When discussing cardiovascular health, few topics stir as much debate as cholesterol, particularly in relation to low-carb and ketogenic diets. Recently, there’s been significant attention given to a proposed model that suggests high LDL cholesterol may not pose the same cardiovascular risk in certain individuals, specifically those labeled as “lean mass hyper-responders.” This raises important questions: Is it possible that high cholesterol might not be dangerous for everyone? Or are we witnessing a dangerous misinterpretation of the science?

In this episode, we break down the ideas behind the “lipid energy model” and explore how it has been framed in the context of low-carbohydrate and ketogenic diets. While proponents claim this model sheds light on how some people can have elevated LDL without increasing heart disease risk, critics warn that miscommunication and oversimplification of these ideas are leading many down a dangerous path. With real-world health decisions hanging in the balance, it’s crucial to carefully examine what the science truly says about cholesterol, inflammation, and heart disease.

Join us as we dive into the evidence with Dr. Gary McGowan. We’ll dissect what the current research supports, what remains speculative, and how social media has amplified both the promising and problematic aspects of this model. If you’ve ever wondered about the impact of high cholesterol on heart disease risk in the context of ketogenic or low-carb diets, this episode is essential listening.

Timestamps

• 02:27 What are the “Lean Mass Hyper Responder” phenotype and the “Lipid Energy Model”
• 27:29 Looking at recent publications and the “KETO Trial”
• 47:06 Public communication and misinterpretation
• 51:18 Clinical implications of diet-induced dyslipidemia
• 55:14 Responsibility in scientific communication
• 57:30 Real-world examples of poor communication or misinterpretation
• 01:13:27 Ethical concerns with the promotion of the model
• 01:25:59 Final thoughts

Related Resources

• Go to episode page
• Join the Sigma email newsletter for free
• Subscribe to Sigma Nutrition Premium
• Enroll in the next cohort of our Applied Nutrition Literacy course
• Find Dr. McGowan at:
  • Triage Method
  • Instagram: @drgarymcgowan
• Papers discussed in this episode:
  • Norwitz et al., 2022 – The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets
  • Norwitz et al., 2021 – Elevated LDL Cholesterol with a Carbohydrate-Restricted Diet: Evidence for a “Lean Mass Hyper-Responder” Phenotype
  • KETO Trial: Budoff et al., 2024 – Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis

---