The LCHF Diet and cholesterol - Quality is key

Cholesterol is a common topic with diet, not only on the LCHF. With Doctor Jeff Gerber having joined the LCHF Podcast team, we got some more information on what cholesterol markers really mean. A lot has changed in Cholesterol research in recent years, so what does it all mean?


Welcome to this edition of the LCHF podcast, it’s good to have you on board once again, I’m Brad Brown and we head off to Denver in Colorado once again. We’ve got Dr Jeff Gerber on the show. Doc welcome back, nice to catch up. We’ve got a question in from Kim Young-Blom and it’s a question that we get often. It’s almost every day that we get a question along these lines and I like this one because it’s more general.

It’s not too specific and I think we could go into guidelines and it’s got to do with cholesterol. A lot of people are obviously concerned about what they’ve been told about cholesterol and the dangers and what they should be worrying about.

Kim wanted to know, could you go into detail about HDL as well as triglyceride ratios. What we should be looking for, how relevant are they and could you explain what a good HDL level is? What that ratio should be between HDL and LDL? As she says, it’s something that bothers her and she’s not 100% sure what she should be tracking and what she shouldn’t be worried about.

Research has rebuffed old Cholesterol thinking

Jeff Gerber: Well Brad, thanks for having me back on the show and Kim, to answer your question. Traditionally as a physician we were trained to focus on cholesterol quantity and looking at lipo protein, specifically total cholesterol and the LDL cholesterol. We think of them as the bad cholesterol and now what we’ve come to realise, looking at the evidence over the last 40-60 years, that there are some flat with this thinking that the problem in terms of cardiovascular risk may not correlate with the cholesterol and LDL or total cholesterol.

So we have looked at diet in particular over the last 40-50 years, looking at whether or not there was a correlation between the consumption of saturated fat in the diet and cardiovascular disease. It is true that if you eat a diet that’s higher in saturated fat that you tend to see higher cholesterol. But despite that, they really haven’t been able to show a correlation that this high, this diet high in saturated fat correlates with cardiovascular disease.

Your cholesterol quality numbers are the important factor

In fact, when you look at the studies on feeding trials, it’s mostly statistical noise, it doesn’t tell us a whole lot. So now in the low carb world we’ve actually started to look at changing the diet and what happens to these cholesterol ratios. What we’ve come to realise is that although the cholesterol quantity factors into it, the quality is what’s most important. There are several ways to measure quality and this would hopefully answer your question where we look at the ratio of the triglyceride to HDL.

In the US using our units, that ratio should be less than 2:1, I know that units are different in SA. Then we also look at the size of the LDL particle and so larger LDL particles seem to be associated with less cardiovascular risk. So we see the quality of cholesterol improve by measuring the particle size and the ratios.

But now the LDL response with the total cholesterol response is actually variable in these low carb high fat diets. Some people, the LDL actually drops and then nobody is concerned. In others LDL stays about the same, again, there’s no concern, but in others the LDL sometimes goes way up and it can be transient. But in some it’s persistent and so that’s where the big question is, does that mean that the patient’s at increased risk.

On average we all cholesterl markers improve on a LCHF Diet

What we do know, if you look in populations or you look at some fairly well done trials that run out two years looking at low carb high fat diets. On average we see all the markers improve, including LDL which either doesn’t go up or goes up slightly. The one missing link is that we don’t have any long term outcome on the studies beyond 2-3 years looking at heart end points like heart attack, stroke, death from heart attack.

So hopefully we’ll see some more studies over the next several years. But we can definitely tell you, on a well formulated low carb high fat diet, a Banting type of diet; the cholesterol ratios improve in such a way that we’re seeing decreased risk for inflammation, oxidative stress of the LDL particle. This is because that is what inflames those blood vessel walls. So you want nice, healthy, favourable LipoProtein molecules circulating in the blood.

BB: Great, I love that, doc, thank you very much. Kim, I hope that helps and some great information in there as well, all that info on the show notes for this episode of the LCHF podcast. Don’t forget, if you’d like a question answered by one of our panel of experts, you can, all you need to do is head over to, submit it there and we could be answering it next time out. So from myself, Brad Brown and Dr Jeff Gerber, until next time, it’s cheers.


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