Healthy Cholesterol
The Breakdown – Are Your Levels Really High?
Interpreting cholesterol numbers can be fairly complicated.
Most people are familiar with Total, HDL and LDL cholesterol.
People with high HDL (the “good”) have a low risk of heart disease, while people with high LDL (the “bad”) have an increased risk.
But the true picture is much more complicated than “good” or “bad” … the “bad” LDL actually has subtypes, primarily based on the size of the particles.
People who have mostly small LDL particles have a high risk of heart disease, while those with mostly large particles have a low risk (4, 5).
However, science is now showing that the most important marker of all is the LDL particle number (LDL-p), which measures how many LDL particles are floating around in your bloodstream (6).
This number is different from LDL concentration (LDL-c), which measures how much cholesterol your LDL particles are carrying around. This is what is most commonly measured on standard blood tests.
It is important to get these things tested properly in order to know if you truly have anything to be concerned about.
If you can, have your doctor measure your LDL-p (LDL particle number)… or ApoB, which is another way of measuring LDL particle number.
If your LDL cholesterol is high, but your LDL particle number is normal (called discordance), then you probably have nothing to worry about (7).
On a low-carb diet, HDL tends to go up and triglycerides down, while Total and LDL cholesterol tend to stay the same. LDL particle size tends to increase and LDL particle number tends to go down. All good things (8, 9).
But again… this is what happens on average.
Within those averages, it appears that a subset of people on a low-carb ketogenic diet DO get a rise in Total cholesterol, LDL cholesterol and LDL particle number.
This phenomenon is described in detail here by Dr. Thomas Dayspring, one of the world’s most respected lipidologists (hat tip to Dr. Axel Sigurdsson):
Lipidaholics Anonymous Case 291: Can losing weight worsen lipids?
If you want to dig into the science behind this paradoxical rise in cholesterol on a ketogenic diet, then read that article (you need to sign up with a free account).
Unfortunately, not everyone can have advanced markers like LDL-p or ApoB measured, because these tests are expensive and not available in all countries.
In these cases, Non-HDL cholesterol (Total Cholesterol – HDL) is a fairly accurate marker that can be measured on a standard lipid panel (10, 11).
If your Non-HDL is elevated, then that is reason enough to take measures to try to get it down.
Bottom Line: A subset of individuals do experience increased cholesterol on a low-carb diet, especially if it is ketogenic and ultra high fat. This includes elevated LDL, Non-HDL and important markers like LDL particle number.
Check out the original source here: