Has your cholesterol skyrocketed on a low carb or ketogenic diet?
Or did it start out already high, and hasn’t come down like you thought it would after cutting carbs for a while?
Is your doctor on your case to “do something” about it? Are they pushing you to take cholesterol-lowering medication and stop that crazy high-fat diet you’ve been following?
Or maybe your doctor’s actually pretty easygoing about it, but you are alarmed by the big jump in your cholesterol since you started low carb. Maybe you’re wondering if all that butter, cheese, bacon, and red meat isn’t quite such a good idea after all...
People who adopt carbohydrate-restricted diets have widely varying effects on their lipid profile. Generally speaking, triglycerides go down and HDL goes up. This is practically a given. Happens like clockwork. Totally predictable. If you were the betting kind, you could put money on it and have a virtually guaranteed return. And this is a good thing. More and more evidence is emerging that regardless of your total cholesterol or LDL, the triglyceride-to-HDL ratio is a strong predictor of cardiovascular risk.
According to Drs. Phinney and Volek in their book, The Art and Science of Low Carbohydrate Living:
“The triglyceride/HDL ratio provides a broader assessment of risk, and its relationship with insulin resistance makes it far superior to LDL-C. And how best to improve your triglyceride/HDL ratio? The striking reductions in plasma triglycerides and consistent increases in HDL-C in response to low carbohydrate diets are unparalleled by any other lifestyle intervention, or even drug treatment, and therefore represents the most powerful method to improve this ratio.”
LDL is a different story. In some people, LDL goes down, but in others, it goes up. Something that happens on a low carb diet often, but not always, is a shift from LDL particles that are “small and dense” to LDL particles that are “large and fluffy.” Even when the total LDL goes up, the pattern of the particle makeup shifts. It’s believed—but has not been proven conclusively—that the latter pattern, called “pattern A,” is less atherogenic. That is, when your LDL particles are predominantly the large, fluffy type, they’re less likely to “clog your arteries” (*groan*) and cause a heart attack, stroke, or other cardio/cerebrovascular disease than when your particles are predominantly small & dense, called “pattern B.” So, on balance, even if LDL goes up on a low carb diet, it’s believed that the shift from pattern B to pattern A is a beneficial change and represents an improvement in your cardiovascular health.
But what if your total cholesterol or LDL absolutely skyrockets? Does your particle pattern even matter then? If your total cholesterol is 300, 400, 500, or higher, and your LDL is 200 or higher, surely—surely—all that cholesterol has to be clogging your arteries, right? Surely your very next slice of bacon could have you staring down the barrel of cardiac arrest, right? I mean, even if your triglycerides are low and your HDL is high, and your glucose and insulin are low, all your inflammatory markers are low, you’ve lost 60 pounds, your energy levels are through the roof, and your doctor has stopped your GERD medication, your beta-blocker, and your insulin injections, there’s no way your cholesterol could be that high and not cause trouble.
Not so fast.