Dr. Eric Westman - Adapt Your Life - My LDL Is High, Can I Still Do Keto? — Dr. Eric Westman [Presentation]

Short Summary

Main recommendation: Dr. Eric Westman says, based on his clinical experience, that a high LDL cholesterol result does not automatically rule out a keto diet, and that it should be judged alongside triglycerides and HDL cholesterol, not on LDL alone. He notes that for most patients, the markers improve on keto, and that the "new way" of reading blood markers looks at the triglyceride-to-HDL relationship as a reflection of insulin resistance and metabolic syndrome.

Key Points

• In Westman's experience, about two-thirds of keto patients see all the markers (total cholesterol, LDL, triglycerides, HDL) improve.
• In Westman's experience, roughly one-third of patients may see LDL stay high even after reaching their weight goal, while triglycerides are low and HDL is high.
• He describes the old approach as focusing on total cholesterol and LDL, which he calls "lousy" or "lethal" cholesterol, and the new approach as also weighing triglycerides and HDL.
• He frames LDL, total cholesterol, and the other markers as risk factors that act over time, not as an immediate emergency.
• He says triglycerides and HDL reflect what's called insulin resistance and metabolic syndrome, which he says is thought to be a cause of atherosclerosis, strokes, and heart attacks.

Details Worth Noting

• Concrete instructions: - Westman's own practical suggestions: avoid checking LDL and total cholesterol while still losing weight, since markers can temporarily rise; check them once at goal weight. He suggests comparing triglycerides and HDL as a ratio, aiming for HDL roughly equal to triglycerides (he gives 70 as an example of a great number). He mentions the CV Risk Calculator (cvriskcalculator.com) as one tool, based on an American College of Cardiology guideline, for estimating 10-year risk. He advises against a panic reaction to a single blood test.
• Westman notes that age, high blood pressure, smoking, gender, and race are also heart risk factors, though some cannot be changed.
• He describes the triglyceride-to-HDL ratio as "not a perfect indicator" of all metabolic problems, but a good and useful one.
• He says some experts argue both the old and new approaches are valid ways to reduce heart disease risk.
• Westman is speaking as a clinician describing his own practice; this is not a substitute for individualized medical advice.

Bottom Line

A high LDL on keto is not automatically a reason to stop, and the full picture, including triglycerides, HDL, and an individual risk estimate, should guide decisions.