Cholesterol

I am sure that most of you have read the online quackery surrounding cholesterol. Most of it is being spewed by "keto/low carb doctors" as they recommend you eat gallons of coconut oil in order to sustain ketosis. In this post, I am going to keep cholesterol information simple and sane. So erase whatever information these charlatans have forced into your brain, with their shenanigans, and start anew.

There are two important issues that are not correctly understood in the fad "keto" world - ketosis and lipids. 

The first one ketosis, is easy. The type of ketosis that a person with metabolic issues wants to be in, is the ketosis produced from the burning of their own body fat. Not the burning of coconut oil. Burning coconut oil means nothing. It just means you are alive and can produce heat. Being able to burn your own body fat means a lot. It is an indication that your metabolism is on the road to correcting itself. You need properly working leptin to burn body fat and that's not achieved through the consumption of coconut oil.

Now comes the hard part - lipids. Coconut oil absolutely raises total cholesterol in some individuals more than others. This rise includes both HDL and LDL (lipoproteins) and the rise between the two depends on genetic variability. Coconut oil is composed of a variety of fatty acids but it's the lauric, myristic and palmitic acids which produce the main affects on LDL. What does that mean? We don't know. The reason we don't know is because rises and falls in lipoproteins do not tell us a thing about whether their function is benign or malignant. We usually discover this when you drop dead of a heart attack, not before.

Unfortunately, lipoprotein function is extremely complicated and science has not caught up with what exactly causes lipoprotein pathology. For this reason, the go-to "treatment" is to lower all lipoproteins (total cholesterol). The premise is that lowering them might cause some good and certainly no harm.  That has not panned out for the majority of people but it has for a small segment.

There is a small segment of the population that has an LDL abnormality which puts them at high risk for heart disease and no, it's not simple hypercholesterolemia though it falls under that umbrella. There are actually many forms of hypercholesterolemia, many which are benign. After all, hypercholesterolemia simply means "high cholesterol". Instead, this malignant form of hypercholesterolemia is an actual LDL malfunction which is not fully understood as it is not known if the malfunction is in the LDL itself or in various apolipoproteins or both or what. What is known is that these people benefit significantly from an aggressive reduction of LDL. For this reason, we know that LDL is implicated in the atherosclerotic process but no one knows exactly how it becomes pathological.

To make matters even more complicated, many people have LDL malfunction with absolutely no rise in its levels. In fact, that is the most common form of LDL malfunction. This is why the vast majority of people suffer from heart disease or die of heart attacks with low to normal total cholesterol.

I tried to keep the above explanation as simple as possible because it's an extremely complex topic and goes way beyond the scope of this blog. It is so complex than even lipidologists, who have dedicated their entire lives researching this, have differing opinions on what the research has shown so far. Worse, this is not only complex, it is not helpful to you. It's interesting. It's fascinating. But it's not helpful, particularly for those trying to resolve their metabolic syndrome. This is what irks me about "low carb doctors". They are trying to act as if they know about a subject matter that is so incredibly difficult, and goes way beyond the scope of their practice and knowledge, that they shouldn't be advising on it at all. All they want to do is find an excuse for you to continue taking their snake oil, even if it's at your detriment. Well, I don't sacrifice people in order to push an agenda.

For this reason, the best approach that someone should take with there cholesterol is that of caution. That's how we deal with this subject matter on this blog – very cautiously, because unlike "low carb doctors", I do not claim to know everything and I am certainly not a lipidologist.

Use common sense and stay away from coconut oil if it's raising your LDL cholesterol. In fact, you should stay away from coconut oil even if it's not, particularly if you have a family history of heart disease. This is because you can be one of those people that simply cannot metabolize these fatty acids well and end up with early onset heart disease. No one will be able to tell you in advance if you are that person or not, unless you are able to perform extremely expensive genetic testing that has to be interpreted by a lipidologist. If your doctor has issues prescribing you an insulin test, you can only imagine how they will feel about a rare genetic test, that they might not have even heard of before. Don't wait for your doctor and don't wait for a heart attack to get answers. You also don't want your answers coming from a low carb bozo. You have to advocate for yourself. Stop putting your health in someone else's hands.

The vast majority of us are of ancestry that did not evolve consuming coconut oil. Particularly not out of a hunter/gatherer environment. Coconuts are quite rare. They are only available in very specific regions. This means you can easily swap out coconut oil for ghee and keep to your fat macros. If your lipids are particularly sensitive, you can swap out all saturated fats for monounsaturated fats and still be in ketosis. Like I said before, ketosis is only beneficial if it's coming from the burning of your own body fat.

Below is the link to Dr. Peter Attia’s 5 part podcast with Dr. Dayspring, a lipidologist. They discuss the latest science on lipids:

Tom Dayspring, M.D., FACP, FNLA – Part I - V: An Introduction To Lipidology

This is the transcript of the podcast between Dr. Peter Attia and Dave Feldman. The transcript includes notes by Dr. Dayspring correcting many errors, made by Feldman, about lipoproteins:

Transcript — The Drive — Dave Feldman