How to LOWER LDL on Keto. No meds!

DISCLAIMER: This is NOT a "You Should" video. I am also NOT making claims about the dangers, or lack thereof, of high LDL is particular metabolic contexts (e.g. LMHR). However, I believe that when it comes to health more OPTIONS/TOOLS are generally better. Therefore, take this for what it's worth: information for you to act on (or ignore) as you see fit.
House Of Macadamia Landing Page: partner.houseofmacadamias.com/nick-norwitz
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My Blog on Macadamia: ketodietapp.com/Blog/lchf/mac...
0:00 -- Overview
0:49 -- 2 phases
1:20 -- Part Ia: Specific fibers
4:10 -- Part Ib: Fatty acid profile
8:30 -- Macadamia
9:51 -- Part II 4 Levers for LMHR
14:05 -- Ranking the 4 Levers
14:29 -- "rock and hard place" patients
16:50 -- Not Tribal, a collaboration
Saturated Fat Meta-analysis: ajcn.nutrition.org/article/S0...
OreoVsStatin: www.mdpi.com/2218-1989/14/1/73
Lipid Energy Model: pubmed.ncbi.nlm.nih.gov/35629...
Arabinoxylan paper: www.cell.com/cell-host-microb...
Tahini dressing: ketodietapp.com/Blog/lchf/eas...
Tahini: amzn.to/42JFSai (Amazon)
Icelandic Cod Liver: amzn.to/3I5j0bW (Amazon)
Tazo Dark Chocolate with Ginger: amzn.to/49jMCOK (Amazon)

[@stevelanghorn1407]

Your summary to this video summarises why I listen…& learn! It’s you’re balanced, undogmatic, open-minded approach, which is all about communicating & pushing forward the science…not simply a particular message.

[@nicknorwitzPhD]

I deeply appreciate this comment. Thank you.

[@jasond4084]

@@nicknorwitzPhDI agree with Steve. That being said I think it’s time you upgrade your microphone. Please? My old ears have not yet been fixed with carnivore 😅

[@davidzip8841]

The question Nick always conveniently ignores on X. “Nick. Why do you spend so little time discussing LDL clearance? Presumably everyone on a lchf diet has high VLDL output. It seems like massive LDL receptor down regulation explains the syndrome much better.” Adding carbs stimulates insulin, which up regulates LDL receptors”

[@nicknorwitzPhD]

I don't ignore this question. I just answer it far too frequently. So how about I explain your question with more questions (1) refer me to any literature showing insulin could account for the magnitude of the effect we see (2a-b) how does insulin-induced up regulation of LDL explain the triad [beyond isolated LDL-C; re HDL-Cs in the 120s?! up from a baseline in to 50s/60s?] and/or (b) exercise-induced exaggerations in the triad. An LDLR-focused explanation is insufficient. Also, I don't see undereducated T1D with LDL of 450mg/dl that often... @@davidzip8841

[@espinosalexis]

@@nicknorwitzPhD Please explain in a video

[@Kuba-nk8zg]

This is exactly in line with my experience. If you are fit, healthy and active, doing IF etc but your LDL is too high, gain some body fat, limit activity, go to bad with full stomach and after few days your LDL will improve. Overall health will deteriorate. This should be treated as best evidence that something is fundamentally wrong with traditional guidelines on lipids.

[@davidsoper3851]

I'm not lean mass but my LDL way up and a very low carb diet. It seems like between the lines several of the solutions for getting the LDL back down sabotage the keto diet, especially fix it by adding carbs!, Sheeze. One doctor said stay low carb but avoid saturated fats. Low carb + avoiding saturated fats = a miserable diet. There's so much more to that fat story I'll not go into. I have a spreadsheet where I calculated the carb to fiber ratio. This video is reminding me to revisit that. Chia seeds at the top, must remember to always add to salad. Lily's Stevia chocolates, still too many carbs and hard to control consumption. Same with Pecans that I used to buy and eat a bit but too frustrating, portions to small so rely on broccoli, cauliflower, and spinach. There's no magic bullet. I feel the weight loss, end of high blood pressure, end of diabetes, fatty liver, higher HDL, lower triglycerides all together out way concerns about LDL. LDL a long complicated story as to other reasons I wouldn't worry about it if my Dr. would stop making me doubt my own research.

[@johnmartinsen963]

Just eat carnivore...it's simple and works great. Very little trash, food waste or excrement. Plants are what my food eats.

[@althe]

Yes.

[@sadtosuccess]

You doctor has to say that or they could lose their licence. Also, you've researched it, your doctor likely hasn't, they are just parroting what the pharmaceutical industry told them (many medical schools take their funding from the pharmaceutical industry so it starts early in their career). I agree though, it is difficult. I eventually got to the point where I figured even if they could guarantee I would live 10 yrs less, the improvement in my quality of life from following this diet was worth it. After that it doesn't matter what they say.

[@paulkam4059]

Can't agree more when the world is not clear about the significance of high LDL. I also feel helpless. Adding net 100g net carb means >> 100g of total carb especially for low GI food. Does this mean abandoning keto or carnivore ? I feel like victim of the insuffiency in the health profession.

[@stargazerbird]

Sounds like you use keto for weight loss and the benefits that go along with weight loss. So you don’t need to be in ketosis for your health. Adopting a high fibre Mediterranean diet would give you the same advantage regarding avoiding sugar and processed foods and keep your lipids in the normal range. Nick has a Mediterranean recipe book if you want to try. I recommend.

[@nealcox8204]

Bro… please don’t stop making videos!! I soooo appreciate your wisdom and insight. You are a rock star in this space and most importantly a scholar of the highest quality!! Stay curious my friend!!!

[@lindabirmingham603]

Why should we micromanage our cholesterol and LDL levels? Doesn't our genes and our bodies do that for us based on our physiologic needs? I could see doing this short term to pass a physical for a job or to get insurance. Just because you can lower these values, doesnt mean you should. Also, be aware that foods you have recommended to lower LDL such as sweet potatoes, tahini, and chocolate are very high in oxalates. Oxalates prevent the absorption of minerals and accumulate in all the tissues of the body causing arthritis, osteopenia, anemia, fibromyalgia, bladder pain, urinary stones, etc.

