Lean Mass Hyper-Responders

Introduction

I have had a classic article on the list to review for some time. It is called “Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes” and Creighton was the lead author (Ref 1). Readers of the Monday note may be more familiar with the names of two other authors: Professors Stephen Phinney and Jeff Volek. Phinney and Volek are the authors of a couple of classics in the field of low carbohydrate literature: The Art & Science of Low Carbohydrate Living (2011) and The Art & Science of Low Carbohydrate Performance (2012).

The Creighton et al article was the first (of which I was aware), which tried to address the paradox (as they called it) of high cholesterol and low-carbohydrate diets. Some people find that their cholesterol measurements (total and LDL-cholesterol especially) increase markedly when they adopt a low-carb diet. These people then face a difficult decision, as they are generally valuing the benefits of the low-carb diet, but they see the cholesterol change as a significant downside. Many report that their doctors and cardiologists (if they have one) become very concerned and it is then more difficult to continue with the low-carb diet.

In November 2021, May 2022 and August 2022, three other articles on this topic have been published including authors likely known to you.

1) November 2021: Norwitz et al. Elevated LDL Cholesterol with a Carbohydrate-Restricted Diet: Evidence for a “Lean Mass Hyper-Responder” Phenotype (Ref 2). (Authors you may know in this team include David Ludwig and Dave Feldman).

2) May 2022: Norwitz et al. The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets. (This paper also features David Ludwig and Dave Feldman as authors) (Ref 3).

3) August 2022: Diamond et al. Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet (Ref 4). (You may recognise Ben Bikman and Paul Mason as co-authors).

This is a topic of interest to many people who limit their carbohydrate intake and/or go as far as keto or carnivore diets, so I’ll cover the Creighton et al and the first Norwitz et al papers this week. I’ll look at the second Norwitz et al paper, on the Lipid Energy Model, next week. The Diamond et al paper is on the list for a possible future Monday note.