The Truth About Lean Mass Hyper Responders and Keto

Episode 66

Podcast Drop Date: 

9/17/2025

In this episode of Functional Medicine Foundations, host Amber Warren, PA-C, sits down with Dr. Mark Holthouse, MD, IFMCP, to unpack the controversial topic of lean mass hyper responders and the surprising findings of the new KETO-CTA trial. They explain why some people see skyrocketing LDL cholesterol and ApoB levels on a low-carb diet, what this means for cardiometabolic health, and how study design can sometimes hide the real risks.

You’ll learn:

• Who qualifies as a lean mass hyper responder

• Why high cholesterol still matters, even in fit, keto-adapted people

• The role of gut health, fiber, and the microbiome in protecting your heart

  
  

Whether you’re passionate about keto, carnivore, or functional medicine, this conversation gives you clarity on the science—and tools to protect your long-term health.

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root-cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like-minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Amber Warren, PA-C: Welcome back everybody. I'm here with Dr. Mark Holthouse to go on another yet deep dive on cardiometabolic medicine, which we're so excited about. So Dr. Holthouse, MD, IFMCP is board certified in Family and Integrative Medicine and a certified functional medicine practitioner, and he is currently our Chief Medical Officer. He is passionate about delivering proactive, patient centered care. Dr. Holthouse focuses on addressing root cause rather than merely managing symptoms. Frustrated with the limitations of traditional medicine, he transitioned to a healthcare model that prioritizes preventions, cures, and lasting wellness over simply prescribing medications. Dr. Holthouse is dedicated to empowering patients to achieve optimal health through personalized and holistic approaches. He currently specializes in cardiometabolic medicine, obesity, metabolic medicine and hormonal health for both men and women, and also anti-aging.

Dr. Mark Holthouse, MD: Little peptide dabbling.

Amber Warren, PA-C: Um, anti-aging peptide medicine. The list goes on and on.

Dr. Mark Holthouse, MD: Fun stuff.

Amber Warren, PA-C: It's awesome. So we're here to to focus on, again, the cardiometabolic piece and specifically talking about, um, a new ish topic that's been discussed in our realm and some new data that's come out that we are going to find our way through and discuss a new study that was released in March.

Dr. Mark Holthouse, MD: Yes. Yes.

Amber Warren, PA-C: So we've touched on this, this, this idea of, um, lean mass hyper responders. Scroll back. Um, I don't remember what episode number it was. Maybe we can link it here, but a cardiometabolic talk where we discussed ApoB and LP(a) and the concerns with high particle number. And Dr Holthouse mentioned these lean mass hyper responders. But today we're going to take a deep dive. And since then there's been a study that's been released. But it's worthwhile to go ahead and go back and define what a lean mass hyper responder is. So what is that? Take it away, Dr. H.

Dr. Mark Holthouse, MD: Yeah. You know, this is a bit of a lightning rod.

Amber Warren, PA-C: Um, yes it is.

Dr. Mark Holthouse, MD: Don't get run out of Idaho on a rail. But, you know, I talk about this because I love my carnivore and keto patients.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Uh, why? Because they are so motivated to be healthy. They're willing to do almost anything. Yeah. Um, there's been an information gap, I think, between the science and this study that came out in March of 25, the keto CTA trial, which has been looked forward to for a while now.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Was really taking some of the promoters of the lean mass hyper responder phenomena and and putting it to the test. You know, the lean mass hyper responder is a subgroup of athletic, lean, healthy patients, both men or women who don't have diabetes, who don't smoke, who don't have, you know, high blood pressure. Um, problems with fatty liver. They're generally when you define this. And it's really a self-described handle. This is not a scientific name. One of the, um, gentlemen that's promoted this heavily in the literature and been on a lot of different podcasts, um, on this topic. It really came up with the term. The idea is that they have an LDL cholesterol that's 190 or higher. Many of them are as high as 200 300. Um, granted, normal is less than 100. Uh, they've got HDL levels that are above 60 and often triglyceride levels that are very, very ideal, less than 80. And this kind of defines this group of patients that, um, is eating a very low carbohydrate keto diet. This study was a 24 month actually, it was a one year trial. They had been on keto diets for two years prior. It took them a long time to find 100 people. That's all that's in the study to follow for a 12 month period that met all the health requirements. Uh, so these are specimens. These are people that you see, you know, that are 12% body fat, 15% body fat, that are absolutely ripped, shredded.