[@bobbygetsbanned6049]

Man when adding Oreos, decreasing your activity and gaining weight are a Doctor's recommendation for lowering cholesterol, something's gotta be fucked with our understanding of cholesterol....

[@user-ep6iw9he7e]

Almost seems like he's trying to navigate his own bias about keto being superior, trying to solve issues he created first. Be keto! But also eat oreos, they're not Keto but something about oreos is helping... i wonder what it might be...

[@janezschrott8429]

There is healthy LDL ( big fluffy particles) and unhealthy LDL (small particles). No point in having low LDL if it's healthy. With keto or LCHF you don't need to watch your LDL, your body is making it as much as it needs to. We are different and have different LDL numbers, there is no one number to apply to everyone.

[@karend.9218]

Hey, thanks for this. My husband’s doc is always freaking over his LDL. After reading your Oreo cookie experiment, and being well versed in the lipid energy hypothesis, I asked my husband if he wanted to game the next tests so his doc would be less concerned. We will implement some of these 2 weeks before his blood tests. He is not quite LMHR, but almost. Keto/low carb since 2018, lost weight, got rid of metabolic syndrome and feel the energy of good health.

[@gsts379]

Let us know his results

[@Krunch2020]

If you manipulate the results you should educate your doctor not fool them.

[@abbiec6057]

You are freaking brilliant!! So many gems here!! Thank you!

[@jaeLAX23]

As always, thanks for uploading Nick!!

[@aprilek6003]

thank you Nick - this video is wonderful. I love that you are giving folks the information and not telling them what to do. Experiment on yourself. I also "love" that you are able to bring folks together and that they can agree on the data. Love the document. I am a LMHR

[@mddrive2]

hello....can you point me to the link for the how to at the end of his presentation? thnx if you are able, if not no worries

[@milenasenov6228]

Why would anyone want to lower LDL?!?! If he is insulin sensitive with low levels of inflammatory markers, I see no point in such actions. Except from a purely psychological point of view. When I switched to NCHFD, LDL increased sixfold, but so did HDL....tyrglycerides almost zero. Thanks for sharing your knowlidge

[@NelsonRazo]

Nice, Nick! Leveling up the video production! Kudos!

[@motolover5697]

Being a T1D and an a LMHR it is difficult to find the solution. No carb way of eating stabilised my blood sugars and lowered my A1c to 4,8% for the last three years.

[@dr.julia-heyakarcic8862]

Valter Longo Ph.D is curing T1D in mice, read his work.

[@jamesdellaneve9005]

That’s amazing. I assume that you are on insulin as well.

[@motolover5697]

@@jamesdellaneve9005 Sure, I wouldn't survive without it.

[@michaelhashimoto1650]

How do you deal with your Endo & PCP with your high LDL? Do they suggest you take a station?

[@dr.julia-heyakarcic8862]

They can suggest. You dont have to take. Do Your research.

[@jorgefranco8522]

Love your content Nick!

[@jrmint2]

excellent summary, thank you!

[@thewellnessroom6574]

Excellent video! Very practical for those choosing to lower their LDL while continuing a low carb lifestyle. You are the best!

[@3buzzy]

More videos like these on the benefits of eating certain foods. Great! Thanks, Nick.

[@helenahandkart1857]

Wow! Such a fascinating & practical information rich video, thank you so much!👌

[@nicknorwitzPhD]

You’re welcome

[@AnneAlready]

This is so helpful Nick! Top notch info. Thank you.

[@AnneAlready]

PS Your description of how to add a ketone level "buffer" in order to play with adding more carbohydrate containing foods is spot on, in my experience.

[@nicknorwitzPhD]

Appreciate it!

[@user-gi9bs6fu7y]

Cholesterol 431,ldl 315,trg49,hdl 100, it's ok

[@mixxsky]

Thanks for the video and handout! I was really glad to hear that Keto burns PUFA preferentially, I saw a couple papers on it tonight. I've been looking for ways to burn PUFA stores. Was also glad you mentioned chia and flax, something I mentioned in a comment earlier this week. It is very nice that you often read and respond to comments here. Very informative, keep up the great work! Personally I'm aiming to avoid processed seed oils and high Omega 6 foods. I blame PUFA consumption for weight loss stalls I've experienced and for regaining some weight back on keto several years ago. Glad to be back on keto now but I'm intending to balance my omega ratio and reduce seed oils this time.

[@nicknorwitzPhD]

Happy you're finding what works for you as an n = 1! That's always "the way!" Keep killing it and thanks for the engagement and $5 :). Means a lot.

[@user-nj9nl5uy6d]

Thanks, Nick!

[@888jucu]

Nice video Nick and as you say the information is to be used as a guide for those who may wish to use it, nothing more 👍

[@dannakjohnston]

Thank you. Quite informative.

[@caitlinhoey841]

Great channel you have here! Glad I subbed!

[@nicknorwitzPhD]

Woot! Welcome welcome!

[@prestomattwine]

Hi Nick, this has been the best KZbin video I’ve ever seen explaining this. I have been low carb since 2019 and my lipid levels have doubled since going low carb and more saturated fats. I was on 40mg of Simvastatin from 2008-2018 and stopped taking from all the problems I heard about them. My levels were pretty much kept in check with the statin and eating a SAD diet. I’m 60 now but have eaten the SAD diet for all my life, with being pre diabetic range for the last 25-30 years or maybe even more. I just had my last labs done about a week ago and finally decided to go on a low dose, 10mg. of Crestor and doc will retest in 2 months. In the meantime, I am cutting back on saturated fats and adding in more fiber, since being on keto I was eating very little. I also started lifting weights and I do walk most days of the week. Last night I ate a mix of smoked salmon and sardines with some roasted red peppers and this morning my blood sugar reading was 86. Usually it’s around 95-105 with low carb diet. Today, I lifted weights and an hour later my blood sugar was 90, haven’t seen this number early in the afternoon, it usually comes down in 80’s and 90’s at night. So I hope eating more of a Mediterranean diet and weight lifting helps my insulin sensitivity and my lipid profile because as you’ve mentioned in your video, that high fat low carb might not work for some people. You made me a subscriber!!😊😊😊

[@karhukoira]

Super useful info, especially didn't know about PUFAs more readily converting to ketones than what SFAs do!

