A study of 10 keto-adapted athletes and 10 high-carbohydrate adapted athletes describes typical cholesterol changes seen in people who go on low carbohydrate, healthy fat (LCHF) diets. Often only one number is looked at (LDL-C) in criticizing this approach, however there are other changes that may be compensatory at the same time. It’s not known exactly why this happens or if it increases CVD risk.
Noting also from the data above that while none of the athletes (high carbohydrate and low carbohydrate) met criteria for insulin resistance, markers of insulin sensitivity (TG/HDL-C ratio and Lipoprotein insulin resistance index) were significantly better in the low carbohydrate group.
“Ketogenic diets in normal-weight and overweight non-athletes result in a moderate increase in total, LDL-C and HDL-C concentrations relative to low-fat diets. The observation that highly trained, ultra-endurance athletes consuming a very low-carbohydrate/high-fat diet exhibited a more dramatic and uniform hypercholesterolaemia is counterintuitive since high-volume exercise tends to lower total and LDL-C levels. The explanation for this paradox may involve high intake of cholesterol and saturated fat combined with high-energy demands for lipid metabolism characteristic of the keto-adapted phenotype. LC athletes who adopt a ketogenic diet may experience an expansion of their endogenous cholesterol pool during the adaptation phase of the diet, after which they maintain greater circulating cholesterol levels.”
Individual lipid measures for high-carbohydrate (n=10) and low-carbohydrate (n=10) ultra-endurance athletes. Bars represent mean±1SD. HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol. TC, total cholesterol; TG, triglyceride. Source; Creighton BC, Hyde PN, Maresh CM, Kraemer WJ, Phinney SD, Volek JS. Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes. BMJ Open Sport Exerc Med [Internet]. 2018 Oct 4;4(1):e000429. Available from: bmjopensem.bmj.com/lookup/doi/10.1136/bmjsem-2018-000429 – Re-use permitted under CC BY-NC.
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