Are LMHR Patterns at a Higher Risk of Heart Disease?

Added: 2026-05-15

[00:00:00]In this episode, I am going to just lightly touch on lean mass hyper responders.

[00:00:07]Is that phenotype safe? Is it a risk? Is it only about metabolic disease? What is a lean mass hyper responder? And then we'll talk about what can be [music] contributing to higher cholesterol.

[00:00:21]I now eat a lot of meat, and so do [music] they. If you want to thrive, you need to eat meat. Meat is required.

[00:00:30]Hey guys, my name is Judy Cho, and I'm board certified in holistic nutrition, and I have a private functional medicine practice where we focus on root cause healing, and it often starts with the carnivore cures all meat elimination diet. Not too long ago, I interviewed Dr. Malcolm Kendrick, and we touched on lean mass hyper responders, and if a LMHR or a lean mass hyper responder, if that phenotype is in fact safe, are they at risk for cardiovascular disease, and are they at risk for anything? And while I did touch on a couple things, as I'm wrapping up my next book, I have a lot of the information in my head, and I share a lot of what we have seen clinically with LMHRs in our practice.

[00:01:15]And so, let's first start with what an LMHR is. I'm not going to talk about how all the cholesterol then makes a LMHR. I have multiple interviews with Dave Feldman that I've done in the past, so I will put that in the show notes. You can also go to Cholesterol Code, which has a lot of information. You can see and plug into their calculator if you fall into the LMHR phenotype. Lean mass hyper responders or LMHR is a pattern that we see when individuals eat a low-carb, high-fat diet, and they're usually on the leaner side. Their total cholesterol goes up to, I think it's 300 to 350 plus mg per deciliter. Their HDL is 80 and above mg per deciliter, and then their triglycerides are low, um at least 70 mg per deciliter and below that. There's no number for LDL, but if the total cholesterol is sort of a math equation of all of the other numbers, the LDL is obviously high. And the thought is that when we are using fat for fuel, we need more carriers to basically get the fuel to our tissues and our muscles for energy, so the fat. And then some of that leftover cholesterol, the remnants of it, and the VLDL gets converted into cholesterol, and so it can make your total cholesterol or LDL look high. Now, again, that's the very basic part. If you want to know more of the science, I highly recommend going to look at Dave Feldman's work. And again, I will put two of our last interviews together in the show notes.

[00:02:50]Does the high LDL or the total cholesterol warrant a concern for cardiovascular risk? If the heart hypothesis says that high cholesterol or total LDL is going to cause a heart attack, well then these lean mass hyper responders would be very at risk for a heart attack. And what I can tell you is in our practice, we do not see that.

[00:03:16]These individuals, usually they're lean, they're very insulin sensitive, they are their blood glucose is pretty within healthy normal ranges, and it is just that their cholesterol, again, is high. Their triglycerides are below 70, HDL is above 80, and their total cholesterol is above 300 plus. We've seen people above 600.

[00:03:41]I believe Dave Feldman et al., their work is trying to show that there is no metabolic disease or cardiovascular risk with this LMHR pattern, and I think that's a true statement. Now, we will see with time as research evolves, but I do not think these LMHR patterns is a risk of heart disease.

[00:04:04]Now, if you consider my conversation with Dr. Malcolm Kendrick, he says that heart disease, the process is usually that endothelial cells get damaged, the glycocalyx gets damaged. And so, in that sense, then if LMHRs have other imbalances, and then those imbalances damage the endothelial cells and the glycocalyx, then sure, there is a risk of heart disease that way. But from a metabolic perspective, metabolic syndrome, diabetes, insulin resistance or hyperinsulinemia, I do not see that pattern in our LMHRs in our practice.

[00:04:39]But I wanted to do this podcast episode because I do not want individuals that have the LMHR pattern to then think, "Well, my cholesterol is high, but everything else, my metabolic health is good. I'm insulin sensitive, so I don't have to worry." Because while the metabolic health side may be true, we still see LMHRs with other imbalances in our practice. And it could be that we work with people that obviously have something that they want to heal or get better from, but all of the LMHRs we work with have underlying illness. And that's where I think there should just be an asterisk.

[00:05:23]If you are an LMHR, could it be a signal from the body that something else is imbalanced? Sure, it might not be heart health related. Sure, it might not be metabolic syndrome, but is there something else that the body is compensating for? And so, I just wanted to bring up a couple things that I've seen in the research. And one is that when you are hypothyroid or your thyroid is just not functioning at capacity, your cholesterol levels can go up. So, the correlation should be many individuals with an LMHR pattern also have hypothyroid. And I would love for anyone that's an LMHR to put in the comments if that's a true statement. If you fall into the pattern of an LMHR, do you also have hypothyroid or Hashimoto's? And so, the imbalance of the liver-thyroid connection can be causing excess cholesterol and a lack of LDL clearance.

[00:06:20]Remember, most of your cholesterol is produced in the body, about 70 to 80%, and then the majority of that cholesterol is produced in the liver.

[00:06:29]The adrenals make some, and the intestines make some, or the gut, but the majority of your cholesterol is produced in the liver, and then every cell can synthesize cholesterol. So, if that's true, why is cholesterol so bad?

