Why LDL Goes Up on a Low Carb Diet

Is LDS Cholesterol Bad? What are the Risks of Statins?

Discover why some people see their LDL cholesterol rise on a low carb, high fat diet and how to interpret that change in the context of overall metabolic health, statin use, and long term heart disease risk.

Synopsis

In this hour long interview, interventional cardiologist Dr. Nadir Ali talks with Dr. Morgan Nolte about why LDL cholesterol often rises when people adopt a low carb, high fat diet and whether that automatically means higher heart disease risk. Dr. Ali explains how low carb eating can improve markers like insulin, glucose, inflammation, triglycerides, weight, and HDL cholesterol even while LDL goes up, and why he views LDL more as a “firefighter” responding to vascular injury than an automatic villain. He describes his evolution from doing stent procedures to focusing on metabolic health, reviews population data and statin trials that challenge the simple “lower LDL at all costs” narrative, and shares concerns about statin side effects such as muscle problems, fatigue, cognition changes, and increased diabetes risk. Along the way he uses concrete clinical examples (including type 1 diabetes and vegan versus carnivore eating patterns) to illustrate how context metabolic health, insulin resistance, and lifestyle matters far more than any single cholesterol number.

Summary

Low carb diets and LDL rise: Many patients on low carb or ketogenic diets see lower insulin and glucose, less inflammation, lower triglycerides, higher HDL, weight loss, and improved function, yet are alarmed when LDL goes up and their doctors immediately recommend statins.
Rethinking “bad cholesterol”: Dr. Ali challenges the idea that LDL is inherently harmful, emphasizing its roles in fighting infections, carrying antioxidants that reduce inflammation, delivering cholesterol for estrogen and testosterone synthesis, and transporting CoQ10 for muscle energy production.
Dietary cholesterol and liver regulation: He explains that vegans eat no dietary cholesterol so the liver produces large amounts, while carnivore style eaters consume more cholesterol so the liver downregulates production and takes up less from the blood, which can raise measured LDL without necessarily indicating harm.
Metabolic health context: Comparing uncontrolled type 1 diabetics with poor glucose and triglyceride control and low LDL to metabolically healthy low carb patients with high LDL, he argues these are “two completely opposite people” in terms of true risk, so LDL must be interpreted in context.
Population data and “paradoxes”: He cites large European cohorts such as the HUNT study and cohorts from Leiden and Japan showing that higher cholesterol and LDL sometimes track with lower mortality, fewer infections, and lower stroke rates, especially in older adults, which conflicts with the simple LDL centric model.
Firefighter vs arsonist analogy: When LDL is found in a plaque, he asks whether it is there to heal injury (like a “fireman” at the fire) or whether it caused the damage, and concludes current biochemical and clinical evidence does not conclusively prove LDL to be the primary culprit in atherosclerosis.
Limitations of statin trials: Dr. Ali notes that most cholesterol lowering drug trials are funded and controlled by pharmaceutical companies, discusses past examples of industry misconduct, and emphasizes that the best statin trials show only about a 0.6 percent absolute mortality reduction per year in high risk patients.
Potent LDL lowering, modest benefit: He points out that newer statins and PCSK9 inhibitors can reduce LDL by more than 50 percent, even to very low levels, yet trials like JUPITER and FOURIER show minimal additional mortality benefit, with one PCSK9 trial even numerically favoring the non drug group for deaths.
Statin side effects in practice: In his experience roughly half of patients on statins report some degree of muscle symptoms, fatigue, or weakness, and he also sees memory issues, lowered testosterone, erectile dysfunction, and increased diabetes risk, which he feels are often minimized or dismissed in routine care.
Need for individualized risk assessment: Throughout the conversation Dr. Ali stresses uncertainty in the science, urges critical thinking about LDL and statins, and advocates judging risk based on the whole metabolic picture rather than reflexively treating any LDL rise from a low carb diet as dangerous.

Video description

Dr. Morgan Nolte, Zivli

Feb 11, 2021 (0:59:42)

Dr. Nadir Ali, an interventional cardiologist clears up confusion about LDL and answers questions like is LDL cholesterol really bad for us? Why does LDL cholesterol go up on a low carb diet? Are statins bad for you? Do statins prevent or cause heart disease?

As a leading cardiologist in the high fat, low carb space, Dr. Nadir Ali has been paving the way in advocating that we should not fear high LDL cholesterol when other numbers are in line such as low triglycerides, low insulin and glucose, low inflammation, and high HDL cholesterol.

Statins are commonly prescribed for elevated LDL cholesterol but as Dr. Ali discusses in this video, we may be treating high LDL all wrong. Statins have been shown to have significant side effects like cognitive and memory problems, fatigue, and muscle pain for many patients. Elevated LDL has been shown to be important for sex hormones, muscle function, cognition, and inflammation.

