Did you go keto or very low carb, high fat and witness your cholesterol go sky high? If you did, you are not alone. But let your MD have a heart attack over their concern. You don’t necessarily need to worry. Read on, there may not be a problem as a lean mass hyper responder.
What is a Lean Mass Hyper Responder?.
A lean mass hyper-responder (LMHR) is a newly described cholesterol/lipid condition. It is reserved for people with a pattern of cholesterol response after adopting a low-carbohydrate, high-fat diet. This is often referred to as a Keto, or Ketogenic, diet. The same cholesterol response is noted in many who adhere to a Carnivore nutrition plan.
Lean mass hyper-responders are individuals who experience a substantial increase in their total cholesterol, total LDL, total HDL and all particle numbers. Triglycerides typically go down, often below 50.
This is a common phenomenon in those who follow low carb. There is a Facebook group dedicated to this topic with over 8000 members.
Some Science
Here is what we think happens. In the context of carb restriction, there is a greater energy demand by cells, tissues, and organs for fat-based fuel. Aside from ketone bodies made by the liver, this can come from one of two sources: (i) non-esterified fatty acids (NEFAs) released from adipocytes and (ii) TG-rich lipoproteins (TGRLs), including VLDL secreted by the liver. In the latter scenario, TGRLs undergo lipoprotein-lipase (LPL)-mediated hydrolysis to supply TG from the lipoprotein particles. The process of LPL-mediated remodeling of VLDL yields surface remnants and core remnants, which contribute to increases in HDL-C and LDL-C, respectively.
In brief, the Lipid Energy Model postulates that, in leaner metabolically healthy individuals, there is an increase in VLDL secretion, LPL-mediated TG hydrolysis and VLDL turnover, resulting in a profile of low TG, elevated HDL-C, and elevated LDL-C.
Is This Cholesterol Profile Dangerous?
There is not a lot of research here, but many who claim to follow a low carb diet for years deny any cardiovascular events. In fact, they claim improved health, lower risk, and mental clarity. Testimonials often include stories of zero coronary calcification by CT scan and even coronary plaque reversal, in those with a previous CT. (side note, I am anti-CT scan).
I have seen the same in many of my patients, but time will tell the impact of what is commonly thought of as “high cholesterol”. There are many more data points to collect that provide more information than total cholesterol, LDL and HDL. See below.
My Approach
I have said it before and will say it again here, I am a Paleo diet believer and follower. I do eat starchy carbs like potatoes and yams. I eat plenty of vegetables like broccoli, kale and salad greens. I also eat fruit and occasional honey.
In addition to diet, I get sunshine, sleep, movement and avoid toxins.
AND I check my labs. You should too. Specifically, you want to know markers of inflammation. Parameters like hs-crp, ox-LDL, PLA2 and others tell if your body is inflamed. Check hemoglobin A1C, a marker of blood sugar control. Check homocysteine. If your other data point are under good control, I am not overly concerned with your lipid numbers. Here is my suggested panel for you, we call it Level 2 testing.
If the cholesterol “numbers” make you nervous, I don’t believe statins are the answer. Here is my article about the risks/ benefits of statin drugs.
An alternative to statins may be a 3 month trial of our OptiLipid. The seven nutrients in OptiLipid help the liver clear excess lipid particles. See if that strategy works for you. Also, consider an NHD coach-guided liver cleanse.
