Carnivore Diet & Cholesterol | Implications of High LDL | Should You Worry?

HIGH CHOLESTEROL ON CARNIVORE? 🤔 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀ ⠀ ⠀

Here's my personal experience with cholesterol and the carnivore diet.

My LDL (“bad” chol) is 480 mg/dL, nearly 5X the recommended <100 mg/dL level ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Am I concerned? No! Here’s why: ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ My other blood tests (view image below) ⠀⠀⠀⠀ ✅ High HDL, low trigs, & few small LDL particles ✅ Low insulin, C-reactive protein, homocysteine ⠀

✅ Good insulin sensitivity (HOMA-IR score)

⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ In this context (good metabolic health & low inflammation) elevated LDL is NOT a bad thing. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ↪️ Dr. Nadir Ali recently shared his theory for why LDL cholesterol SHOULD go up on a low carb diet. Prepare to nerd out! 🤓 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ 1️⃣ There are 2 main types of blood lipids: triglycerides & cholesterol. Trigs are an energy source for the body & cholesterol is important for many functions (like cell membrane fluidity, neurotransmission, building hormones, & vitamin D production) ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ We need these lipids throughout the body, but they can’t dissolve in blood since blood is water-based (like how oil & water don’t mix) ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Cue lipoprotein molecules to transport these lipids around the blood (like an Uber 🚗 ) since they’re capable of making the lipids soluble in blood. LDL is one of these lipoproteins! ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ So here’s Dr. Nadir Ali’s theory for why LDL levels rise... View image below.

⠀⠀⠀⠀⠀⠀⠀ When in ketosis, the liver makes ketones as an alternative to sugar/carbs 🍞 ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ The enzymatic machinery activated to make ketones is ALSO MAKING CHOLESTEROL - they share the same biochemical pathway⚠️ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ So fatty acids enter the liver ➡️ converted to Acetyl CoA ➡️ then HMG CoA, which is then converted to ketones or cholesterol. The two molecules share the same precursor molecule! ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ So by design, increased ketone production leads to increased cholesterol production, & more cholesterol requires more LDL for transportation.

⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Other supporting evidence (view image below). In one study, LDL increased by 70% after 7 days of fasting! Fasting shifts our bodies into fat metabolism, so the liver is producing ketones (& cholesterol!)

⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ How cool is this? 🤓

So now that we've addressed why LDL rises on a low carb diet, let’s discuss whether this is a good or bad thing. Can LDL can actually BENEFIT us?

LDL cholesterol got it’s “bad” rep from the lipid hypothesis, which suggests LDL is toxic to the endothelium (tissues lining organs/cavities), playing a huge role in the development of atherosclerotic heart disease.

Considering there’s the same amount of LDL throughout our circulation (like in both arteries & veins...) Dr. Malcolm Kendrick poses: if LDL is directly toxic to the endothelium, then why do we only see plaque build up in arteries, & not in veins?

Turns out, LDL is likely NOT toxic to the endothelium, & may just be there for repair (aka, LDL is caught at the crime scene, but not necessarily responsible for the crime)

LDL actually serves many important functions: ⠀⠀⠀ • Transports triglycerides (energy) & cholesterol to all cells (which is important for hormone, cell membrane, & vid D production) ⠀⠀⠀⠀⠀⠀⠀ • Helps immune system fight bacteria & viruses • Transfer CoQ10, which is a critical nutrient produced in the body that helps generate energy & is like the “spark plug” for the mitochondria in cells. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Supporting studies that demonstrate LDL is beneficial: ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⏩ Meta Analysis from Dr. Kendrick in 2016 which identified an inverse relationship between LDL and mortality (image below).

⏩⏩ Leiden 85+ study, which followed 724 patients for 10 years. The highest chol group had the lowest overall mortality, lowest cancer mortality, & least risk of infection (image below).

⠀⠀⠀⠀⠀⠀⠀ ⏩⏩⏩ Lothian Birth Cohort, which included 1078 individuals. The highest chol group had the lowest risk of hypertension, lowest risk of stroke, lowest risk of heart disease. Also, the higher the cholesterol, the better thee IQ, processing speed, & memory of participants (image below).

⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀ ⠀ ⠀ ⠀ ⠀ ⠀ ⠀ ⠀ ⠀ In sum, in the context of good metabolic health (low triglycerides & high HDL) -- having high LDL cholesterol may actually be beneficial.