Low-carb LDL hyper-responders - New evidence - Diet Doctor Podcast

[@claybutler]

I'm a lean mass hyper-hyper responder. When I was a higher carb lacto-ovo vegetarian eating 8 to 10 eggs a day, I had LDL 77, HDL 94, TG 55. As soon as I made the slightest move towards low carb my LDL took off - 116, 175, 225, 275, 310. Eventually my LDL got to 678 when I was doing near carnivore two meals a day. But my HDL also took off and has been averaging between 125 and 146 for about four years. And the triglycerides range from 45 to 65. LDL particle distribution is A+. Very low small particle count, and a very robust LDL peak size between 226.9 and 229.9. This phenotype is very real. And if you don't want the high LDL all you have to do is add some carbohydrates and it comes right back down. Sometimes very significantly for only adding 50 to 100 g of carbohydrates.

[@Giovan_Nino]

Thanks that’s most enlightening..

[@carmenross1077]

Wow amazing

[@Seanonyoutube]

I have T2D and noticing my HDL rising on lowish carb (80g/day). my A1C came down from 14.2 to 5.4 in four months though. If I eat more carbs my a1c will probably creep back up a little (and won’t be great for my fatty liver either). So, now i’m forced to decide if I should increase carbs to lower my LDL (currently 199) and risk H1C going up, or sticking to low carb and ignoring the LDL…seems like everyone has a different opinion…

[@Lamz..]

@@Seanonyoutube Looks like your other comment (and our convo) has been strategically deleted. One wonders ...

[@Seanonyoutube]

@@Lamz.. I deleted it because I changed my mind and felt kinda dumb. There still is some value in discussing these kinds of studies even if the data quality is poor as long as we don’t overdraw conclusions.

[@helenf1439]

I'm hoping that we'll eventually confirm that the LMHR is healthy status and normal! I'm over 60 and fit this profile eventhough I'm not as active as I should be. Of course I've ignored my docs and refused meds all my life. Thank you for researching this!

[@maryisitor276]

My BMI is about 30 and my LDL greatly increased after I started low carb/ketogenic diet. I went on the diet to reduce my weight to reduce my blood pressure.

[@TheHoth1]

@@maryisitor276 hope it has worked out for you. I went LCHF and exercised as often as I could. Typical result with elevated HDL and LDL level and a huge drop of Triglycerides number. Blood pressure went down. My BP is no longer considered as hypertension :)

[@paulpladin9590]

I wish more people understood that "Abundance of caution" is not cautious or even admirable. It has long been the realm of unintended (but well meaning) consequences. There is no reason (other than politics) to constantly stress that high LDL is a generic risk factor in and of itself. It could just as easily be a proxy for some other risk and lowering it specifically could well be a vain aspiration. "When a measure becomes a target, it ceases to be a good measure". Why do we allow speculative "Cautions" to be grandfathered in without a matching demand for evidence that matches the claims made. As far as I know, no one has proved a high LDL as being causative of anything.

[@alan2a1l]

This! The calcium score (CAC) is an actual look at arterial calcification, yet my own doc chose to put his trust in the indirect marker, LDL, which depends, for its validation, on predictions which fly in the face of NHANES and other data that show a protective effect of LDL. The conflict of interest of the pharmaceutical industry and its influence on treatment options should, at the very least, provoke a second look at the value of LDL by itself as a danger signal. The”abundance of caution”, to me, is irresponsibility, now that we can see significant evidence that the LDL “marker” is so dietarily malleable, at the cost of a potato a day. And who is to say that the potato-adjusted patient is healthier than he or she was before, in ketosis? I’m really looking forward to the follow-on study. Bravo to Dave & Co for unsettling the “settled science”!

[@Malcolm-Achtman]

My intuitive guess is that if a lean mass hyper-responder were to take statin medications to lower their LDL, that would spell trouble. I think the LDL in these people is rising for a purpose that the body recognizes as useful. The body is pretty smart. Drugs, on the other hand, are dumb. As a hyper-responder myself, I would not take a statin to lower my cholesterol. I might play around with my diet and bring the LDL down by eating less saturated fat and phasing in a few more healthy carbs, but that's about it.

[@faiosung]

my bmi is 20, and my ldl and hdl went up, my ratio gone better in last 12 months but my doc has now prescribed statins. i agree this may be harmful as body elevates for reason on keto

[@songforguy1]

Yes I agree Malcolm, having the ApoE 4 Gene would be the only concern that I know of.

[@patrickdezenzio4988]

The key though is activity. What if you are a hyper-responder but don't exercise? Could exercise reverse my higher LDL? Or would it make it even worse?

[@Malcolm-Achtman]

@@patrickdezenzio4988 I don't think exercise would affect LDL that much. I think moderate exercise is useful for people no matter what their LDL is. I have heard that doing a heavier amount of exercise could raise HDL. But you would have to do a lot to raise it "somewhat." Remember, before worrying about high LDL, be sure to get an advanced lipoprotein test to see what your LDL particle levels are. Do you have a high number of LDL particles? What is your small LDL particle number, which is the more important value to pay attention to.

[@saltygirl764]

Hi. Could you please help me with some thoughts about having that dense lol test done and it turns out really high? I'm so confused and trying to be healthy and feel better on less carbs but Dr is very concerned. It's not fun.

[@tralalabonbon8294]

This is by far most powerful discussion on LMHR yet. Dr. Tro's part is perfect conclusion to this topic. Thank you Diet Doctor

[@KenJackson_US]

I wish more doctors would order blood tests that differentiate small dense and large buoyant LDL.

[@deirdreniemann4044]

There is also Very Low Density Lipo Proteins I think these are the large buyant - they were saying these were the killer tho - so careful here

[@TheHoth1]

Well, how would they prescribe statin if they did that;)

[@DavidBrown-bp4iq]

Ken Jackson. Right. It's kind of incredible that such testing isn't considered an automatic part of testing LDL levels.

[@ozysjahputera7669]

You can request it, NMR Lipoprofile. My doc recommended statin. I took it for 7 weeks and started having side effects (bleeding gum, falling hair, low energy). I stopped it and the side effects are going away after 2-3 weeks. My doc suggested to try a different statin or class of statin. But I insisted that we check my LDL composition using the NMR Lipoprotein. He agreed. Btw, my total cholesterol is 206, good HDL at 60, good TG at 68, VLDL is 12, and the only thing off is the LDL at 133.

[@KenJackson_US]

@@ozysjahputera7669: _"You can request it, NMR Lipoprofile."_ Yes, I almost did that. But my insurance wouldn't pay for it and I didn't want it bad enough to pay for it. I was on a statin a number of years ago. It wasn't until I stopped it (because I lost my job and couldn't afford to refill it) that I realized it was the cause of my brain fog. Now I just flat out refuse to take it. Your TG:HDL is well below 2. Very Healthy. Congrats!

[@keywestfan2503]

Don’t understand why this is so perplexing. When you are BURNING FAT, you need these lipoproteins as transporters of the fatty acids/triglycerides which are being used for fuel. Inversely, carb fueling lowers lipoprotein levels because you don’t need fatty acid transport since you’re burning sugar! Triglycerides go down because you’re burning fat. HDL goes up as your LDL empties its triglyceride cargo and converts to HDL. Eezy peezy

[@KH-jf8ps]

smart ass!

[@kovyfra5987]

But why would this only happen for lean people ?