Amber Warren, PA-C: And very aware of their health.

Dr. Mark Holthouse, MD: Very health conscious, who often don't eat any carbs, including vegetables, maybe a little bit of fruit and things like this. So they're not folks that have had heart disease. Um, these are not people that necessarily have high genetically acquired, um, cholesterol. These are folks that had relatively normal ApoB and ldls prior to eating this style of keto or carnivore esque plan and then became abnormal on their labs. So incredibly healthy. Took them a long time to find people that met this criteria that had good numbers. Started eating a certain way and their numbers went kind of bonkers. And the study premise was, are those people is it necessary for them to pay attention to their LDL and ApoB, or does it not really matter when it comes to plaque and cardiovascular risk? That was their hypothesis that they didn't think it maybe mattered. Um, so yeah, so we wanted to just go over that particular study and, and give a bit of a critique, um, the way that the authors on, on social media and the way it was rolled out was a bit disingenuous. Uh, when you look at the actual science and the details of the results, um, it was very, very they ended up really kind of disproving their hypothesis, in fact. Um, so we kind of go through, uh, tonight, the idea, the things that make this maybe not what it seemed on its face, the way it was presented.

Amber Warren, PA-C: Right. Yeah. Yeah. Okay. Good way of putting that. So what the authors did, what was their primary endpoint?

Dr. Mark Holthouse, MD: So their primary endpoint that was stated. And this is what you do with a clinical trial ahead of time, was to look at the change in the non-calcified plaque volume. Um, over a year's time in these hundred healthy people who had very high LDL and Apob cholesterol, that was the stated primary outcome. Um, what was interesting is that they had a they did a post-hoc analysis after the results came out, and they realized that the results were not favorable to their hypothesis, and they changed. They did a switcheroo on, uh, what actually, they were looking at. And instead of looking at the median change over a year from baseline plaque non-calcified the stuff you can't see in a coronary artery calcium score over the year, they looked to see, well, this is going to be a study that instead looks at what's a better predictor of of heart disease. Plaque, that you already have as a baseline starting or ApoB, LDL. So they actually and that's taboo in the clinical research world to switch your primary goal after you see a result you don't like.

Amber Warren, PA-C: And so what's ApoB?

Dr. Mark Holthouse, MD: So ApoB is basically a protein that's on all the plaque forming atherogenic particles of cholesterol in your blood. So things like triglycerides, LDL have ApoB protein stuck to it. Things like VLDL and some of these other particles, intermediate density lipid particles. So it's a protein that's representing all your plaque forming, uh, lipoprotein particles in your blood. So it's more approximating the risk of actual cardiac disease than either LDL or triglyceride or non-HDL cholesterol. These other measures that we have for risk. It's now recognized as the most, uh, accurate at predicting cardiac risk and plaque.

Amber Warren, PA-C: So they looked at baseline ApoBs on these?

Dr. Mark Holthouse, MD: They did.

Amber Warren, PA-C: On these 100 participants.

Dr. Mark Holthouse, MD: Baseline ApoB. They had LDL cholesterol and some other labs that were that were looked at. And, um, you know, as part of the entry criteria is, is that you're on a keto diet, you're meeting, you know, these criteria of a lean mass hyper responder. So they're LDLs were, you know, 190, 200, 250 and up again, normal being less than 100. So it was a group of people otherwise very healthy whose diet had made their cholesterol do this. And and that was the that was the initial group.

Amber Warren, PA-C: And so what did we see? What kind of changes did we see and how were they measuring those changes? We want to touch on that too.

