How to LOWER LDL on Keto. No meds!

How to lower your cholesterol on a ketogenic diet. I want to do this video because I find that ketogenic diets have a broad range of clinical utility, not just diabetes and obesity, but also things like mental health conditions, epilepsy, inflammatory bowel disease, X, Y, and Z. And some people who go low carb see increases in their LDL, so-called bad cholesterol, and this represents a clinical obstacle, either because patients and/or their physicians are scared and then want to abandon the diet because their cholesterol levels are high. It's important to clarify, most people who go low carb or keto actually don't see increases in their LDL. In fact, people with Class 2 obesity tend to see decreases in LDL cholesterol. That said, some people do see increases, so it's useful to have tools available to toy with your cholesterol over and above medication options, which certainly are on the table but not the topic of this video. So this video will be broken into two phases. The first are things that'll work for basically anybody, and then the second phase I'm going to be talking about interventions that work in particular for people with very, very high LDL cholesterol that are of the so-called lean mass hyper-responder phenotype. And if you aren't familiar with that, I'll get into it in a moment.

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Now, phase 1, things that'll work for most people. The first thing is fiber. Adding fiber to your diet can lower your cholesterol. However, not all fibers are created equal. There's soluble and insoluble fiber. Insoluble tends to kind of push things through your GI tract. Soluble tends to gel up a little bit more. Insoluble fiber tends to be more effective at lowering LDL cholesterol. But there are also specific fibers. Fiber is actually a very heterogeneous and broad group of molecules, and one in particular, which I'm going to abbreviate AX, has been shown in recent studies to be very effective at lowering cholesterol. So in a 2022 study published in the journal Cell, Host, and Microbe, in which 18 people consumed various fibers in a randomized order, they found that this AX fiber was most effective at lowering LDL cholesterol. And you can see that here in this graph, where the red line represents AX, shown at different doses. And you can see especially the 30-gram dose of AX had a very potent effect on lowering LDL cholesterol. AX can be found as part of the plant cell wall, although different plants have different proportions. So targeting plants that are high in AX may— this is speculation— have a bigger bang for their buck with respect to fiber intake. Some foods that are very high in AX, or particularly high, include barley and finger millet. Now, that said, these are also higher in net carbohydrates, so they're more useful if you are okay exiting ketosis and going on a lower-carb but not ketogenic diet, or carb cycling, which some people choose to do. But in general, I think just targeting low-carb foods that are high in fiber can be effective, especially if you want to stay ketogenic, in which case barley and finger millet might not be the best things. Instead, you want to aim for fibrous low-carb vegetables, things like spinach, asparagus, broccoli, and especially chia and flaxseeds, which have an incredibly high fiber to net carb ratio, which allows you to keep your net carbs low while increasing your fiber, potentially reducing your LDL cholesterol levels if that's desired. Now, this is an aside. Personally, my favorite keto-friendly fiber source is certain dark chocolates, which can be surprisingly high in fiber. My favorite myself is 95% dark Taza Ginger. One single bar has 14 grams of fiber, which is a lot. And I don't know about you, but although the serving size is in one bar, I can't eat just one half bar. So I say 14 per bar because realistically that's what I'm going to eat if I open a bar. You may be different. I also highlight this brand not because they sponsor me, which they don't, but because I know that in dark chocolate heavy metals have become a concern, in particular lead and cadmium, based on a Consumer Reports that came out last year. So the Taza brand actually tends to be lower in cadmium and lead, which provides another advantage. And the ginger, just because I really love that flavor. Anyway, that aside, there are lots of other dark chocolates. Look on the back and you can see it's surprisingly high in fiber in general. Moving on from fiber, another thing you can do is manipulate your fatty acid profile, exchanging saturated fat-rich foods with unsaturated fat-rich foods, which can also lower LDL cholesterol. Easy practical exchanges you can do with cooking fats include exchanging things like butter, ghee, coconut oil, or