In my last post, I reviewed some of the background on how and why cholesterol came to be viewed as a risk factor for heart disease, and how this creates a clinical conundrum for those who go on a low-carb diet and see a big rise in their LDL (the “bad”) cholesterol but see every other aspect of their health improve. I discussed how there is a paucity of research on this particular population of patients and, hence, a lot of controversy about this topic. Then I introduced the work of Dave Feldman, a software engineer and internet personality who has been leading a grass roots research effort into this very topic. And I reviewed how Dave has proposed that maybe – just possibly – the metabolism of people on low-carb/keto diets is so different from that of a person following a more typical diet that cholesterol simply doesn’t behave the same way in their bodies, and hence the research we have until now suggesting that high cholesterol is a risk factor for heart disease might not apply to them.
I’m going to spend the rest of this post discussing a fascinating study that Dave and his colleagues just published which attempts to shed some light on this question. But first, let me stress that all of this remains theoretical, and – spoiler alert – we still do not know if having severely high levels of cholesterol due to a low-carb/keto type of diet is safe. One study does not a fact make, and most doctors would advise continued caution in this area. And while I do feel that the obsession on cholesterol and its treatment has had some real downsides (by emphasizing a laser focus on this one risk factor, while far more important risk factors such as metabolic syndrome/insulin resistance get ignored), it’s only fair to admit that there are still many, many, papers out there showing that – on a population level – there is a strong link between elevated cholesterol and cardiovascular disease risk. Please keep that in mind as you read the rest of this.
