A lean man on keto has LDL over 400; an obese man on keto has LDL of 120-140. New evidence suggests low BMI, not saturated fat, drives high cholesterol on low-carb diets. UCLA research is investigating whether this actually increases heart disease risk.
These are two real people, both on low-carb, high-fat ketogenic diets. Now, this gentleman has a BMI of about 21, and this gentleman has a BMI of about 61. Importantly, the guy with the six-pack abs, as a result of being on a ketogenic diet, has LDL, the quote "bad cholesterol," that's through the roof high, over 400 milligrams per deciliter, which is on par with people with a 1 in 1 million genetic condition called homozygous familial hypercholesterolemia. But by contrast, the larger gentleman, has a much, much lower LDL, quote, bad cholesterol, between about 120 and 140 milligrams per deciliter. So here's the provocative question: if I give you no more information, who is at higher cardiovascular risk? The guy with the six-pack and the sky-high LDL, or the guy with big belly and the very, very low LDL, at least in comparison? Pause and answer that for yourself. For those of you just joining us, this is not a made-up nonsense question. It's a question based on serious data. We have data now from multiple studies, including most recently a meta-analysis of 41 randomized controlled human trials showing us that lower BMI, i.e., being leaner, is the primary driver of high LDL, the quote bad cholesterol, on low-carb diets. This is opposed to more conventionally assumed factors as drivers of LDL, like saturated fat. So basically, or in other words, being lean, having the six-pack, not pounding the egg yolks and the butter, being lean is what may drive your cholesterol sky high when you're on a low-carb diet. This appears to actually be a metabolic response, one explained by something called the lipid energy model, which we review in prior videos and papers that you can find below. But briefly, when you're very lean and you cut out carbs from your diet and deplete your liver's store of carbohydrates, your body increases fat fuel trafficking if you're lean and insulin sensitive. And this results in the phenomenon of really high LDL along with high HDL cholesterol and low triglycerides, the triad that is known as lean mass hyperresponders. So I return to the question, the gentleman the six-pack abs has higher LDL, the quote bad cholesterol, because he is leaner, i.e., because he has the six-pack. In fact, and as an aside, when this individual eats carbs, even Oreo cookies, his cholesterol drops like a stone through air. So I pose the question again: whose heart do you think is more likely to be in worse shape in 5 or 15 years down the line, keeping in mind that these two men's LDL cholesterols, the quote bad cholesterol, in this low-carb dietary context are each a function of their BMI. The guy with a six-pack and the low BMI has high LDL because he is lean. The guy with a high BMI with obesity has lower LDL because he has obesity relative to the guy who is lean. Isn't that interesting? Here's the second question extending on the first. If our larger gentleman with a starting BMI 61 is consistent about his low-carb diet, say he loses 200, 300 pounds and gets lean, and then as a result of getting leaner, his LDL LDL shoots through the roof. Is this a greater or a lower risk profile for having lost the weight? Would he have been heart healthier to have severe class 3 obesity and lower cholesterol, or to be lean on a low-carb diet with much higher cholesterol? And again, the fact of the matter here is that these represent real people and a real phenomenon, that being lean, fit, and active are actually major risk factors for having high cholesterol when you go low-carb and keto. Contrary to popular belief, I'm not here to place a value statement. I'm not here to answer that question for you, tell you this is good natural or bad, atherogenic. I'm just here to highlight the questions that we need to be asking. And yes, they are provocative, uncomfortable questions, but that's no reason to shy away from them. In my opinion, that's why they need to be asked. So if you're curious, if you're truly curious, here's what I want you to do next. I want you to go down the rabbit hole. Below are linked 4 videos. The first one is on the new meta-analysis that I mentioned, which we just published in a top nutrition journal showing that lower BMI, being leaner, is a major driver for elevated LDL cholesterol on low-carb diets. The second video covers another paper that we just published. It was an n=1 crossover experiment in which I actually lower my LDL drastically with Oreo cookies. The third covers the lipid energy model, which we have a hypothesis paper on and which explains this phenotype. It's a model to explain what we're seeing, this curiosity that I'm explaining here in this video with this comparison of these two gentlemen. And then the final one, the fourth video, is a glimpse into what all this might mean. The preliminary data from a study that's going on out of UCLA, the Lung Cancer at the Nick Norwitz Institute looking at heart coronary plaque progression in people like this six-pack gentleman with the 400 LVO. Are these people at elevated risk or not? These are the questions we're asking, these are the questions we're answering, and what I want you to do now is to just think about them. Think about these questions, get curious, and get engaged with our scientific journey.