[@veronicaheaney3464]

I can really use this info. My TC and LDL went up a lot when going keto. I did lose a lot of fat. While I am not particularly worried since those are virtually the only negative markers I now have for metabolic problems or CVD. (Can’t do anything about my age, 76, so I don’t count that 😊). I am really glad you made this video.

[@betonmischer_86]

This is invaluable information for someone who's trying to get LDL in check while being on strict keto. Especially the fiber part, given the well-known benefits of it. A while ago I also checked if switching from metal to paper coffee filters would have any impact on my LDL, and it kinda did, not dramatically though.

[@sabine8419]

Good luck with having digestive problems and breathing problems and a bit of malabsorption and other ills with all those fibres and plant toxins.

[@ScienceAppliedForGood]

It was a useful advice. Thanks.

[@michaelj2276]

This is amazing and concise information. Thank you, Nick for continuing to explore the science - and sharing your knowledge with the rest of us!

[@nicknorwitzPhD]

Thank you :)

[@larrydykes7643]

Excellent content & great presentation style. fully appreciate the true science non-tribal approach!

[@nicknorwitzPhD]

Thanks! Appreciate this

[@joybecker2335]

This is perfect for me. Thanks so much. I will do the lean-mass protocol. My LDL is super high.

[@MaryJohanna]

Thank you so much, some things just make more sense on my health journey.

[@nicknorwitzPhD]

thanks for watching and commenting!

[@kk-gM98]

LOVE your practical videos ! I'm LMHR and have gone on a statin (40 mg Rosuvistatin) after a years of 2 of fighting with my cardiologist. (family history fatal MI in a parent at age 51) and for the month before going on the statin, I tried the half a sweet potato and did a recheck of the lipids. They were exactly the same as before making that change. I have BMI 20.5, 62 yo female, runner, cyclist, yogi, use a strength trainer 2x a week for 1.5 years and am on HRT (including testosterone). My eating window is generally 6-8 hrs. I'm also on low dose amlodipine (2.5 mg) for mild hypertension (and Raynaud's syndrome, which the calcium channel blocker has helped symptoms). I am watching and waiting for some results of the LMHR study which is underway. My coronary calcium CT test 2 years ago was zero. I know the statin is not a settled issue and have chosen to go on it with much thought. I have no noted side effects from the statin and I take CoQ10 to possibly mitigate the muscle side effects. I ordered the mac bundle as well as the chocolates (I subscribe to the chocolate almond bars already but am going to try the ginger 95%) Thanks. I am very curious how long the added carbs would take to see a change in LDL. I have been keto since 2011. I understand this is not medical advise.

[@kk-gM98]

fasting insulin = 1.7

[@Merzui-kg8ds]

Question: Why would a LMHR WANT to mess with their cholesterol numbers? This implies that there should be concern about their numbers, when there seems to be some consensus that there does not need to be concern.

[@karend.9218]

Some of us just want our health practitioner who keeps harping on statins to shut up when they see how dynamic cholesterol levels are and how they are crying wolf. Also, if a person has certain genetic variants then homocysteine buildup is a real issue. It would be great if every body could be predictable but there are factors at play that prove and disprove the rule.

[@beejereeno2]

Find another health practitioner lol@@karend.9218

[@cates_keto]

I became a LMHR even though I am still 10lbs overweight! But I resolved it by increasing my potassium, a once a week sleeve of Oreos, (yes it seems to work!) and increasing fibre though Irish ☘️ very high fibre brown (soda) bread. ❤😂🎉 honestly, I feel amazing on the inside.

[@KeepingItReal321]

With the triad of low TG, high HDL and high LDL?

[@donjaknow8591]

Interesting, I am the same. How much potassium and where do you find this magically bread and how much. Loving the Oreos!! Thx

[@cates_keto]

@@KeepingItReal321 triglycerides 0.94mmol/L, HDL 2.2mmol/L and LDL 5.0mmol/L (I live in Ireland), 🇮🇪 but my triglyceride to HDL ratio was excellent at 0.423

[@cates_keto]

@@donjaknow8591 I take one third of the daily recommended each day for 15 days then I don’t take it again for another month. It seems to work as I was getting some sort of hypertension and the potassium resolved it. Oh yes the oreos are nice!!!

[@KeepingItReal321]

@@cates_keto I would choose any other option to the sleeve of OREOs. NN just put out a video that offers several options. I’d prefer you not worry about LDL-C, instead of eating a sleeve of OREOs weekly. Stop it for 60 days and get an NMR plot of lipoproteins, to check if you have any small dense lipoproteins. The OREOs might be causing more damage than the LDL-C in isolation. The combination of the two is likely much worse. Or maybe just the OREOs alone would be responsible for all/most of the risk. There is a lot of research underway. But that’s what I’d wager would be how it comes out.

[@Herosix]

Great job Nicholas! Thank you so much for your explanation. I am a nutritionist from Portugal and like to "play" with keto/ Carb cycling. That said, i have been really enjoying your videos and your very open minded aproach and style. Justo one thing, what about raw avocado? I love chocolate as well but avocado is just fiber and essencially MUFAs.

[@gailm.8190]

Thank you! I think this is one of your best videos to date! I wonder whether one could ferment the AX containing grains to remove antinutrients and reduce carb load?! That’s what I’ve been doing with oatmeal. I’m a LMHR trying to increase carbs and fiber a bit.

[@clairecesta9491]

You rock Nick!!!!

[@willbrink]

Excellent evidence based info.

[@nicknorwitzPhD]

Thanks!

[@gstlynx]

Thanks Doc.

[@HamhockandHemorrhoids]

I really appreciate your channel. I know you are going against what I call the cathedral of modern medicine, so I really admire your courage. I went keto to help with my mood and ended up being a full-blown exercise addict. Your insights are a tremendous help on my journey. I'm really hoping you get the following you deserve. Just don't give up because of low follower count... please.

[@nicknorwitzPhD]

Appreciate it. Cheers :)

[@Maiden4eva1995]

Thank you for being objective in your gradual journey and desire to seek out the truth. Bright individuals like yourself aren't interested in dogma and tribalism, rather you are interested in the learning journey itself, no matter where it leads.

