3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers Cohort Study https://t.co/LVEhOk0vDi Case Report https://t.co/truYXx2pSF Cholesterol drop protocol https://t.co/YL3HjXIhGD Lipid Energy Model https://t.co/LaE4kenaD8
Case Report: Hypercholesterolemia "Lean Mass Hyper-Responder" Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet.
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Apr 2022 – Sep 2025Where it's discussed
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What people are saying
In several posts, users reference specific data from the case report, such as the sudden rise in LDL cholesterol experienced by the subject. Phrases like 'one dodgy case history' reflect skepticism while invoking discussions on dietary impacts, illustrating the varying perceptions of the study's credibility. The tone often oscillates between analytical and skeptical, reflecting both excitement about the implications and caution regarding the results' applicability.
Most discussions reflect a supportive stance towards the article's findings, with many participants acknowledging the significance of the case report.
There is a heightened curiosity around the Lean Mass Hyper-Responder (LMHR) phenomenon, with multiple users seeking more information and sharing related research.
While many posts engage with the research, few delve deeply into the implications and methodology, limiting the level of engagement.
Overall, contributors perceive the publication as having a substantial potential impact on understanding dietary effects on cholesterol levels and health.
Abstract in brief
- Recent studies indicate that individuals with lower BMI may experience significant increases in LDL cholesterol when following carbohydrate-restricted diets, particularly in a subgroup known as Lean Mass HyperResponders (LMHR).
- A case report details a subject, LM, who adopted a ketogenic diet for ulcerative colitis, resulting in a marked rise in LDL cholesterol from 95 to 545 mg/dL, alongside high HDLC and low triglyceride levels, characteristic of the LMHR phenotype.
- Analysis shows that the LMHR phenomenon does not rely on saturated fat intake and is inversely related to changes in BMI, with further testing revealing no arterial plaque development in LM despite hypercholesterolemia.
Top posts
Most liked on X and BlueskyPatient’s LDL was 545!
The next domino was this beautiful case report from @nicknorwitz Outlining LMHR physiology without the expected findings on CCTA https://t.co/qM8pqknRyk
We know Twitter has the potential to confuse messaging around sensitive topics, including those of our research on #LMHR Therefore, I want to play 20Q with you about our papers! All answers can be found in the manuscripts! Begin! https://t.co/sU9yDlUtxl https://t.co/LVEhOjZXNK
Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carbohydrate-Restricted #Diet Congrats, @nicknorwitz @realDaveFeldman! Attn: @shashiiyengar @Travis_Statham https://t.co/HE5lA6gNIy
1/ For those concerned that our report could encourage others to disregard high LDL, we have been and continue to be clear that these data do advocate for safety of high LDL nor that any other patient refuse therapy ... https://t.co/qRXhQj20wi @realDaveFeldman https://t.co/lfElGDcyo6
All mentions
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Impact of Ketogenic Diet on LDL Cholesterol in Lean Individuals
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LMHR Paper Q&A
The Real Reason You Can't Stick to Your Diet
@_earthling74 @BioLayne It goes up. High ApoB has already been reported in case studies. The LEM does predict higher circulation of all ApoB particles. https://t.co/Bzfg3A7RfL
RT @nicknorwitz: @Derek_Fitness Okay you need to admit @PeterAttiaMD choosing age 24 at the age one might see plaque on CCTA is highly iron…
@Derek_Fitness Okay you need to admit @PeterAttiaMD choosing age 24 at the age one might see plaque on CCTA is highly ironic (CCTA in LMHR subject age 26, TPS 0, consistent with median in LMHR cohort mean age 55) https://t.co/qRXhQiKpEK Also, please view recent video … Will wait reply https://t.co/vyvmwtN497
Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet https://t.co/RQpjVsdNtq
@IntuitiveSpider @holmanm You're probably referring to this one from last year: https://t.co/djPmZPty7s cc @nicknorwitz
@Seeking_Dao @nicknorwitz @realDaveFeldman @SBakerMD @joerogan "Whole exome sequencing performed by Veritas Genetics, and independent dyslipidemia and ASCVD genetic risk testing by GB Healthwatch, revealed no pathogenic or likely pathogenic variants that could account for LM’s phenotype." https://t.co/U9IBDDwLyI
RT @PenelopeFigtree: One dodgy case history : a guy with heart disease stops his statin due to side effects, also goes on a keto diet, LDL…
One dodgy case history : a guy with heart disease stops his statin due to side effects, also goes on a keto diet, LDL rises , some time later his heart disease is worse. And the world is in uproar at keto. What about this case then? https://t.co/98VtdFqX4e ? #biasnotscience https://t.co/67PQlYrzG8
@nicknorwitz 17)(6) Lean Mass Hyper-responders – Cholesterol Code. https://t.co/Z2iWQCmEH7. (7) Lean Mass Hyper-responder Measurement Study - Citizen Science Foundation. https://t.co/tP6Dc7YbAH. (8) Frontiers | Case Report: Hypercholesterolemia “Lean Mass Hyper .... https://t.co/Yp3FpvpSlr.
