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Diet Doctor Podcast · July 10, 2023 · 43m
Elevated LDL on Keto — Should You Be Worried?
Dr. Scher addresses the elephant in the low-carb room: some people on keto develop very high LDL cholesterol. When to worry, when not to, and what additional testing (ApoB, Lp(a), CAC score) can clarify individual risk.
Highlights
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ApoB is a better risk marker than LDL-C for people on low-carb diets — it measures particle number directly
Scher: standard LDL-C can be misleading on keto because particle size shifts toward large buoyant LDL. ApoB measures the actual number of atherogenic particles, providing a more accurate risk assessment regardless of dietary pattern.•
Risk assessment on keto requires multiple markers — LDL-C alone is insufficient for clinical decisions
Scher: evaluating cardiovascular risk on a keto diet requires looking beyond LDL-C to include ApoB, Lp(a), hsCRP, coronary calcium score, insulin level, and triglyceride-to-HDL ratio. No single marker tells the full story.