[@olekirkelund7755]

Another great video thanks, Nick! I suspect I could be LMHR as I consistently se HDL at around 100 (2,5 mmol); TG at 45 (0,5 mmol) and going very low carb I saw a rise in my LDL from 120 (3,0 mmol) to 200 5,0 mmol). BMI is 21,5. I am 60 years old and relatively fit and muscular VO max >45 (and that was BTW at a recent low point). Introducing 100 g of carbs daily, however, does seem to put me between a rock and a hard place. If i want to lower my LDL. :-)

[@stargazerbird]

So the Mediterranean diet. Interesting about the polyunsaturated fats and a useful tool to bare in mind if you want to stay in ketosis for medical reasons. Thanks Nick. Also a huge appreciation that you are willing to annoy the people married to the tribal stance on LDL in favour of following the science.

[@KyleNickerson-fg3pf]

Subscribed. Love Taza! I was eating Lindt 95% for a while until I read about the potential heavy metals and switched to Taza 95%.

[@nicknorwitzPhD]

It's great, right!?

[@lizandhercat1618]

Thanks Dr Nick! A couple of thoughts post-video: The fact that LDL-c (and other parameters) are so labile makes a mockery of the idea that you can predict anything (like mortality from heart disease) from 1 measurement of a labile biomarker. Likewise: that the numbers can be manipulated through dietary hacks. So I am a LMHR and my LDL-c would give the average cardiologist an event. However, all my other numbers are wonderful, and if I really wanted to game the system, I could consume a 100g of carbs for a week or 2, back off the exericse at the same time, and eat more often, prior to my next blood test. But .... why bother? I treasure nutritional ketosis. For me personally, it is not worth trying to keep statin-obsessed doctors happy.

[@etejan42]

I appreciate this , Nick. Everyone in my family has gotten elevated LDLs. I would like to get them down if I can. And my insurance pays me to have good cholesterol, so I need excellent numbers myself. (mine area already pretty good, but I have lots of fat to remove so hopefully my higher LDLs will just be transient). 🤞

[@nicknorwitzPhD]

"And my insurance pays me to have good cholesterol" ... I wish we could get discounts for functional metrics... like on paper my LDL isn't good by insurance standards, but I get nada for being able to run a sub 6 min mile or sets of 100 push-ups or for having a great VO2 max... come on insurance... ;)... jokes aside, I appreciate the comment

[@dwp2659]

well done!

[@nicknorwitzPhD]

Thanks :)

[@sabine8419]

No way! I removed fibre, plants, carbs, seafood, and poultry from my diet for a reason. This has been miraculous, and I'm not going to change it because of an unimportant lab value.

[@ColByte]

Hey Nich! Great video, sort of a lengthy question if you have the time. Ive been worried about the 3-6 ratio as my liver enzymes went real high increasing my fats from conventional beef, canned sardines etc. (had plenty of greens, I now buy organic) I've since switched to grassfed sources and started taking cod liver oil daily. I'm a very skinny guy and am not worried about getting any subcutaneous fat so I've since left ketosis with complex carb sources. Would having these 'healthy' omega 3 fat sources still cause a 'toxic' environment for my liver as Im not keeping my net carbs low? (High fat+high carbs inherently damaging to liver?) I am scared to have things like nuts and fruits now as well and I'm wondering where these fit into the mix for someone like me. Thank you for helping so many people with your content!

[@chrisminifie219]

Is there any reason to lower LDL other than to keep your doctor happy?

[@baccaratfitness2360]

If ldl particles stay around too long they can become oxidized and glycated which makes them inflammatory which can cause atherosclerosis.

[@user-yb7pr5cl2k]

@@baccaratfitness2360 That is if the LDL is mostly type B particles and high TRG.

[@user-qq5du7iv4t]

How does one lower apo-b?

[@btudrus]

@@baccaratfitness2360 " If ldl particles stay around too long they can become oxidized and glycated which makes them inflammatory which can cause atherosclerosis. " That is one of the many mechanisms how atherosclerosis comes to be. But already the state in which LDL particles stay around very long is a symptom of metabolical dysfunction. And that metabolical dysfunction is causal for the other mechamisms which cause atherosclerosis / prevent the healing of the arteries. So the metabolic dysfunction MUST be the target, not a symptom thereof...

[@baccaratfitness2360]

@@btudrus No, LDL particles can stay around if someone has familial hypercholesterolemia too because their liver has either fewer LDL particle receptors or Dysfunctional ones that are unable to remove them from the blood. Listen to Chris Masterjohn’s podcast on living with h-FH (heterozygous familial hypercholesterolemia). Since my heart attack I’ve been looking for and researching information on this and there isn’t a lot out there but his understanding is thorough and helpful. Would you consider me to be metabolically unhealthy if I’m lean, muscular and have triglycerides in the 50’s, HDL around 70 fasting insulin at 5? FH is a genetic disorder. Masterjohn’s in depth analysis explains the role of insulin signaling, stress response, pcsk9 inhibitors and much more.

[@danielpincus221]

Tahini-wise: Pro tip from famed chef, Michael Solomonov: first, macerate the chopped garlic in the lemon juice. The longer, the less sharp the garlic flavor.

[@nicknorwitzPhD]

Thanks for sharing

[@FutureLaugh]

thank you for mentioning the lead and cadmium in chocolate, i will check out this taza bar

[@pefrat]

Dr. Norwitz, Love your videos! So helpful. Question regarding oils in nuts (and other oily bagged products). For example, a bag of roasted Macadamia smells/tasks fine, but within a few weeks or more, it starts to smell rancid. This always seems to happen to products with PUFAs, but do you think it’s more likely to happen if the nuts are roasted (or products are processed at high temps)?

[@AnneMB955]

I want to live longer. Keeping my LDL. Thx Nick, really enjoy your analyses.

[@josephnebeker7976]

From the lay person research I have done into LDL related to metabolism and cardiovascular health, I am no longer convinced that high LDL is necessarily a danger. Especially since I am lean and healthy. I believe there's still so much about LDL we don't fully understand that it could be more dangerous to go messing around with than not when it does not seem to negatively impact people without cardiovascular inflammation.