[@keywestfan2503]

@@kovyfra5987 It happens to practically everybody that has low carb/carnivore. What he is emphasizing is the dichotomy that exist between people that are athletically fit looking and in great shape but have what most people would consider dangerously high cholesterol. The point being, how can people be muscular and lean and athletic but have these high cholesterol levels? With the notion being that this is a proxy marker for heart disease. What he is emphasizing is that within this context, it isn’t a marker for heart disease but just a normal physiological response to the energy being utilized

[@anabeatrizmachadosobrinho6552]

Absolutely fantastic episode! To me, being a LMHR myself, I learnt A BUNCH! Thanks to all the participants! Really amazing!! 👏🏻👏🏻👏🏻👏🏻

[@ElizabethMillerTX]

I am part of the LMHR phenotype. You might as follow and study us, because, given how we feel - (and you should see what this group looks like - WOW!) - very few of us are giving up this lifestyle. I eat a primarily animal-based whole foods diet high in saturated fat because I have a connective tissue disease (Hypermobile Ehlers Danlos), and (all secondary to the EDS, probably) autoimmune issues, dysautonomia/POTS, GI issues, and a sleep seizure disorder. TLDR: This WOE, and getting metabolically well/flexible, works. I'm much improved, in so many ways. Yes, also my HDL is high, my trigs super low, and my LDL has skyrocketed above 200. No telling what it is, now. Whatever. I'm not putting my LDL# above being able to function on a daily basis. I shall not eat seed oils, again. Nor shall I give up saturated animal fat. Or animal protien. I still generally eat about 20% or more of my calories from carbs, much of it from fruit and honey. I'm unlikely to ever eat a lot of fiber or oxalates, again. I shan't take statins, absent a change in circumstances. This way of eating, and being metabolically well, is working too well for me and helping me too much, to give it up, regardless of what this diet means for my cvd risk. So y'all might as well watch me and see what happens.

[@kpirron7635]

Maybe you should be interviewed or have your own YT or blog site so that you can share your experience in greater detail.

[@nancy9478]

There is a young adult in my neighbirhood with E-D, pots, lotsa stuff. I suggested low carb, plenty of meat and fat. She said she has texture issues. I don't doubt that (my daughter has pots and texture issues with meat too) but I also know her for years, and she loves breads,sweets etc. I can at least make meats my daughter can eat and she butters lotsa stuff. Her pots is getting better. I am glad you are too. Just wish the other kid was.

[@albertarancher7780]

Smart.. good.for you.. eventually the Docs will cat h on and realize that LDL is not only not BAD , ..but very necessary.. Check research that Dr Berry and Dr Bikman point out..

[@TheHoth1]

I am close to LMHR. My LDL is not yet 200. Only 180. My triglycerides and HDL are super high:) My PCP is frustrated but I am happy as a clam ;) I live to see my PCP’s face of frustration and disbelief once a year. I feel great. That’s what it counts 😆;)

[@ElizabethMillerTX]

@@nancy9478 Yeah, the EDS/POTS/MCAS GI issues are aplenty, as our inside skin is at least as mushy, flimsy, and wonky as the outer skin. Eating the meat and fat helps me with that, too. My inner/outer skin integrity, Gi, digestion, etc are all better. Haven't puked in weeks, now that I think about it. Pretty sure that's some kind of pots/eds record. Lol. Please wish her well for me.

[@carriersailor2474]

I just had my annual VA physical as a 64 y/o who went Keto in good shape purely out of wanting very good elderly health, and transitioned to Carnivore after many months of Keto. In this physical, even tho my LDL was close to 300, my VA Doctor did not insist on Statins. He might have, but I was firm about not taking them. Weirdly, my blood glucose (GLU on the lab report) was high - only a few points from the highest normal range number. And I take only few walnuts and macadamias and pistachios, with cheese, with butter coffee to start the eating. Those few nuts, some goat milk in the butter coffee, are the only exception to butter and eggs! Over a stick of butter and sixteen eggs. The yolks raw, the whites lightly cooked. One day a week some medium rare or rare meat, with the fat. Two days a week fasting. So - how, how do I have this high level of blood sugar level? The A1C also was high. He asked pre-diabetes questions with a smile, as I have zero "metabolic syndrome" problems. He had to ask due to the high A1C. This blood sugar issue really makes no sense to me.

[@aprilek6003]

Dr.Bret, Another great interview. I love how you ask the question "is there any evidence to refute the current dogma about LDL" This new observation is so interesting and I hope that we will see more folks becoming interested enough to look deeper. I hope you can convince Dr. Malcolm Kendrick to come on the show to talk about his book "The clot thickens"

[@Malcolm-Achtman]

Two questions: 1. If LDL is supposedly so strongly linked to heart disease, why is it never used in the "risk" calculators and why do cardiologists like Dr. William Davis say LDL is virtually the worst predictive marker for heart disease?

[@claybutler]

Because you can calculate LDL was long as you have total cholesterol, TG and HDL. And it's also not weighted that heavily as well.

[@johnutube5651]

Three years ago I started low carb diet to manage pre-diabetes when my BMI was around twenty three. While my goal of lowering HBA1C and fasting glucose was achieved, when I got lab results after six months, my LDL number was in five hundreds. Doctor warned me, however I was aware that this is what going to happen. Pretty much I followed the same diet, probably added five to ten grams more of carbs to my diet which makes it less than thirty grams of carbs perday. Also I started easing on saturated fat stuff like beef, cheese, butter and substituted with avocado, chicken, fish and oilive oil. Saturated fats were not completly omitted, quantity was reduced. I have a feeling that it is the beef that spikes LDL. Somehow I trust eggs, though that too is taken in moderation as I do not have any evidence. Next blood test after six months the lab numbers especially of LDL came back to normal. Ever since I do not have problem with lab results. However I should say that saturated fats are more satiating. Certain days I am struggling with satieity.

[@iss8504]

Dr Scher had said in the past that subbing in non animal fat for sat fat would lower ldl. Thing is, this increases your linoleic acid and that is known to oxidize readily in your body and cause arteriosclerosis. So really, we don't know what to do. The ldl studies are based on mixed diets and people eating a lot of carbs. They had high triglycerides. It is quite logical to say these studies are the best we have but to extrapolate them to lchf diets is a huge stretch of the data and technically is not the proper application of the studies.

[@coffeemachtspass]

I’m not a lipidologist or an anthropologist, I just play one on the internet. Humans ate red meat nearly exclusively for 350,000 years (stable isotope analysis) up until the agricultural revolution of 8-10,000 years ago, in all places and at all ages. I suspect that red meat is satiating to you because it is proper human food. My own view is that our bodies are not stupid; they know what to do with proper human food and what levels to keep lipids at for optimal health.

[@MarmaladeINFP]

I was speculating about saturated fat. It could be that the hyper-responders are hyper-responding to the saturated fat, whether or not it has anything to do with the context of a low-carb diet. It might simply be that many people increase saturated fat with butter, coconut oil, etc when going low-carb. But it might not really be saturated fats either. Some studies show that the negative effects attributed to saturated fats are actually mediated by omega-3 deficiency. That is because omega-3s are needed for the utilization of saturated fats. Most on LCHF diets are probably increasing saturated fats without increasing omega-3s. And many of these people already were deficient in omega-3s. The greater amounts of saturated fats might be exacerbating that deficiency. This might dovetail into the evolutionary discussion. Dairy is a relatively new introduction to the human diet, and dairy has much higher amounts of saturated fat than any other animal food. And, in addition, the fatty acid profile of factory-farmed cows would be a bit different from pasture-raised, presumably with less omega-3s. The ruminant meat humans ate for hundreds of thousands of years is different than the animal foods we get today. How different and how significant, I don't know. This would be easy to test by looking at the biomarkers of hunter-gatherers and pastoralists on low-carb diets: Masai, Hadza, Piraha, Inuit, etc. Are they hyper-responders? If so, that would be important info since they have low rates of cardiovascular disease.

[@lynnwilliams5432]

I’ll eat the saturated for you see how it goes in the next 20 years

[@MarmaladeINFP]

@@lynnwilliams5432 - I also eat a lot of saturated fat. But I also get plenty of omega-3s in my diet as well, along with oleic acid from pork and a myriad of other important fats like the inflammatory-modulating omega-6 arachidonic acid that also comes from animal foods. I figure the body knows what to do with a diet that is similar to what humans evolved eating.

