A 33-Year-Old with Type 1 Diabetes Has ZERO Coronary Calcium After 10+ Years on Keto

What a brand-new case report (just published Nov 25, 2025) tells us about ketogenic diets and heart disease risk in T1D

Let’s be honest: when someone mentions “keto” and “heart disease” in the same sentence, most doctors and dietitians still reflexively picture skyrocketing LDL cholesterol and early heart attacks. That narrative just took a serious hit.

A brand-new case report published in the Journal of Applied Physiology (PMID: 41289606) describes a 33-year-old man with type 1 diabetes who has followed a strict ketogenic diet (≤50 g carbs/day) for over a decade — and his coronary arteries are completely clean.

Zero. As in an Agatston calcium score of 0. No detectable plaque. Not even a speck.

For context, in the average 30-something male with type 1 diabetes:

• 30–70% already have measurable coronary artery calcium (CAC > 0)
• 10–20% have significantly elevated scores (CAC > 100)

This guy has none.

The Details

• Diagnosed with T1D at age 19
• Started ketogenic diet shortly after diagnosis
• Has followed it religiously for >10 years (average carb intake ~30–50 g/day)
• HbA1c consistently ~5.5% (normal non-diabetic range; <5.7%)
• No lipid-lowering medications (no statins, no ezetimibe, nothing)
• LDL cholesterol is elevated (as expected on low-carb, high-fat diets in some people)
• Yet his coronary CT scan shows pristine arteries

Why This Matters

Type 1 diabetes is a cardiovascular wrecking ball. Life expectancy is reduced by ~10–15 years, mostly because of heart disease. The single biggest driver of that risk? Chronic high blood sugar.

Fewer than 1% of people with T1D ever achieve a normal HbA1c (<5.7%). This patient has done it for a decade — largely because a ketogenic diet dramatically reduces glucose excursions and insulin requirements.

The Elephant in the Room: High LDL

Yes, his LDL-C is high. The authors don’t hide it. This is the exact scenario that makes many clinicians panic and yell “keto will kill you!”

But… his arteries disagree.

This single case doesn’t prove ketogenic diets are universally safe. It does, however, provide proof-of-concept that excellent glycemic control might trump elevated LDL particles when it comes to actual plaque formation — at least in some people with T1D.

Bottom Line

For the first time, we have direct imaging evidence (not just theory or surrogate markers) that long-term ketogenic management in type 1 diabetes can be associated with zero coronary calcification despite elevated LDL.

It’s one person. It’s not a randomized trial. But it’s a powerful anecdote that demands attention and — more importantly — larger studies.

In a world where most adults with T1D already have silent heart disease brewing in their 30s, a spotless coronary CT at age 33 is extraordinary.

Read the full case report here: https://pubmed.ncbi.nlm.nih.gov/41289606/

Sometimes the evidence shows up one patient at a time. This might be one of those times.