[@sadtosuccess]

If you're doctor is worrying you before you decide what to do make sure you understand the magnitudes of the risk you are dealing with. Find a cardiovascular risk calculator online that includes some of the things you have under control using the diet if relevant (in the UK qrisk is a validated option). Put in your metrics as they are now. Then answer the questions again with the LDL in a normal range and see what the difference is. For me 0.1%, over 10 yrs risk of heart attack. There is no way I am taking a statin, and that risk isn't worth giving up the benefits I've experienced (I need to be in ketosis to get those benefits and I don't do well with plant oils even the good ones). It's also on a par with my risk of dying in a RTA in the same time frame given the mileage I travel and I'm not planning on stopping travelling to work either. If you've seen a benefit from the diet such as weight loss, also try putting in you're metrics with your original weight and lower LDL (because that's where your going back to if you give up the diet) and see what your risk would be then. For me the ketogenic diet is definitely a net benefit in terms of my risk of heart disease (overall 8.7% risk prior to diet vs 1.4% risk after). Doctors focus too much on LDL but that isn't the only risk factor for heart disease and the ketogenic diet improves may of the others.

[@cates_keto]

Great video. Keto rocks! 💪🎉❤

[@tonyzhuhai4132]

This is definitely a much better video compared to that Oreos , Keep up the good wok Nicholas- really well done 👍

[@nicknorwitzPhD]

not sure I agree, lol... but thanks for the kind words on this one ;)

[@tonyzhuhai4132]

@@nicknorwitzPhD I did my own n=1 experiment too b4 your video came out. indeed from my own, 1) increased in carbs is a strong factor- 100-150g per day. 2) reduced in physical activity- cut from brisk walking 6-8km daily by half. 3) Increase intake of fiber basically from China seeds, flaxseed meal and psyllium husk. 4) didnt test increase in weight, as I am T2D and have hard time putting on weight n was one of the reason i switch out from strict keto. 5) Fasting- the last meal and first meal gap ranges from 15-19hrs , not sure how it impact LdL. 6) I did have morning fasting blood ketones of 0.5mmol. Question regarding fiber, is the effect from fiber or from the plant sterol which are also presence in most of them ?

[@atransformedlife]

Please do a video on people with suspected familial hyper cholesterolemia. I used keto to basically save my life from multiple auto immune diseases. I completely recovered. Fast forward… With a cholesterol of 380, small, particle sizes, high levels of apob.... unfortunately, I am not a lien mass hyper responder… As my triglycerides seem to go up with my cholesterol. As a result, I am revisiting a pescatarian diet via orders by my Functional Medicine physician. Hoping I do not run into trouble reintroducing beans, and some gluten-free grains like wild rice and quinoa into my diet.

[@zwanzikahatzel9296]

Hey, great channel! Do you have or could you make a video about what you believe to be the ideal diet for most healthy people? What foods are very healthy/ok/detrimental and in what quantities. What about cholesterol, saturated fats, seed oils? It would be nice to have a high level bigger picture, as it's hard to piece all together from videos about specific topics.

[@pardogg]

Too many comments on here from people that know very little about lipoproteins, but passionately parrot their favorite influencer lines. I doubt many of the commenters are medical doctors or PhD holders in a relevant field. Keep up the good work and wishing you success in your future medical career.

[@shellderp]

would be great to see you debating on other people's channels, I don't think anyone else understands the science like you do

[@nicknorwitzPhD]

Who do you suggest? I've offered to "discuss" LMHR (or debate) with Attia, Layne, Dayspring... none have accepted. But I do enjoy a good 'exchange of ideas'

[@Nataswen]

Debate Bart Kay

[@scotchbarrel4429]

Actionable tools, my man 👊 As an ex keto guy, i appreciate this info. I've changed to Hubermans advice on a omnivore type diet. I originally used keto for the mental benefits, and i can testify that it does provide mental clarity, and i only did it for 6 months, following Dr Bergs version of healthy keto. I turned away after realising my strength was degrading, and so ive borrowed a mixture of both, using IF and organic whole foods to arrive at a omnivore diet. Im hoping that with healthy nutrition, exercise (hubermans protocols; cold/heat therapy, strength & cardio training etc) and a job that requires i move around all day, averaging 15k steps a day, im hoping that gives me the benefit of a long and healthy lifespan. Attia had me worried about LDL, so im focusing on high VO2 training to offset any LDL effects from nutrition. If my matrix for healthy living makes sense, let me know what you think i should do as an omnivore guy to make it better 👊😎

[@nicknorwitzPhD]

"strength & cardio training etc and a job that requires i move around all day, averaging 15k steps a day" sounds pretty great to me... I'm jealous ;) ... except you can keep your cold shower... I will never! ;)

[@scotchbarrel4429]

@@nicknorwitzPhD cold showers i do twice a week, great when you need a shot of adrenaline. Sux to think about, but great once youve done it a few times. I do an ice bath after a 2hr run once a week. It took me three weeks to get comfortable with the idea of regular cold therapy, really does help to have Huberman walk through the required mindset to make it work, otherwise, id agree with you.

[@johnmartinsen963]

​@@scotchbarrel4429Berg is a con. His version of keto is not healthy, it helps him sell supplements. Anthony Chaffee MD has the best dietary advice on KZbin.

[@99jacka]

Really good information. Question: What about non soluble fiber? or maybe a fibre containing beta glucan? for example pure oat fiber meal? or could you suggest other types?

[@billtrudell1636]

Great info I’ve been trying the fiber way since my walnut diet doesn’t work as well on low carb. And 100% dark chocolate.

[@lisacee3237]

Thank you so much Reading the comments, I realized I did not give you credit or thanks for the handout & for even presenting these videos to help inform the masses. Luckily there are more professionals coming out every day & going directly to the people.

[@kefirheals7383]

Extremely interesting.

