Low carb for doctors: What about cholesterol?

By Adem Lewis / in , , /

So many patients and doctors
are worried about cholesterol. And this is one
of the most important reasons that you are going to take a baseline
lipid profile, not just the cholesterol. The other thing is to think about how you’re going to discuss
the lipid profile with patients. So when I’m talking to patients we are talking about the headline cholesterol,
the total cholesterol, in actual fact that normally drops a little,
but not always. I’m explaining to patients
that their whole lipid thing is more complex than just
a simple cholesterol. So many patients have an idea,
“What is my cholesterol? It’s 5, it’s 6?” So I find it best to introduce the idea
that it’s more sophisticated than that, though we’re looking at both helpful
cholesterol and harmful cholesterol. That brings in the idea
of the HDL-cholesterol, which you will have measured
in the profile, so often you’ll see the HDL go up. So that even if the total cholesterol
goes up a bit, this is more than weight
or counterweight by the HDL, which I find goes up significantly. And it’s so helpful for patients
to get that next step of the ratio idea. I actually rather like
discussing triglycerides. Triglycerides for me
used to be a real problem because I didn’t know what to say
about a high triglyceride, but now showing an interest
in triglyceride levels it works very well
with the low-carb approach, because so often you are going to find
significant improvements in triglyceride. Very often at the end of the day
you are going to end up with patients and some things have improved and
some things have got slightly worse possibly. And the idea is to help your patient
understand this more sophisticated approach to managing risk that yes your total
cholesterol may have gone up a little perhaps, but actually weighed against that,
your HDL has improved and your triglyceride is better and
your blood pressure is better. Because patients with their doctors
have to make overall decisions about,
“Was this a good idea or a bad idea?” But coming back
to what I said at the beginning, in my own experience most patients
see nothing but improvements. Now there has been
some mention of hyper responders. These are people whose cholesterol jumps up
significantly on the low-carb. I’ve seen this twice
in four and a half years and in both cases the cholesterol
did go up very significantly, but at the same time so many other
risk factors improved substantially in terms of blood pressure, weight,
how the patient felt about themselves, that these two patients on balance
much preferred the low-carb approach and decided for themselves they were not
worried about this high cholesterol, because they felt it was outweighed
by the advantages of the approach. So there are hyper responders, maybe not as many
as some people would expect, and when that happens you have to deal with it
in an individual basis as to what the risk is. My final thoughts on that is you could do
calcium scoring on the coronary arteries and that would really tell you
where that patient is in terms of risk. And then you wouldn’t really need to worry
too much about cholesterol at all, but that’s only going to these
hyper responders that are rare. The majority of your patients
are going to see on balance better lipid profiles
in my clinical experience.

5 thoughts on “Low carb for doctors: What about cholesterol?

  1. I am one of these hyper-responders. Had "normal" lipoprofile before low carb diet. Now it looks like I have FH. Low insulin, inflammatory markers, & feel better now. Almost 4yrs into this and I guess only time will tell if it will be detrimental or not.

  2. I'm a hyper-responder too – LDL high, but all my other lipid markers are very good. Couldn't get my doctor to approve a CAC, but we did get a carotid ultrasound which was fine, and all my inflammation blood markers are good or within normal limits. I'm hoping in 2018 they learn more about hyper-responders and what the heck is going on, but in the meantime I'm sticking with the LCHF diet because it's very good for hubby's health and (except for missing pizza) we enjoy it.

  3. Well, they say that (as in my case) that HDL will go up, but your LDL will go down, which indicates that the particles in your blood become fluffy and will bounce of the artery walls, whereas if you have high cholesterol and eat a normal diet they will mostly be small and sticky, and could clog up.Hoping this is true, I have read this a few times. Maybe this doctor could address this in another vlog.

  4. My doctor would probably prescribe a statin to lower cholesterol since the Low-Carb diet raises it , LoL. You just cant win on any diet ! They have their agenda about high cholesterol since the Low- Fat diet .

  5. Nice balanced video. I'm a hyper responder.
    Mine jumped up a lot but the ratios are really good and my LDL is very much pattern A and I have low TG and VLDL. So I'm gonna roll with it. A total cholesterol of 327 doesn't sound bad when it's broken down like this:
    HDL:138, LDL:176, Triglycerides:40, VLDL:12

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