If your doctor has ever been alarmed by your elevated LDL cholesterol or APOB levels while following a ketogenic diet, you are not alone. For decades, conventional medicine has directly linked these markers to an increased risk of heart disease. However, a groundbreaking scientific study has just challenged this relationship, especially for metabolically healthy people following low-carbohydrate diets.
This finding could radically change our understanding of cholesterol and cardiovascular health in certain population groups. The results suggest that the metabolic context is fundamental to correctly interpret these values.
A paradigm-shifting study of cholesterol
The study, recently published in the prestigious Journal of the American College of Cardiology Advances, analyzed 100 people who had followed a strict ketogenic diet for years. These participants had particular characteristics:
- LDL greater than 190 mg/dL (considered very high)* Elevated levels of APOB (another measure of cholesterol considered risky)
- Heavy consumption of foods high in cholesterol and saturated fats* Healthy metabolic profile (high HDL, low triglycerides)
- Low levels of inflammation* Normal insulin sensitivity
The researchers used high-resolution coronary CT angiography, an advanced technique that allows accurate visualization of the state of the arteries. They performed measurements at the beginning of the study and after one year, while the participants continued with their ketogenic diet (verified by regular ketone measurements).
Surprising results that challenge established beliefs
The main finding was truly shocking: despite having LDL and APOB levels considered dangerously high by conventional medical standards, the participants showed no increase in arterial plaque burden.
Using Bayesian statistics, considered more accurate than typical p-values for this type of analysis, the researchers determined that APOB was 6 to 10 times more likely to have no impact on plaque progression in this specific population.
This directly contradicts the so-called "lipid hypothesis" that has evolved over the years:
- Initially: "Do not consume foods rich in cholesterol"
- Then: "Avoid saturated fats"
- Then: "Your total cholesterol should not be high"
- Later: "Your LDL is the really dangerous thing"
- Currently: "Elevated APOB indicates higher risk"
The study found that in this specific population, none of these metrics predicted an increase in arterial plaque. The only true predictor was having pre-existing plaque.
What does this mean for followers of the ketogenic diet?
If you identify with this profile-you are lean or losing weight, you are metabolically healthy or improving your metabolic health, and your LDL or APOB levels increased significantly when adopting a ketogenic or carnivorous diet-these findings offer a reassuring perspective.
The main message is clear: you can stop worrying. According to this rigorous study, in people with your metabolic profile, these elevated markers showed no association with an increased risk of plaque buildup in the coronary arteries.
The metabolic context is fundamental
Importantly, these results apply specifically to individuals with a healthy metabolic profile. Key indicators that define this profile include:
- High HDL ("good" cholesterol)* Low triglycerides
- Low inflammation* Normal insulin sensitivity
However, the study also found an important finding: where arterial plaque was already present, there was a greater likelihood of developing more plaque during the 1-year follow-up, regardless of LDL or APOB levels.
Evidence-based practical recommendations
If you find yourself in a similar situation to the study participants, here are some practical recommendations:
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Don't abandon a diet that is benefiting you just because of an increase in LDL or APOB. If you are improving other metabolic markers, you may be on the right track.
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Consider a more comprehensive assessment of your cardiovascular health that goes beyond a simple lipid profile. This could include testing for inflammation and insulin resistance.
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Share this information with your doctor to have an informed conversation about your particular situation. Bring referrals to the study if necessary.
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Keep regular monitoring of your cardiovascular health, especially if you have additional risk factors or pre-existing plaque.
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Remember that everyone is different and these findings, while promising, may not apply to everyone equally.
This study represents a significant advance in our understanding of the relationship between cholesterol and heart disease in the context of low-carbohydrate diets. Although it does not completely rule out APOB as a risk factor for heart disease in general, it offers a more nuanced and personalized perspective that could benefit many people who have seen their cholesterol levels rise by adopting a ketogenic eating style.