[@jjohnnyc]

All I know is I’m 69, in good shape exercising 3x a week at the gym, and 20-30 min (Canadian Airforce Exercises) on off days at home, I’m not overweight, normal BMI, I subscribe to a low carb/keto ore lifestyle (1 & 1/2 years ketogenic), and my 1st wellness visit in 2 years delivered a high LDL reading.

[@seesharp81321]

I think most doctors need to be a heck of a lot more humble than they are right now. What I see is that most treatment, especially for the so called chronic diseases, is merely treating symptoms and not the root cause. This is probably because it's not all so cut and clear as they like to present it. It sure makes their life a lot easier, but it hardly helps us. I stopped taking medication just to get the right number in lab test result. Until doctors start being doctors again instead of being an overpaid drug pusher I'm sticking to my protocol. I do have respect for guys like doctor Tro working with the patient searching for the best possible outcome. That takes effort and energy.

[@iss8504]

If the guidelines say x, you have to do x . Not all doctors like this. One thing they complain about is insurance companies and the b school people running medical practices now. My mother calls them the 15 minute doctors because you get 15 minutes only before running out the door. My father was a doctor, self employed and he would spend as much time as needed. But he's old school and gone. These young doctors with $250k of debt have to make money, and are pretty much forced into these hospitals or clinics. It's not easy for them. Nobody goes to medical school wanting to be a drug dealer. They all wanted to solve problems.

[@MarmaladeINFP]

Most doctors now work for other people in hospitals and clinics. Independent doctors running their own practices have become rare. And even those independent doctors have to follow the rules of insurance companies, Medicare, etc. And if they don't follow conventional practice, they open themselves up to liability or having their license revoked. Most doctors don't want to go through the experience of Tim Noakes, Gary Fettke, etc.

[@seesharp81321]

@@MarmaladeINFP All I hear is excuses also from the other response I get. Doctors have an obligation to their patient and if they can't do that then they shouldn't be a doctor in the first place. I do recognize that it's not an easy situation they are in. When I get into discussion with people who come with the arguments you give I often ask them to ask their doctor, if they're on medication, how the medicine interacts with your body and what the possible consequences are. Most doctors don't know how to answer that question. I understand that. It's complicated stuff and there's a lot of medicine they subscribe. That being said, is it ethical to subscribe people a poison which you don't understand yourself? A lot of people trust their doctor without a doubt and yet medicine use is becoming an important death risk. I know most doctors are trying to do the best for their patients, but shouldn't they do the right thing instead? If doctors don't start to stand up against the authorities that try to control them nothing will be left to defend in the near future.

[@MarmaladeINFP]

It could be argued that we all have moral responsibility to do what is best for everyone involved. It's not limited to doctors. Yet few people act with moral courage beyond their self-interest, group identity, peer pressure, social expectations, fear of repercussions, incentive systems, etc. It sucks, but it's sadly common. Few people want to question authority, challenge hierarchies, and stand up for the disadvantaged. That is because such actions often leads to harsh consequences, even the ending of careers, or at the very least conflict, stress, and unhappiness.

[@perrysebastian6928]

This is good and necessary research. I worry about ending up on a hospital ward and having a bunch of carbs or satins pumped into me based on bad medical practices. In theory, standard practice should not kill me, but it certainly will not aid in any recovery

[@AmericanRefugee212]

Its amazing how when i ate standard with mcdonalds and pizza thrown in i had “good readings”. Went VLC high fat carnivore dropped all the junk and my readings of LDL went through the roof! Great video and awesome that people are looking into this. Ive subsequently added sweet potato and more fruits.

[@jreynolds3208]

Did adding carbs help lower your LDL?

[@lydiaahrens7156]

Two years ago my LDL 132 , HDL 83 and Try . 45 . After starting a low carb diet my LDL 201, HDL 145 and Try .50 My Dr wanted me to take a statin but I refused . I have starting to eat a little more carbs while watching very close my glucose levels . I hope that by reducing my time window of eating during the week to 6 hours , will help me to keep insulin levels low . I am 59 and thin like never before . I have a lot to learn and grateful to came across Dave Feldman work . I need to go back in 6 months to report my progress in lowering my LDL Levels, we should see……..

[@saltygirl764]

Hi. How was your latest check up if you don't mind me asking? Thank you.

[@lydiaahrens7156]

@@saltygirl764 Hello there , I have increased my protein intake keeping carbs low , I eat berries and sweet potato two or 3 a week with diner I still look slim but have more muscle on me I feel very comfortable I don’t work out I go for walks or hikes do sauna twice a week , I work 3 days a week cleaning and do volunteer work. My lipid panel on 1/19/24 is : LDL 195 HDL 108 Tryg. 70 Not planning on taking a statin . Thanks for asking ☺️

[@alchemy1]

42:00 into the video. Wrong. I am one of them people who was not lean. I am 5'7". 65 years old. Before Keto my weight 210 lbs. My LDL was 130. HDL was 40. TG was 240. 4 months after Keto. Weight 174 lbs. LDL 230. HDL 60. TG 57. I am still losing weight. I can expect to be less than 160 before the end of the year which suits me just fine. Lean before or after the diet? As far as I am concerned I am a hyper responder but not lean mass added to it. When I looked at my triglyceride value, I basically felt they goofed up with their lab result.

[@MarmaladeINFP]

This keeps coming up. Right now, I'm in the middle of a debate with someone who is critical of LCHF diets. His reasoning is that, when he was on a keto diet, his LDL went up. And conventional healthcare, of course, asserts that is a risk factor for cardiovascular disease. Yet we still have zero evidence of any causal link for low-carb LDL hyper-responders. We have proven that such people exist, but we have no clue about what it might or might not mean. As far as that goes, we don't even fully know what overall LDL, as opposed to more specific LDL biomarkers (e.g., particle size), signifies for anyone on any diet. A key confounder is brought up around the 18:00 minute mark. Most people go on low-carb diets precisely because they are overweight and seeking to lose weight or otherwise dealing with some aspect of metabolic syndrome like insulin resistance, type II diabetes, non-alcoholic fatty liver, etc. After all, 88% of Americans are metabolically unfit, many of them lean. So, we furthermore have next to no scientific research about healthy people on low-carb diets, not people who regained their health on a low-carb diet but who were never unhealthy in the first place and had no sign of developing metabolic syndrome. We need to focus in on the lean hyper-responders. What is their health history, demographics, etc? I lost weight on the paleo diet and it wasn't particularly low-carb, at least not during the period when I lost the weight. But, as should be noted, this was following decades of an unhealthy standard American diet. I might have had insulin resistance and pre-diabetes for many years. It was only after losing weight and returning to a lean state that I took up very low-carb diets, from keto-paleo to keto-carnivore. My being lean when I started a ketogenic LCHF was not indicative of long-term metabolic health. Another confounding factor is that many Americans and other Westerners are multiple generations into a high-carb diet and metabolic syndrome. A few years on a very low-carb diet might not be able to reverse years or decades of metabolic harm, on top of generations of inherited epigenetic changes. To control for both genetics and epigenetics, it might be needed to use subjects from traditional communities on very low-carb diets, maybe including those on calorie restriction that is effectively very low-carb. There are some hunter-gatherers who eat a LCHF diet with some arterial calcification but without higher rates of cardiovascular disease, as apparently something in their diet or lifestyle is protective.

[@jamesdellaneve9005]

This hyperresponder type is basically unknown by the general medical community. As a result, the traditional markers assume that everyone is similar except for those with HFC, which is acknowledged. Therefore, those traditional marker values are misleading for LMHRs.

