NEW STUDY Proves it's BMI not Butter that increases Cholesterol on Low-Carb Diets

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Link: www.sciencedirect.com/science...
0:00: intro
0:15: NEW paper!
0:38: Low-Carb for various diseases
0:57: LDL boogeyman
1:17: Lean Mass Hyper-Responder #LMHR
1:35: The BIG question
2:11: Intro to NEW study, meta-analysis of RCTs
2:46: BMI Results!
4:43: Not the Saturated Fat!
5:58: Lipid Energy Model
6:56: Conclusion

[@SydneyCollin]

This makes SO much sense!!! When I ran in college, a blood test uncovered I had high LDL. It's been 35 years, I've never taken a statin, am still exercising, still lean and still have high LDL. With high HDL, low trigs, I'm a LMHR and am low carb. Now in my mid-fifties, my doctors have been freaking out. Went to a cardiologist who ran a myriad of tests, which all came back stellar and just had a CAC scan of zero. Thanks for more explanatory evidence that this is the right path!

[@mjs28s]

So change your diet anyways. I was always active, had total lipid over 300 for a number of years and always over 240 no matter what I did. Then I cut out animal products and BOOM! Total Cholesterol went down 130 points. Still active as always, eat a better diet. Strength, endurance, etc. are about the same but recovery time is better.

[@ghostviggen]

@@mjs28sBut low cholesterol actually increase total mortality and is bad for mental health.

[@gudnikristinn]

​@@ghostviggenA normal body produces all the cholesterol you need. You have a abnormality if its ever lower than you need. Dietary cholesterol is absolutely unnecessary and plant based diets that we have lots of data, such as Mediterranean, Vegetarian and even Vegan, always show better health outcomes than low carb diets when compared. Every single time. Just Googling Low carb and life expectancy and you will see that low carb diets show even higher mortality than the SAD diet in most studies.

[@SydneyCollin]

@@mjs28s No thank you. I'm not going to change something if it ain't broken. Oreo cookies & seed oils also reduce cholesterol. High cholesterol is not the problem.

[@0626love]

@@ghostviggen no, low cholesterol does not increase mortality. Thats nonsense from wackos. There is fatal diseases in society that lower cholesterol amounts - coz cancers, for example, use up cholesterol, so cholesterol goes low - that also happens in young people - so low cholesterol gets associated with mortaliy BUT it's the reverse causality you idiots

[@grochef]

Thanks for this. I was seeing a new family practitioner who tried to convince me to take statins. I told her that I could easily reduce my LDL. She "allowed" me to get a follow-up lipid test. I am 64, and at about 63, I tried an experiment (N=1) by getting two lipid tests done, fairly close together (~6 months). My BMI is about 22. I fasted for about 18 hours for one test and ate eggs and bacon prior to the next test. As shown in this study, when in need of fatty acids (fasted state) my LDL was higher than when I had a fatty breakfast (lower LDL). I fired that physician. There are numerous studies that show that higher LDL in older individuals (>60) is beneficial and result in fewer upper respiratory illness and all cause mortality. I continue to be drug free. I eat low carb, resistance train for 2 hours 3 times/week and regularly hike with my wife. Thanks to folks like Nicholas, we have the ability to find the medical studies to teach ourselves how are bodies work and to know when we are being handed a pile of allopathic lies.

[@TrishCanyon8]

Brilliant ❤❤❤

[@motzoh]

I have done almost exactly what you did and experienced similar results. (Loosely speaking, N=2? 😁)

[@mottgirl13]

Wow that’s cool! I wanna try.. make it N=3

[@adim00lah]

It's a known fact that fasting increases ldl serum levels due to ketosis. The thing is, if your ldl levels are still high, even after eating, your cholesterol is too high. I know the study you are referring to, "Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review" This was a meta-analysis of many studies. But 2/3 of the people were from t his study. "Association of lipoprotein levels with mortality in subjects aged 50 + without previous diabetes or cardiovascular disease: A population-based register study" This study said there were benefits in survival from taking statins. So clearly the lower cholesterol was providing benefits due tot he drug. It's odd that the meta-analysis study tried to say you don't need statins, when one of the studies it's based on that accounted for most of the people said that it had significant benefits.

[@grochef]

@@adim00lah Thank you for that. From the second study that you noted: "All-cause mortality was lower in the groups with TC or LDL-C above the recommended levels." And: "These associations indicate that high lipoprotein levels do not seem to be definitely harmful in the general population. However, high triglyceride levels in females are associated with decreased survival."

[@pwfitid]

The more lean I am, the higher my LDL. I am doing carnivore for 5 years now, and whenever I got to 10% body fat or lower, my LDL will go through the roof. 300-400+. But when I cheat a lot, put some weight, back to 17% body fat, my LDL goes down to 200. WOW. Amazing research

[@JWB671]

I was similar, but I developed Xanthelasmas on high fat diet and advanced lipid tests showed I have terrible LDL particle size and high lp(a). Hopefully you don’t have a genetic lipid disorder because, if you do, LDL of 400+ will likely cause you some problems.

[@Magnulus76]

An LDL of 200 is very high. That's not really much of an improvement.

What is your apoB?

