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Short Summary
Main recommendation: Do not judge cholesterol by total cholesterol or LDL alone; look at the full pattern, especially triglycerides, HDL, and the triglyceride-to-HDL ratio, along with age, family history, blood pressure, and diabetes status. Dr. Eric Westman says rising LDL on a low-carb diet is often paired with lower triglycerides and higher HDL, which he views as a favorable pattern, and he advises calm, rational discussion with your doctor rather than fear.
Key Points
- Dr. Westman says cholesterol performs essential functions in the body and was not "put in the body to become a problem."
- The older blood panel focused on total cholesterol and LDL ("lousy" cholesterol); the newer approach emphasizes triglycerides (want low) and HDL (want high).
- Westman says that in his experience, low-carb eating sometimes raises LDL and total cholesterol while almost always lowering triglycerides and raising HDL.
- Westman mentions the CV Risk Calculator, a new guideline calculator available online, and notes that LDL isn't even part of it anymore.
- Westman says that in his view, atherosclerosis begins with inflammation, and that if low-carb eating reduces inflammation, cholesterol particles may not cause the same damage.
Details Worth Noting
- Concrete instructions:
- Use the CV Risk Calculator online and enter your age, gender, family history, blood pressure, and diabetes status along with your cholesterol numbers.
- If you want more detail on LDL particle size, ask your doctor to order an NMR lipoprofile or VAP test; Westman says any doctor can order it, and it can be done at LabCorp in most places.
- Calculate your triglyceride-to-HDL ratio; Westman says a ratio under 1 makes small dense LDL particles very unlikely in his experience, and a ratio around 1 or with HDL higher than triglycerides is, in his view, an excellent metabolic sign.
- Avoid checking cholesterol while actively losing weight, and wait until you reach your goal weight.
- If you take warfarin, keep your intake of leafy greens and vitamin K consistent day to day; Westman suggests about a cup or a fistful of greens as a starting reference and monitoring your blood levels.
- Give your doctor a heads-up that you are following a low-carb diet before labs are drawn.
- Westman says that in his clinical experience, HDL can take six to twelve months to rise and up to a couple of years for its full effect, while triglycerides may fall within one to two weeks.
- He cites the book Cholesterol Clarity by Jimmy Moore and himself for the advanced science.
- Westman says that in his view, maintaining normal blood pressure matters more than any single blood cholesterol number.
- He mentions a UK essay by Dr. Aseem Malhotra arguing that saturated fat is not the cause of heart disease and that heart disease is an inflammatory condition.
Bottom Line
Westman's view is that a cholesterol result should be read as a pattern in the context of the whole person, with inflammation and blood pressure weighing as much or more than any single LDL value. Decisions about medication or changes should be made with a clinician who understands these markers.