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// R E S O U R C E S
Free Low Insulin Food Guide | What to Eat to Lower Insulin, Burn Fat, & Build Muscle – https://www.zivli.com/ultimatefoodguide?el=YT
Test Your Insulin at Home | https://www.zivli.com/testing?el=YT
Free Master Your Macros Training Videos – https://www.zivli.com/macros?el=YT

👉 Join Zivli – Personalized online course and coaching program to reverse insulin resistance, lose weight, and prevent disease. – https://www.zivli.com/join?el=YT

HLTH Code Meal Replacement Shakes – https://gethlth.com/?rfsn=5986322.ea9… Use the coupon code ZIVLI for 15 percent off your first order!

// V I D E O S
Low Carb and Sugar Lifestyle Playlist – https://www.youtube.com/playlist?list=PL5_RBZm7ejTtyqyOa8pN9w9FlMs0PV1nG

// F O L L O W
▸ website | https://www.zivli.com/
▸ email | support@zivli.com
▸ apple podcasts | https://podcasts.apple.com/us/podcast/reshape-your-health-with-dr-morgan-nolte/id1494789211
▸ instagram and TikTok | @drmorgannolte
▸ Dr. Nadir Ali’s website | https://alicardiology.com/ and https://eatmostlyfat.com/
▸ Dr. Nadir Ali’s email | contact@eatmostlyfat.com

// D I S C L A I M E R
Dr. Morgan Nolte is a doctor of physical therapy and a board certified clinical specialist in geriatric physical therapy. This video is for general informational purposes only. It should not be used to self diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor patient relationship between Dr. Nolte and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Zivli, LLC and Morgan Nolte, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this video or site.

This video and description contains affiliate links, which means that if you click on one of the product links, I’ll receive a small commission.

#drnadirali #eatmostlyfats #cholesterol #lowcarb

Transcript Summary

Dr. Ali’s background and shift in focus

Dr. Nadir Ali introduces himself as an interventional cardiologist who spent decades as a “plumber” opening blocked coronary arteries with catheters, balloons, and stents, but became frustrated that patients’ blood pressure, diabetes, weight, and heart disease kept worsening despite medication and cholesterol lowering. He describes his personal struggle with weight gain around 2011 to 2012 despite frequent cycling, his discovery of low carb eating through reports of Tour de France cyclist Chris Froome, and his rapid 20 pound weight loss with improved satiety on a low carb lifestyle. When he applied these principles to older patients, he saw dramatic weight loss, reduced need for diabetic and blood pressure medications, and improved mobility, which convinced him to spend more time in clinic counseling on lifestyle and reexamine his beliefs about cholesterol.

Why LDL rises on a low carb diet

In his early low carb practice, Dr. Ali noticed consistent patterns: insulin, glucose, inflammation, and triglycerides fell, HDL increased, patients lost weight and felt better, but LDL levels often rose, prompting concern among patients and their physicians. He frames the central questions as: is higher LDL itself bad, and why does LDL rise when metabolism is clearly improving, arguing that simply blaming LDL despite across the board improvements creates cognitive dissonance. Dr. Ali explains that low carb diets tend to be higher in animal foods and dietary cholesterol, so the liver downregulates its own cholesterol production and reduces uptake from the bloodstream, which can increase measured LDL even though the body is not “making more cholesterol” overall.

LDL’s biological roles and the “firefighter vs arsonist” analogy

Dr. Ali outlines several key functions of LDL: it participates in host defense by binding and neutralizing bacteria and viruses, carries antioxidants that help dampen inflammation, supplies cholesterol to ovaries and testes to produce sex hormones, and transports CoQ10 essential for muscle energy metabolism. He likens CoQ10 to spark plugs in an engine and warns that lowering LDL can deprive muscles of CoQ10 and cholesterol, potentially impairing muscle function and strength. When LDL is found in arterial plaque, he asks whether it arrived to heal an injury from inflammation, high blood pressure, or metabolic dysfunction like a firefighter at a fire, or whether it is the arsonist that started the fire, arguing that current evidence does not conclusively support the arsonist view.

Metabolic context: type 1 diabetes and low carb patients

To highlight the importance of metabolic context, Dr. Ali contrasts uncontrolled type 1 diabetics, who produce no insulin and without treatment develop very high blood sugar and triglycerides, low HDL, and surprisingly low LDL, yet carry extremely high cardiovascular risk. He notes that when such patients adopt low carb diets and intermittent fasting to normalize blood sugar, their triglycerides fall, HDL rises, inflammation improves, and LDL can “rise dramatically,” creating a picture of high LDL in someone who is metabolically much healthier. He emphasizes that a person with high LDL plus low insulin, low triglycerides, high HDL, and low inflammation is fundamentally different from a high LDL patient with insulin resistance, high triglycerides, poor glucose control, and low HDL, so LDL cannot be interpreted in isolation.