Dr. Mark Holthouse, MD: Interestingly enough, um, they you know, they stated that the change in non-calcified plaque volume over a year was their primary goal. But nowhere in the paper was it mentioned. Only after other scientists critiqued their results and said, where's your primary endpoint? Was it reluctantly shared. And what they shared was an 18.8 cubic millimeter increase in plaque thickness in these hundred people over the year. Now, this was a, um, a median level. This there were people above, that even worse, and people below that. And the issue there was that when you look at the technology they used for this test, which is the Clearly Coronary CT Angiogram, which looks at non-calcified plaque, it's one of the only technologies that's doing that.

Amber Warren, PA-C: And we care about that because the non-calcified plaque is more dangerous, more atherogenic than what we can pick up on coronary calcium.

Dr. Mark Holthouse, MD: Exactly. Yeah. And, um, there were other cohorts, other studies done using that same CT AI technology, looking at non-calcified plaque. And what they found was that that change over a year was about four times faster than other folks that were healthy who didn't have such high ApoB and LDLs, like these lean mass hyper responders. So they were laying down this non-calcified plaque four times faster.

Amber Warren, PA-C: Very concerning.

Dr. Mark Holthouse, MD: Than people that were matched in other studies. The problem is this wasn't even really a a trial because there was no randomization. There was no control.

Amber Warren, PA-C: No control. Okay.

Dr. Mark Holthouse, MD: So everybody that was studied was exposed to really high levels of ApoB and LDL. There wasn't a group of lean, healthy folks with normal levels.

Amber Warren, PA-C: Why do you think they didn't have a control group?

Dr. Mark Holthouse, MD: It's a good question.

Amber Warren, PA-C: Like like ApoB of 75 with an LDL of 95, that would have been a really good group to study alongside this group of 100, okay.

Dr. Mark Holthouse, MD: So we've had to go and look at other similar studies, cohorts with healthy people matched and without diabetes, without heart disease. And what we found, in fact, was much lower rates of non-calcified plaque being laid down.

Amber Warren, PA-C: And so we do have that data with a Clearly, looking at the non calcium.

Dr. Mark Holthouse, MD: Yes, using the same technology.

Amber Warren, PA-C: Good good good. Yeah.

Dr. Mark Holthouse, MD: Um so yeah part of the problem is they switched their primary endpoint.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: They didn't publish it. And then when they did publish it, um, you know, they talked about just looking at the median, which when you use the median instead of an average, you're protecting yourself from outliers. You know, because it's really just kind of that number that's in the middle, as opposed to taking all the values and dividing by the total, uh, which would have looked even worse. And some people estimate that instead of 18%, it would have been somewhere between 20 and 30mm cubed, which which was far more significant.

Amber Warren, PA-C: That's a significant difference.

Dr. Mark Holthouse, MD: In fact, it was five times worse than the they, the authors, predicted it was going to be before doing the study.

Amber Warren, PA-C: Wow.

Dr. Mark Holthouse, MD: Yeah. So pretty, pretty outlandish results. And so, you know, making a switch in your, your primary endpoint to something that they call it an exploratory observation looking at, hey, is baseline plaque and ApoB, which is better at predicting, uh, plaque progression.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: It's a, it's a smoke screen. It's a gaslight. Mhm. Um, but uh yeah that's basically what, what went down.

Amber Warren, PA-C: So I have a question going back to the original definition of a lean mass hyper responder. I have a feeling there's a lot of people out there that would have an LDL that would fit in this category with trigs that would be optimal. Um, in this case you're saying below 80. But genetically speaking, I feel like there are a lot of I'll speak for my clients. I have a fair amount of clients that would fit this category, except for they have an HDL that is low and not, not high. And a lot of that, I think, is genetic reasons. And I'm kind of digging into that literature right now on, on, on low and potentially too high HDL. So how do they fall out of that, like how do we know? I guess I'm asking for a more sharpened definition of a lean mass hyper responder.