[00:06:41]But that's beside the point. So, one area can be thyroid related. So, if you become less hypothyroid, I wonder if your LMH pattern will reduce. And these are just things that we should be thinking about in our community. The other big area I really wanted to talk about is the detoxification part of cholesterol. So, our bodies use bile acids to remove a lot of the toxins in our body, especially fat-soluble toxins.

[00:07:10]So, these are basically a lot of the BPAs, the phthalates, the mycotoxins, or some of the molds. And many of the modern-day toxins that we are exposed to are actually fat-soluble, which then just requires the liver to have to process it down to a way that it could then get mostly eliminated through the stool. And one way our bodies do that is through bile salts and our bile acids.

[00:07:37]And so, the liver uses cholesterol to then synthesize it into bile acids, and then it excretes it, the toxins, into our stool. And then what we end up not eliminating, so if we have constipation, it ends up getting recirculated back into the system. And one reason that happens is because bile is really expensive to make internally in our bodies, and so our body has this really smart system to try to reuse things and recycle things, so it does not be an extra burden on our body. And so, when we don't eliminate, um and that's including estrogens and estrogen metabolites, um the fat-soluble toxins as I was talking about, when those don't get eliminated, the body knows that we're not eliminating properly, and one thing that our bodies do to detox is, okay, maybe we produce more cholesterol to help the bile acid synthesis to then reduce the toxins even more. And so, that can increase your cholesterol levels. So, could LMHRs or people with the lean mass hyper responder pattern have an issue with constipation? And then in addition to that, they have a hard time detoxing. And if you have a hard time detoxing, that's what can cause the cholesterol levels to go up, but also that means it's indicative of your body is not able to expel toxins that are circulating in our system. So, if there's an excess of the wasteful estrogen metabolites, that can absolutely impact your sex hormones. So, not just your thyroid now, but also your endocrine system. And your endocrine system is all of your hormone function.

[00:09:20]So, that also affects your cortisol levels and your stress levels. So, I just have seen too many patterns in our practice where I do not feel comfortable to say LMHRs equals safe. Because we understand this pattern, you don't you probably won't get a heart attack, you are healthy, but yes, you are metabolically healthy, but I do not think it means you are everything else healthy.

[00:09:48]I am okay if you are an LMHR and you have nothing that I'm bringing up, and you have no signs of illness, then I would feel a lot more comfortable that you are an LMHR and maybe you just as Dr. Malcolm Kendrick said, maybe you just have that familial high cholesterol levels. It's just kind of runs in your family and then maybe this is your new baseline eating this way of a carnivore diet or a low-carb diet. But if you have other health symptoms with an LMHR, I just want you to make sure that whether it's poor detoxification, bile acid issues, so that would also be digestive issues, poor liver function or poor liver clearance or hypothyroid or Hashimoto's, these areas will absolutely affect your cholesterol levels and could it be that lean mass hyper responder patterns now that we are eating higher fat, is the body showing a signal that when we cannot clear enough cholesterol that something is actually imbalanced in the body and we have never seen it enough until now. And that this is our bigger signal that now we can actually fix the root cause. It's really just trying to understand what is the delineation. Is it that individuals with hypothyroid then show up with signals as an LMHR? Is it that individuals that can't detox, those individuals show up as an LMHR?

[00:11:19]And that's the signal to then work on those areas or is it that they're two separate things and they're just showing up together?

[00:11:26]I think there needs to be more discussion about the lean mass hyper responders outside of just metabolic health. Everyone does not die just of heart disease. I know it's one of the biggest, but there are other ways that people die. And so I think it is very important that we understand LMHRs more than just they are at risk for cardiovascular disease or not. We have individuals in our practice with a total cholesterol of 600 mg per deciliter.

[00:11:59]Cardiologists are literally shocked and I hate to say this, but there are low-carb dieters or advocates or cardiologists that will recommend them behind closed doors to get on a statin because their total cholesterol is that high.

[00:12:12]And I think it's because it's just a risk to their maybe license, but those individuals then get a CAC score and their score is zero. And we have enough of those in our practice that again, I am not as concerned about metabolic health and maybe even plaque.

[00:12:30]But that does not mean that they are safe in the rest of holistic health. And so I hope that if you are an LMHR that you look further into what may be causing your cholesterol to skyrocket. I always think of if there is a normal range of individuals that react to something, then why are you outside of that range if you are? And that will tell you so much about your health. I like to call it the canary in the coal mine. Dr. Kendrick calls it the black swan. But wherever you are, if you are outside of the normal range, that's fine as long as you understand why you're outside of that range. And for individuals that say a carnivore diet didn't work because my electrolytes never balanced, there's a reason for that. It's not just the carnivore diet doesn't work. You are an individual where again, you're outside of that normal range. If you are an LMHR where you eat higher fat on a carnivore diet or you eat low carb and with a fatty cut of meat and you're outside of this normal range of cholesterol, then why is that happening? And as long as you can understand that and you have this clean bill of health where you have no symptoms, no markers are out of range, then it might be okay. But until you have that security, I highly recommend individuals to keep researching because I don't think to just say again that I'm an LMHR, I have no risk or low risk of cardiovascular disease, so I'm good. I don't think the conversation should end there.

[00:14:04]All right, guys. Make sure to eat a lot of meat. Take care of your bodies because it is the only place you have to live. I will talk to you later. Bye, guys.

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