[@BeHealing]

It's so interesting. Thanks for your work & for sharing this, please continue. I'm a really healthy 52 year old athlete. I'm about 23% fat, really fit, I feel amazing, better than I ever have, glowing skin, eyes, boundless energy, lots of muscle. But my doctor took blood & said I need to bring my LDL down. So I refused meds & said I will try myself. I went from eating almost perfectly (the occasional croissant when out with a friend for coffee, the occasional ice cream, never more than once a week) to eating perfectly (by that I mean, only fresh food, meat, eggs, fish, chicken, vegetables, fruit, fat free greek yoghurt, nuts, seeds, all prepared at home, olive oil & ghee. I went back, he took more blood and my LDL was even higher. I refused meds once again and lied to say I was going to another hospital to get more checks. I knew that him looking at this number was wrong, it makes no sense, and if it makes no sense then it's not true.

[@mariacallas9962]

I assumed you’re not a Christian then…

[@nicknorwitzPhD]

"I feel amazing, better than I ever have, glowing skin, eyes, boundless energy, lots of muscle." -- congrats BeHealing... I'm happy to say you're not rare in this respect

[@basiirhasan673]

Check ur triglyceride bcoz fruits increase it which can be dangerous. If itz within the range never think of LDL-c

[@otallono]

if you have no health issues and feel amazing what was the purpose to the doctor visits?

[@jameswilson1972]

Sounds like you just need to add some super-healthy Oreo cookies to your life in order to get that pesky LDL down. 😂😂

[@pohkeee]

Kudos Nick! Stick to your current mindset regarding science and you will continue to excel. As I have observed through the years, the tension between the initial thrill of discovery that energizes new scientists and the later dangers of egos tied up to theories and (sad to say) funding sources, extinguishes many true scientists. It’s difficult to stay true to the principles, but you give me hope! The slippage of quality and ethics in the sciences has as done incredible damage to both the scientists themselves and the public trust in science! You are a breath of fresh air to an old geek layperson like me!

[@trentriver]

Very well put and I concur 100%!

[@nicknorwitzPhD]

You have no idea how your words resonate with me. There are things I've seen that I can't share. But, rest assured, curiosity will remain my North Star and I won't compromise my scientific integrity for ego, $, or anything else.

[@Natures-Rhythms]

This reminded of a famous quote which I went ahead and looked up: German physicist Max Planck somewhat cynically declared, science advances one funeral at a time. Planck noted “a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents die, and a new generation grows up that is familiar with it.”

[@tnelly6588]

@@nicknorwitzPhD Can you discuss further the skyrocketing LDL for some, including yourself, where LDL can reach 300, 400, 500 and even higher? I recently went on a very low carb diet to ease some joints aches and lose weight, so was in a serious calorie deficit. I am 6ft tall and was a fairly muscular 210 with some extra evenly distributed body fat. I lost 25 lbs in 2.5 months to get down to a lean 185. After weight loss and low car diet my LDL was 311 but TR 71, HDL 70, VLDL 9, low blood glucose and low A1C. I believe being in a serious calorie deficit on top of low carb, additionally boosted LDL due to the bodies desperate need for energy, thus aggressively breaking down and releasing my own body fat for energy. Any thoughts would be appreciated! Thanks for all you and your team are doing!

[@ArcoZakus]

@@tnelly6588​, Have you seen the other videos of Dr. Norwitz or Dave Feldman where they do "discuss further" their research on the Lipid Energy Model or Lean Mass Hyper Responders (LEM, LMHR)?

[@bcro83]

Glad you are doing this Dr. Norwitz i'm 14 years old and I would love to become an endocrinologist when I grow up and I would soon want to do a study on Carnivore VS WFPB.

[@lillygordon9121]

Start reading books on pathophysiology, study the human body, get medical texts now, you will be a head of your classmates when you get into medical school. You can easily buy the text online for medical classes. Good luck.

[@makelaris12]

That is Amazing work! Keep giving us more data to throw in the faces of the doctors that keep asking us to "stop this craziness with eating Saturated Fat" :) Thanks Nick!

[@nicknorwitzPhD]

Hopefully these data are enlightening to those who need a little light

[@otallono]

why see a doctor like that in the first place, just to have the debate with them? That costs you money doesn't it?

[@tallcedars2310]

@@otallono Well, it is beneficial to try to make all doctors see the light, than allow them to wallow in old ways? If we are to have truth in our medical system, it starts with one doctor at a time. Cheers

[@neatengineering]

Also, there is no such thing as 'saturated fat,' there are saturated fats, and they all have different properties.

[@itatae10]

@makelaris12 Process saturated fats are bad for you(like ones you find in creamer or process goods) natural sat are very beneficial to hormones and vital for material synthesis (hence what cholesterol is) butter of course isn't nearly as processed.

[@user-uq4wp6ux3b]

Nuance is REQUIRED for meaningful conclusions to be established in any scientific realm, well done Nicholas 👏👏

[@AnneMB955]

Nick, thx so much for interpreting the data for us. Love how new studies’ findings are now becoming believable with trustworthy people like you involved. 👏👏

[@nicknorwitzPhD]

Thanks!

[@michaelj2276]

This is *incredible*. Thank you Nick, for continuing to pursue the science! 👏

[@countrydwell]

Nick - your ability to articulate the ‘pointy’ highlights and summarise in an easy to understand summary is of the highest value. The time and effort you take to share your breakdowns is immensely appreciated. Many thanks and appreciation.

[@beautifulgirl219]

Thanks Nick for all your work. Keep up the great work. Cheers!

[@MrWoodward42]

Really nice job on the presentation with this video with the supporting slides. Greatly appreciate the visuals/graphs!