Dr. Mark Holthouse, MD: Yeah. So if you don't have an elevated HDL, you don't make the cut.

Amber Warren, PA-C: Okay. So you wouldn't fall into that category.

Dr. Mark Holthouse, MD: 60 for a guy is a relatively high HDL. And a lot of these people are at, you know, 60, 70, 80. And it's because they're so lean. There is certainly some genetics to it for the females. The estrogen has a big role.

Amber Warren, PA-C: For sure.

Dr. Mark Holthouse, MD: Uh, in, in raising HDL. So there are some predisposing factors that speak to HDL. The main issue is that when you look at people that have HDL of that caliber and triglycerides that are less than 80, the ratio of triglyceride to HDL, you know, that's less than 2.5 is clearly not somebody who has insulin resistance. And so they don't have any evidence of what we call metabolic disease or metabolic inflexibility. These are people who can use ketones and fats as well as they can use glucose.

Amber Warren, PA-C: Absolutely.

Dr. Mark Holthouse, MD: You know, which is they're a minority of the population.

Amber Warren, PA-C: They are. Yeah.

Dr. Mark Holthouse, MD: So what so what's so telling about this is that, you know, what happens if you take somebody that's got these kinds of numbers, who's not a lean mass hyper responder, you know, who's has, you know, more than four times the rate of laying this non-calcified plaque down. This is an elite group of people.

Amber Warren, PA-C: So that's a great point.

Dr. Mark Holthouse, MD: It makes you realize, wow, how many people who think their lean mass hyper responders that are out, you know, crossfitting and they're carnivore and they look amazing. Their body compositions to look at them. You'd think, well, I want to be like that. But yet inside this chaos is going on and they're laying down and they might not even be as healthy. Their HDL might be 40, they might have borderline high blood pressure or blood sugar.

Amber Warren, PA-C: It's a good point.

Dr. Mark Holthouse, MD: They're going to have even worse risk. We know from many other studies than this group. So if you take the elite elite who have this adopted diet that artificially raises their ApoB and LDLs sky high. This study helps us now to kind of confirm, and there'll be more studies that need to come along that are longer term to look at absolute risk. But now the burden of proof after this initial study, they haven't proven really anything about ApoB and LDL and its relationship to plaque progression. Why? Because everybody in the study was exposed to the same high level. It'd be kind of like saying people who smoke 2 to 4 packs of cigarettes a day. Um, it really doesn't matter for people who smoke, uh, you a few cigarettes a day. If you're not comparing the nonsmokers data. You'd think smoking's not a risk to lung cancer. But with that same logic. So the burden of proof was to show that this group of highly healthy folks with this particular lab abnormality was somehow protective. And in fact, it showed the opposite.

Amber Warren, PA-C: Opposite.

Amber Warren, PA-C: So, clinically, how are you changing your verbiage with some of these really healthy clients that are Keto-ish or full blown Keto.

Dr. Mark Holthouse, MD: So I tell them, look, the reason that you're not inflamed, the reason that you're as svelte and as ripped as you are is because not because you're eating meat three times a day or 15 eggs a day. And denying yourself anything Thing green that has fiber or of color that grows. That's not why you're healthy. The reason that you're healthy is because you're avoiding simple carbs. And when you're eating a lot of those low carb, high animal product foods, your satiety is amazing. You're full. You're satisfied. It's easier than doing a lot of vegetable prep. It just is. So I say, as does now Paul Saladino and others. Um, hey, add some squash. Yeah, add some yams, add some cruciferous veggies. Um, some of these things that aren't high in, in, you know, phytates and oxalates and anti-metabolites and sky high in lectins for those that are sensitive to those things. And, um, it's it's going to help lower these numbers, these ApoB and these LDL. So it's really helped with saying, look, we now know that you're not immune.

Amber Warren, PA-C: Absolutely.