[@MarmaladeINFP]

I have an additional thought. What if the hyper-responders are not hyper-responding to the low carb levels so much as the increase of fat levels. Or rather what if the component is the amount of which kinds of fats and maybe in what ratio. It could be similar to how there is a healthy balance between omega-3s and omega-6s. More importantly, the PUFAS also play a mediating role in the utilization of saturated fats. Much of the blame that gets put on saturated fats, according to certain studies, seems to instead be caused by specific PUFA deficiencies. Our body can only use saturated fats well in concert with PUFAs, and those PUFAS themselves need to be in balance. On many very low-carb diets, specifically dirty keto, there is typically an increase of saturated fats and an increase of omega-6s but not a corresponding increase of omega-3s. The PUFAs being out of balance might be throwing the saturated fats into problematic territory. One could solve this problem by decreasing saturated fat, but maybe it could just as well or better be treated with rebalancing the PUFAs with sufficient omega-3s. The point is that maybe this has nothing to do with a low-carb diet itself, other than it's common for people to raise fat intake commensurate with carb reduction. Would we see similar hyper-responders on any diet that had a similar increase of similar amounts and/or similar ratios of particular fatty acids? I assume this has never been tested.

[@jamesdellaneve9005]

@@MarmaladeINFP yes. Multiple variables immediately make you think about confounders. I would break your ideas into separate hypotheses and then design trial to test each variable.

[@Malcolm-Achtman]

I think Dr. Bret Scher did a fantastic job hosting this interview.

[@az10sbum1]

I agree! I'm always impressed with how Bret interviews his guests. Diet Doctor made a great choice when they picked Bret

[@victoriakoski7606]

Agreed, and always. This paper could (better, SHOULD) change the way GPs throw around statins. Any advice on how i can get mine to read it? Do I just go into "MyChart" and post a link? Do I try to email her? It's been 2 years of "Concerning" LDL numbers since my weight loss and right in there they acknowledge the WHY as being my low carb lifestyle. That said, I still get the push for meds.

[@joyceelmer131]

He always does. He’s a great interviewer

[@lloydhlavac6807]

I fit in the LMHR group, as my LDL is over 300, but it's nearly all large pattern A, and my HDL is also high, in the 80s, and my triglycerides are only 66, along with VLDL of 6. Fasting glucose is normal, and my Insulin Resistance score is low at

[@dondajulah4168]

Where is the evidence that we should even be concerned about LDL scores as a casual factor in CVD or any other poor health outcomes? Distinguishing between causation and correlation should have been understood by freshman year undergrad, if not before then.

[@dondajulah4168]

Diet doctor and others in the keto world should be focusing more on AGE’s and how to combat the effects of them in a low carb framework. I believe that more study will reveal this to be “the missing link” that causes low carb not to demolish alternative dietary patterns in long term outcomes. Proper food preparation and the right vegetables and supplements might be all it takes for a diet high in saturated fats to do better than “no harm” when competing against other diets

[@OttoNommik]

That “insulin resistance” score (HomaIR) is NOT LOW if it’s around 24/25. Ideally, it should be 1, but under 10 is acceptable.

[@lloydhlavac6807]

@@OttoNommik My test result doesn't give an exact number.

[@saltygirl764]

Hi Lloyd. How is your lol particles now, any changes? How is your dr about it? Thank you for any info!

[@bettywhill]

I am also a LMHR. I am more interested to finding out how high LDL affect my overall health. Is it positive or negative? Prior to LCHF diet, my cholesterol was quite normal (TC 221, TRI 55, HDL 95, LDL 112). After LCHF, my cholesterol skyrocketed to TC 375, TRI 78, HDL 106, LDL 250. The most recent result is TC 441, TRI 70, HDL 100, LDL 323. I am not going to take statin seeing what it did to my mom, but I also unsure if the high LDL is going to do damage to my body. My CAC score was zero. Probably will do another in a year or so to see what happens. Anxiously waiting for Dave Feldmen's study.

[@murraypooley9199]

I am 68 male BMI 24.8, zero carb diet, very high fat. 100% carnivour. Triglycerides 0.9, HDL 2.3, Tri / Hdl ratio 0.39. Sugar makes you fat, fat makes you slim. It never fails to amaze me how ignorant of health most doctors are, while so many non medical persons such as myself just gets on with supurbly healthy life.

[@susantroupe9341]

As a lmhr who started keto May 2021 dt prediabetes and extremely high carb diet for most of my 67 years, I’m finally able to ditch the desserts and unhealthy carbs. Now, more metabolically stable and feeling great, am I to believe that my body is too stupid to realize that my diet is much improved? I tend to think that there is a reason for every small detail in how our body works , that lifestyle change for the better should and does improve the inner workings that are quite complex and that we don’t necessarily understand yet. I have read that ldl has a positive impact on the immune system. The jury is still out.

[@robyn3349]

Thank you! I believe I am in the LMHR group, last LDL = 354. Quite a shock for my MD! Glad to have more information. I plan on some consulting this year, so far, all is good except the LDL.

[@robyn3349]

I tried a high dose statin, with zetia. LDL went down, but the adverse effects were intolerable. Perhaps I am an outlier on statin response, but I am now afraid to take them again.

[@biodivers5294]

I’ve also seen my triclycerides/HDL ratio improve even more then before after starting keto, while my LDL increased very much (just as my HDL did). I do have a BMI far under 25, so I proudly consider myself now as a hyper-responder 😉

[@MartinaTUDArt]

Good morning Roeland Please see the comment above about subprofiles for LDL and so on. Not all are bad. Especially the vLDL is needed to transport the fatty acids to the cells in your body. It's your fuel. In studies there is shown, that the damaging parts are the sLDL (small-dense LDL) in particular and that the level of triglycerides correspond (somehow) with the sLDL and is more relevant. It also happened that diabetologist just refer to HDL and Triglycerides respectively to that ratio.

[@biodivers5294]

@@MartinaTUDArt Thank you for your comment👍. I was aware of that, but it is good to highlight this kind of information!

[@vondabell7600]

Me too

[@jobrown8146]

I'm a *High Mass, Hyper Responder* I started eating low carb in Oct 2021 after a diagnosis of diabetes. My blood test 1 year later: TC 8.7, Tri 1.0, HDL 1.7, LDL 6.5 (USA 250). In one year I lost 20% of my body weight, but I'm still classed as overweight. I've recently had a CAC done which was zero.

[@jobrown8146]

And no, I am not going to take a statin, even though the cardiologist recommended a low dose.

[@patriciamedina8193]

I am a type 1 diabetic. No high cholesterol in my family. I am fairly lean. Adopted a lo carb diet as soon I was diagnosed at 40. I have other health issues, to many details to discuss here. But inflammation, high viral loads, sensitivities etc. to name a few. My diet, along with other modalities, is what keeps me feeling as best as I can. Yet my HDL cholesterol has gone very high since making these dietary changes. Of course, my endocrinologist's keep encouraging statins, I keep refusing. I have always made an educated guess that on becoming a type 1 my body responded well by providing the the portion of cholesterol it know my brain and body needs. My sense is that this response might be some sort of protective mechanism. My triglycerides and LDL are great! If you need people to study, I might be interested.

[@elizabetha2056]

This was so informative. Thank You so much. I love that Dr Tro really listens to his patients.

[@test_account3536]

Great talks and great summary! I have very close valuesto be LMHR and my physician wants to put me on a statin at 26 y.o. I am now playing around with my diet and checking my cholesterol levels regulary. All my ratios are perfect, which makes me less anxious. Looking forward for more insights from the study!

[@nancy9478]

Mine keeps going up but the calcium score is 0. If your body is running on fat, of course cholesterol will go up. Your calcium score is a better indicator. Dont let the doc nag you into statins.

[@TeflonBubba]

Bravo! 👏 Such a fantastic interview showcasing a long journey by a talented team to highlight a phenotype which may broaden our collective understanding of human metabolism! 🥳

[@icarapelicana]

I don't see a point in wanting to lower LDL in people who eat a clean diet when the actual problem is having damaged cholesterol from eating seed oils and processed food. To avoid calcification of arteries people can supplement magnesium IF they're still eating plants. But in a carnivore diet there shouldn't be any problem because cholesterol wouldn't oxidize. Why keep on taking those "risk" standards into account when those standards are taken from studies that don't differentiate between a clean carnivore diet and the rest. It doesn't make sense specially for people who only live well by following that WOE.