[@RoseMary-gl4ee]

My entire life I had exquisitely low cholesterol. Recently I follow a low carb diet, and my LDL skyrocketed high. I’m hoping to stay low carb, and my results are consistent with the analyses of this video. I hope to crack this code, please keep up the good work!

[@SchmittsPeter]

Congrats! You guys really put out one interesting paper after another.

[@Part_121]

The part I don't understand, and I don't think it has been explained yet, is that people on a low carb diet, at least for some period of time in the beginning, are in a state of transition. I started out with a BMI of 34, lost 80 lbs via Virta's low carb program, and now have a BMI of 24, but the LDL started skyrocketing as of my first few months of low carb. I meet all the numerical qualifications for LMHR, but I certainly did not when I started low carb. The only things I see changing are my VLDL, which was unmeasurably low 3 months ago, now up to 5, and my HDL, which keeps going up, and is now 98. Trigs have stayed between 40 and 50. After my last bloodwork as a fat person, my Dr. told me I had a perfect cholesterol profile. 80lbs later, and T2D reversed and he no longer wants to talk to me. As a kid, everyone always thought I was too skinny, but no one really did bloodwork back then. Can an LMHR create a fat body for themselves, then revert to being an LMHR when they lose weight again. Could it be that in ever fat person is an LMHR that wants to come out?

[@melissag3005]

same

[@debjordan4399]

Thank you again Nick. Always great explanations and teaching.

[@LakeOuachita]

THANK YOU NICK!! For your hard work and diligence! And to Dave Feldman, Adrian Soto Mota, Dr Buduff…every one of you!

[@TheBigJohny]

Amazing stuff, just came from doctor. first time that I got high cholesterol including LDL. I also got highest BMI ever. before that I got only little bit over 25. last time over 28. I am on low-carb diet now and I am getting much better. Blood pressure returning to normal from high normal to low hypertension results. This study is a godsend

[@ppod450]

Thank you so much for this, I'm a LMHR, trigs 63, HDL 110, LDL 455, bmi 23, low carb for 3 years, very fit. My doctor freaked out at my blood work, sent me to a cardiologist, both said they have never seen numbers like this, so healthy with elevated LDL, tried to put me on statins, told him I want a CAC, scan before considering any meds, he agreed, waiting to have it done. I told him to check out these studies, he said he is always willing to learn something and would, LOL.

[@blahblah2779]

BMI of 23 is NOT healthy. Who are you kidding

[@prettybirdbeenlpeacock6592]

@@blahblah2779 it might be if he is particularly muscular. BMI is not the best health measure in such cases due to how much muscle weighs compared to fat.

[@TeeAnn]

I am not thin, but also asked for a CAC because I was tired of them trying to convince me of statins, when all my other blood work (other than LDL) is great and I am 60 and healthy. I said I would think about a statin if my arteries dont look good. Insurance denied my request, so there is what they think of that. My daughter has high LDL… she is 28, 5’6 123 lbs and is super active. I told her not to worry about it for even one minute.

[@andrewsheppard2404]

Brilliant video as always Nick.

[@nicknorwitzPhD]

Cheers my man!

[@lukasvrana6388]

Well done!!!! Thank you for the content, I´ll try spread the work in our country :)

[@truthorconsequences5470]

I'm thin with high LDL as well, but have high HDL. My cholesterol is 270, but I ate deep-fat fried chicken tenders all last year. This year I've cut them out, and am eating daily 2 T olive oil, a quarter cup of ground flax, and 2 T of apple cider vinegar daily. In April I'll have my labs checked again.

[@cselenyitibor7180]

This is getting more and more awesome Nick. I'm on keto since 2020 and my LDL-C is slightly above "normal", so I made an experiment last time before my bloodwork, I had a 24 hours fast and my LDL-C became the highest ever after this fasting period - proving your LEM.

[@user-lf1gf8ug4u]

and statin pushers

[@aprilek6003]

Bravo Nick and et al. Great paper

[@itatae10]

I really like these studies they help demonstrate the complicated network of our bodies that was once considered different at one point.

[@user-nx5sj2ug5r]

Maybe you answered this question in another video, but the question I have after watching this one is whether or not people with normal BMI put themselves at increased risk of cardiovascular disease if they follow a low carb/moderate to high fat diet. Would love it if you could address this in a future video or give me a link to one you already did explaining this. I ask this because I know there are other factors besides a high carb diet that can increase your risk of heart disease.

[@sophtayl]

great work Nick and team. I can see the nay sayers already : "See - Low carb gives you high LDL - low carb is bad...." I'm eager to see the next study published to reinforce that LDL is not the problem..

[@KnackFarmer-theanswerismeat]

❤ the work you and your team undertaking. Until the 'cholesterol causes heart attacks, strokes' paradigm is busted, this will not have the impact it deserves.

[@robyn3349]

Thank you! More, I want more!

[@fadiyt8816]

Interesting how the paradigm is shifting.. now high LDL can be seen as a marker of fitness, soon doctors will say "your LDL is not high enough" Thank you Nicolas and Dave

[@jakubchrobry3701]

The paradigm is not shifting. In Nick's own words, only 3 in 90,000 are LMHR. Please provide a study that shows fit people have high LDL's. Do you believe this is what Nick's study has found? Also, I hope you can understand that low LDL in the elderly is often a result of disease such as cancer and that's why the data is skewed in the elderly. The disease causes the low LDL, not the inverse. So, of course, people with cancer will not live as long. My father's glucose, weight, and LDL dropped to "healthy" levels one year before he was diagnosed with pancreatic cancer. He lived one more year. I guess he was in excellent health.

