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. Budoff has prepared a comparison between 80 participants

in our Lean Mass Hyper Responder 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 it.

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 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, alright.

We've got a busy morning.

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 couldn't sleep.

I couldn't get over

that 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 can't think of a single better example

of what we're up against, frankly,

than the American Heart Association's Scientific Sessions

rejecting our abstract of 160 people.

Groups of 80 compared with CT angiography,

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 Hyper Responder.

Why not at least accept both?

I'm dumbfounded, honestly.

Very disappointing, for sure.

I thought it would be accepted at American Heart.

But, you know, we'll never know for sure

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 very high LDL cholesterol.

The Lean Mass Hyper Responders

had an LDL of 272 milligrams per deciliter.

And when we compared them to patients with more normal LDLs,

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 Hyper Responder group

has essentially the same low level of plaque.

But I'll just conclude by saying

there is 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.

I don't know how much more I could've 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 eyeopening for a lot of people.

Yeah.

This is it.

I mean, we're across the dotted line now.

Wow, what a revelation.

Earth-shaking in the world 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 a hundred thousand views.

I don't think I've ever had 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 getting pushback too.

A lot of people now are 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. Budoff 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,

but 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 hyper-focused 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 over-consuming these foods

wreaks 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 tenfold.

Those with metabolic syndrome,

which is a cluster of metabolic disorders,

have more than sixfold 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've been lots of theories about why the focus on LDL,

and one is because we have a drug that we can give,

that is, 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. Budoff.

I've waited eight years for this moment.

Dr. Budoff 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.

Alright, 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. Alright.

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

that 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 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 in that range of no progression,

which is a 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 2-300 range, 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.

Heartflow is one of the most thoroughly validated platforms

in cardiovascular research.

Their results broadly matched

Dr. Budoff's semi-quantitative and quantitative analysis.

The median change in plaque volume remains low.

And look at this.

Heartflow shows more than 30 participants with regression.

Plaque regression has been visually verified

by Dr. Budoff's team directly.

Multiple participants have less plaque in their second scan,

people like Mark, Craig, Kathleen, and Lyle.

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 'cause I love the Keto diet

and I wanna stay on it.

Do you feel this study will affect clinical care?

I do.

I think for those patients with a hyper response of LDL

in the setting of a Ketogenic diet,

I think that this should have a change in management.

I can't imagine even a cardiologist

who would say 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 CT scan.

For decades, doctors viewed LDL cholesterol

as the go-to marker for heart disease.

And obviously this was done

because your cholesterol is massively high.

But today, cardiologist 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 can see there's nothing.

Sure enough,

Dr. Jen Unwin has no detectable plaque.

Two negative calcium scores five 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.

Thanks very much.

Alright.

Yep.

So it kind of flies in the face

of what you'd think should happen

and what the GP thought would happen.

Well, and the fact that I've been doing this

for 10 years and there are still no symptoms,

and I'm an older person,

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 gonna help

with shifting the paradigm

because he has extremely high levels of LDL.

He is 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 for the management of Type 1 diabetes.

The Type 1 diabetics that manage their disease

with a low carb approach or a Ketogenic approach,

in general, I've seen faring significantly better

along every metric, every metric.

Dr. Bilal Mannan is also keeping a close eye

on Johnny's heart.

We're just going through slices of 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 keeping an eye on it.

Okay, Robyn, so we're gonna review here your CAC.

Adding back carbohydrates

brought down Robyn'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 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've 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, it's hedging your bets.

You're doing everything you can with lifestyle,

but let's hedge your bets and lower your LDL a little bit.

And as long as it's asymptomatic lowering, no side effects,

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 Hyper Responder

and they have a lot of plaque, you treat 'em.

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 that context of heart disease

or a lack of metabolic health.

Almost every doctor we've interviewed for this documentary

has a similar position to Doctors Agatston and Budoff

for this exact situation.

They say if you have high LDL cholesterol

and poor metabolic health or existing heart disease,

you may wanna 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. Budoff

showed this heart scan?

This is the left anterior descending.

Nice, smooth, big pipe and no disease seen,

so this is a nice, clean study.

Yeah, that was me.

It's very simple.

If you have a patient who is a Lean Mass Hyper Responder,

their LDL is very high, just 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 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.

- Yeah. - Are you Johnny?

I wanna 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 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,

had a new way of thinking,

to now running a major study,

and a very important study that would never have happened

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 wanna do it, that's smarter than not doing it.

I recommend being healthier than 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,

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 (indistinct) success story.

People are now coming out of the woodwork,

sharing their stories.

So, yeah, I think there's 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.

Well, I'll take the side of science every time.

That's where the data led you.

That's the answer the data gave us

and that's the answer that I see in front of me.

And if we do another study

and, you know, can prove something different

or supplement that,

then then the message may change over time.

But that's gotta be led by the science and the outcomes,

not by our personal beliefs.

And I think a lot of times, even in medicine,

it's personal beliefs that 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.

You 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.