[@nicknorwitzPhD]

Thanks for watching :)

[@millionairejh]

ive been on keto for 4 years now. never felt better. but a couple years ago i went to thailand and had a physical from some of the best doctors in the country. my LDL came back as like 400. it was really alarming for them. I was never really that over weight, but i did keto cuz it helped with a lot of different issues i was getting. it cleared up my skin and helped my breathing. I use to think i had asthma, but i later found out it was just me spiking my blood sugar. Nowaday, in my mid 30s, i feel better than i ever have. Im a big tennis player so cardiovascular performance is really important to me. I can tell when im keto, my energy levels are more stable and i can get full breaths of air. Im never out of breath when exercising. But seeing my LDL so high, the doctor basically told me to stop keto once ive "lost the weight" . Its hard to know what right because i feel and look good, but the "professionals" are saying to stop. Also, i basically do everything mentioned in this video already. I eat soluable and insoluable fiber. I have a large bowl of mixed salad everyday (like 72oz worth). I make my own dressing with extra virgin olive oil. I only cook with avacado oil. Eat macadamia nuts, lean on fish or lean cuts of meat. I eat almost a psychopathically clean diet. One thing to note, when i took the blood test in Thailand, I was told to not eat for 10 hours and not even drink water. This is unheard of and I wonder if something was lost in translation. When my blood work came back, they said i was dehydrated (and to drink more water) and my ketone levels were really high. At that point i probably had been fasting from food and water for over 12 hours cuz its hard to plan a perfect 10 hour fast. i suspect that being in such a fasted state with high ketone might have to do with my elevated LDL levels. I also had lots of quale eggs and salad the night before. These days, im trying not to be so strict keto, it seems to me just adding carbs allows ur LDL levels to come down. But as a result im not as lean as i was and my skin kinda breaks out time to time now. Its a little unfortunate, but im trying to play my odds and not completely discredit what the doctors are saying. Also if i do have carbs, i try to pick healthier choices. No high processed carbs. Il lean onto things like chickpeas /whole foods. Ive been meaning to get my blood work checked again. bet my LDL will look better now, but at what cost.

[@sadtosuccess]

Find yourself a cardiovascular risk calculator. Put in all your metrics as they were and see what risk their is. Then put in the same metrics but with your LDL in a 'healthy' range. Finally put in the original metrics with high LDL but with your original higher weight. You might be surprised to see how little lowering your LDL reduces your risk of heart attack, compared to reducing your weight, given all the dire warning from doctors,, as in by their own calculators it may be a net benefit. They you can decide if that small increased risk of heart attack (not death, heart attack) is worth the increased quality of life following the diet. For me reducing my LDL to normal would reduce my risk of heart attach by 0.1% over 10 yrs. That's not high enough to stop the diet given the benefits I see. The fact that I have bipolar and migraine increased my risk by 1.1% (they were options on the one I used). Keto effectively manage my bipolar without medication and to a lesser extent the migraine, so seems like keto overall reduces my risk of heart disease by about 1% over 10 yrs all tings considered. Then there is also the fact that psychiatric medication causes diabetes that would massively bump up my risk much more than even just having bipolar and migraine, so it probably actually drops my risk further given if I wasn't following the diet I would need medication .

[@mimiverschueren4683]

@@sadtosuccessHi, just asking, what risk calculator(s) did you use?

[@sadtosuccess]

@@mimiverschueren4683 qrisk it's UK based, it uses postcode to calculate the risk, but that is optional and if you're in a country similar to the UK it'll probably still give you an idea.

[@mimiverschueren4683]

@@sadtosuccess Thxs for your quick reply!

[@stargazerbird]

I had a blood panel done a few years back while I was losing weight in ketosis. Same advice. Arrive fasted overnight. They do it to measure morning blood sugar but of course it will raise your LDL regardless of your diet. Mine was super high and I have never tested that high before. In fact they used to say my cholesterol was good. My best results were on a high fibre diet.

[@roccosakai8206]

@Nick, are you saying we (LMHR people) should lower LDL and drop out of ketosis? Got confused after this video.

[@HobzyMcRuse]

I don't think he's saying that. I think LMHR are an exception and don't seem to have any issues from high LDL. They're metabolically healthy. My opinion is that high LDL in cardiac patients is a different situation: LDL is part of the healing process of trying to patch up atherosclerosis. I don't believe it's causal, just part of the fire brigade, same with the calcium that comes much later. We just need the data from Dave Feldman's LMHR study to be sure.

[@KeepingItReal321]

@@HobzyMcRuse They may or may not need to be concerned about LDL. There is active research right now. Some even seem to think that LDL is NOT the causative driver for anyone. And that we might need to look elsewhere for causes. They are starting with disease-free LMHR . We’ll know soon if their risk is elevated or not. If LDL doesn’t prove harmful for this select group, then they might have a basis to test LDL in other nonLMHR people with better lifestyle choices. But don’t jump ahead with the conclusions, yet. Just be glad there are earnest hard working scientists and clinicians looking at the issues.

[@ArcoZakus]

@@HobzyMcRuse, I think that "to be sure" will take more than just the results of a single study. It is a great start, but will others be able to duplicate the results? I don't think that will happen during my lifetime though, so I just have to place a bet and hope it wins. (All I really care about is my N=1 results anyway.)

[@HobzyMcRuse]

You could not be more wrong. You are blaming the firefighter.@@stellasternchen

[@arnoldfrackenmeyer8157]

I have no desire to lower LDL.

[@davidsoper3851]

With my research I'm kind of there too. The reason long and complicated.

[@arnoldfrackenmeyer8157]

@@davidsoper3851 Two valuable documents in my research are the heart disease map, and the US timeline for heart disease.

[@jerseyjim9092]

People worried about high cholesterol/LDL probably shouldn't be on a high fat diet.

[@georgemoonman2830]

​@@jerseyjim9092haha, true, stress is probably a bigger risk factor than LDL

[@davidsoper3851]

It's not that simple. HDL and Triglycerides improve on a Keto diet. For some the LDL goes up, some stays say the same, others it goes down. Whether to be concerned about LDL going up is a complicated issue. We don't have all the answers yet. Also, the percentage of larger LDL particles (fluffy) goes up, dangerous small dense LDL "bullets" go down.

[@bottlenecks]

Since you now advertise for palmitoleic acid (16:1n-7), may we ask your opinion about the paper with DOI:10.1093/ajcn/nqab195, which found that people in the highest quintile of palmitoleic acid in the bloodstream had a lifespan an average of 6.62 years less than people in the lowest quintile? Cf. table 3. Thanks.

[@danbance5799]

If IBD is a major concern, I would suggest trying fermented foods. While a high fiber diet produces mixed results (for some people it helps a lot, for others, it makes things much worse), fermented foods typically avoid those problems on account of the fact that they've already been digested by anerobic bacteria. Although, personally, I can only eat so much sauerkraut before giving up. I think this would be a great follow up to the infamous Oreo cookie experiment.