[@cliffmathisen5666]

This pre-print factors in BMI and not being a lean mass hyper responder. Two conclusions which are interesting are that on a low carb diet 1) BMI is a both inversely associated with LDL and 2) BMI is a much stronger predicter of LDL levels than saturated fat intake. The cholesterol paradigm has been radically shifting for a while now and more nuanced studies like this COULD shift it even more. A further study investigating low carb intake, LDL, and something like coronary artery calcification score could help us better understand if a high LDL among low carbers is a safe place to be in the long term. Sorry to hear about your dad and I just lost a friend to pancreatic cancer this week @jakubchrobry3701

[@Evoprimals]

​@@jakubchrobry3701N=1 here, I'm fit as it gets at age 37, with visible abs, triglycerides below 30 and LDL.above 220. When i was on a vegan diet I had much more fat, low LDL, higher triglycerides and felt like shit.

[@barblacy619]

With the clout that big Pharma has on misinformation generation your optimism is refreshing but I do not see main stream ‘medicine’ doing a paradigm shift without the approval of their instructors. Big Pharma sponsors the majority of our physicians continuing education. Talk about a conflict of interest and questionable ethics…sad but true.

[@Magnulus76]

He's proved nothing, just made a conjecture that seems spurious.

[@jenjabba6210]

Would you agree, the lipid energy model also explains why being low carb and/or fasting while LOSING FAT WEIGHT could be the cause of increased cholesterol... regardless of BMI 🎉

[@nicknorwitzPhD]

Very rapid weight loss or weight loss into normal BMI category could cause increases LDL-C via LEM principles, yes

[@stargazerbird]

Happened to me. Got my bloods done right at the height of rapid weight loss on keto that took me into a normal BMI. I had also started doing sprints. My results were scary! Doctor said he’d never seen LDL that high. My Uris acid was also high which is another result of rapid weight loss.

[@jenjabba6210]

@nicknorwitzPhD over the past year I've lost 95 . I've lost about 2lb a week on very low carb, in ketosis. I have about 20lb to go. It will be interesting to see if I'm a LMHR or not when I'm done losing. Thanks.

[@lentilpaff7864]

Same here. After both a 7-day water fast resulting in 9 lbs loss, and then going low carb, my Trigs and HDL massively improved but my LDL spiked up.

[@H4KnSL4K]

Love the butter. Thanks for the great video!

[@biodivers5294]

Great results!

[@doesleapfarm]

Thank you for this!

[@jenniferburke2972]

Super interesting results!

[@AKMcF]

Thanks Nick !

[@danielcordeiro6003]

Wouldn't body fat percentage be a better variable than BMI? The LEM paper suggests that the quantity of VLDLs secreted by the liver is influenced by the extent of carbohydrate restriction and the individual's low body fat level. What are the reasons for preferring BMI over body fat percentage? Is it challenging to consistently obtain accurate measurements of body fat percentage?

[@JD-mz1rl]

I essentially asked the question in a different comment.

[@SydneyCollin]

Important question to get answered. Fat percentage is way more meaningful than BMI.

[@Latebiwsas]

@@JD-mz1rl I think many studies don't measure that, so it would be inconvenient to use that as an indicator in a metanalysis.

[@kasp7674]

I would assume that it's very costly to measure bodyfat % compared to bmi.

[@ethelfitzjohn5151]

As this analysis was a retrospective meta analysis, it may well be that BMI was the measurement used in the original studies (as it seems to be current medical currency still) and therefore that was what was utilised, because it would have been the same benchmark across all studies.

[@ketontrack]

Great! Can you also make a video addressing if a high cholesterol can in some cases be a symptom of low conversion due to hypothyroidism?

[@PJandBethany]

It would be helpful in situations like this if you explained why the lipid energy model takes effect in people with low BMI but not people with high BMI. It would be even better if you described briefly what is happening in those with high BMI and contrasted it to what is happening in those with low BMI.

[@nicknorwitzPhD]

Have. Read: pubmed.ncbi.nlm.nih.gov/35629964/

[@JD-mz1rl]

​@@nicknorwitzPhDI see in the paper "lean" and "low BMI" being used somewhat interchangeably -- although it is possible to be "lean" with a higher BMI. Is low BMI just being used as a proxy for lean, or would the same phenomenons present in persons with low body fat % but above normal BMI?

[@sportysbusiness]

@@LVQ-so5th The way I understand it is that very fat people are fat because they are not able to use those fat stores, therefore they have lower LDL as there is no fat to transport. The opposite for lean people who are good at utilising their fat stores, so the lower the glucose in the blood, the more fat the body will distribute.

[@PJandBethany]

@@nicknorwitzPhD I can follow your videos, and I can usually get the gist of the articles you reference, but in this case I was not able to keep up with section 4 (Adiposity and Lean Mass Influence Lipid Energy Dynamics). I collected a list of about 40 terms I will need to research before attempting that article again. Regardless, thank you for the link, and thank you for making these videos; they have already been a great help in furthering my understanding of this topic.

