Dhru Purohit Show
Is Current Thinking Around Cholesterol Outdated? What You Need to Know About Heart Health and The Root Cause of Plaque Build Up with David Feldman
Wed, 09 Apr 2025
This episode is brought to you by Levels, BiOptimizers, and Birch Living. Traditionally, elevated LDL has been directly linked to a higher risk of cardiovascular disease. But today’s guest is on a mission to dig deeper. He’s raising both awareness and funding to explore the true relationship between LDL, ApoB, and heart disease—challenging long-held beliefs in the process. He joins us to share the results of his team’s groundbreaking study. Today on The Dhru Purohit Show, Dhru sits down with Dave Feldman to discuss his team’s landmark study on LDL cholesterol and its implications for cardiovascular health. Dave shares the personal journey that led him to fund this research and what it means for how we approach and treat heart disease. He breaks down the surprising findings on how plaque progression really occurs—and the key questions that still need answers in future studies. Dave also outlines the most effective tests to assess your risk, along with how to interpret your scores based on age. Dave Feldman is a software and platform engineer, entrepreneur, and founder of the Citizen Science Foundation. His life took a radical turn upon seeing his cholesterol skyrocket after adopting a ketogenic diet, and he became obsessed with understanding why this is common with those who are likewise leaner and more metabolically healthy. Through a series of self-experiments and partnering with formal researchers, he has since published the “Lipid Energy Model,” which may explain this phenomenon. In this episode, Dhru and Dave dive into: Dave’s mission and journey to pursue answers (00:30) What mainstream medicine believes about high cholesterol (4:20) The keto and carnivore view on cholesterol (6:00) Dave's perspective and his groundbreaking research (7:45) Why Dave’s research matters and its implications for cardiovascular disease prevention (15:57) The factors that led to starting and releasing the study (18:23) The surprising results of plaque progression (28:42) What the results mean on a broad scale and how to configure the right type of diet (35:32) Appropriate testing and optimal score ranges (45:32) Factors that contribute to plaque progression (53:32) Injury to cells and arterial lining—and what prevents repair (1:00:32) The likely responses to the landmark study (1:23:47) Advice on ApoB based on large-scale metabolic health concerns (1:38:32) Critical takeaways (1:42:22) Where to follow Dave and learn about his upcoming movie (1:45:32) Also mentioned in this episode: Plaque Begets Plaque, Not ApoB, JACC Journals Citizen Science Foundation For more on Dave, follow him on Instagram, Twitter/X, YouTube, his Website, and other platforms, such as Cholesterol Code. This episode is brought to you by Levels, BiOptimizers, and Birch Living. Right now, Levels is offering my listeners an additional 2 FREE months of the Levels annual Membership when you use my link: levels.link/DHRU. Make moves on your metabolic health with Levels today. Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order of Sleep Breakthrough and find out this month’s gift with purchase. Get 20% off your Birch Living mattress during their Spring Event—just head to birchliving.com/dhru today! Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is David Feldman's mission regarding cholesterol?
Dave, welcome back to the podcast. You are an engineer, a citizen scientist who's on a mission. And today is a very special day because this week you guys have published a groundbreaking first of its kind paper. For anybody who's interested in the idea of does my diet make me more likely to get a heart attack or does it make me less likely to get a heart attack? Is my diet healthy for my heart?
But before we go into the paper and unpack it, tell us about what is that mission that you're on?
First of all, I had no interest in nutrition, medicine, even really science that much as much as I did engineering. And so I've been a software engineer my whole life for the first, let's say, four decades of my life. And then I'd gone on a ketogenic diet. And going on a ketogenic diet, I just felt great. It was so wonderful.
And at the time I was training with running and so forth, I was setting personal records. I lost a bunch of weight. And I thought I just kind of found the fountain of youth and couldn't stop telling my friends, especially my family, my dad and my sister adopted at the same time.
Chapter 2: What does mainstream medicine believe about high cholesterol?
What happened, though, was while their blood work came back looking fine, including lipids like cholesterol, mine shot through the roof. That ended up changing my whole trajectory, literally for my life for like the last decade. That's what ultimately led me to where I'm at today.