[@amyberger-ketowithoutthecrazy]

Cue the PUFA-phobes to come in and crucify you for the sesame oil. 🙄😉 Thanks so much for your work, Nick - we appreciate you!

[@nicknorwitzPhD]

Appreciate you Amy! And oddly haven't gotten trolled on that point yet. But they can enjoy the vision of my 1:1 erythrocyte n6-3 ratio while I enjoy coconut butter-tahini Halva!

[@EduardQualls]

*When speaking of dietary fiber/ fibre, only its singular is used, as in "There are different kinds of dietary fiber." The plural, fibers/fibres is used only when speaking of component structures within larger structural or functional units, like muscle fibers, or woven plant fibers).* Every time you said, "Fibers," it sounded like you had gone off to talk about weaving or macramé.

[@brotzmansportsmedicine2277]

Nik, I would like you to read the ancestral diet revolution by Chris Knobbe or watch one of his recent, KZbin videos with discussion of poly unsaturated fats When you look at the studies of relationship of poly unsaturated fats consumption increasing in a nearly direct correlation with obesity, metabolic syndrome, type two diabetes coronary artery disease, Atherosclerosis ,Obesity, related cancers, and insulin resistance syndrome etc and these Parallels pre-date the 1960s increase in dietary sugar and fructose. While correlation does not equal causation, when you look at the well documented longitudinal studies and the timing of increased pufa consumption as a part of the sad American diet,…. Versus increased dietary fructose consumption etc the primary culprit appears to be the pufas is rather than Fructose interestingly the huge oxidative stresses placed on your mitochondria by the highly unstable poly unsaturated saturated fats resulting in ALE s (advanced lipo-oxidation end products ) that knock out the hydrogen gradient in the inner membrane of the mitochondria, resulting in much more oxidative stress and mitochondrial destruction than fructose via its unchecked hexokinase enzymatic nightmare sending ATP to ADP to AMP to URIC acid and resultanting in de Novo lipogenesis and insulin resistant syndrome obesity etc The correlation in Insulin resistance syndrome and the related downstream metabolic problems is much more linear and clear cut and compelling when you’re looking at the timing of 1930s intro of Crisco transfat /hydrogenated cotton seed oil in it, and then the progression of the other seed oils. Don’t be like Peter Attia and dismiss anything that’s not in your current wheelhouse. These studies show that the obesity rate went from 1.2% to 43% with huge increases and obesity and insulin resistance etc with many of these changes totally predating the increase in fructose consumption in the 1960s with the dishonesty of ancel keys. You are smart, and you figured out the great cholesterol myth . I assume you are on the ketogenic diet because you want to avoid the perils and pitfalls of ultra processed food with its dietary excess is in fructose and complete lack of fiber Killing your metabolic health and causing metabolic syndrome, etc. But when you read these studies, you will see that the main culprit is actually the huge oxidative stress and destruction of mitochondria as a result of oxidative stress killing the mitochondria by poly unsaturated fats They are highly Pro-Oxidative, Pro-Inflammatory, Cytotoxic, Genotoxic, Mutagenic, Carcinogenic, Thrombogenic, Atherogenic, and Obesogenic. Numerous studies beyond Chris Knobbe also showing the same findings When your french fries sit in stirfry full of pufas that are heated and become oxidized six or seven times before the inexpensive seed oil is eventually thrown out it’s actually really killing your metabolism and mitochondria. it’s not the potato. It’s the huge oxidative stress that you take on when you ingest those french fries. It’s great that you’re omega 6 omega-3 ratio is one one and that’s rare in today’s society but you wanna make sure to keep your poly un saturated fats below 2.3 g of ingestion per day, which should be relatively easy in a ketogenic diet that is avoiding high processed foods.etc But you sound a little casual on your omega6 poly unsaturated consumption with your discussion of preferences for salad dressing, etc. S. Brent Brotzman m.d.

[@stargazerbird]

He is on keto for his IBD.

[@3cardmonty602]

I’ve been on Keto for 6 years now. I lost 150lbs and it’s a good thing - I required an Aortic Valve replacement 2 years ago. My coronary arteries are all clean though. I required a heart catheterization before my open heart surgery. My lipids on Keto are: Total Cholesterol=186, Triglycerides=46, HDL=62, LDL=115, VLDL=9

[@akunamatata4266]

Didn’t understand your heart was good but you needed surgery?

[@southern842]

​@akunamatata4266 aortic valve is a common need for surgical replacement due to birth defects such as bicuspid valve. The heart arteries are clear and the rest of the heart is fine outside of the common bicuspid birth abnormality.

[@caitlinhoey841]

I love taza chocolate too!

[@nicknorwitzPhD]

It’s great, isn’t it! Ginger is my fav :).

[@alejandrosegura6968]

@ Nicholas : I have been following your journey with Dave, Dr. Nadir, etc. I had cancer and changed to keto, and want to keep it that way to reduce the amount of glucose to starve cancer cells or to avoid them to grow again. I am a lean mass hyperresponder my tot chol: 375, HDL: 100.54, TG: 53.14, LDL: 263.93. I have been trying to lower the cholesterol but has been difficult. My question is. For someone in keto diet what would you say the cholesterol level should be to be considered healthy. I take macadamia, olive oil, train (table tennis and weights), sometimes I add some carbs but cannot lower enough the cholesterol according to my Dr. and have been refusing to take statins. That's the reason why I asked about the "healthy" level of cholesterol. Thank you very much.

[@beejereeno2]

your HDL and TG are great, so I think the rest is not that important

[@250txc]

I'm just glad I do not have any of these quarks Nick talks about here with my eating ... I eat low CARBS, no processed foods, count nothing, and exercise to some degree ...

[@nicknorwitzPhD]

Quarks you say... would you also say you eat a high Proton diet?

[@250txc]

@@nicknorwitzPhD I eat plenty of protein and fats and come CARBS .. And do not count calories or worry about all the details you talk about here.

[@chadfitch3293]

I developed Xanthomas around my eyes after starting ketogenic diet my lDl is over 500. I’m looking for ways to bring that down naturally without statins. So, this information is helpful thank you so much. Honestly I’m not to hopeful I think I’m just screwed but not giving up. I have atherosclerosis so I’m trying to stay keto. Of course drs in my area are no help.

