In recent years, the conversation around health and nutrition has increasingly shifted toward personalized care. One of the most intriguing topics in this space is the concept of the Lean Mass Hyper-Responder (LMHR) phenotype, identified by American researcher and engineer Dave Feldman.
🔍 What Is LMHR?
LMHR stands for Lean Mass Hyper-Responder. It describes individuals who, after adopting a low-carbohydrate or ketogenic diet, experience a sharp rise in LDL cholesterol levels, while maintaining excellent health markers in every other area.
A typical LMHR lipid profile looks like this:
- LDL-C (“bad cholesterol”): over 200 mg/dL (5.2 mmol/L),
- HDL-C (“good cholesterol”): over 80 mg/dL (2.1 mmol/L),
- Triglycerides: very low, usually below 70 mg/dL (0.8 mmol/L).
Sounds like a paradox, right? Traditional medical advice warns us about high LDL-C, yet these individuals are lean, physically active, metabolically healthy, and show no signs of inflammation or insulin resistance.
👨🔬 Who Is Studying This?
Dave Feldman began researching this phenomenon after observing a dramatic spike in his own LDL-C levels when he switched to a ketogenic diet, despite his other health markers being ideal. He launched the Citizen Science Foundation and, in collaboration with UCLA, started the Lean Mass Hyper-Responder Study in 2022.
The aim of the study is to determine whether individuals with the LMHR phenotype are genuinely at cardiovascular risk or if their elevated LDL-C is simply a natural adaptation to using fat as their primary fuel source.
📊 What Do Early Findings Show?
Initial data—including advanced coronary imaging (CCTA)—reveals that many LMHR participants show no signs of arterial plaque, even with extremely high LDL-C levels.
One published case report describes a healthy 26-year-old male who switched to a ketogenic diet and saw his LDL-C soar to 545 mg/dL. Despite this, a CT scan revealed clear arteries and no signs of atherosclerosis.
Source: PMC9048595
❗ Does That Mean LDL Doesn’t Matter?
Not necessarily. Feldman is very clear: this does not give everyone permission to ignore high LDL-C. The LMHR pattern appears in a specific group of individuals—those who are lean, insulin-sensitive, and have a favourable lipid profile otherwise.
For people who are overweight, sedentary, or have metabolic issues, high LDL-C can still be a significant risk factor.
👣 What Does This Have to Do with Foot Health?
As a Foot Health Practitioner, I work with many clients dealing with diabetes, obesity, and metabolic syndrome. These conditions not only affect cardiovascular health but also directly impact the circulatory health of the feet—increasing the risk of ulcers, infections, and poor healing.
Understanding phenotypes like LMHR helps us avoid one-size-fits-all thinking. Not all high LDL-C readings mean the same thing. For some, a low-carb lifestyle improves insulin levels, reduces inflammation, and ultimately supports better foot and overall health.
📚 Sources:
- Feldman, D. (2022). CholesterolCode.com
- Citizen Science Foundation – LMHR Study
- Case Study: PMC9048595
Lifestyle for Healthy Feet 
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