@ketofan1000 @nicknorwitz @realDaveFeldman I think this study should fulfill all of your criteria: https://t.co/U9IBDDwLyI
@Want2RunAgain https://t.co/LVEhOjZXNK https://t.co/2VPV7tpd4Y https://t.co/truYXx1S37
@Jevan @exfatloss @BHBEnjoyer @JohnnyScott234 @stathitriadis @SamaHoole See here. https://t.co/7AqLLwdIrf by @nicknorwitz
@ChampCaI @PavlicaDanijel @nicknorwitz He did a CTA not a CAC! (And that should've showed soft plaques) Read the case report: https://t.co/U9IBDDwLyI https://t.co/4ZiIa4HWBv
@PavlicaDanijel @nicknorwitz Is having 0 plaque with 20 years ApoB exposure + some years with LDL-c at 500 levels a pretty low bar? You know people with homozygous FH can develop xanthomas at ages 2 and have MI at 6? https://t.co/U9IBDDwLyI
A case report of a "lean mass hyper-responder" phenotype presenting in the context of a low saturated fat, carbohydrate-restricted diet. https://t.co/Fej7ByFYvI
@theproof @stathitriadis @DudzLightLime @NutritionMadeS3 @DoctorTro @nicknorwitz Published case report demonstrates LDL following leanness and not sat fat in successive blood tests (in fact, if I’m not mistaken, the highest saturated fat % blood test actually had the lowest LDL, relatively) https://t.co/W1wNIcomPW
@richcollins @Mikejulian26 Interesting thread. And yes, speaking of LDL > 500 w/ leaner -- see https://t.co/rfPcCh7xFF (Obviously, I'm a bit biased given I'd point to the aspects of this as relates to the Lipid Energy Model and the #LMHR phenotype)
@Pseudome17 @vardaanbhat @NutritionMadeS3 @Metabolic_Mind @CharlieFndation @ethanjweiss @CaloriesProper @realDaveFeldman Would argue prob less to do with SFA, more to do with leanness/global energy demand/energy substrate availability. Can prob attenuate phenotype more with sol fiber or adding back carb to replete liver glycogen stores. https://t.co/F5wwmNShIe https://t.co/Yhzt66nkqw
@vardaanbhat @QuiroMictil @DoctorTro https://t.co/F5wwmNShIe https://t.co/fOOc04PAfc
@medmyths I will accept my reward now! But could I have a nice bottle of EVOO instead? Will DM with address
@thoroughlyconf1 @NutritionMadeS3 If they lost weight irrespective of the dietary composition, ApoB is likely to ⬇️, even on ⬆️ SFA diet. %E from SFA has probably very little to do with the induction of the hyperresponder - more likely driven by ⬆️ TG energy demands d/t leanness. https://t.co/F5wwmNSPxM
RT @realDaveFeldman:
RT @nicknorwitz: 3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers Cohort Study…
RT @nicknorwitz: 3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers Cohort Study…
@mcuban "Maybe some of the untrained are better doctors than the trained?" Yes. A work on LMHR study was pioneered by a Software Engineer. https://t.co/roG8MnE1Dg