[@mariad.5440]

my LDL went from 66 to 153.. I'm lean and was lean before going ketovorous

[@nokrita]

I’m in this Lean Mass Hyper-Responder category. I’m a 47 years old woman. Height= 167cm. Weight=56kg. I just got my lab result. HBA1C= 4.7. Total Cholesterol 469. LDL=270. HDL=108.. Triglycerides=57. I’v never been overweight, but I hv been low carb since I was 11 years old. My cholesterol usually around 220, but, since 4 years ago, with more exercise, it was getting higher and higher and the triglycerides was getting lower. I just wonder if there are any datas in the past that Lean Mass Hyper-Responder (LMHS) had heart attack or stroke? The idea of adding more carb to lower the LDL make me afraid that the HBA1c will rise up. I hope by Feb 2022, Dave has the trial result about the LMHS group calcium scan.

[@kathya1956]

Have you had CT scan

[@margaritamartin9337]

@nokrita, my profile is almost identical to yours and I have the same questions. Any updates?

[@sms9106]

As one who falls in to the LMHR or very close (Keto, BMI 20.5) I find this very interesting and can confirm very similar results. The big question is that with the additional LDL is what do we do now? Do we now need to find a way to lower or just ignore as an unimportant factor? The traditional medical community is completely clueless on this groundbreaking revaluations. I might add we are not looking to justify our diet ~ but just want to know the right path, whatever way that might lead. Thank you for this research.

[@LadyBug1967]

Steve, I like your question and that is also my question. I saw on diet doctor a talk by Dr Fettke and one by Dr David Diamond & at the end they said that those people who live to be 100 have high LDL and that seems to be a predicative for long life and it has NO relationship to heart problems. I tend to think that and I'm trying to understand how eating keto with very high LDL might indicate that you would live to be 100 even if your family does not have that history. I don't know. MY family does have familial hypercholesterolemia-- because that is what the doctor put on my report --and my LDL is high while my HDL and my triglycerides were good and in good ratio & we live to be a hundred in my family easily on both sides. SO I have decided finally NOT to worry about LDL at all. I am NOT on the keto diet. I don't even think I'm a low-carb diet but I tend to be on a vegetarian diet and vegetables have a certain amount of carbs but I don't think as many as compared to people who eat the standard American diet which might be full of cake and bread and donuts and ice creams and other such things. I've been reading dr. Colin Campbell and dr. Caldwell Esselstyn and they both are pretty much vegans-- best I can tell. BUT I cheat constantly with butter on my bread and yogurt so I can get some fermented food into my body and they disallow that as well as olive oil because they're very opposed to fat. FROM what I gather from this talk is people on low-carb do eat fat and they don't consider it bad so I'm not going to worry about my butter and my yogurt. I cut my eggs down to one or two a week which is better than two a day which I had done for a while. I actually went on the doctor Campbell's diet-- with those exceptions I just noted-- NOT to deal with cholesterol and NOT even to deal with weight but to try to detox from the Pfizer vaccine which left a lot of Spike protein in my body and was causing me continual side effects that I had to deal with.🤪 I was interested to see within a few months I had lost 25 lb without trying so that was nice because in my youth I always was what they would probably call lean. I'm definitely still NOT lean and I am confused but I have decided that I think: LDL has absolutely NO relevance unless you want to live a long life and then the higher it is the the better. I still have second thoughts about people who are on keto diets and have cholesterol that goes sky-high cuz I think their HDL gets out of whack & the triglycerides also get out of whack which doesn't seem like that's a good thing. The two doctors I've been reading say that you might with keto have a short-term positive effect but it doesn't mean you're going to have a long or even a moderately long life because they feel it's unhealthy, extremely unhealthy actually. I see their point because when people talk about going back to eat how we did originally BEFORE we lived in big cities etc we definitely didn't have meat everyday because to kill an animal; cut it up; cook it; eat it --that could NOT happen every day. YOU might have a big kill every few weeks and then you could gorge and then it would be back to vegetables vegetables vegetables. THEN you would have another kill that you shared among the tribe and then you'd be back to vegetables vegetables vegetables. Of course when we began living in cities in an agricultural society, it would be probably more grains and things like this which I do think can cause a problem and living in cities is not the healthiest thing truly for our bodies-- as opposed to being hunter and gatherers. WHAT do you think?🤔

[@kathya1956]

Maybe we should think how a whole population has been has-lighted for so many years.

[@RC-tm8jo]

I think Dave answered part of your question at 52:50. He said if you were very low carb

[@iss8504]

Honestly, the fact that increases in carbs lowers ldl tells you that it's all related to energy source being tapped by the body. Our culture is so carb centric, all the testing parameter are based on mixed diet people. Lmhr are asking the question whether our carb centric view is correct, or the only perspective. I disagree with Dr. Weiss, who continues to show he is only concerned about the majority. If u fall into this group this is not some trivial matter. There is no sudden cliff either, this is a sliding scale of health. We can all learn from this. What i wonder is if u lose weight on low carb, eventually will your ldl rise?

[@anthonylawrence5842]

I'm a LMHR with some really interesting data. I'm age 70, 70kg 5'10." I've worked out HIIT and HIRT for 45 years. Keto diet last 5 years along with IF 18:6. I take a small supplement stack. I've got full blood panel, glycome and genetic data. My GlycanAge Test came back at a biological age of 32. If any of the scientists are interested in the data let me know.

[@kpirron7635]

Were you always that healthy? Or did your extreme good health begin when you converted to keto?

[@anthonylawrence5842]

@@kpirron7635 Always reasonably healthy but made some significant improvements in lean muscle mass, mental acuity and mood since keto. I think it is really important to define what type of keto diet you are using. There are many variations. I find for me it works best when combined with 18:6 Intermittent Fasting

[@lo656]

I am a LMHR low carb for hormone balance and autoimmune, I also have the apo little a and a 25% block cad score. I am so confused on whether this means I should not be on a low-carb diet. My Dr Also wants me on a statin. It's a very interesting study, and I look forward to more from these guys!

[@modelsupplies]

They did say to try adding a healthy carb before or after exercise-I think toward the end. They mentioned sweet potatoes 🍠 so that caught my attention as a carb lover 🥲 (of course, I need to lose weight=carb lover)

[@kathya1956]

How long have you been in low carb.

[@fawnburgess1441]

My labs reflect the LMHR after being low carb high fat for several months. My Total is 422; HDL is 89; LDL is 333 and my Triglycerides 92. My triglyceride/HDL ratio is 1. I am a 57 year old woman.

[@Phi1eap]

There are alternatives to statins: Berberine, Niacin+TMG, Amala, Green Tea, Ginger, Artichoke, Fenugreek, Holy Basil, Yarrow, Ground Flaxseed, Hawthorn fruit, Aged Garlic, Plant stanols, Probiotics and Fiber.

[@joanlogiudice2090]

Very cool to have this list. Thank you. Question: how did you come up with this list? Do you use these in place of statin? If so, can you refer me to how you came to this conclusion?

[@ralphking7969]

As a LMHR I have a high CT scan 190 and need to lower my LDL from 392. I want to confirm is the carbohydrate, ~50 - 100 grams the carbs in the potato or the volume of the potato? Regards,

[@deekana]

I think I fit within this type. I'm 5 feet 4" (162 cm) tall, weighing 46 kg. A bit muscular. I exercise at least a few hours everyday at an intermediate level for many years now. I used to be an Atkins but my Lipid went sky high, together with some other health problems. Not wanting to depend on drugs, I dug deeper and found the China Study by Campbell and was converted to a vegetarian. My LDL was quickly brought within a healthy range. My blood glucose was also fine. I remained a vegetarian for 8 years. However, this past year I suffered autoimmune diseases and herniated disk that won't get better. So I dug again and tried low carb. I was definitely not a Keto as I heard many caution about it. But I eat now meat, fish, eggs, whole milk, more nuts and pure cacao. After 1 month, my LDL went up to 235, from 135!!! My HDL improves a lot too though and my TG was reduced significantly. The TG/ HDL ratio is 0.6. My liver fat also is reduced. So I wasn't worried about it at first. But what confuses me is how come my blood glucose goes up to 90 even if I'm going low carb, exercise a lot, am lean, don't eat ultra-processed food or sugar and been practicising time-restricted feeding? As I dig deeper, I heard many concerns about high LDL, that it should be controlled and that many lean mass respectable biohackers changed their minds about Keto. So now I'm a little lost. Anyway, I'm not a Keto person. I'm just a little perplexed as to why now that I'm eating animal-derived protein, mostly clean and not too much, less than 2 gram per kilo of body weight, my LDL seems to be going haywire. Should I be concerned and what should I do?

