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This study claimed that high cholesterol on keto was safe — but did they hide the truth? I’m Dr. Eric Westman, and in this video I break down the controversial “Lean Mass Hyper-Responder” study, the accusations of buried data, and what the real science shows. After decades of clinical work with low-carb patients, I’ve seen how misinformation spreads fast, so let’s look at what actually happened here.
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Video Summary (for/against context; based solely on the video)
Context
- Format: A reaction/rebuttal in which Dr. Eric Westman plays and responds to a critical video by Mike the Vegan about a ketogenic diet coronary CT angiography (“Keto-CTA”) study.
- Core dispute: Whether the Keto-CTA study’s data and rollout support the claim that very high LDL/ApoB in lean, metabolically healthy ketogenic dieters did not predict plaque progression.
“Against” (Mike the Vegan’s critique)
- Data handling / transparency
- Accuses the authors of “gross manipulation” and burying key outcomes.
- Claims the public rollout was mishandled, including release of a figure that a senior author later said “was not the final paper.”
- Says some data had to be “squeezed” out of the authors and that this situation is unusual.
- Study framing
- Objects to calling it a “trial” or “prospective trial,” asserting it’s actually a prospective cohort and that repeated “trial” language is misrepresentative.
- Missing/underplayed outcomes
- Asks whether key CTA outcomes (e.g., percent change in non-calcified/total plaque) were “shoved under the rug.”
- Highlights mixed outcomes across participants (some progressed, some regressed) and argues the presentation overstates safety of high LDL/ApoB.
- Authorial disagreement
- Points to apparent discord among study authors and cites Dr. Budoff’s statements criticizing how a figure was released/handled.
- Call for oversight
- Urges JACC: Advances (the publishing journal) to review what went wrong and at minimum issue a correction.
“For” (Dr. Eric Westman’s rebuttal)
- Primary finding defended
- Emphasizes the study’s central observation: in lean, metabolically healthy ketogenic dieters, LDL-C/ApoB did not predict plaque progression, whereas baseline plaque burden was a strong predictor of future plaque change.
- Imaging method context
- Stresses the distinction between CTA (visualizes plaque directly, including non-calcified plaque) vs CAC (calcified plaque scoring), framing CTA as a more granular modality for this question.
- Heterogeneous outcomes are expected
- Notes it’s normal that some participants regress, some progress, and some remain stable over time; interprets this variability as consistent with real-world clinical experience.
- Study nomenclature and intent
- Treats the “Keto-CTA” label as a colloquial descriptor; focuses attention on what the imaging showed over time, not on the “trial” vs “cohort” wording dispute.
- Clinical takeaway for this population
- Reiterates the population studied (lean, metabolically healthy, long-term ketogenic dieters) and the specific result (plaque predicts plaque; LDL/ApoB didn’t in this cohort over the measured interval).
Neutral clarifications presented in the video
- Population & duration: Lean, metabolically healthy adults on long-term ketogenic diets underwent research-grade coronary CTA; follow-up imaging assessed plaque change.
- Baseline plaque matters: Existing plaque at baseline was repeatedly described as the best predictor of subsequent change.
- Outcome mix: Across individuals, progression, stability, and regression were all observed.
Papers referenced in the video (DOIs)
- KETO Trial (baseline cross-sectional CTA) — Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial (JACC: Advances, 2024).
DOI: 10.1016/j.jacadv.2024.101109 - Keto-CTA longitudinal analysis — Longitudinal Data From the KETO-CTA Study: Plaque Progression and Predictors in Lean Individuals on a Ketogenic Diet (JACC: Advances, 2025).
DOI: 10.1016/j.jacadv.2025.101686