Dr. Mark Holthouse, MD: Even at your amazing observational looking at you. Um, it still matters. And in fact, it appears to matter even more. Um, these folks were compared to, um, other studies, the paradigm study, which looked at your ten year predicted atherosclerotic cardiovascular risk, uh, either being low, intermediate, or high risk. Um, as far as how much of their what we call percent atheroma volume in their coronary arteries, and they had a 1.6, uh, baseline with a 0.8 cubic millimeter increase in a year, which was 50% increase in the thickness of the atheroma volume in their arteries over a 12 month period. Come to find out, that's on par with people that have intermediate and high ten year risk of having an event, a cardiac event, not low risk, folks.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: So none of the folks in the trial had low risk. They were all intermediate or high risk when it came to following the percent change in their plaque volume. So we looked at non-calcified plaque and we looked at something called percent atheroma volume, which is just looking at what percent of the volume of the total artery was involved with, with plaque of both types.

Amber Warren, PA-C: Okay.

Dr. Mark Holthouse, MD: Yeah. Yeah. So, um, a little bit different measurement, but, uh, both results were, were, you know, definitely a cause for pause and certainly not a justification to say they're immune to LDLs and not important. If I and what really stemmed me into going to the science and really delving into this study, I have so many clients that say, well, ApoB doesn't apply to me. LDL doesn't apply to me.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Because an influencer on on a podcast said that it doesn't matter.

Amber Warren, PA-C: It doesn't matter.

Dr. Mark Holthouse, MD: So they're taking this much of the science and misapplying it and just.

Amber Warren, PA-C: Doing whatever they want.

Dr. Mark Holthouse, MD: Misinformation has been unbelievable on this topic. So it's been it's been I think, you know, a wonderful, uh, effort on the part of the study designers to try to gain insight into this small group of the population.

Amber Warren, PA-C: Absolutely.

Dr. Mark Holthouse, MD: It needed to be done.

Amber Warren, PA-C: For sure.

Dr. Mark Holthouse, MD: We need more studies.

Amber Warren, PA-C: Yeah, but we just need to be really transparent about the results.

Dr. Mark Holthouse, MD: Exactly.

Dr. Mark Holthouse, MD: To say that this study in any way, shape or form, with no control, all of them having the same exposure to high.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: Um, has any correlation with, uh, that particular risk factor being a predictor of plaque progression is just nonsense.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: You know, if we were to have had a control group.

Amber Warren, PA-C: It would have been different.

Dr. Mark Holthouse, MD: Where we had metabolically healthy folks with more normal levels of ApoB and LDL.

Amber Warren, PA-C: Knowing what you know about cardiometabolic disease, if they had 100 people that were metabolically healthy? LDLs under 100 Hdls above 60 triggs even under 100. What do you think the outcome would have been?

Dr. Mark Holthouse, MD: The prediction based on other cohorts that have looked at that. Patients without any metabolic disease, heart disease, diabetes that were similarly matched?

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Uh, those cohorts show wait for it less than less than five millimeters in a year. Cubic. So, you know, it's a four time almost.

Amber Warren, PA-C: It's significant.

Dr. Mark Holthouse, MD: 18 significant non-calcified versus five. And for the ones that were on recommended treatment, including pharmaceuticals, to get the ApoB and LDL down, -21.

Amber Warren, PA-C: Oh, yeah. You can't argue that data.

Dr. Mark Holthouse, MD: -21 cubic millimeters. So they went almost as far the other way negative as the lean mass group.

Amber Warren, PA-C: The other way.

Dr. Mark Holthouse, MD: Yeah. So that's a huge swing.

Amber Warren, PA-C: Yeah it is.

Dr. Mark Holthouse, MD: When you look at it that way. So,

Amber Warren, PA-C: And you said they were on nutraceuticals and pharmaceuticals.

Dr. Mark Holthouse, MD: These were in the studies that I reviewed, these were people that were on prescriptions.

Amber Warren, PA-C: Okay. Okay.

Dr. Mark Holthouse, MD: So I'm assuming they're talking about statins.

Amber Warren, PA-C: Okay.

