Does LDL cholesterol play a role in a ketogenic diet, or does it not?
The ketogenic, keto, or keto diet has gained a lot of popularity lately, with many blogs and shows devoting time to it. The purpose of this article is to clear up the misinformation surrounding LDL-c, or "bad" cholesterol.
A lot of effort, ink, time has been spent on videos and internet blogs that try to either diminish the predictive value of LDL-c for future cardiovascular events, or try to emphasize insulin resistance.
Unfortunately, if even one of them had any idea of lipidology, they would know that no one denies that insulin resistance is associated with atherosclerosis and an increased risk of cardiovascular disease.
A recent Research refutes these utopian and dangerous claims as well.
There are no words to express how friendly to the ketogenic diet the people who led this study were.
Perhaps a few extracts from the study can give some insight.
The worst methods of an investigation. Not even a control group.
This particular quote is unbelievable. At least the authors are relatively honest and instead of throwing the ball into the stands, they admit the increase in LDL-c. They admit, even indirectly, that saturated fat consumption is directly linked to an increase in LDL-c.
The rest of the text ranges from unacceptable to dangerous, since it clearly states that these changes are not dangerous, but instead tells us that they show people with reduced insulin resistance and good cardiometabolic health.
And if you have the impression that the text is trying to say something else, you are mistaken:
One of the people who did this study tells us that LDL-c is only dangerous when we eat high-carbohydrate diets. There is no evidence for this, no research has ever shown anything that we can even think of to begin to make such claims.
To understand what we are talking about, let's go below, to the effects of the diet zero in carbohydrates, increased in saturated fat:
Coronary artery calcification based on the CAC (coronary artery calcification) score worsened in participants who provided adequate data (numbers in parentheses)! Simply put, these people's arteries are now hardened, resulting in a greatly increased risk of a heart attack.
Remember, not only is there no control group to compare, but the results were sent in by the participants themselves, who are already part of the carnivore community and have every reason to send improved results to the researchers. Should we make things worse?
Arterial plaque takes time to develop, and yet here we see deterioration within 14 months. Other measurements, such as the thickness of the medial mediastinum of the common carotid arteries (CIMT) are usually considered more appropriate, as the particular test we brought up as an example allows doctors to detect thicknesses in the lining of the artery much earlier, allowing for earlier detection compared to the CAC (Coronary Artery Calcification) score.
Here the easy, quick method was chosen which may show more favourable results than reality. And it failed.
So as we explained in "Ketogenic Diet: Some Useful Tips", if we choose a ketogenic diet, we should watch out for saturated and trans fats, too much salt and processed meats, as in any other diet.
- Yes, a carbohydrate-free diet can raise "bad" cholesterol.
- Yes, high levels of LDL-c will lead to atherosclerosis.
- Yes, a diet high in saturated fat will lead to high levels of LDL-c and atherosclerotic plaque, regardless of the carbohydrates in the diet.
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- Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, Daemen MJ, Demer LL, Hegele RA, Nicholls SJ, Nordestgaard BG, Watts GF, Bruckert E, Fazio S, Ference BA, Graham I, Horton JD, Landmesser U, Laufs U, Masana L, Pasterkamp G, Raal FJ, Ray KK, Schunkert H, Taskinen MR, van de Sluis B, Wiklund O, Tokgozoglu L, Catapano AL, Ginsberg HN. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020 Jun 21;41(24):2313-2330. doi: 10.1093/eurheartj/ehz962. PMID: 32052833; PMCID: PMC7308544.
- Lennerz BS, May JT, Owen HH, Ludwig DS. Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a 'Carnivore Diet' Current Developments in Nutrition, 2021, doi: 10.1093/cdn/nzab133.