You went on a ketogenic diet. You felt good. Most of your blood work looked good, except for a few of these markers. What were the markers? And for our audience that considers themselves largely professional amateurs, they know a lot about these things. They may not have a degree in medicine. They may not be a nurse practitioner or PA. They like to know the specifics.
Chapter 3: What is the keto and carnivore perspective on cholesterol?
So what were the markers and what were their levels for many of us, including myself, who are paying attention to our cardiovascular health.
Chapter 4: What are the key findings of David's groundbreaking research?
So when you get your quote unquote lipids, the lipid panel has four different markers on it. One is total cholesterol. The second, the one most people are paying attention to is called LDL cholesterol. Often the mnemonic is that it's the L for lousy, lousy cholesterol. Then there's HDL cholesterol, which is the so-called good cholesterol.
And then there's triglycerides, which is a measure of fat in the blood. Usually a doctor is looking at those first two. They're looking at total cholesterol or they're paying attention to LDL cholesterol. And the ranges for that, total cholesterol per the guidelines, they're supposed to be 200 or less. LDL cholesterol is supposed to be 100 or less.
And then frankly, they don't pay much attention to HDL and triglycerides quite the same. Now, my historic LDL cholesterol was between 120 to 130. And my doctor was usually like, ah, it's about the average of what I see for an adult male. But it would be nice if it was a little bit lower. But I go on a ketogenic diet and my LDL, goes from that 120, 130 up to 250. So naturally, I'm quite concerned.
And my doctor says this is like one of the highest cholesterols I've seen. And I almost never see somebody change to this level of cholesterol because usually it's genetic. That's where the tie-in with my dad and my sister are relevant. They go on the same diet about the same time. They don't see this jump in cholesterol. And that's what got this whole obsession going for me.
Before we get into the paper and what questions you guys were answering, some of the pretty profound results that you had and unpacking some of the questions that come along with it, I want to actually ask you for a favor because you are so well-versed on this landscape of these different theories and views when it comes to cardiovascular health.
So my audience is very well aware of a lot of different people or organizations in health. They are interested about what is the truth for themselves when it comes to how to pursue down the path of cardiovascular disease. But let's lay the land out a little bit, and then we'll get into your theory, your original theory, and this paper that you guys put together. So give us the view.
On those panels, on heart disease, what does traditional sort of mainstream medicine throw in like Tufts University, these schools of nutrition, Harvard University, when it comes to high LDL, when it comes to high cholesterol, what is their view of our diets and the risk of cardiovascular event in the future?
Without question, the conventional view right now across really every single organization around heart disease is that high cholesterol is high risk. End of discussion. The higher your cholesterol, the more at risk you are. And you'll often hear phrases like the lower, the longer, the better. Because
Generally speaking, no matter what, just like a smoker, if you smoke three packs a day, sure, there's the once in a while example of somebody who managed to escape getting heart disease or lung cancer. But as a population, everybody who's smoking three packs a day is at risk, even if they're otherwise healthy in every other respect.
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Chapter 5: How does plaque progression occur?
So if you've got good metabolic health, if you're good at pulling the fuel out and putting it back away again, but you're powered more by fat, What's relevant, that fat in the blood needs a carrier. And the biggest bulk carrier are these complexes called lipoproteins. So that LDL I mentioned earlier, that's short for low-density lipoprotein.
So these lipoproteins, if you're trafficking them more in the body, particularly if you have to move more of those fatty acids around, it gets a bit complex. But we would argue that cholesterol is ride-sharing in that process, in these containers. That's the reason why you're seeing higher LDL cholesterol.
Because in short, if I have to release more fat and then replete it back again, and I have to power my muscles more with fat and so forth, that metabolism, that pulling the fuel in and out, I have to have... get carried on these ApoB-containing lipoproteins like VLDL, which remodel to LDL when they drop off their fat-based cargo in the form of triglycerides.