Dr. Mark Holthouse, MD: And that's a whole nother discussion.

Amber Warren, PA-C: Yes it is. Yeah.

Dr. Mark Holthouse, MD: You know how we use those in different ways in microdosing or we use alternatives have other things we can do. The key is do what you can to get that ApoB and that LDL down. In a lot of these folks, if it's diet induced, and you simply add a little bit of those complex carbs that I mentioned, um, you'll see a pretty dramatic improvement with ApoB.

Amber Warren, PA-C: Well, and that's what I was going to mention. When you're looking at these, these, these 100 people that had already been doing this for 24 months, I wanted to see their gut microbiome and how that was influencing their LDL and ApoB. And if you could have just modified their gut microbiome with some insoluble fiber that could have made such a significant difference in their. We know the data on that. So there's so yeah, there's so many different studies I want them to do based on this. Just knowing what we know about about so many other aspects.

Dr. Mark Holthouse, MD: Its certainly not done. And I take my hats off for them having the courage to do this study, it needed to be done.

Amber Warren, PA-C: For sure. Have they spoken out since then? Have they said anything?

Dr. Mark Holthouse, MD: No. It's been pretty quiet. There was a huge backlash.

Amber Warren, PA-C: I saw that, yeah.

Dr. Mark Holthouse, MD: Um, after it came out in March for probably the first 2 or 3 months, and as of June, it's kind of died down. And I think what people were going to say has been said on both sides.

Amber Warren, PA-C: Not much else to say.

Dr. Mark Holthouse, MD: Yeah. What was disingenuous is that they said, well, we just used the ApoB and the baseline plaque, um, comparing both of those as a predictor of plaque progression as an exploratory interest. But then they chose to title their paper that way.

Amber Warren, PA-C: Oh yeah.

Dr. Mark Holthouse, MD: Yeah. And it basically the title was something like, uh, is it baseline plaque predictive of plaque progression? Yes. ApoB, not so much. So it was very deceiving.

Amber Warren, PA-C: Yeah. It was.

Dr. Mark Holthouse, MD: Um, but they used their exploratory, um, you know, primary goal switcheroo. That was when we called him out on it. People called them out on it as, um, they said, oh, it was just exploratory. We didn't mean to say there was any causality or either way, being insinuated. Well, you called your the title of your study.

Amber Warren, PA-C: Just that.

Dr. Mark Holthouse, MD: By that phrase.

Dr. Mark Holthouse, MD: So there was it appears to be that there was some intentional, um, shenanigans going on because it didn't come out like they wanted. But a negative study is as good as a positive.

Amber Warren, PA-C: Absolutely.

Dr. Mark Holthouse, MD: It's all information. I wish they would have seen that.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: I think there are so many other spin offs, uh, studies that could be done. Uh, Microbiome as you insinuate, the reason we we care about that is that a lot of folks that don't eat plants, fiber, that's how we feed and thrive, our microbiome. And that's one of the criticisms of many of carnivore.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Outside of, um, cardiovascular risk is that the microbiome really suffers, which is a whole nother topic. So if somebody had, um, a way to evaluate that as another comorbidity or another variable and control for that. Yeah, that'd be wonderful.

Dr. Mark Holthouse, MD: They need, they just need controls. Period.

Amber Warren, PA-C: Yeah. Lesson learned. Lesson learned. Yeah. For all of us. Well, so intriguing. And I know there'll be so much more to come on this on. Just, um. Yeah. What we're seeing with this cardiometabolic stuff. Because we all need to remember that, what's the number one killer of men and women?

Dr. Mark Holthouse, MD: Oh, yeah.

Amber Warren, PA-C: It's still cardiometabolic disease. So everywhere we have to pay attention to this data.

Dr. Mark Holthouse, MD: Yeah. And it's I just take my hats off to folks that are doing low carb diets that are trying to, uh, avoid what their parents and their friends, you know, they see the disaster, which is the standard American outcome of eating the way we do. I take my hats off, I encourage them. It's just I think that, you know, that understanding that that piece wasn't important. This answers a little bit, I think, to the contrary, and that maybe there is a path forward by implementing just a little bit of complex carb. And what I want to see as a follow up study is a gradation of, you know, where is that sweet spot?