[@xd-vf1kx]

Thanks Nick for your hard work. I don't remember if the study included a significant amount of LMHR females? Are there any nuances or differences for lean mass females not mentioned in the video? (perhaps due to hormones, higher fat %). I was wondering since historically many studies simply extrapolate results to females.

[@amberlebrun8785]

I've been a LMHR since at least 2013. My acupuncturist was concerned when she saw my LDL was over 300, except she saw my triglycerides were under 50 so she thought it was an auto immune response. Thank you for your work.

[@JennifertxCarnivore]

Everyone share the study link on your social media! The news channels won’t be sharing I am sure! Share share share link to the study!

[@cathiemcginnis3997]

​@@stellasternchen How did you come up with that?

[@ematise]

It's more like, this is normal for a lean and fit body (I guess) as I understand from the study.

[@PistolPete3322]

Hey Nick. How about trying a fermented food experiment like you did with Oreos? See if ferments have a similar effect. Thx. Love your content.

[@kcummo]

My favorite is that study that showed all cause mortality and total cholesterol levels and how 200-250 actually has the lowest all cause mortality hazard.

[@meldacano1525]

I’m a new subscriber.. heard about your channel from Dr. Eric Westman.

[@fifa697]

Hey Nik! Thank you for your work. Can you please share your opinion on the topic about PUFA's and the level of the ketones you can achieve consuming PUFA's instead of saturated fats. Thank you one more time.

[@user-qq5du7iv4t]

Excellent.

[@khalilsh]

Hi Nick, This also meets exactly what happened to me (42M, did Keto in my late 30s), this is what I later discovered from watching Dave's work as "The Inversion Pattern" I went on Keto while obese, BMI=35 (137KG on 1.95 cm height), I tracked my lipids very closely (once every 3 months), at the beginning I had a small uptick in LDL, and then steep decline to bottom out at 80 md/DL, once my BMI dropped below 25, it crept up again, and reached a maximum of 120 mg/DL. My relative high BMI is due to my very large build and being a weight lifter, 25 BMI is normal weight for me.

[@shinjokagama7521]

Your height is 1.95 m. Not 1.95 cm.

[@sansi106]

I have been looking for this BMI vs LDL journey for the same person for some time. Thank you for sharing your data! Do you have the rough timeline on how long each phase took (ex: from keto start to BMI starts to go down, to LDL leveling and starts to go up, to LDL leveling, etc.)? I think each of us will experience a similar process with different values and timeline, but most likely sharing the same pattern.

[@khalilsh]

@@sansi106 It was fast, really fast, 137 --> 104 (I was actually below 100 for the 1st time since high school, after 4 days fast to end the Keto phase, but refeeding then carb loading bumped it up to 104KG) in 9 months. I never had LDL problems even when I was obese, the stark difference for was in Trigs dropping from 300 to 100 and HDL from 35 to 45.

[@khalilsh]

@@stellasternchen feel free to not believe, not my aim to convince anyone. The reason this wasn't supposed to happen is that I was on low carb, eating mainly saturated fat, even the bacon was from lamb, which is exactly what Nick is saying the study found, BMI is the main driver of LCL-C on LC, not sat fat intake.

[@sansi106]

@@stellasternchen Remember, high LDL is not a disease, Atherosclerosis is. This only shows you what a bad indicator high LDL is by the classic lipidology. In fact, once you get all biomarkers down to normal, just eat some Oreos can lower your LDL (see Nick's video). Not sure anyone would do that ...

[@Absolomthecarnivore]

Makes total sense and I can confirm on myself being low carb on the last 4.5 years. When I'm closer to BMI 22 especially during summer, I have the highest LDL when winter comes and BMI goes closer to 24, my LDL drops visibly.

[@cassieoz1702]

Its always worth clearly defining whether, when LDL is reported in these studies, is it measured LDL or calculated LDL.

[@davedewsnap288]

This is a very interesting paper, the results of which could have a huge influence. Just as an aside, Nick - can you indicate what your thoughts are on fibre and the microbiome? Is it overhyped in terms of overall food intake? Do you include some fibre in your daily meal structure? Would you consider it important, or are in agreement with Zoe Harcombe - that fibre is very overrated?

[@M.Campbell]

When will information like this be taught in medical school? Such research flies in the face of much of what is being taught to future doctors.

[@PudgyCurmudgeon]

It will be taught as soon as the food and pharma industries stop funding nutritional studies and building new wings on medical schools. - Which means never without congressional intervention. Unfortunately Food and Pharma are big congressional donors. We the people are on our own but thanks to doctors/scientists like Nick, Ken Berry, Robert Lustig, Jason Chaffee, Shawn Baker and other ethical and honest Scientific/Nutritional and medical people, we have a fighting chance.

[@rosannagajdanelson999]

Curious about triad people who ARE overweight and on a very low keto diet.

[@nicknorwitzPhD]

It is relatively rare, but possible. But I haven't seen it in anyone with class II obesity, despite seeing hundreds on LMHR, if not thousands at this point

[@rosegarden9120]

@@nicknorwitzPhD Just for information sake: 73 yo, BMI 29.6, Trig 65, HDL 75, LDL 188, Fasting glucose 84. Can't take statins due to rhabdomyolysis. My MD is aware of this possibility with Keto and we are working together on it with further testing.

[@ClassicJukeboxBand]

Paul Mason says that when you take vegetable oils out of your diets, that raises cholesterol because the oil lowers it.

