For decades, conventional medicine has considered elevated LDL cholesterol as the main indicator of cardiovascular risk. However, a rigorously scientific study recently published challenges this association in metabolically healthy people following low-carbohydrate diets. This discovery could transform our understanding of cardiovascular health and dietary recommendations.
The study that changes the cholesterol paradigm
Recently published in the prestigious Journal of the American College of Cardiology Advances, this study examined 100 people with a specific profile:
- Strictly followed a ketogenic diet for years
- Consumed significant amounts of cholesterol and saturated fats
- Presented extremely elevated LDL (above 190)
- Showed ApoB (currently considered the definitive risk marker) at very high levels
The surprising finding: plaque burden in their arteries did not increase despite these elevated values.
Essential characteristics of participants
Study subjects presented a particular metabolic profile:
- Lean build
- Metabolically healthy
- Elevated HDL ("good" cholesterol)
- Low triglycerides
- Low systemic inflammation
- Normal insulin sensitivity
This profile notably coincides with what many experience when following ketogenic or carnivore diets to reverse metabolic conditions, a phenomenon known as "lean mass hyper-responders."
The evolution of the lipid hypothesis
Medical understanding about cholesterol has constantly changed:
- Initially: "Don't consume foods high in cholesterol"
- Then: "Avoid saturated fats"
- Subsequently: "Elevated total cholesterol is dangerous"
- After: "Elevated LDL is the main risk indicator"
- Currently: "Elevated ApoB is the definitive risk marker"
This new study seriously questions the latest interpretation.
Innovative methodology and compelling results
Unlike previous studies that used CAC (coronary calcium) scores, this research employed:
- High-resolution coronary CT angiography
- Measurement of total plaque (calcified, non-calcified, inflamed, soft, oxidized)
- Continuous ketosis verification through ketone analysis
- Initial and final evaluation (after 12 months) of plaque burden
- Bayesian statistical analysis (superior to traditional p-values)
Results showed it was 6-10 times more likely that ApoB had no impact on plaque progression in this specific population.
Revolutionary clinical implications
This study doesn't suggest cholesterol never matters, but that metabolic context is crucial:
- Lean, metabolically healthy people with elevated LDL/ApoB due to low-carbohydrate diets don't show increased risk of plaque accumulation
- The only significant predictor of new plaque formation was the presence of pre-existing plaque
- High LDL and ApoB alone didn't cause more plaque accumulation in coronary arteries
What does this mean for you?
If you identify with this profile, these conclusions are potentially liberating:
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If you're metabolically healthy (adequate weight, good metabolic markers) and your LDL/ApoB increased with a ketogenic diet, this study suggests you can stop worrying
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Context is fundamental: The same LDL/ApoB values have different implications depending on overall metabolic status and dietary patterns
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Pre-existing plaque was the only significant predictive factor for developing more plaque, regardless of LDL/ApoB levels
Beyond numbers: A comprehensive vision
This research represents possibly the first "nail in the coffin" for universal ApoB theory as a definitive risk factor. It suggests that:
- Isolated laboratory values can be misleading
- Complete metabolic profile is more important than individual measurements
- Cholesterol responses are highly individualized
- Inflammation and insulin resistance may be more important factors than LDL itself
Practical applications
If you abandoned a ketogenic diet due to elevated LDL or ApoB values, this study suggests that:
- You were improving your overall metabolic health despite increased LDL
- Real cardiovascular risk might not have increased (especially with low inflammation and good metabolic markers)
- You might reconsider this dietary approach, particularly if you experienced other health benefits
Beyond cholesterol: Alternative markers
Based on this and other emerging research, the following factors could be more relevant for evaluating cardiovascular risk:
- Triglyceride/HDL ratio (ideal <1.5)
- Inflammatory markers (hs-CRP, interleukins)
- Insulin sensitivity (HOMA-IR)
- Waist circumference and visceral fat percentage
- Glucose variability
Conclusion: An emerging new paradigm
This revolutionary study invites us to reconsider the relationship between diet, cholesterol, and cardiovascular health. It suggests that metabolically healthy people following ketogenic diets can experience increases in LDL and ApoB without corresponding increase in real cardiovascular risk.
Personalized medicine is gradually replacing universal recommendations. Your individual metabolic profile, inflammatory patterns, and insulin sensitivity could be much more important than isolated cholesterol values.
This research represents a significant step toward a more nuanced and personalized understanding of cardiovascular health, where complete metabolic context matters more than isolated numbers on a blood test.