tallow for avocado oil as a cooking fat, which I select out because of its higher smoke point. The smoke point is the point at which an oil or fat starts to smoke when you're heating it up. Some have lower smoke points, which means they're not as good for cooking, and some have higher smoke points and tend to be better for cooking at higher heats. So an avocado tends to have a smoke point around 500°F, which means it's decent for cooking. Actually, I think quite good. Personally, some people feel differently, but I don't like to use polyunsaturated fat rich oils for cooking because under high heat they're very fragile and they get damaged. And I do use them in cooking, I tend to try to use only very low heat, but they can be used as a dressing or in a raw form. Personally, my favorite polyunsaturated fat rich source is sesame-based products. Including tahini and toasted sesame oil, especially on seafood. As an aside, I really have this go-to tahini dressing that I love to make. It's a personal favorite, really simple, with 3/4 of a cup tahini. You mix in about 4 teaspoons of lemon juice, 2 to 3 cloves of minced garlic, or you can actually roast the garlic before, that gives it really nice flavor and you can blend it in. A little bit of salt, optional sweetener, you can use some allulose sweetener if you want, and then you whisk in a little bit of water, maybe 4 tablespoons, and it makes this beautiful creamy dressing that's great over whitefish or salmon, chicken, or vegetables like eggplant. Really, you try it, I'm sure you're gonna love it. In terms of other polyunsaturated fat sources, pecans and walnuts are very low carb and high in the fats that will lower your cholesterol. I do recommend getting them raw so the fats aren't damaged. And if you're gonna toast them, if you like that flavor, it's usually safe to toast them based on the data I've seen below 130 degrees Celsius, which is 265 or so Fahrenheit for less than 20 minutes. So you can roast them, but if you roast or toast them, kind of do it on a pan, I think really lightly, and the fat should overall be okay. So for omega-3s, which are also a polyunsaturated fat, albeit less prominent in the diet than omega-6s, fatty fish is of course great. I love salmon, mackerel, anchovies, sardines, and herring, the smash fish. But if you really want to go above and beyond, I really like Icelandic cod liver packaged in their own oil. I know some people have concerns about the oil being packed in tins, but I find it's personally just fine. I'm not having high levels of inflammation or oxidation. Really delicious, and the omega-3 dose is through the roof. Proof. And I can provide links to some of these foods in the video notes below if you're interested. Again, they don't sponsor me, I just like the product. Now I'm going to pause and just mention, I realize that there are people that are anti-PUFA because they're fragile fats and prone to oxidation. That said, I do think if you generally consume them in their raw or unheated form, it's fine. Additionally, when you eat these whole foods that are packaged with the food matrix, nature does package them with things that will prevent oxidation, especially sesame. So there are lignan antioxidants in sesame, in tahini, that protect the linoleic acid, the omega-6, from oxidation. So again, I think eating these raw whole foods that are higher in polyunsaturated fats is just fine, and I wouldn't be overly concerned about the seed oil content. Drinking, guzzling fryer oil from McDonald's is a whole different story. That said, what's more, when you are on low carb, and this is something that's not usually appreciated, you preferentially burn PUFA and omega-6 as fuel really, really quickly. They don't have time to store up in your cells. —this is as compared to someone on a mixed diet. So if you're low-carb and keto and burning fat quickly and then you put PUFA into yourself, you actually will burn these fats and generate more ketones. They're more ketogenic, and that can have utility if you use it cleverly, as I'll get to later in the video. And for what it's worth, I'll just mention I know people are concerned about their omega-6 to omega-3 ratio. It can be a marker of inflammation, and it's important to note your omega-6 to omega-3 ratio intake doesn't necessarily match your blood levels or levels in your blood cells.. I, for example, have a 1:1 ratio of omega-6 to omega-3 in my red blood cells, in my cell membranes, which is very, very good. And I'm not trying to avoid omega-6 fatty acids in my diet. Again, that doesn't mean I'm guzzling fryer oil, but it does mean I like to incorporate things like walnuts and pecans and tahini, and I'm not really necessarily afraid of the omega-6 content. I actually think these can be quite helpful foods.