3/8 Our second paper brings a case report on a single #LMHR with extremely high #LDLc (~500 mg/dL) for 2.5 years, their eating patterns, and current CT angiography. (⚠️Please note this is a single case report and should be considered anecdotal, ofc) https://t.co/rfPcChp8xd
RT @nicknorwitz: 3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers Cohort Study…
3/ 1 year ago, we started researching #LMHR more formally, and in this year, we've published 4 prior papers Cohort Study https://t.co/LVEhOk0vDi Case Report https://t.co/truYXx2pSF Cholesterol drop protocol https://t.co/YL3HjXIhGD Lipid Energy Model https://t.co/LaE4kenaD8
RT @nicknorwitz: @holmanm 2/ I take issue with ideological dissemination of misinformation. & for those watching on, let me remind you who…
@holmanm 2/ I take issue with ideological dissemination of misinformation. & for those watching on, let me remind you who is actually doing the work to push the frontiers of inquiry on this topic of LDL on LowCarb https://t.co/LVEhOk0vDi https://t.co/truYXx2pSF https://t.co/YL3HjXIhGD
@MarcVanDam @DaleWil39870290 @holmanm @realDaveFeldman 3/ for consideration, some of our recent work https://t.co/LVEhOkhyFi https://t.co/truYXwKgEx https://t.co/YL3HjXq8sv
RT @TheNutrivore: @TheBhupiThakur https://t.co/LKCt3kKi7D
@KetoGaia @AnnChildersMD @realDaveFeldman On LMHR we have 4 papers https://t.co/xxLNpNnBUw https://t.co/truYXx1S37 https://t.co/2VPV7tpd4Y & Dave’s cholesterol drop + case series that was just published And I promise… just getting warmed up… @realDaveFeldman
@Natural_Fallacy @nikhilsomani @kevinnbass https://t.co/G9WbrkZd3O
RT @realDaveFeldman: @DrNadolsky @SkyZer0_
@DrNadolsky @SkyZer0_
@RZubiranS @Drlipid @Hragy @SABOURETCardio @drscottyk Definitely worth considering. More research is needed about atherogenesis during carb restriction. In this case report, no evidence of atherosclerosis was found. As in the case series in our 1st LMHR paper, I would consider adding small amount of carbs. https://t.co/G81fJ44SAk
RT @nicknorwitz: @davykevinp @DrNadolsky @realDaveFeldman 1/ Yes. I deleted the tweet because I was having trouble posting something that d…
@davykevinp @DrNadolsky @realDaveFeldman 1/ Yes. I deleted the tweet because I was having trouble posting something that didn't come off as a "we told you so" to Spencer Not FH. In fact, baseline LDL levels in our CR were 95, lower than Spencers at the beginning of this trial. https://t.co/truYXx1S37
@TheBhupiThakur https://t.co/LKCt3kKi7D
RT @realDaveFeldman:
5/ general pattern that lower BMI associated with larger increased in LDL https://t.co/xxLNpNnBUw ; https://t.co/truYXx1S37 as can be explained by the lipid energy model https://t.co/2VPV7tpd4Y. In fact...
