Does the Low Carb Diet Raise Cholesterol?

You may see studies that purport to prove that eating a low carb diet raises cholesterol. There was one reported in the latest edition of Diabetes in Control which you can see HERE. You may even see your cholesterol go up when you start to eat a low carb diet.

Is this reason for concern?

No. And here's why. The studies that show a rise in cholesterol are always studies of very short duration. The study reported in Diabetes in Control lasted six week. If you look at long term studies, you will see the exact opposite occur. Over time people eating low carb diets develop more favorable cholesterol profiles than those eating high carb/low fat diets.

You can see this finding documented in this metastudy published in the Nature journal, Obesity:

Cardiovascular and Hormonal Aspects of Very-Low-Carbohydrate Ketogenic Diets. Jeff S. Volek* and Matthew J. Sharman. Obesity Research (2004) 12, 115S–123S; doi: 10.1038/oby.2004.276

The very slight and short-lived rise in LDL--and it is very slight--12 mg/dl in the study described by Diabetes in control--is nothing to be afraid of. By six months into the diet it will be gone in most people, replaced by a better cholesterol profile.

The only people who may not experience this improvement are the very small number of people with diabetes who, because of some specific genetic issue, are very fat sensitive. You can tell if you are one of them because if you are, when you eat a low carb diet for six weeks your blood sugar will go up, not down. This is very rare. I have heard from two people over the past five years who experienced it.

No research has ever shown an increase in any negative health outcome from long-term adherence to a truly low carb diet--one that does not exceed 100 g per day--and trust me, they have looked for them. Because these diets are so effective in lowering blood sugar, they lower the incidence of new diabetic complications.

You can find links to many more studies proving the safety and efficacy of the low carb diet HERE. You'll also find the huge, multi-million dollar, multi-year study that proved beyond a doubt that the low fat diet, whatever its short term effect on cholesterol might be, has no effect at all on the incidence of heart disease or cancer.

Analyzing Your Cholesterol Results

If your cholesterol goes up after you start a low carb diet, it is important to understand that cholesterol is only very weakly associated with the incidence of heart disease--despite the myth promoted by the companies that sell drugs that lower total cholesterol.

Here are the measurements that actually map down to a slight rise in heart disease. To find more discussion of the studies that document this, with links, visit THIS PAGE:

1. High fasting triglycerides. If your triglycerides are over 150 mg/dl, your risk of heart disease may rise. Triglycerides are blood fats, but they rise in response to carbohydrate consumption.

2. Low HDL cholesterol. HDL the so called "good cholesterol" is protective for most people, especially when it rises to levels above 60 mg/dl. However total cholesterol is computed by adding in HDL, so it is possible to see your total cholesterol rise because your HDL has moved from a low, dangerous level to a high protective level. It is not uncommon to see people who eat long-term low carb diets develop HDL that ranges from 80 to over 100 mg/dl. This is not a problem.

3. Apo(a). This is a factor family doctors rarely measure, but it is a much more sensitive indicator of heart attack risk than cholesterol measures. If you have a family history of early heart attack, it would be a good idea to get it measured.

4. Cardiac Specific CRP. Heart disease is now understood to be an inflammatory disease that affects the arteries. The Cardiac specific CRP (C-Reactive Protein) test will tell you if your arteries are inflamed. High levels on this test suggest that you would benefit from a statin drug, because what statins actually do that prevents heart attack is NOT lower cholesterol but lower inflammation.

5. A1C Rising over 5% and Post-Meal Sugars over 153 mg/dl at 1 Hour. This is starting to look like the single strongest predictor of heart attack. Details HERE. Since lowering your carbohydrate intake is the single most powerful tool you have to lower A1c, the long term benefit of cutting carbs becomes very clear.

One Last Thing: You Don't Have to Lose Weight to Get The Benefits

Doctors often tell you that you have to lose weight to improve blood sugar and heart attack risk. While losing weight takes strain off your heart, you will get significant benefits from a diet that cuts carbohydrate even if you don't lose a single pound. That's because that kind of diet lowers blood sugar, and it is high blood sugar that is so damaging to your capillaries, nerves, retinas, and kidneys.

Many people think that to get the benefits of a low carb diet they have to eat at extremely low levels--ones many people find difficult if not impossible to sustain. However, this is not true. Many people can see impressive improvements in their health by eating at higher levels of carbohydrate intake--closer to 100 g a day, with no meal exceeding 35 g, rather than 20 g a day.

The key to health is to eat at a level that keeps your blood sugar below the levels that cause damage to your organs. Using the strategy you'll find described here, you can determine what carbohydrate intake level normalizes your blood sugar. It is different for every person:

How To Get Your Blood Sugar Under Control

If diet alone can't give you normal blood sugars, carefully chosen, safe drugs plus lowered carbohydrate intake will.