Elevated LDL Cholesterol with a Carbohydrate-Restricted Diet: Evidence for a “Lean Mass Hyper-Responder” Phenotype

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Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism

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Conflicts of Interest

Identified Weaknesses

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Paper Summary

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Low-Carb Diets Might Raise LDL Cholesterol, Especially in Lean, Healthy People

This study found that individuals with lower BMI and better metabolic health (low TG/HDL cholesterol ratio) experienced larger increases in LDL cholesterol on a carbohydrate-restricted diet. A subset of individuals, termed "lean mass hyper-responders," exhibited markedly elevated LDL cholesterol despite having normal pre-diet levels and otherwise favorable metabolic markers.

Possible Conflicts of Interest

One author (NGN) co-authored a Mediterranean low-carbohydrate-diet cookbook and donates royalties to nutrition research. Another author (DF) receives financial contributions for research and is a partner in a company whose proceeds go to the Citizen Science Foundation. Another author (TK) is on the board of a health practitioners society and produces podcasts on health, with proceeds donated to charity; his spouse has ownership in a food company. Another author (DSL) received royalties for books recommending carb-modified diets and his spouse owns a nutrition education business.

Identified Weaknesses

Self-reported data and recall bias

The study relies on self-reported data from a web survey, which can be subject to recall bias and misreporting, especially regarding past BMI and dietary habits.

Selection bias and non-representative sample

The sample is not representative of the general population, as it is biased towards lean individuals with good metabolic health, limiting the generalizability of the findings.

Observational design and lack of causality

The study is observational and cannot establish causality. Other unmeasured factors, such as saturated fat intake, could contribute to the observed LDL cholesterol changes.

Lack of prior BMI data

Prior BMI data were not collected, limiting the ability to fully assess the relationship between BMI and LDL cholesterol response.

Rating Explanation

This observational study presents interesting findings on the heterogenous response of LDL cholesterol to carbohydrate-restricted diets, suggesting a potential link between leanness, metabolic health, and increased LDL. However, several limitations, including selection bias, self-reported data, and lack of causality, warrant a cautious interpretation and further investigation.

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Topic Hierarchy

Domain:

Health Sciences

Field:

Medicine

Subfield:

Endocrinology, Diabetes and Metabolism

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Original Title:

Elevated LDL Cholesterol with a Carbohydrate-Restricted Diet: Evidence for a “Lean Mass Hyper-Responder” Phenotype

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