[@plightn]

I think the issue with BMI is that it misses visceral fat, the stuff around our organs. You can be skinny fat, meaning you’re not heavy but there is bad fat around your organs.

[@realstradman]

Very interesting. Thanks! Wonder if there is a difference in response between complex and simple simple low Carb diet

[@IonTrone]

Well done! 🧈🧈🧈!

[@maryk6407]

For nine months between 2015-2016, I lost 95 lbs by eating low carb (20-100g per day). I stopped eating anything with added sugar, rarely ate bread and didn’t think to eat pizza the entire time. My cholesterol went down, no more fatty liver, and I went from pre-diabetes to normal. I gained the weight back over eight years (by thinking I could eat a candy bar even though I was a proven sugar addict). Got the fatty liver again, but now I was also fully diabetic (type 2). I took Mounjaro, started doing keto (now less than 50g a day) and I lost 90 lbs in just about the same amount of time. I did eat less blueberries this time, but otherwise no food with added sugar. I did not have any side effects from the Mounjaro until I got to 7.5mg and developed bad breakthrough heartburn (I was on 80mg Nexium from 1995-2023). Then I backed down to 2.5mg and no more side effects. Only difference losing weight this time was my LDL cholesterol shot up to 300. But… My HDL shot up, my triglycerides went way down (HDL/TRIGLYCERIDE=1.5), and no more fatty liver. The LDL started shooting up when I was still a BMI of 40 (3 months in and down from the starting BMI of 42). Ive been in a holding pattern at a BMI of 28 due to my cardiologist and endocrinologist freaking me out since last September regarding my cholesterol. I even took Nexletol for 4 weeks last Fall to get them off my back, but the bempedoic acid soon gave me the same, painful muscle spasms and weakness as when they put me on the statins long years ago (uh, duh as it works further up that pathway than an f’in statin). I’ve had a lot of other stressful stuff going on recently, so I ate some crème brûlée cheesecake and went on a week long, sugar bender. Just off of that by a couple of weeks and I went back on the Mounjaro to get back on track. I don’t care what anyone thinks about Mounjaro, it curbs both the amount of food I eat and the insane compulsive need to eat (even when not hungry). So, do you think Mounjaro turned me into a LMHR? My next question for you, Dr. Norwitz is WHY?

[@vulcansaur]

Thank you for this information. That explains why my LDL goes up drastically since I went on a low carb diet. I can now explain it to my doctor 😂.

[@JBBII]

Nicolas, did the meta analysis take into account individuals who were above a 30 BMI when they started keto and then dropped their BMI to normal? Is a LDL rise inevitable if keto is successful?

[@dsonyay]

So interesting to read. I posted this question on another of your videos- will try here: Can a LMHR use the addition of whole Milk (or yogurt/kefir etc) for the carb source to lower LDL instead of Oreos? I ask because maybe someone wants to stay purely carnivore instead of adding plant sources or junk food. Although I don’t want to lower my LDL- it would be something to consider prior to an annual physical in order to appease the doctors under the influence of drug companies.

[@nicknorwitzPhD]

"Can a LMHR use the addition of whole Milk (or yogurt/kefir etc) for the carb source to lower LDL instead of Oreos?" Think so, yes. You'd need quite a bit... maybe add some honey to kefir or Greek yogurt?

[@dsonyay]

OK, thanks very much that’s good to know. I just figured I could drink two or three big glasses of whole milk and get quite enough carbs to do the job that a couple of packs of Oreos would do lol and I get to still remain in a “ state of carnivore. “

[@PardieDiem]

I eat quite a lot of full fat dairy and my ldl continues to rise, but other indicators look good.

[@knutskovereng]

Very interesting study. Question: You do not report baseline LDL (or I cant manage to find it)? What are actual LDL levels after the interventions in the different groups? Change scores can only tell you so much.

[@loganvesty9925]

I agree, a bit annoying they only show "change in LDL". The higher BMI groups likely already had elevated LDL. If showing LDL change, shouldnt this be compared with saturated fat change too

[@mariomenezes1153]

Had a question. In the lipid energy model, the presumption is that low triglycerides are the result of the liver not having to convert glucose/fructose to fat for storage in the form of triglycerides used to transport for storage. Thus triglyceride numbers drop. You also mentioned that as glycogen stores are depleted in the liver, the body breaks down fat deposits which the liver then converts to triglycerides. Would this not drive the triglyceride numbers up? Or are these triglycerides transported via a different pathway so they don't count in the total triglyceride count or are they in very low volumes that do not impact the triglyceride volume substantially. Thanks! BTW, love the research you guys are doing. This is the intersection of engineering and medicine and is redefining the traditional medical research dominated by the pharmaceutical industry due to no one else having money to conduct unbiased research or needing to push product.

[@chadhill9612]

This is crazy interesting but as a regular dude who's bmi is like 50 what am I supposed to do? What's the practial application? Is this channel specifically for the special lmhr phennotype? What's the practical application for the rest of us who are not X-Men or whatever? Thank you for your work and sorry if I missed it somewhere but ELI, please!

[@amallie6541]

Nick, in your opinion, what causes xanthelasma, when following a ketogenic diet? (Not eating high fat, but high protein), LDL 173, triglycerides 79, HDL 82, WT 84, BMI (SECA scan) 16.1 Thank you.

[@ferndawg665]

Hello Nick! What about apoB? If LDL may not be causative to cardiovascular disease, what about apoB? Is that a better metric to use? Thanks!