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Thank you. Moving on to part 2, things that'll work for a particular subpopulation, the so-called lean mass hyperresponders. Lean mass hyperresponders are people who go low carb and then see massive increases in LDL cholesterol above 200 mg/dL, along with increases in HDL and low triglycerides. So I really want to highlight that if you're someone who doesn't have high HDL and low triglycerides, then you're not a lean mass hyper-responder. So the following won't necessarily apply to you directly, but for these people, they're the ones that tend to see the highest increases in LDL, which therefore tend to be the most concerning to their physicians and often those patients. Now, because of the physiology and the driving force behind this phenotype, this triad of the high LDL, high HDL, and low triglycerides, which appears to be a phenotypic manifestation of a metabolic metabolic response to carbohydrate restriction, particularly in lean active people where the demand for fat fuel in that lean context increases the trafficking of lipoproteins and increases LDL. The physiology there implies that there are particular tricks you can employ, levers you can pull that are quite distinct. And I'm going to highlight 4 of these levers based on our understanding of the lean mass hyper-responder phenotype in the lipid energy model. I'm going to rank them 1 to 4 in terms of their practicality and also rank them based on a star system. 1, 2, or 3 stars based on their potency. So starting with number 1, if you're a lean mass hyper-responder, the easiest way to drop your cholesterol way, way down is to add back carbs. Usually about 100 grams of carbs will do, although that varies based on how active you are and how large you are. I'm quite a small guy. 100 grams of carbs for me is not the same as 100 grams of carbs for someone who's 6'5" and 250 pounds. So adding back carbs can work. Really, any net carb will work. I've seen people drop their LDL cholesterol by 200, 300, 400 milligrams per deciliter using mango, sweet potato, rice, Again, any carbs will work. I've demonstrated you can use Oreo cookies, although I don't recommend that. Point being, it's not specific to what carb you use. Choose your favorite carb, and if you're okay incorporating it, if you're able to do so, that's the most effective way to lower your LDL cholesterol. That said, you will no longer be on a ketogenic diet if you're adding back the carbs, but you can remain low carb or pretty low carb. And if that works for your lifestyle and it helps you maintain your LDL and ApoB levels where you want them while enjoying the benefits of a low carb lifestyle, then I think that's fantastic. Fantastic. The next most practical thing, which will actually allow you to maintain ketosis, is eating more frequently. Eating more frequently will, all things being equal, tend to lower your LDL, at least based on what I've seen. We don't have rigorous published data on that, so I'm just going off my clinical observations. That said, whereas I'd give adding back carbs 3 stars because it's very potent at lowering LDL cholesterol in lean mass hyperresponders, increasing meal frequency, it will have an effect, but it won't have a big effect. It's practical and easy, but I'd only give it 1 star in terms of potency. So that will be, for example, going from a 4-hour eating window or a 16:8 eating pattern to something like eating 3 meals a day over a 12-hour eating window. That can lower your LDL while you're eating the same foods, although it's not a very potent approach. The other options if you're a lean mass hyper-responder are to put on weight, which I'd give 2 stars because it's very effective, but I put it lower down in the order because it's not practical for most people. Most people don't want to put on weight. That said, if you are someone who is looking to put on weight— say you're quite lean or scrawny and you're looking to put on, um, you know, a little bit of bulk, then that's something you can target and it will lower your LDL. As I put on, you know, weight— I'm not a big guy, but my weight does fluctuate— my LDL can drop quite a lot, by as much as I've seen it drop 150-200 mg/dL putting on a little bit of weight, which means some muscle but also some fat tissue. So if that's something that you're willing to do and interested in doing, I think it's an option. And then another option that I'd also give 2 stars, but again put lower on the hierarchy because it's not necessarily practical or necessarily healthy, is decreasing your activity, especially cardiovascular activity. Again, remember, lean mass hyperresponders manifest because of increased demand for fat fuel trafficking. So