If you’ve had some resistance from your doctor about your low-carb diet, then this post is for you. Your doctor maybe concerned about your potential for an increased risk of coronary heart disease if you the low carb, high fat diet has led to elevated cholesterol levels.
This concern arises firstly from historical research in the 1960’s which associated elevated blood cholesterol with increased rates of heart disease (but did not prove cholesterol as the cause) and secondly from the guidelines of most national Heart Associations which recommend ‘safe’ levels of blood cholesterol.
There is, however, a lot of debate currently in this area of cholesterol and heart disease because according to the bulk of modern research, neither dietary cholesterol nor saturated fat intakes are significant risk factors for coronary heart disease and we know that total blood cholesterol levels are a very weak predictor of heart disease risk.
More detailed information such as HDL levels, total cholesterol : HDL ratio, size & density of LDL particles and blood triglyceride levels are more predictive of risk. In addition we know now that dietary cholesterol does not make any significant difference to blood cholesterol levels.
A low carb high fat nutrition program can affect the ‘taxis’ involved in blood cholesterol transport – these effects have been subject to a limited number of studies and can be divided into 3 subgroups:
- Most people experience no change or even slight decreases in their total blood cholesterol or LDL and see positive improvements in their other heart disease risk markers such as increased HDL (“good cholesterol”) and reduced triglycerides (blood fats).
- Some people experience a transient increase (of 20-30%) in blood cholesterol and LDL which declines to normal levels after about 4 – 6 weeks.
- A small number of people see an ‘outlier’ response of significant (>50%) elevation in total cholesterol levels (and LDL) but also with improved other biomarkers like higher HDL and larger LDL particle size.
Let’s be clear though that your doctor is your chosen medical advisor and it is not for me to question their judgement. There are three things that you can consider.
- Firstly you can revisit the doc and have a chat about your overall ‘cholesterol profile’ including facts like:Your HDL level (ideally above 1.3mmol/L)
Your ratio of Total Cholesterol : HDL (ideally below 4.5)
Your triglyceride level (ideally below 1.2mmol/L)
Your ratio of Triglceride : HDL (ideally below 0.87)
- Secondly you can wait 2-3 months and repeat your cholesterol test and see if it has changed.
- Thirdly you can attempt to manipulate your diet in one or both of two ways without ‘abandoning’ the Banting program. You can add back a little more unprocessed carbs and/or you can reduce your saturated fat intake (animal fat, coconut oil) and replace it with more mono-unsaturated fats (olive oil, avocados). These nutritional strategies have been shown in some people to reduce total cholesterol levels.