[@geraldboyer5298]

Following. My BMI is 19, very athletic, I started Keto 3 months ago and my pre keto numbers are all within 10% of the pre diet parameters of the lean mass hyper responders. I should have blood work in July. Gonna try to go Mediterranean diet style proteins and stay on my greens and veggies and see how crazy my ldl gets. Gonna try to order an NMR test but I’m in Saipan a small island by Guam and that might be difficult to do here.

[@kenadams5504]

I told my doctor today about the lmhr category my lipid scores match (trigs,hdl,ldl ). She had heard of lmhr ,and eventually accepted it as a legitimately possible explanation of my elevated ldl of 220 . She also agreed to refer me for a cac scan to measure me for residual plaque ,considering my poor metabolic health previous to keto ,and age (50 yrs). I can then compare that cac score with another score in 12 months... (and know if my lmhr really is atheroprotective, or not).

[@MartinaTUDArt]

What's about taking a closer look to the distribution of subtypes for LDL and so on. Because the actual profile, and respectively the risks of high amounts of sLDL, cannot be seen just by measuring LDL, HDL and Triglycerides. In addition there is a hint, that for Mody Typ 2 (Glucokinase-Mutation) especially the profile of HDL itself is somehow better (than average of population) while the total amount is lower. Annotation: The initial question by Mody Typ 2 is in general the bias, that despite a life-long elevelated blood-glucose level exist the typical risks of diabetes seems not to be given. One theory is, that's because an adapted lipid profil.

[@forajc]

Would like to know the change in Trigs and HDL of Dr Tro's patients that increased their carbs to lower their LDL. Does anyone have any numbers from their own n=1 experiment in this area? I am also a LMHR, Trigs 48, HDL 102, LDL 223, 5'11" 165 pounds, very fit 15% body fat, 66 year old male....doing low carb since 2012. I feel very healthy. My Doc recommends a statin each check up as this is part of his standard of care that he must CYA to maintain his license.. However my Doc understands my objection to using statins.

[@ozysjahputera7669]

This is happening to me. I went to low carb diet 4 yrs ago. Lost 40 lbs. My LDL before the switch was in 110-115 range. I saw a steady increase of LDL every year. My LDL last week was 133. Getting an NMR Lipoprofile next week to see the composition and size of the LDL.

[@saltygirl764]

Hi. Did you get your results back from that yet? If so could you please share with me if the lol were dense or big and"fluffy" as my Dr said mine should be? Thank you. I hope it's all good for you!

[@ozysjahputera7669]

@@saltygirl764 yes I did. TG 78, HDL-C 55, LDL-C 143, LDL-P 1638, HDL-P 28.2 (low, should be >30.5), LDL-P 1638 (high, should be

[@catylovesjesus9609]

My Calcium ct was 239, family history... grandfather, dad & his sister died in their 30s from heart disease... my dad passed at 37 in 1968. I do have high cholesterol and my NMR is the best. I've been on keto, IF for five months and all my labs are great but ldl was 149... doc wants to increase my statin from 5mg to 10mg... I don't respond well to 10mg so she's prescribing low dose of zetia. She said I'm doing well with changing my lifestyle but my family history pushes me over the edge...

[@catylovesjesus9609]

My NMR is NOT the best

[@MayasDream]

I am a hyper responder. I was BMI 21 when I transitioned and my LDL more than doubled. With that said, when I went high protein, with high fiber, and lower fat (especially fat from eggs and veggie oils), the LDL normalized within 2 weeks.

[@jeannedigennaro6484]

Yes, but is normal LDL optimal LDL? I think the jury is still out.

[@eugeniebreida1583]

Of course no veggie oils . . . did you kick out olive oil as well though?

[@shirasagi9390]

what do you eat to reach high protein intake without the fat ?

[@MayasDream]

@@shirasagi9390 Broccoli, Chicken Breast, Lean Ground Turkey, NonFat Cottage Cheese, Nonfat Greek Yogurt, Nutritional Yeast

[@shirasagi9390]

@@MayasDream thank you very much for your reply ! it really helps

[@MsElke11]

I'm a bit confused about the conclusion. Should we still take statins if our LDL goes above 190?

[@thomashughes4859]

Now I want to learn ALL I can about cholesterol in general! WOW! 💪😎👍

[@songforguy1]

Have just literally received my CAC CT scan score a few minutes ago which was 12. I'm diagnosed as having FH with an LDL of 375

[@Malcolm-Achtman]

Another question: If FH (familial hypercholesterolemia) is so devastating why do I hear Dr. David Diamond referring to studies that say the majority of people with FH live a normal life span (normal in this case being say 70 - 80 years old) while only a small minority of them die prematurely - with the cause being "clotting factor" problems versus the actual high cholesterol itself?

[@joecaz]

Exactly. And so, why the insistence on lowering LDL after Dr. Tro indicates there’s not genetic markers for FH and no prior Hx of elevated LDL? LMHRs have low HDL/TRG ratios, meaning their LDL is unoxidized.

[@baharsahin]

It’s not just the clotting factor. sLDL also predict CHD in FH. Dr. David diamond who is not a medical doctor is criticized for cherrypicking his data. A Man with heterozygous FH has 50% changes of developing early CHD. Early aggressive Statin therapy lowers this risk to a normal level. If you have untreated homozygous FH, you’ll very likely be dead before 20. He never talks about the positive effects of the statins. clotting factor, lipoprotein a, or tg/hdl ratio may predict CHD better than LDL but this doesn’t mean that statin therapy should be avoided ; especially in people with FH

[@baharsahin]

Also most people don’t die from Covid, and the ones who die have more risk factors. does that mean that we shouldn’t vaccinate the people to prevent death? The only valid point he has is that Statin therapy shouldn’t solely based on the target LDL levels. Patients with FH and lower risk factor may take less doses of statins but we need to conduct research and clinical trials before doctors change the treatment protocols

[@baharsahin]

I have FH and I think Dr. diamond jeopardizing people’s health by manipulating the reality behind FH and giving the impression that statin therapy is useless for FH patients. No medical doctor, including the pro-keto doctors would recommend avoiding treatment (statins or pcks9 inhibitors) to a FH patient because there is a high risk of developing heart disease.

[@baharsahin]

@@joecaz because we don’t know that high LDL levels won’t cause heart disease. people with good Tg/hdl and high ldl also develop heart disease. You cannot expect a doctor to not treat you when your LDL is 600. It would be unethical

[@ptarlow7708]

This is so interesting. Will keep looking for more about this subject.

[@msfitnessnut]

Do the LMHR also have an issue with higher blood glucose and lower ketones? I sure would love an answer to that question.

[@juanpalma7387]

Very illustrative video thank you very much.

[@davidgrimes4726]

RE: What do you tell a patient with FH? Tell them they need to prioritize metabolic health (insulin sensitivity, normal cortisol), optimal blood pressure, and optimal sex hormones! Just giving them a statin and crossing fingers is insane!!

[@bert_buikema]

As I understand it LDL cholesterol particles are mainly 'dangerous' when they are oxidated or glycated as a result of (too) high blood glucose levels, AND when arteries are damaged because of (too) high blood glucose levels. When being on a keto or carno diet for a significant stretch of time, (too) high blood glucose levels are non-existing. So, where is the logic of the high LDL scores in LNHRs hysteria?

