LDL Cholesterol: The Debate Is Over
The Controversy
Keto influencers claim high LDL doesn’t matter if inflammation is low. They point to short-term studies showing no plaque growth despite sky-high LDL.
The cardiology community disagrees. Strongly.
What The Evidence Says
LDL causes atherosclerosis. This isn’t controversial in cardiology: it’s settled science (Ference et al., 2017):
- Genetics: People born with lower LDL have dramatically lower heart disease risk
- Trials: 200+ studies show lowering LDL cuts cardiovascular events
- Guidelines: AHA recommends <5-10% calories from saturated fat (American Heart Association, 2021)
Keto case studies are interesting but niche. Decades of data trump months of anecdote.
The 80/20
You can eat low-carb without ignoring your lipids:
- Swap sat fat for unsaturated : Olive oil and avocado instead of butter
- Monitor your numbers : If LDL spikes, adjust. Don’t rationalize.
- Don’t pick sides : Optimize glucose and cholesterol (Attia, 2023)
Your heart doesn’t care about dietary ideology.
Definition
The saturated fat and LDL debate centers on whether dietary saturated fat raises LDL cholesterol and whether elevated LDL causes cardiovascular disease. The scientific consensus is clear: LDL is a causal factor in atherosclerosis, supported by genetics, randomized trials, and decades of epidemiology. Dietary saturated fat reliably raises LDL in most people. The contrarian position — that LDL doesn’t matter if inflammation is low — is not supported by the weight of evidence.
When This Applies
- Choosing a diet approach: If your diet raises LDL significantly (common on keto/carnivore), monitor and adjust rather than rationalize
- Interpreting bloodwork: LDL is the primary lipid marker to watch; don’t ignore it because of internet influencers
- Balancing diet goals: You can optimize for both glucose control and lipid health simultaneously — they’re not mutually exclusive
- Evaluating health claims: When someone dismisses LDL as irrelevant, check whether they’re citing peer-reviewed cardiology or YouTube
Related
- Protocol: Eat Well (practical nutrition that manages lipids)
- Protocol: Preventive Screening (regular bloodwork catches problems early)
- Concept: Calories vs Hormones (the broader diet debate)
- Concept: Nutritional Density (whole foods naturally manage lipids)