[@azdhan]

Great video! Many thanks for sharing. What is your view on resistance starch such as unripe green bananas and potato starch given its potential rrole in promoting healthy gut microbiome bowel flora which may inturn have a potential contributory role in reducing ldl levels. How about psyllium husk given research suggesting it can greatly assist in lowering ldl. BTW, I make a killer Turkish Halva Dessert using coconut flour, Tahini, Allulose, and pistaschios. I use a little Extra Virgin Olive Oil as needed to mold and shape as needed. I am not low carb or keto and while I have the characteristic appearance of a LMHR, I am far from it. I was just an obese 38% super obese guy with 40 inch waist and NAFLD which were a direct consequence of a homer simpson diet to someone who lost 57lbs, got down to 11.7% body fat. 29 inch waist. and total reversal of my NAFLD. I just achieved that though consistent cardio and resustance training. and adoption of healthier “flexible’ dielting with no to minimal consumption of ultraprocessed and fast foods. Thanks again for the great video!

[@jupiterman7]

Hi sir just new to your channel... enjoying it but feel its all a bit over my head... Very interested in the one pager document but I'm not seeing in on the community page? I feel like if i could see this it might help me absorb and understand a bit better Thanks

[@FutureLaugh]

keto has been around for over 100 years, epileptics who are non responders to medication have been on this diet for long enough to know- do they have a statistically higher propensity for heart disease?

[@Velheibgnar]

The discussion is good and for sure needed, but my first thought was that to lower LDL in LMHR you need to make them less LMHR or even less deep down into keto. It can even be named as "make the high responders less responsive" if you know what I mean, how it's a thinking loop. Do we even know exactly WHAT is the responsiveness here (besides the energy models) and where it's classification starts as "high" to fit the "model"

[@mzanecastro]

This is very cool information: How can we definitively determine if we are a LMHR potentially? I am recent ketogenic due to declining symptom of metabolic health and wanting to rapidly impact the effects of elevating A1c. In 3 short week I can tell that I'm improving, but the real question is my VLDL and potential cardio vascular health with labs of prior to above changes being high in apo b. Getting doctors to test and rule out other concerns has been challenging to say the least. Any direction possible?

[@johnk6578]

The first sentence of the paper’s summary is: “Dietary fibers act through the microbiome to improve cardiovascular health and prevent metabolic disorders and cancer.” Does this statement presume the high LDL is bad for cardiovascular health and that by lowering LDL then cardiovascular health is improved? If one assumes that LDL isn’t universally negative regarding cardiovascular health, then the summary is at best only conditionally true.

[@adrianvisentin534]

I've always had high LDL. Also high testosterone, great musculature, tops in my scholastic adventures, cornered the stock market, and am now climbing (cycling) mountains in Spain at the age of 67. I'm not going to fight nature - it seems to be doing fine.

[@davidzip8841]

Since Dr. Cromwell is a collaborator, let’s hear what he says about ApoB. “1. ApoB lipoproteins are a causal component in the development of atherosclerosis. 2. The risk posed by ApoB is a function of quantity over time. The higher the ApoB and the longer the high ApoB exists, the greater the ASCVD risk. 3. In the absence of data to the contrary, it is presumptively unhealthy for ApoB to remain high for extended periods in most physiologic states. 4. The ASCVD risk of high ApoB over short periods differs from that of high ApoB over long periods.”

[@ApoBeef]

Can’t wait for PCSK9 inhibitors to become generic.

[@btudrus]

Ad 1. Causal component doesn't mean neither "necessary" nor "sufficient". Ad. 2. That is simply not true. Ad. 3. There is already evidence to contrary. Ad. 4. So what?

[@ApoBeef]

@@btudrus Keeping your head in the sand I see.

[@btudrus]

@@ApoBeef "Keeping your head in the sand I see." LOL, you are brainwashed by all that unscientific nonsense and reluctant to see the facts...

[@grantlawrence4600]

@@ApoBeef He's not wrong.

[@tommydinob]

Regular release niacin 1000mg BID dropped mine significantly. Added bonus….it burns so good.

[@Albundy11373]

Niacin is bad for your liver and increases homocysteine. I prefer taking fish oil or krill oil.

[@_________9996]

There's been a recent buzz about links between higher levels of B3 and an increased risk of heart disease and stroke. Worth looking into, if you haven't already

[@tommydinob]

@@_________9996 I’ll check it out. Thank you for taking the time to post this.

[@tommydinob]

@@_________9996it’s a Cleveland clinic study vilifying 4PY…a metabolite of niacin. The study has some holes in it, and is unconvincing. Check out Dr. Ford Brewer’s take on it.

[@zefrum3]

Can Nicholas Norwitz explain @6:30 regarding SMASH fish being packaged in their own tin with oil causing inflammation?

[@karhukoira]

Two questions: 1. What is the mechanism by which fibre lowers LDL? 2. How does increasing your weight via muscle vs. fat compare with respect to lowering LDL? On a surface level based on the LEM it would seem adding muscle is not helpful, as it just increases your energy demands and thus the need to ship fats around.

[@mimiverschueren4683]

Can’t find the 1 pager?

[@truehealth992]

@nicknorwitzPhD have you tried using B5 as an experiment to lower cholesterol? There's both Pantothenic B5 and a derivative of B5 called Pantethine. Thanks!

[@nancysmith-baker1813]

What sbout triglyceride s Those are the ones .Dr Brewer is concerned with .. On you tube .thankyou for your vid .

[@wilcurran3377]

Nick, I think it's only fair to mention that both dark chocolate and sesame are extremely high in oxalates.

[@passionpourelegance]

I'm a LMHR doing a therapeutic Keto Diet and can't and won't go back to carbs. Just finished a 30 days water fast. I used to have a high LDL. Had a blood panel done days after the water fast. My LDL is now in the 'healthy range'.

[@jorgefranco8522]

I wish someone had an answer why my HDL dropped to 38.5. My TGS remain low at 66, fasting insulin 2.8. Scratching my head. Hope u read this Nick. I totally value your thoughts and opinions. That low HDL keeps me out of the lean hyper responder phenotype.