Population data and cholesterol “paradoxes”

Dr. Ali reviews demographic data including the large HUNT study in Europe, which followed about 50,000 people for 10 years and found that in men, higher total and LDL cholesterol tended to associate with lower mortality, while in women higher cholesterol clearly linked to lower overall and cardiovascular mortality. He mentions analyses of around 60,000 individuals grouped into thirds of cholesterol where again higher total and LDL cholesterol associated with lower total mortality, as well as data from the town of Leiden where elderly people with the highest cholesterol had the lowest mortality and fewer infections and cancers. He also describes historical data from Japan showing that when the population had much lower cholesterol than Americans they experienced higher stroke rates, and as cholesterol rose with affluence and increased animal food intake, stroke rates fell markedly, challenging simple narratives that higher cholesterol always means more cardiovascular events.

How vegans and carnivores illustrate LDL regulation

Dr. Ali contrasts a vegan, who consumes no dietary cholesterol so the liver must produce roughly 3,000 milligrams of cholesterol daily, with a carnivore focused on red meat and egg yolks who eats large amounts of cholesterol and allows the liver to “go on vacation” by producing less. He notes that in controlled experiments where liver cells are grown in cholesterol free media they ramp up cholesterol synthesis, while cells exposed to cholesterol rich media shut down production, mirroring what appears to happen in humans with different diets. In practice, he has seen low carb patients with LDL levels of 300 to 800 milligrams per deciliter drop their LDL to around 100 in just three weeks on a vegan diet but gain weight and see triglycerides and other markers worsen, which he believes shows that chasing lower LDL alone can trade off overall metabolic health.

Statin trials, absolute risk, and industry influence

Turning to statin trials, Dr. Ali points out that pharmaceutical companies design, fund, and largely control the data and manuscripts for most cholesterol lowering studies, creating inherent conflicts of interest and opportunities to selectively report favorable outcomes. He highlights that before 2006 companies could run multiple trials and publish only the positive ones, and references past scandals such as Vioxx to illustrate that industry misrepresentation of data has occurred. Even giving companies the benefit of the doubt, he focuses on robust endpoints like mortality and notes that the landmark Scandinavian simvastatin trial (4S) in high risk patients showed only about a 0.6 percent absolute reduction in cardiovascular mortality per year when treating 100 patients, meaning the individual benefit is small.

Newer drugs, PCSK9 inhibitors, and limited mortality impact

Dr. Ali explains that newer statins and agents like PCSK9 inhibitors lower LDL much more aggressively than older drugs, with some trials cutting LDL by more than half and PCSK9 inhibitors driving levels close to zero. Yet when he looks at trials like JUPITER, the additional absolute mortality benefit over a few years is tiny, around 0.2 to 0.3 percent, and in the large FOURIER trial with 28,000 patients the group receiving PCSK9 had numerically more deaths than the control group, though the difference was not statistically significant. He quotes another physician to emphasize that “dying with corrected cholesterol is not a successful outcome,” arguing that drug induced LDL lowering without clear survival advantage should be viewed skeptically, especially in patients with otherwise good metabolic health.

Statin side effects and diabetes risk

Drawing on his clinical experience, Dr. Ali estimates that around half of his patients on statins report some form of myopathy, including muscle pain, weakness, or fatigue, even though early trial reports suggested a very low incidence. He also observes cognitive and memory problems, reduced testosterone and erectile dysfunction, and cites evidence that statins and other cholesterol lowering medications can increase the risk of developing diabetes by impairing insulin sensitivity. He suggests that many physicians dismiss patient complaints as simply aging rather than recognizing drug related side effects, and cautions that newer drugs have driven increased acknowledgment of side effect rates in order to position alternatives.

Groupthink, guidelines, and the rise of low carb patients

Dr. Ali attributes the persistent fear of LDL in medicine partly to groupthink, where early assumptions that LDL causes heart disease became entrenched in guidelines and teaching, and subsequent research built layers of confirmation rather than reexamining foundational questions. He believes the low carb movement has forced a reevaluation, because patients who improve their metabolic health, lose weight, and feel better show up with elevated LDL and challenge physicians to explain whether this truly represents increased risk. He emphasizes that he does not claim to have all the answers, but wants clinicians and patients to understand the uncertainties, examine the full risk profile, and avoid reflexively labeling any LDL rise on a low carb diet as dangerous without considering the bigger picture.