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Where how much complex carb, veggies and fruits you need with with something like that. I think the people that are cycling on and off, keto and carnivore, probably are getting as close as you can, and I'd like to see that study.

Amber Warren, PA-C: Yeah, that would be good to see.

Dr. Mark Holthouse, MD: What happens when you're not doing 24 months of keto? When you're doing.

Amber Warren, PA-C: Just eight weeks.

Dr. Mark Holthouse, MD: Two Months, eight weeks. And then you have some.

Amber Warren, PA-C: As a reset? Yeah.

Dr. Mark Holthouse, MD: Reset. And then and it needs to be a longer duration study to watch what's going on.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: Not just with ApoB and LDL, but, you know.

Amber Warren, PA-C: Crp. Crp.

Dr. Mark Holthouse, MD: What's going on with these plaque volumes? It's going to be difficult, you know, to measure serial changes in non-calcified plaque volume and atheroma, you know, within a shorter time of a year.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: But I think that there are some metrics that we could look at to get a little bit better idea.

Amber Warren, PA-C: Well, and I think the other take home message is to pull back a little is also hey guys, and some of you gals, um, you're 42 years old, carnivore-ish, keto-ish in the gym a ton. Looking great, feeling great. Hormones are optimized. Get in and look at your labs because a lot of people don't even know where they stand. Are you in, do you fall into this category of being a lean mass hyper responder? You probably want to know that even though this like we said, the study outcome was poor, but there's so much more to be known and so much more we need to study. Get your biomarkers done.

Dr. Mark Holthouse, MD: Well, I don't even fall into that category myself. My LDL runs, it runs high, but not that way. My HDL doesn't meet or trigs, my trigs meet the criteria. That was the only one you know, and my own Clearly CT angiogram. I had some stuff there and it was none of it was calcified. It was all non-calcified.

Dr. Mark Holthouse, MD: My CAC score, of course, calcium was zero and I would have been reassured when in fact that wasn't the case. So it's really been, um, I think kind of a wake up, but yeah, it's it's helpful, I think, to look at labs. And I also tell people, look, if you're higher risk, you definitely don't even meet the criteria. You know, it's going to be as bad as this study or worse.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: Get an image. Get a scan.

Amber Warren, PA-C: Yeah. Get a Clearly done.

Dr. Mark Holthouse, MD: The images don't lie.

Amber Warren, PA-C: Yeah.

Dr. Mark Holthouse, MD: You know, because each of us are individuals and we're different. And so to just say as it categorically, hey, people that do this that have these labs all have the same risk.

Amber Warren, PA-C: Nope.

Dr. Mark Holthouse, MD: It's just not personalized medicine.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: Um, so get some labs. Come in. Let's do a meaningful image. Um, a lot of these things aren't covered by insurance, but, hey, it's your life. It's your number one cause of death.

Amber Warren, PA-C: Yep.

Dr. Mark Holthouse, MD: If you get one, it's fine. You don't necessarily have to redo it. If you get one, that's got some things and you repeated it 3 to 5 years, it can really help guide what your program looks like.

Amber Warren, PA-C: Right.

Dr. Mark Holthouse, MD: Uh, based on evidence, not just social media.

Amber Warren, PA-C: Mhm. Yes. It's a great way to end that. Yes. Great. Thank you so much, Dr Holthouse, this is so interesting. And I love to, yeah, poke holes in all these things and all the data and. Yeah, yeah science has become an interesting thing nowadays hasn't it?

Dr. Mark Holthouse, MD: For sure. Thanks.

Amber Warren, PA-C: Thank you so much for joining us.

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Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundation's podcast. For more information on topics covered today, specialties available at the FMI center for Optimal Health and the highest Quality of supplements, and more go to funmedfoundations.com.