So if I'm understanding correctly, you've trained your body if you're on a low-carb diet, right, or lower-carb diet or ketogenic diet, carnivore diet, you've trained your body to use fat as fuel, and so you just have more fat flowing around the blood, right?
And that's going to get picked up in a blood test and it's going to make it look like to the outside, hey, this person could be unhealthier, quote unquote, than maybe they actually are simply because they have a lot more fat flowing around their bloodstream.
Almost. This is where it gets tricky because a lot of times when I'm talking about this, folks say, well, wait a sec, the major cargo, the fat that's being carried by lipoproteins is triglycerides. I mentioned that as part of the panel. But a lot of people go on a low-carb diet, and this includes myself, would see their triglyceride levels in the blood test go down. So how can that be?
If I'm saying you're moving more of these around and you're powered more by fat, well, in truth, the model is positing that there's just more successful delivery. So taking a snapshot of your blood is kind of like taking a snapshot of an active shipping lane that's out there in the ocean, but most of the boats don't have cargo in them. Why?
Even though you know they're shipping a lot of the cargo because they're successful, they're moving it quickly, and the turnover is faster. So when we're seeing the high cholesterol, what we're doing is we're actually seeing empty boats Boats that started out with a lot of cargo, but are so quickly shipped and taken up by the tissues that are making use of it.
That gets us all back to this larger theme of metabolism. Because even if you're not on a low-carb diet, having, for example, high HDL cholesterol and low triglycerides tend to be associated with good metabolic health. It's just if you're powered more by carbs, you're shipping less fat. But the turnover of that cargo is still a part of the same story.
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Chapter 6: What tests should you use to assess cardiovascular risk?
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If you currently believe that the metric of cholesterol is in and of itself the central driver of cardiovascular disease, I often hear terms like atherosclerosis, the development of plaque in the arteries, is a disease of cholesterol, then it's understandable why you may hyper-focus on that as being the central thing to change. And all of your heart disease risk will follow suit.
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Chapter 7: What factors contribute to plaque progression?
Chapter 8: What are the implications of David's study for heart health?
But before we go into the paper and unpack it, tell us about what is that mission that you're on?
First of all, I had no interest in nutrition, medicine, even really science that much as much as I did engineering. And so I've been a software engineer my whole life for the first, let's say, four decades of my life. And then I'd gone on a ketogenic diet. And going on a ketogenic diet, I just felt great. It was so wonderful.
And at the time I was training with running and so forth, I was setting personal records. I lost a bunch of weight. And I thought I just kind of found the fountain of youth and couldn't stop telling my friends, especially my family, my dad and my sister adopted at the same time.
What happened, though, was while their blood work came back looking fine, including lipids like cholesterol, mine shot through the roof. That ended up changing my whole trajectory, literally for my life for like the last decade. That's what ultimately led me to where I'm at today.
You went on a ketogenic diet. You felt good. Most of your blood work looked good, except for a few of these markers. What were the markers? And for our audience that considers themselves largely professional amateurs, they know a lot about these things. They may not have a degree in medicine. They may not be a nurse practitioner or PA. They like to know the specifics.
So what were the markers and what were their levels for many of us, including myself, who are paying attention to our cardiovascular health.
So when you get your quote unquote lipids, the lipid panel has four different markers on it. One is total cholesterol. The second, the one most people are paying attention to is called LDL cholesterol. Often the mnemonic is that it's the L for lousy, lousy cholesterol. Then there's HDL cholesterol, which is the so-called good cholesterol.
And then there's triglycerides, which is a measure of fat in the blood. Usually a doctor is looking at those first two. They're looking at total cholesterol or they're paying attention to LDL cholesterol. And the ranges for that, total cholesterol per the guidelines, they're supposed to be 200 or less. LDL cholesterol is supposed to be 100 or less.
And then frankly, they don't pay much attention to HDL and triglycerides quite the same. Now, my historic LDL cholesterol was between 120 to 130. And my doctor was usually like, ah, it's about the average of what I see for an adult male. But it would be nice if it was a little bit lower. But I go on a ketogenic diet and my LDL, goes from that 120, 130 up to 250. So naturally, I'm quite concerned.
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