[@smokedbrisket3033]

My entire lipid panel has changed for the better in the last 30 months since I've gone mostly fatty meat + IF. HDL up to 72 from the low 40s, tri-g down from nearly 200 to 74, LDL down from over 200 to 120. I started this journey at 6'6" and 265, now down to 215. My scale says body fat% down from just under 30% to 21.8%. Now idea how accurate that part is, need to get my doc to verify. But I have lost a lot of fat weight.

[@kraftzion]

Thank you! I believe that if we find any correlation between cholesterol levels and health it will be the inverse of what Ansel Keys preached. Did he select the studies that supported his hypothesis out of ego? Or was he given a hypothesis and told to find evidence to support it?

[@acke26]

Nick and Dave ! The first rule in scientific research is to NOT have preconceptions. Everyone involved in the LMHR research seems to have the preconception that being lean is healthy. Being lean means the body can't store excess fat. Putting on weight as subcutaneous fat is to protect the organs such as liver, pancreas and kidneys from the damaging visceral fat. People that have this ability to create fat cells and storing fat as subcutaneous fat are more protected = healthy, cause their organs will be protected as long as they don't put on weight as visceral fat. Obese people will though reach a point whereas their bodies can't store more subcutaneous fat. When they've reached this personal fat threshold, then they'll also get damaged organs due to an increase in visceral fat. This is the whole thing with LMHR

[@JayClarke88869]

Hi Nick. Been following you and the team's story over the past few weeks, good choice with Oreo's :) But how to convince the stat sally docs that will still insist that LDL must be reduced due to its negative correlatiion to ACS, because they are ignoring the specificity of the ACS data that shows highly insulin sensitive people i.e. LMHR's have zero increased mortality despite the high LDL?

[@nicknorwitzPhD]

Need more data on LMHR risk. Others, senior to me, tend to advise to order a CCTA/CAC to assess for presence of plaque. See Dr Budoff's presentation of the LMHR baseline data for more

[@JayClarke88869]

@@nicknorwitzPhD Thanks for the further information Nick, much appreciated. Really enjoying following the debate and looking forward to your further discoveries and provocations!

[@markotrieste]

I don't understand: is the quoted BMI at the beginning or at the end of the considered diet? In other words, does going lean cause increased LDL or it only happens to people that are already lean?

[@volaryu]

I went low carb (well basically low ultra-processed) because I had type 2 and reversed it somewhat with keto, my cell are still somewhat insulin resistant but with metformin and keeping my diet to real food I can avoid any kidney overloading that will lead to ketoacidosis or worse, good to hear that even under 130g is still considered "low carb"

[@joy_1939]

So it looks like you excluded exercise from this study? Will you be doing another study to see what effects that it has on the lipid markers? I am overweight but my numbers are well within the LMHR triad despite not being lean and the LDL has went up and not down which is the exact opposite of what this study shows. So I am guessing it has something to do with the amount of exercise that is done and that your comment below that states that weight loss towards a normal BMI could increase LDL. Can you elaborate a bit more?

[@prettybirdbeenlpeacock6592]

I love "less so the butter and more so the 6-pack" hahaha😂

[@susanbeever5708]

Well done. Next step show how low carb diet decreases stimulation of TRPV1 and therefore less insulin, less ROS in mitochondria and less mitochondrial oxidation of lipids.

[@Ilethsamael]

While it may be an interesting mark to further research, I'd say it pretty much aligns with the idea that cholesterol is a reaction to vessel inflammation and therefore akin to firefighters. It would be interesting to try to stop this kind of research for a while and try to verify mechanistic hypothesis.

[@natfat9064]

Kudos to the study organisers, but what to do with the reports when people substitute saturated fat with olive oil, their LDL-c goes down while they still stay in ketosis? One of them Dr. Dom D’Agostino.

[@sansi106]

@nicknorwitzPhD Can you share typical timelines regarding keto starts --> BMI bottom --> LDL bottom --> LDL peak --> both stable ? @khalilsh below shares his/her journey, but without how long for each phase. This data can help us knowing where we are in the journey. Thank you Nick!

[@skc-wg2yq]

Take that Peter and Layne! Thank you, Nicholas!

[@monnoo8221]

it is! 😁 For those that dare to listen, I guess. Good work! opening lots of further questions!! you will have work for the next 30 y :) Would be interesting to see, what happens in normal non-LMHR people, with a labelling study... What happens eg. to obese people, that just went to fasting for 3 days, then into ketosis, and then feeding on 30 g fructose per day... Where does the fat land? in freshly made vldl --> LDL or in the liver? And how long would the fructose generated fat stay in the blood lipid compartment? I think, and you showed that there is no genetic allel story behind, that there is a continuum, and every metabolism could be trained to respond according to the lipid energy model, even if LDL does not go up so much.

[@PatchyE]

So what does this mean? Does it mean having high LDL is ok in this case, or does it mean thin people should stop the low carb diet? I'm borderline underweight (BMI 18). I don't really follow a keto diet, but I just like eating mostly meat and high fat foods (like fried chicken) and I skip meals sometimes so it ended up having a similar effect to a slightly low carb diet (but sometimes I would suddenly eat a lot of sugar, because I eat ice cream or other desserts for meals sometimes, and I eat snacks and candies regularly). My LDL is 152 mg/dL, HDL is 71 mg/dL, Triglycerides is 57 mg/dL, CHD ratio is 3.3. It seems what is said in this video describes my situation (although I don't really exactly follow a low carb diet, but according to the video my low BMI probably contributed). So should I be worried?