if you decrease your energy expenditure, you decrease the demand. All things being equal, your LDL levels will go down. So, you know, if you're a lean mass hyperresponder doing a ton of running, lowering your running load and exchanging that for maybe some more weight training might have an effect on lowering your LDL. So to review, part 2, if you're a lean mass hyperresponder, 4 levers you can pull include adding back carbs, which is the most potent. I'm going to give that 3 stars out of 3 3 for potency. More frequent eating, it's easy, although I'd only give it 1 star for potency. And then weight gain or decreasing your activity, especially cardiovascular exercise, which I'd each give 2 stars, although they're not necessarily desirable things to do. Now, to give a little bit of bonus to part 2, I want to acknowledge that many lean mass hyper-responder patients won't be able to add back carbs because they're using a therapeutic ketogenic diet for conditions like epilepsy, inflammatory bowel disease, or bipolar disorder. For these patients, when they want to lower their LDL, this can be tricky, especially if their GI systems don't don't tolerate plant fibers and/or they have medication intolerance. So you can see how people can get really caught between a rock and a hard place. Still, for these patients, there are experimental and innovative options that can be leveraged if you understand the physiology. For example, I can get my BHB, my ketones, to over 6 millimoles within 20 hours by adding in sesame oil. This is how I do it. I add 3 to 4 tablespoons of sesame oil to my diet at the end of the day with dinner as part of my fat source. And then about 20 hours later, if I fast, my BHB will be at 6 millimoles. And what this allows me to do— this, or say incorporating MCT oils or exogenous ketones— is create a buffer to then play with other things like carbs. So imagine you want to be at a ketosis level of 1.5 millimoles, right? If I'm hovering right at 1.8 at baseline, then adding back carbs will get me below that 1.5. But if I can boost my levels and have that buffer using a higher polyunsaturated fat-rich diet, adding MCTs or exogenous ketones, then I might have more wiggle room to play with titrating carbs back in. And then on top of any effect of the polyunsaturated fat lowering LDL, you get the carb effect, which in lean mass hyperresponders is much, much more potent. Hopefully that makes sense. In summary, there are many tools at your disposal to modify your lipid levels on a low-carb diet, aside from medication, which is a whole different discussion. It's important to acknowledge different approaches may work better for different people. A person with obesity on a very high saturated fat ketogenic diet with high triglycerides might get the best results for swapping their their butter for extra virgin olive oil, and bacon and eggs for eggs and avocado. Add some unsaturated fat and some fiber. Versus a lean mass hyper-responder might get even more bang for their buck by eating 80 to 100 grams of net carbs in the form of their favorite fruit or starch— banana, papaya, sweet potato, what have you. Or they could play with meal frequency, going from 1 to 2 or 3 meals a day, or eating over longer eating windows. Point being, there are things and variables you can play with, and I think understanding the mechanisms and the physiology and the options helps us better tailor metabolic approaches to reach our own desired outcomes. I think that's very cool.

I want to add a layer of value to this, or what I hope is value, and provide a clarification. First, the clarification: this is not a "you should" video. You can do whatever you want as an individual, and all I'm here to do is provide information and, in this case, tools that you can implement at will depending on your your personal priorities and preferences. Additionally, this is not a diet camp video. This isn't about keto versus balanced diet, plant-based versus animal-based. And to demonstrate that and provide some value, what I've done is collaborated with people from the plant-based and animal-based communities, including Simon Hill, a prominent plant-based advocate, Dr. Shawn Baker, a prominent animal-based advocate, and also Professor William Cromwell, a lipidologist psychologist with over 30 years of experience to put together a one-pager, very simple, covering what we've gone over in this video. And if you click on one of the links below, you'll be brought to a Google Doc where you can download it for yourself. I hope you find that helpful. Again, this isn't about you should, you shouldn't. This is just about data, information, and tools and bringing those to you for you to use as you see fit.

Thank you.