[@TheCarltonator]

I see that the criteria for being a Lean Mass Hyper Responder is: HDL > 80 Triglycerides < 70 LDL > 200 My LDL level after going animal based for 4 months (a lot of meat, eggs, dairy, butter and a little bit of fruit) show up to 428. My HDL is 70, Triglycerides are 72. So, do I still qualify for Lean Mass Hyper Responder even tho my HDL & Triglycerides are slightly lower than the bar? For references, I am 25 years old, male, 5’10.5”, 110lbs, BMI 15.6 and exercise 3-4 times a week.

[@boutthere3374]

Here is my 2 cents....I've (54) been full carnivore for 3.3 years now and if LMHR is a thing then I'm one. latest blood work(canadian) chol=10.58mmol/L - HDL=2.33mmol/L - Tri= 1.10 my bmi is 23.4 and my Chol/HDL (risk ratio) is 4.54 which is under the 4.9 they look for. My BP is ideal to normal range. My tri/HDL ratio is 0.47. Blood work 3 months prior was similar. Am I worried? I've no idea to be honest. I ask myself how do I feel and my answer is great. I can safely say I am in the best shape I've ever been and thats without even trying. My Dr was freaked out last blood work but she is open to new things. She confessed this was new territory and she actually had to consult her medical books and then contact her cardiologist friend who instantly said "Statins" which will never happen. When you look at my big picture the only thing negatively standing out is my LDL number(if Ancel was right) while every other metric admired so does it even make sense to worry? Physically/mentally I am in the zone most would love to be in.

[@CatCambak]

My LDL is over 600 I’m absolutely a lmhr I went from having a 33 in waist and inflammation and acne with insulin resistance and pcos. Reversed all of it doing zero carb now I’m lean fit and 25in waist. How could I ever go back…I am thinking of conceiving a child which I can not do on a statin and I’m still young so it’s a hard choice.

[@smokey11a1]

I was thin and adopted lower carb. My carbs are higher than Keto or I lose too much weight. It really helped my heart problems. My energy is now better than when I was 18. I haven't had a cholesterol check. Its probably very high.

[@24bellers20]

My bmi was bang on 25 when I started keto 14 months ago. I’ve lost 22 pounds . LDL dropped from 5.2 to 4.2 mmol /l. Hdl went up from 2.2 to 2.71 and my trigs down from 1.07 to 0.88mmol/l. My doctor says that’s abnormal and now I need statins. I’ve flatly refused.

[@trianglejudoclub5873]

I am in ketosis since October 2022 age 64 and previously lean, extremely fit and healthy. Metabolic age was predicted at age 35/40. Now leaner but with greater muscle mass and feeling amazing by comparison with higher energy. No idea what before / after lipoprotein levels are but hopefully LDL levels are much higher with negligible triglycerides.

[@dlfincher6887]

My question: Is the LDL rise from body fat dissolution? Is it from eliminating the “bad stuff” filling our fat cells being processed out through the body, and if so, once the body eliminates extra fat does the LDL level return to normal?

[@Quran_eee]

Very good point my man Can I use that to study or make researchin the future?

[@elbay2]

Top-notch post;…thank you so much for this!

[@SuzanneU]

I don't fit the profile (highest LDL 191) and I don't eat less than 100g carbohydrate. However, my doctor was bent out of shape over my lipid panel. HDL 80, triglycerides 66. My BMI runs between 20 and 21. I am not athletic and I don't work out beyond short sessions with an exercise band and reasonably long walks.

[@dondajulah4168]

Why are we talking about BMI as a measure of fitness and not body fat percentage?! Fit muscular people do exist! Even some of us > 50 yo

[@timshel011]

I agree with you. They should focus on bady fat percent rather than even mention BMI.

[@dondajulah4168]

@@timshel011 I saw later in the video that Dave Feldman clarified that the LMHR identification had nothing to do with BMI. In fact, it did not have anything to do with "leanness" at all but was based on the marker scores.

[@kindnesstoall]

Been on keto 2 yrs about. Dr concerns me. Wants me on statins due to high LDL. Had a Heart CT Scan came back 0 Calcium. My lab work came back. Chol 328, Trig 75, HDL 99, VLDL 15, LDL chol 214. Has me concerned & convinced. Any info or input....oh I don't eat meat. Tired about hearing about it.

[@ghost666recon]

Not everyone can afford blood tests and in Britain you probably will not get one unless your ill, so should i be concerned if i think im LMHR ? I am below 25 bmi and slim before starting low carb/keto

[@anitamcentofanti3277]

I'm over 65 years and lipid pattern indicates LMHR but I would not call myself "lean." Did the more detailed Ldl particular panel and it said "pattern A - low risk" so for now, I'm staying on low carb pending strong indication not to.

[@isabellelee2658]

Same here.

[@rebeccaarcher5139]

Was that one potato per day for a period of time? If so, what time period?

[@bennguyen1313]

My BMI is normal-high, with a TC=300, TG=67 HDL=95.. so perhaps this falls under LMH where a low-carb diet may cause the cholesterol to go higher... But any thoughts on how ApoB fits into the risk-picture? For example, do ApoB increase in proportion to the raise in LDL-C.. or do the number of particles stay the same, and just the size/payload increases?

[@williambuckley6128]

Was Dr. Chafee, Baker, and Mason included in this study?

[@Malcolm-Achtman]

If Dr. Tro sees a patient with a high calcium score he should first consider how that high score developed. Was the patient previously eating a high-carb standard American diet for the past 30 or 40 years? Probably. Well then, that didn't work very well, did it? Maybe if the patient reverts to a very low carb or keto diet for the next 20 - 30 years (even if it comes with super high LDL and no statin use) no more heart disease will develop. At the very least, you're not just repeating the same dumb mistake that lead to your heart disease in the first place.

[@helenf1439]

Or are they simply supplementing D3 ?

[@baharsahin]

how do you know that ketogenic diet could reverse atherosclerosis? There is no evidence for that. However there is enormous evidence that Whole Foods plant-based diet can reduce or reverse atherosclerosis, obesity, and prevent heart disease. Carbs do not cause heart disease. Japanese diet is high in carb; but they don’t suffer from heart disease or obesity as much as Americans. Whole Foods plant-based diet is high carb, but it’s preventive for heart disease, diabetes and obesity.

[@christinashawgo6510]

My BMI is 25.9 I’ve been low carb for 2 years. My LDL just keeps going up. I’ve lost 60# LDL is 337. HDL 68. TRI 75

[@chazwyman8951]

My LDL is high but I still have a high BMI. My HDL has improved as has A1C and TGL. It seems to me that since I am fat adapted one ought to expect more LDL to carry fat to the tissues. Having lost 45lbs with 15-20 more to go should I give up my low carb?

[@carolinewilhite6362]

Looks like I’m LMHR, LDL - 390, HDL-122, triglycerides 56 I’m 5,6, 125 lbs, not athletic but active. This happened when I lowered my carbs more by living off mostly beef and eggs. I’ve always had high LDL, high HDL and very low Trig (40’s). I’m not on any meds.

[@frankmerryman6383]

I'm 73 with 1050 calcium score and much higher cholesterol / lDL after keto and 30 lb weight loss. Now 146# at 5'8. Have prediabetes so want to stay keto but suggestion to try adding more carbs with potatoes but not with fat food presents an issue i think. Since I intermittent fast eating eating keto high fat at noon and 5 or 6, I would have to eat the potato without fat in between those two meals and spike my blood sugar. Seems that could be problematic?

[@philippineswithjohndoe5529]

the question is: Is low carb diet and high LDL in increase mortality or not? If not then it's not an issue?

[@KenJackson_US]

That seems to be the key question. But I think Dave Feldman said they're now doing a long-term study to try to answer it.

