Is high LDL cholesterol always a red flag for heart disease? New research says… maybe not.
Transcript:
Keto is bad for the heart, right? Well, new research suggests that’s not the case, even when LDL cholesterol skyrockets. People around the world are using ketogenic diets to reverse a variety of physical and mental health conditions. Most see little change in LDL cholesterol, but a small percentage can see their LDL levels skyrocket. Does this automatically mean they are at high risk for heart disease? Surprisingly, recent groundbreaking studies suggest the answer is no. Research led by Dr. Matt Budoff of UCLA’s Lundquist Institute, along with Dave Feldman, Dr. Nick Norwitz, Dr. Adrian Soto-Mota, they studied 100 individuals who had been following a ketogenic diet for an average of 5 years. The participants had good metabolic health, as told by low triglycerides and normal levels of HDL, which used to be referred to as good cholesterol.
So good metabolic health, but they also had dramatically elevated LDL cholesterol levels, on average 253 mg per deciliter, when traditionally a “normal” range is around 100 to 130. So what are the results of this study, which used state of the art imaging to look directly at participants’ hearts? Well, the degree of LDL elevation did not predict coronary artery disease. Let me say that a different way. There was no correlation between either baseline plaque in the arteries or progression during the 1 year period of the trial, with either LDL cholesterol or the related measure ApoB, which I and many cardiologists believe is a more useful marker. These data build on previous findings showing that people with high LDL on a keto diet had no more plaque on average, than those with normal LDL who weren’t on a keto diet, and neither group was LDL, a reliable marker of atherosclerosis. Now these findings challenge the widespread belief that high LDL cholesterol, no matter the context, automatically equates to heart disease risk. While more research is needed, this opens the door to a more nuanced conversation between patients and their doctors.
If LDL cholesterol levels were not associated with the progression of coronary artery disease in this population, we can ask what was, right? Well, the existence of plaque in the arteries, which is to say those who had clean arteries at the start of the study, did not see much progression, regardless of LDL levels. But those who did have plaque, well, they saw more progression over a period of 1 year, but it was not associated with their LDL cholesterol levels. So according to this emerging research, if you already have plaque, a keto diet is not more likely to lead to progression than other diets but, no matter what diet you’re following, if you have plaque, it may mean you want a different treatment course than someone with clean arteries without plaque, right? Like that makes sense and is reflected by this research. While there’s still much to learn, this research offers hope for people for whom a ketogenic diet has been life-saving, but whose LDL rises. A next step would be to consider direct heart imaging, like a coronary calcium score or CTA, tests that offer a more reliable picture of heart health than LDL. It doesn’t mean ignore everything, but this is a way to look directly for disease rather than relying on a marker that this research suggests is not reliable.
So in closing, if a low-carb or ketogenic diet has changed your life, but you’re afraid your high LDL as you prime for a heart attack, this new research should give you some confidence that maybe that’s not true. Consider working with your doctor for a more personalized approach and discuss the option of more direct measurements like a calcium score or a CT angiogram, the tests that look directly at your arteries. You can find more information on these tests in the description, but of course, none of this is medical advice. Everything needs to be personalized to you, and you need to work with your physician and your health care team to find the right approach. And lastly, I mean, I highly encourage you to read the research and watch interviews with the studies investigators on Metabolic Mind’s YouTube channel. If you’d like to follow along as the science unfolds and be alerted to screenings of the The Cholesterol Code, which is a documentary film, all about the study and about the people around the world using keto to reverse disease, who kind of inspired this research. To learn more about it, you can sign up at cholesterolcodemovie.com, and we’ll keep you informed of screenings and streaming release later this year.
