Total Cholesterol & LDL-C on a Ketogenic Diet.



Dr Nally dispels the myths about LDL-C and Total cholesterol and discusses in great detail why using these markers is not effective in assessing heart disease risk on a ketogenic diet.

Research in the last 10 years points to the small-dense LDL particle as the atherogenic component of cholesterol (Hoogeveen RC et al., Arterioscler Thoromb Vasc Biol, 2014 May; Ivanova EA et al., Oxidative Med Cell Longevity, 2017 Apr). Studies in the last five years have identified that elevated small-dense LDL cholesterol correlates much more closely with risk for inflammation, heart disease and vascular disease (Williams PT, et al. Atherosclerosis. 2014 April; 233(2): 713-720.)
Recent research in the last three years demonstrates that small dense LDL cholesterol is a better marker for prediction of cardiovascular disease than total LDL-C (Hoogeveen RC et al., Arterioscler Thromb Vasc Biol. May 2014, 34(5): 1069-1077l; Ivanova EA et al., Oxidative Med Cell Longev. 2017).
Additionally, higher LDL-C is actually predictive of longer life and has been demonstrated to correlate with longevity (Ravnskov U et al., BMJ Open, 2016 Jun 12;6(6): e010401).
And, a low LDL-C actually increases risk of early mortality (Schwartz I et al., Lancet 2001, 358: 351-55).
It is commonly understood that LDL-C will rise with increased saturated fat intake on a ketogenic diet. This has been know and reported in the scientific literature for over twenty years. This is to be expected, because LDL-C is really a measurement of three different LDL sub-particles (“big fluffy, medium, and small dense”). Increased saturated fat intake, while at the same time lowering carbohydrate intake, actually causes a shift in these low density particles to a bigger “fluffier” particle conformation (Griffin BA et al., Clin Sci (Lond), 1999 Sep).
The 2015 British Medical Journal, referenced above, analyzed the relevant 19 peer reviewed medical articles that included over 68,000 participants. This review showed that there is no association of high LDL-C with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart or vascular disease). I realize that, in stark opposition to the landmark review above, The American Heart Association’s Presidential Advisory published their position in the June 20, 2017 issue of Circulation. They stated that saturated fat is the cause of increased LDL-C and they further extrapolated that elevated LDL-C is associated with an increase in death by cardiovascular disease. This boldfaced claim is only based on one single small four year (2009-2013) literature review completed by the World Health Organization with a total of only 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement (Mensink RP, Geneva: WHO Library Cataloguing-in-Publication Data, 2016).
Based upon the most current scientfic evidence above and my clinical experience, the large body of evidence above demonstrates the use of total cholesterol and LDL-C to determine vascular disease risk to be ineffective tools. A low carbohydrate/ketogenic diet lowers small dense LDL cholesterol, triglycerides and blood sugar and in many cases, the use of cholesterol drug (STATIN) therapy is not needed and ineffective in comparison with a ketogenic/carbohydrate restricted lifestyle.

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10 thoughts on “Total Cholesterol & LDL-C on a Ketogenic Diet.

  1. Replay. I watched this a month or two ago and really like the information. Thank you. I was finally able to get a particle size test done. Lipo (a) less then 10. LDL pattern is “A”. 5 1/2 month keto. So I guess headed in right direction. My HDL is low and large partial HDL is 3512. Any thoughts? Appreciate all you are doing! Oh by the way have lost 62 lbs and no longer prediabetic

  2. This is a great educational video about cholesterol. Thank you for taking the time to make and share this with us. Learning about how well a keto diet works in relation to our blood vessel health and SEEING the results of that 2 year study is something I'll never forget. I've shared your video on facebook and with friends as I think what you've shared is so valuable. Thanks again!

  3. I have been strict keto for 14 mos. all markers are better….except LDLp over 2500. Hdl 34 trig 94. 5.0 A1C. Does fasting reduce LDL-P?

  4. My Kaiser doctor won't give me a LDL particle number test, or an NMR test. Should I go through a lab outside of Kaiser and will I understand how to read it?

  5. Dr. Nally, I just watched your video with Dr. Ken Berry and found it very impressive. As you have worked with mostly seniors having heart disease, I am hoping you might be able to help me with a question. My husband who was thought to be so healthy by his primary based only on his lipids of a constant for the past 15 years, Total Chol 177, HDL 43, LDL 116 and A1c of 5.1 said he was the pillar of health. He followed a SAD his whole life. I had a CAC and asked him to have one. His score was 1538. Met with a local strict AHA doc who did a carotid ultrasound and stress test. He passed his stress test but had mild blockage in his carotids. She gave him a script for Lipitor 80mg. My question is, I read pudmed studies showing that statins cause a doubling of calcium after one year of statin use. I see that the recommendations with AHA, are for statin use with a score this high. I have him now on a keto diet and really don't want to start the statin therapy. What are your thoughts? I don't want to give him the wrong advice. Thank you for your time in reading this and by the way, I love Surprise! I almost bought a home there years ago. My daughter lives in Mesa.

  6. REPLAY-dr.nally I just had my a1c checked and in 3 months my a1c went from 11,0 to 6.4 on the keto diet. my question is even though my a1c has gone down my fasting sugar is still sometimes high like 177 is this normal ????

  7. Very interesting, thank you. I do have a question. I have been on Keto for about a year, all my numbers are getting better, but the slowest is HDL. When I started I was at a horrible level of 24, currently, I am at 31. So it is better, but going up very slowly. In fact three months ago it was 32 so it went down one point. Is this normal for it to go up so slowly, and is it normal for it to go up or down in any given few months period?

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