[@jamesp5301]

I think I’m on the Dr Berry view. If you get healthier then why would you worry about ldl! However I would definitely consider it with other significant risk factors.

[@lbee8247]

I started cutting carbs as a thin woman. London low starch diet for Ankylosing Spondylitis. I am trying to become a carnivore. I weigh 115 lbs. I'm 48. I have 4 adult children.

[@michaelt2974]

I started low carb diet with 16/8 fasting and no other changes in august 2022and by December 2022 my ldl went from 232 to 420. My doctor highly concerned. Hoping no need for a statin. I’m hoping this is a normal reaction

[@warmpapi]

Is there a ration that can be followed? Wondering if we have more journals, I believe my tri is low, 83 and HDL high 71. But LDLs above 200

[@gj9933]

This happened to me! I went on a lowcarb diet in 2004 to lose weight. My BMI was the high end of normal. 10 years later my LDL was around 220! My blood pressure was also high. I had a heart attack in 2014 and had a single vessel bypass. I still eat low carb/keto but I cut my saturated fat and upped my fiber intake a lot. I don't eat bacon etc like i used to. I also take a statin and BP medication. I now have a BMI around 21 (5'10 147lbs). Thanks for this I am a hyper- responder without FH.

[@Lamz..]

Did you do low carb from 2004 till 2014, when you had the heart attack? Having a high blood pressure suggests you might still have had too many carbs and possibly poly unsaturated fats in your diet?

[@gj9933]

Yes for the most part I did low carb from 2004-14 and I still do it now with way less sat fat and way more fiber. My ldl went up gradually from 2004 and when it was tested around 2012-2014 it was like 200+! I advise people not to brush off a high ldl result!

[@Lamz..]

@@gj9933 It's the 'for the most part' that tickles me. Usually BP drops significantly on a keto diet, and calcium buildup in the arteries stops or diminishes. Were HDL and tour Triglycerides measured at the same time your LDL came in at 200+ ? Thanks for sharing your story, by the way!

[@gj9933]

@@Lamz.. I had high hdl like 75+ and my tri were and are around 45. And because of these results I thought I was ok ....So dont ignore high LDL esp super high ldl. Also I was around 165 - 168 lbs through that period which is still normal for my height

[@MarmaladeINFP]

It sounds like you were on a moderately lower carb diet. Have you tried a very strict keto diet where you tested ketone levels or even a keto-carnivore diet?

[@patrickdezenzio4988]

I'm not even close to the numbers these people have, but LDL hyper-responder was described as a possibility. I went on Keto + IF to kill my carb addiction. At 56 years old and slowly gaining to 200 lbs, and also pre-diabetic, with some pre-hypertensivity, I had to do something. So after 19 months, I'm down to 165 at 5' 10" and I feel great. My fasting glucose shows 85 and even 90 minutes later shows only mid 90s. But my LDL is concerning to my doctor because I had what he considered a perfect lipid panel until I screwed it up with keto. He wants me on a statin but before I did that I would get off keto then because I don't like the side affects. But then again, I only need to reverse overall LDL from my current 133 to 90. Could adding a sweet potato or blueberries do that without forcing me off Keto? Definitely something to think about. Also, even though my LDL is 133, there are other markers that are more alarming like LDL-P, small LDL-P, and LDL size. Even though I've been on keto and IF for 19 months, my small dense LDL particles were considered high.

[@ylcalif3681]

Are your triglycerides high with a low HDL?

[@gunarsvaivods3760]

I would like to know why you are not mentioning total cholesterol. My total cholesterol is 9,15, LDL is equal to 6,82 , HDL is 1,86, and my triglycerides are equal to 0,83. I am 61+, 185-85.

[@andrewtan4936]

One of the future directions of LMHR-related research (which I personally wish to know) is the effect of low-carb diet with high frequency exercise and IF on the regulation of blood glucose and tissue glycation -- before one jumps in to conclude that FBS/RBS and HbA1c will definitely drop (logical isn't it) there are quite a number of "responders" who appear to experience (after some time) elevated, though might not be fluctuating, glucose level and highish A1c toward or even in the pre-diabetic range. Yes things like glucose sparing, physiological IR (even gluconeogenesis) are proposed.. Essentially, what would be the outcome - as with the raised LDL phenomenon we probably can still be cautiously optimistic but it would be reassuring if this can be addressed scientifically.

[@keylanoslokj1806]

So low carb is not for everyone

[@ylcalif3681]

Where did you see reports of "responders" who appear (after some time) to experience elevated glucose levels?

[@susanmckenzie5700]

Thank you for asking BMI prediction from computer because under 25% includes some normal (not low) BMIs.

[@les0nick]

Good review, however no information on how it correlates with LDL particle numbers and Apo B.

[@williambuckley6128]

Does the LDL value go down as time goes on for this group?

[@hermangarrett3486]

LDL is only dangerous with low particle size LDL. Right?

[@Philly1958]

Did he look at ldl particle size?

[@iss8504]

No not yet

[@claybutler]

I'm sure he looked at LDL particle distribution but from my experience it is very unusual for somebody who has a lean mass hyper responder who doesn't have excellent LDL particle quality.

[@timshel011]

Does anyone ever mention that LDLc is a "calculated " number ???

[@claybutler]

When your LDL is 300 plus it really doesn't matter if it's calculated or directly measured. Because no amount of variance in measurement is going to bring that down to anything close to standard recommendations.

[@timshel011]

@@claybutler Then why even bother with a fictitious number? That's as good as a guess. If the gas gauge in your car is off plus or minus 3 gallons how reliable is that?

[@claybutler]

@@timshel011 Because if your tank holds 1000 gallons 3 gallons either way doesn't matter. Discrepancies can only be understood as a ratio. If the chance to win the lotto with a single ticket is one in a million, then you can increase your chances of winning by 100% by buying one more ticket. But once you understand your chance went from one in a million to two in a million, that 100% increase is not impressive. So if someone is sporting 300 LDL, it doesn't matter if it's calculated or measured it's still going to be near triple recommended level. And it's not the same as a guess. You have total cholesterol. If I know your triglycerides and your HDL I can tell you what your LDL is. If I have your LDL and your HDL I can tell you what your triglycerides are. There's simple calculations for all of this. Triglycerides divided by 5 is what is contributing to your total cholesterol.

[@godfatherossy]

based on the cut points discussed here - i think i fit the LMHR phenotype well and will watch further developments with great interest as although i intend to make some small changes to reduce my CHO to a degree, i certainly do not intend to take a statin at any point even if my GP recommends this course of action.

[@modelsupplies]

I have an idea for another group you can look at. Type 1 diabetics. My husband was extremely thin and had a high LDL so they put him on statins. I think they did more harm than good.

[@Greekmuslimah]

What is the percentage of lean fat high responders within the low carb group?

[@sueprator9314]

Thank you for mentioning that has nothing to do w/BMI. I am 74, have a degree in Phy Ed/dance, runner for 30 years, was almost 5"6" most of my Life. BMI has to do with Height/weight and is SO FLAWED. Often female athletes will weigh more than what was the "recommended" weight...usually due to muscle development, in my opinion. Now that I am older, and shorter due to age, the idea that BMI is a criterion for this subject is B.S TO ME. BMI was a flawed measurement, to begin with in my opinion. ALSO as I aged the "BMI" doesn't take into account your age!!! So a 20 year old female should be 5"5 120lbs. So you expect a 74-year-old woman to have the exact same heigh/weight??? IT DOESN'T TAKE INTO ACCOUNT ATHLETIC DEVELOPMENT THAT DOES NOT STOP WITH SOME OF US AS WE HAVE AGED. Most people think I am at most 59.

[@desertviews]

Since the BMI in these participants is (as stated) a continuum, and a low carb diet generally generates weight loss it seems it may be possible that during the test period many people went from High BMI to Low BMI. I guess you could say they changed teams.

[@jimmyg3855]

I’m curious if they logged the transition

[@Brani1974]

Great talk! So what's next? More people and more calcium scores over longer period of time!