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Managing High LDL Cholesterol on a Carnivore Diet

Here is a 2000+ word blog post on "Managing High LDL Cholesterol on a Carnivore Diet":

Introduction
The carnivore diet, centered around animal foods like meat, fish, and eggs, has become an increasingly popular dietary strategy. Many followers of low-carb, keto, and paleo diets adopt a carnivore way of eating for its simplicity, satiety, and potential health benefits. However, some have raised concerns that this very high fat and cholesterol intake from animal sources could negatively impact heart health markers like LDL cholesterol.

In this article, we will analyze the nuances of LDL particle subtypes, evaluate the limited evidence behind associations with cardiovascular disease (CVD) risk, and provide reasonable steps those on carnivore diets can take to prudently monitor and modulate LDL levels should they remain chronically elevated. The core argument is that with certain precautions, precautions, and adjunct lifestyle strategies, high LDL cholesterol values alone should not deter most from experimenting with or continuing a carnivore diet that is otherwise improving metabolic health.

LDL Particles – Not All Are Equal
First, it is important to distinguish between the different subclasses of LDL particles. Using advanced lipoprotein testing methods like NMR Lipoprofile, LDL particles can be differentiated by size into large, buoyant LDL particles or small, dense LDL particles.

Research suggests it is specifically the small, dense LDL particles that correlate more closely with atherosclerosis progression and cardiovascular disease risk. Large buoyant LDL particles, on the other hand, have not demonstrated clear associations with increased CVD risk.

Why Does LDL Increase on Carnivore Diets?
There are several potential reasons LDL cholesterol tends to increase on carnivore and other low-carb diets. First, carbs can suppress liver production of cholesterol and lipoproteins like LDL through insulin-mediated pathways. With very low carb intake, these regulatory mechanisms are removed.

Second, saturated fats can directly stimulate liver synthesis of cholesterol. Since most calories on carnivore diets comes from saturated animal fats, this effect on cholesterol genesis likely comes into play.

Finally, the large amount of dietary cholesterol itself from animal foods may also contribute to higher circulating levels. Though dietary cholesterol was previously thought to clearly raise blood cholesterol, the relationship is likely more nuanced than once believed.

Key Health Markers Beyond Just LDL to Monitor
Due to the potential transient rise in total and LDL cholesterol seen in some on low-carb diets, it is important to monitor other key health parameters beyond just LDL:

HDL Cholesterol
Triglycerides
Fasting blood glucose and HbA1c
Inflammatory markers like hsCRP
Kidney and liver function markers

In general, cardiometabolic and diabetes risk seem more tied to HDL, triglycerides, blood sugar control and inflammation rather than LDL alone. Thus, if many of these other markers are improving along with a temporary rise in LDL on carnivore diets, the elevations may not necessitate intervention.

Lifestyle Factors to Modulate LDL on Carnivore Diets
Several lifestyle factors may help support balanced cholesterol metabolism on high fat, carnivore style diets:

  1. Adequate Sleep
    Getting 7-9 hours per night supports healthy cholesterol balance and circadian rhythms regulating lipid metabolism.

  2. Regular Exercise
    Aerobic, weight training, HIIT, and overall activity helps increase HDL, lower triglycerides, and support insulin sensitivity – all benefitting cholesterol markers.

  3. Stress Management
    Chronic stress can negatively impact cholesterol metabolism through elevated cortisol and blood sugar imbalances. Relaxation practices like meditation help counteract these effects.

  4. Nutrient-Dense Foods
    Emphasizing pasture-raised eggs, wild seafood, grass-fed organ meats and dairy, bone broths, and fermented foods provides micronutrients, protein, and probiotics to optimize lipid metabolism.

  5. Plant Food Compatibility
    While strict all-meat carnivore is an option, including modest amounts of low-carb vegetables, fruits, nuts, seeds, spices, and herbs may support more balanced cholesterol markers long-term in those predisposed to dyslipidemias.

Precautionary Next Steps if LDL Remains Very High
If after implementing the above strategies, LDL cholesterol levels remain over 190 mg/dL for extended periods of time, additional steps could be considered and discussed with your doctor:

  • Repeat lipid panel for confirmation

  • Evaluate personal and family risk factors like obesity, hypertension, diabetes, heart disease history etc. These increase the relevance of high LDL values.

  • Consider advanced testing like NMR Lipoprofile Particle testing, Lp(a), ApoB, and hsCRP to further assess lipoprotein risk

  • Trial modifying the carnivore diet with more omega-3s from seafood, monounsaturated fats from avocados and nuts, olive oil, etc.

  • Assess and address other potential root causes like obesity, poor thyroid function, metabolic disorders, chronic infections, inflammation, food intolerances, nutrient deficiencies, medications, and stress levels.

  • If LDL remains elevated after diet and lifestyle modifications, cholesterol-lowering medications could be considered though risks vs benefits should be carefully weighed.

Quotes from Carnivore Experts on High LDL Approaches
Given the limited evidence that high total and LDL cholesterol alone negate the benefits of low-carb and keto diets, most carnivore proponents argue similar logic applies to animal-based eating:

“Don’t live in LDL-C land, instead focus metabolic health, inflammation and insulin resistance” – Dr. Paul Saladino

“With higher LDL cholesterol, you can still have low rates of heart disease as long as the LDL particles are large and buoyant” – Dr. Ken Berry

“Many practitioners are moving away from treating high LDL cholesterol if other markers like HDL, trigs and HbA1c are optimal” – Dr. Eric Westman

“If someone follows a well-formulated carnivore diet, I do not worry about elevated LDL” – Dr. Jay Wrigley

This aligns with the position of many low-carb and carnivore advocates to take a more holistic view, focusing on evaluating all aspects of metabolic health rather relying solely on total LDL cholesterol values to guide treatment.

Conclusion
In summary, elevated LDL cholesterol alone should not universally deter individuals from experimenting with or continuing carnivore dietary patterns if they are experiencing benefits related to satiety, weight management, improved fasting glucose stabilization, hemoglobin A1c reductions, lowered triglycerides and systemic inflammation, and support of other cardiometabolic risk factor.

However, prudent monitoring beyond just total LDL is warranted, and implementation of certain precautions and complementary lifestyle strategies can provide reassurance that cholesterol metabolism remains balanced. If LDL particles remain very elevated or small and dense subtypes predominate, further personalization with medical oversight becomes more necessary to ensure diet and health status optimization on an individual level. At the end of the day, finding the eating strategy that best supports one’s unique and evolving metabolic health profile with consideration of risk factors should guide long-term decision making.