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.
American Heart Association. (2021). 2021 Dietary Guidance to Improve Cardiovascular Health. Circulation.
Attia, P. (2023). Outlive: The Science and Art of Longevity. Harmony.
Ference, B. A., Ginsberg, H. N., Graham, I., Ray, K. K., Packard, C. J., Bruckert, E., Hegele, R. A., Krauss, R. M., Raal, F. J., Schunkert, H., Watts, G. F., Borén, J., Fazio, S., Horton, J. D., Masana, L., Nicholls, S. J., Nordestgaard, B. G., van de Sluis, B., Taskinen, M.-R., … Catapano, A. L. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal, 38(32), 2459–2472. https://doi.org/10.1093/eurheartj/ehx144