@TamarHaspel @DrNadolsky … have you seen our LMHR case report out just recently? he was on a very Mediterranean style low-carb diet, but relatively low in fiber, and saturated fat (<15%), yet LDL in 500s — Which came down when his BMI increased. https://t.co/djPmZPboTk
RT @DoctorTro: The next domino was this beautiful case report from @nicknorwitz Outlining LMHR physiology without the expected findings o…
The next domino was this beautiful case report from @nicknorwitz Outlining LMHR physiology without the expected findings on CCTA https://t.co/qM8pqknRyk
4/ If the effect were driven saturated fat intake, then one would necessarily be proposing leaner people eating low carb preferentially eat higher sat fat diets on a BMI continuum, and/or that sat fat is causally associated with leanness. Seems unlikely https://t.co/truYXx1S37 https://t.co/hXKZg7UKmM
RT @ctcapapers1: Case Report: Hypercholesterolemia "Lean Mass Hyper-Responder" Phenotype Presents in the Context of a Low Saturated Fat Car…
Case Report: Hypercholesterolemia "Lean Mass Hyper-Responder" Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet https://t.co/q3fsRjvxIK https://t.co/TYu9qHbUzP
RT @realDaveFeldman:
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RT @nicknorwitz: We know Twitter has the potential to confuse messaging around sensitive topics, including those of our research on #LMHR T…
We know Twitter has the potential to confuse messaging around sensitive topics, including those of our research on #LMHR Therefore, I want to play 20Q with you about our papers! All answers can be found in the manuscripts! Begin! https://t.co/sU9yDlUtxl https://t.co/LVEhOjZXNK
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@VLangs @ginsbergonomics @ChrisLakin_com (2/2) There is however studies looking at healthy individuals on a similar diet to Chris. https://t.co/sD45kJADDt
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https://t.co/CQdp74P2RL
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RT @nicknorwitz: 1/ For those concerned that our report could encourage others to disregard high LDL, we have been and continue to be clear…
RT @realDaveFeldman:
RT @nicknorwitz: 1/ For those concerned that our report could encourage others to disregard high LDL, we have been and continue to be clear…
https://t.co/CQdp74P2RL
RT @nicknorwitz: 1/ For those concerned that our report could encourage others to disregard high LDL, we have been and continue to be clear…
RT @HealthyFellow: Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carb…
1/ For those concerned that our report could encourage others to disregard high LDL, we have been and continue to be clear that these data do advocate for safety of high LDL nor that any other patient refuse therapy ... https://t.co/qRXhQj20wi @realDaveFeldman https://t.co/lfElGDcyo6
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RT @nicknorwitz: Patient’s LDL was 545!
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RT @nicknorwitz: Patient’s LDL was 545!
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RT @nicknorwitz: Patient’s LDL was 545!
RT @nicknorwitz: Patient’s LDL was 545!
RT @nicknorwitz: Patient’s LDL was 545!
RT @nicknorwitz: Patient’s LDL was 545!
RT @nicknorwitz: Patient’s LDL was 545!
Patient’s LDL was 545!
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RT @nicknorwitz: Such astute ideas incoming re our case report! 1/ On Leptin: our #LEM actually predicts very low leptin via a COMBINATION…
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RT @DoctorTro: "yUor LdLs wiLL Kauz heArt diZeaze " -your local cardiologist Except when it doesn't... https://t.co/52yVZHCIG9 https://…
RT @realDaveFeldman:
Such astute ideas incoming re our case report! 1/ On Leptin: our #LEM actually predicts very low leptin via a COMBINATION of low body fat AND glycogen store depletion. That may, in part, be a reason MODERATE carb reintroduction works for #LMHR reversal… https://t.co/qRXhQiKpEK https://t.co/IA4iK2H4dW
RT @DoctorTro: In keto diets, SATURATED FAT DOES NOT CAUSE MASSIVE changes in LDL, its weight, carb restriction & baseline metabolics
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RT @HealthyFellow: Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carb…
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Top story: Frontiers | Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet | Endocrinology https://t.co/1x2yuAbkmh, see more https://t.co/9OrA8wXmYX
RT @HealthyFellow: Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carb…
RT @HealthyFellow: Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carb…
Case Report: #Hypercholesterolemia Lean Mass Hyper-Responder Phenotype Presents in Context of a ⬇️ #Saturated #Fat #Carbohydrate-Restricted #Diet Congrats, @nicknorwitz @realDaveFeldman! Attn: @shashiiyengar @Travis_Statham https://t.co/HE5lA6gNIy
RT @FrontEndocrinol: New Research: Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low…
New Research: Case Report: Hypercholesterolemia “Lean Mass Hyper-Responder” Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet: Emerging evidence suggests that “leanness” and good metabolic health… https://t.co/g3QC4BbR4k #Endocrinology #Endo