High LDL, Rapid Plaque Progression?! Dave @FeldmanProtocol & I Debate the Data

Dave Feldman came into my studio and we went through Simon Hill's critique of the KETO-CTA data one clip at a time — high LDL, "rapid plaque progression," the retracted paper, the new preprint. We disagree, and we do it honestly. At the center is the new KETO-CTA preprint: 100 lean mass hyper-responders, two coronary scans a year apart, and a real fight over what the numbers mean. Why the first paper was retracted, the measurement "noise floor" that makes one-year plaque data so slippery, whether 21–29% "rapid progressors" is alarming or expected, and if NATURE-CT is a fair comparison or a borrowed control group. Long and in the weeds on purpose. Watch and decide for yourself. ⏱️ CHAPTERS 0:00 Why I brought Dave Feldman on 3:30 "We only care about LDL because of drugs" 5:28 Why the film resonates: mistrust of medicine 7:19 Biology vs. drugs, HDL, and admitting when medicine is wrong 11:21 What a lean mass hyper-responder actually is 16:00 "Cautiously optimistic": Dave answers for the phrase 19:54 KETO-CTA: 100 people, two scans, one year 21:35 The retraction and the Cleerly anomalies 26:45 The new preprint: same data, Q-angio and HeartFlow 28:02 Reading the abstract: "15% regressed" and the bias question 30:18 The noise floor: what one year of imaging can't tell us 32:56 Which endpoint matters: total vs. non-calcified plaque 40:39 Percent atheroma volume, and defining "rapid" progression 47:11 Where the 1% comes from: PARADIGM and MACE 52:59 NATURE-CT: 3% vs. 21–29%, and my rebuttals 1:01:04 "Integral over time": LDL of 400 and lifetime exposure 1:03:30 Population vs. individual prediction 1:09:25 Gambling on being an outlier, and the comment-section problem 1:12:45 The film clip: Eric's story, and who to treat 1:16:53 The hard question: treat high ApoB with no plaque? 1:20:26 The "business model" question — and Dave's answer 1:23:35 My takehome: debate is healthy, the science isn't settled 📚 STUDIES DISCUSSED NATURE-CT (the comparison cohort): Aldana-Bitar J, et al. NATURE-CT. J Cardiovasc Comput Tomogr. 2026. https://www.sciencedirect.com/science... PARADIGM registry (where the "1%/year = rapid progressor" definition comes from): Lee SE, Chang HJ, et al. Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study. JACC Cardiovasc Imaging. 2018;11(10):1475-1484. doi:10.1016/j.jcmg.2018.04.015. PMID: 30093065. https://pubmed.ncbi.nlm.nih.gov/30093... ▶️ WATCH NEXT: My reaction to the KETO-CTA retraction:    • Surgeon Reacts to the KETO-CTA 'Scandal'   ⚕️ DISCLAIMER This channel is for education, not medical advice. I'm a board-certified vascular surgeon, but I'm not your surgeon, and nothing here replaces a conversation with your own physician. If you have high LDL or ApoB — on a ketogenic diet or otherwise — don't start, stop, or change a medication based on a debate you watched on YouTube. Bring it to your doctor and decide together, with your own numbers and your own history in front of you. 💬 If this kind of respectful, in-the-weeds debate is useful to you, subscribe — Dave and I floated doing a round two on the lipid hypothesis itself, and your comments help me decide what's worth the deep dive. Pre-Order my book Disconnected here: https://www.amazon.com/Disconnected-S... Sign up for more information on my own practice here: https://corsighthealth.com/ High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljo... Order your own labs here: https://www.ultalabtests.com/partners... OR www.ownyourlabs.com Other tools for optimal health (note these are affiliate links): Home BP Cuff: https://amzn.to/49Cq7rh Sonicare Toothbrush: https://amzn.to/3KllfMS WaterPik: https://amzn.to/4894Xi8 Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS Intake Breathing Nasal Support: https://amzn.to/48dfQQ1 Personal Blender: https://amzn.to/4pyNGGl True Nutrition Protein: https://oken.do/q2xzqeqw Glass Meal Prep Containers: https://amzn.to/4ocEPJ2 Sleep Mask: https://amzn.to/48fSJV5 Air Purifier: https://amzn.to/4puzTQZ ___________________________ 🧬 About Dr. Lily Johnston Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.