[@SleepyPaul]

Would be interesting to see bodyfat/composition rather than BMI

[@vpellegrino]

I’m curious what was the response of HDL and Trigs?

[@dry509]

Not following…what are you saying regarding diet? How would I use this information to make dietary, exercise, body weight decisions?

[@andrewleon7325]

Thanks Nicholas and what happens to LDLc when the person on a LCD loses weight and goes from obese to a "normal" or lean BMI?

[@nicknorwitzPhD]

We've seen people actually develop into LMHR by loosing "too much" weight

[@trail.blazer]

How lean does lean need to be with LMHR? My BMI is around 22. Muscular legs (cyclist) upper body not so much. No 6-pack and I'm not an athlete, but I'm fit for 60 years old. Can I still be LMHR? I already had quite high LDL when I was on SAD diet, but it doubled on a mostly carnivore diet and overall I lost around 17kg of weight. CAC of zero and good CIMT when I had scans about 4 years ago.

[@markusantonious8192]

As a newbie to this notion of LMHR....I rush to address the crux of the matter pour moi, i.e., not 'why' or 'how' (you've answered those), but 'does it matter?'. That is, are lean-mass-hyper-responders at risk given their high LDL...or is the triad of high HDL, low Triglycerides and high LDL a perfectly healthy adaptive response, or not?

[@rmgpdoc]

What baffles me is why don’t these guys check small dense LDL levels and prove that these patients have a relative low level of small dense size, hence decoding that the raised LDL level is not relevant.

[@MeatMikeD]

Just so you are aware, I am lean (BMI < 22). My LDL was 480+, such that my small LDL was very high (2700) despite being very much pattern A (size 21.7 nm average). So while the percentage of small dense is very low, due to the very high particle counts, I still have "high" numbers of small dense particles. Point being, a standard doc would not be reassured by my numbers. FWIW I had a CCTA recently which showed zero hard and zero soft plaque.

[@HAL-1984]

Interesting. I wonder how it translates to those who have high BMI but are lean for example bodybuilders. Presumably they are still going to see high increases in LDL because they are lean even though they have a technically high BMI.

[@nicknorwitzPhD]

We do see some larger LMHR if very lean too. However, there's likely an added element related to lipoproteins playing a structural role, with LDL levels dropping as they are endocytosed, esp in body builders... speculative atm... need more research on this

[@XaqNautilus]

Neat!

[@HalfGodHalfBeast]

I would be interested to hear your take on Dr. Paul Saladino's claim that chronically low insulin levels are not healthy as a result of a low carb diet and that his health has been better after eating around 200g of carbs a day, claiming that it gives the body a signal of abundance; wheras low carb is giving the body a constant signal that food is in short suplly, I am skeptical of his claim but it has worried me somewhat still. I was hoping you may be able to you speak to this?

[@lotembenatar7163]

From your article: "Reduction in dietary carbohydrates and depletion of hepatic glycogen stores results in a greater demand for fat as a metabolic fuel, to compensate for reduced glucose availability", why does high cholesterol compensate for reduced glucose availability? And why are triglycerides not elevated to compensate?

[@mattermat1925]

When it comes to energy balance, cholesterol is just a bystander. High cholesterol really means high LDL, so the question is really: what does high LDL have to do with reduced glucose availability? If the body is in a "fat-burning" mode as a result of lower glucose/insulin, then triglycerides will be broken down to free fatty acids at a faster rate (lipases are more active). VLDL is rich in triglycerides and loss of these converts it to LDL. Conversion of VLDL to LDL will therefore occur more quickly if glucose/insulin levels are lower, so LDL levels will rise, even though it is really a shift in the proportion of VLDL:LDL, rather than a change in total lipoprotein count.

[@lotembenatar7163]

@mattermat1925 Thanks for your answer. That is fascinating. Something is yet not clear to me. if there is high VLDL production, which makes sense, we would see high ApoB, but not high serum cholesterol. Why would the liver make so much cholesterol to be a bystander?

[@StephenWampler]

Are you looking at BMI at the beginning of the low carb diet? The end? Or where you are when LDL is checked?

[@nancysmith-baker1813]

My triglycerides are high do I increase good fats .?? Or just wait to adjust to keto vore . Thankyou .appreciate you vidios .

[@Frostbiker]

There's one thing I don't understand and would love somebody like Nick address. Isn't it true that some lean athletic folks on a low carb diet don't see elevated LDL? E.g. Dr. Peter Attia was on keto for a few years, lean and muscular, and I haven't heard him say anything about ever having elevated LDL. Doesn't this undermine the lipid energy model? Even if the general trend points at BMI correlating well with LDL increases on keto, it is useful to explain the exceptions.

[@RichardAMorris]

Just another reason to attempt lowering LDL in a LMHR using equicaloric butter supplementation evenly spaced between meals instead of Oreos

[@kend2006]

So do you become a LMHR as you get leaner?

[@pozzo1979]

Does this mean that we shouldn't worry too much about LDL levels in our blood and that we should instead focus on our Waist-to-Height ratio?

[@danieltschmitt]

My biggest question is whether high LDL in lean hyper-responders on a low carb diet increases cardiovascular risk compared to them eating more carbs (and having a lower LDL because of it)?