HPN 11: Steps To Healthy Cholesterol Levels, Theories for Increased Lipids When Low Carb, and Are Those Non-Nutritive Sweeteners Risky Or Not?

November 15, 2019


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Welcome to episode 11 of Holistic Performance Nutrition (HPN) featuring Tawnee Gibson, MS, CSCS, CISSN, and Julie McCloskey, a certified holistic nutrition coach who you can find over at wildandwell.fit.

On this episode:

Research Review:

Non-nutritive Sweeteners (NNS) Implications for Consumption in Athletic Populations 

  • Purpose of this review: (a) consolidating the existing metabolic concerns in cell culture and animal models, (b) demonstrating the risks and benefits of use in human subjects, and (c) establishing where future research should investigate with regards to consumers using NNS to increase performance and optimize body composition.
  • Types:
    • Saccharin
    • Sucralose
      • Sucralose represents one of the most researched NNS used commercially, making up more than 4,500 products and 62% of the over 1-billion dollar NNS market (79).
    • Aspartame
    • Acesulfame potassium (Ace-K)
    • Stevia
  • Conclusions:
    • Most studies thus far on animal or in vitro studies; not enough studies done on humans to make any conclusive statements.
    • Not enough evidence to link them to cancer.
    • Some evidence between them and the impact on the gut microbiome.
    • Saccharin seems to be the worst in terms of gut health.
    • Stevia seems to have the potential to be the least harmful, but also hasn’t been studied for long enough to determine anything for certain.
    • “Overall, the inclusion of NNS in popular protein supplementation may be perpetuating many of the hypothesized mechanisms relating to altered metabolism and decreased satiety.”


Jeff asks:

Cholesterol & Low Carb Diets

I have a very functionally minded primary care physician who agrees with past show guests that the most important lipid statistics are ratios.  While my key ratios are all ideal, my total cholesterol is at such a high level that it cannot be ignored and we finally gave in to trying low dose statins in the last few months.  We will run a full set of tests again after 6 months to determine our path forward.

I would ask that you have a general discussion on managing cholesterol levels with a typical low carb eating style.

Personally, I am a 54 year old male, describe myself as an “active couch potato” – run 30-60 miles per week, but have a desk job, typically eat a 1-egg vegetable omelette, wild-caught smoked salmon, decaf expresso with whole milk and a small amount of seasonal berries for breakfast, a salad with olive oil, fresh squeezed lemon or lime and meat left over from the previous night’s dinner for lunch, and whatever meat, potatoes and veggies we have for dinner – plus another glass of whole milk.  I may indulge in a bowl of ice cream a couple times week for dessert…


Cholesterol Chat Outline

  1. Ideas for high cholesterol on LC/keto.
  2. Why we need/want cholesterol (but things can go wrong).
  3. What biomarkers matter and why you might need to go deeper in testing more than typical lipid panel.
  4. What are some numbers to look for.
  5. Dietary / nutritional interventions.


  • 3 theories of high LDL & lipids on low carb or keto
    • Feldman’s theory – “Higher energy demands, lower body fat stores, and lower glycogen stores in lean mass hyper responders trigger the liver to increase production of lipoprotein particles so that TGs can be transported to cells for use as fuel. Since cholesterol travels along with TGs, blood cholesterol levels might rise as the liver pumps out more lipoproteins to keep up with the body’s energy demands.”
      • Keep in mind this is so far unproven.
    • “Ketone production requires acetyl-CoA, precursor to cholesterol. Having more acetyl-CoA in circulation could theoretically increase cholesterol synthesis.”
    • “Higher saturated fat intake increases cholesterol absorption; low insulin state decreases LDL receptor activity. Together, these variables can in theory increase circulating LDL concentration.”


  • Also check:
    • Thyroid!
      • Hypothyroid at even subclinical levels may put lipids at higher risk.
      • Studies show that LDL-P (particle number) can decrease with use of thyroid hormone.
      • TSH < 2.5, and T3 and T4 is low, could be low pituitary function.
      • If TSH is normal, check diet for high in carbs and saturated fat.
    • Leaky gut / gut dysbiosis
    • Genetics


  • Dr. Tom Dayspring – Lipidaholics Anonymous Case 291 Can losing weight worsen lipids?:
    • About ⅓ of patients who go low carb demonstrate tremendous improvements in:
      • insulin sensitivity
      • loss of weight
      • decreased waist size
      • improved TG and HDL-C
      • decreased inflammatory markers…
    • BUT develop an increase in:
      • TC
      • LDL-C
      • ApoB – ApoB are proteins found in lipoprotein particles.
      • LDL-P – Particle number, i.e. the concentration of LDL particles.
    • Dr. Dayspring says that atherosclerosis is a disease of EITHER too-much-inflammation OR too-much-cholesterol. He writes:
      • “The worse scenario is to have both high apoB and an inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation. It’s a myth to say it’s just inflammation and not about too much cholesterol. Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease… it is both.”
      • “There is little doubt after a review of the literature that the most important CHD risk factor apart from age and smoking is having too many atherogenic lipoproteins as measured by elevated apoB (LDL-P).


  • Cholesterol/lipid values:
    • Numerous studies have shown that high risk (80th percentile population cut points) LDL biomarker levels are:
      • LDL-C > 160 mg/dL
      • LDL-P > 1600 nmol/L
      • ApoB > 120 mg/dl (<100mg/dl is what is best)
    • Numbers put another way:
      • The average person should be below the 20th-percentile cut point, which includes:
        • apoB < 80 mg/dL
        • LDL-P < 1,000 nmol/L
        • LDL-C < 100 mg/dL
        • non-HDL-C < 115 mg/dL
      • For high-risk patients aim for the following 5th percentile cut off:
        • apoB < 60 mg/dL
        • LDL-P < 800 nmol/L
        • LDL-C < 70 mg/dL
        • non-HDL-C < 85 mg/dL
      • Source
    • Other numbers you WANT to see:
  • Where to test when the average lipid panel isn’t enough?
    • Directlabs.com is one source online.
      • A la carte biomarkers (i.e. LDL-P, ApoB, etc.) or their “Cardio IQ Advanced Lipid Panel and Inflammation Panel”


  • Roles of Cholesterol
    • It’s not a swear word – no cholesterol, no life – why would the body make something detrimental to itself?
    • Saturated fat and cholesterol make our cells firm, without them we would look like worms.
    • They also embed protein to the walls of our cells so they can communicate with each other. Without Cholesterol our cells wouldn’t be able to communicate and transport various molecules in and out of the cell (i.e. we wouldn’t function well).
    • Immune system: LDL binds and inactivates dangerous bacterial toxins.
    • Vitamin D is made from the cholesterol in our skin!
    • Cholesterol is a precursor to bile which we need to break down fats.
    • Brain! Anywhere from 8-22% of dry weight of the brain is cholesterol. And it is estimated that 25% of the bodies cholesterol is taken by the brain.
    • 20% of myelin is cholesterol. Myelin is one of the most abundant materials in your brain and nervous system. It coats every nerve cell and fiber, providing nourishment and protection.
      • Lower cholesterol? Putting your brain and nervous system under threat. MS, memory loss, emotional instability, behavioral problems.
      • “Low blood cholesterol has been routinely recorded in criminals who have committed murder and other violent crimes, people with aggressive and violent personalities, and people prone to suicide and low self-control.
    • Many Hormones are made from cholesterol: regulation of metabolism, energy production, mineral assimilation, brain muscle and bone formation, and reproduction.
    • POINT: when you go on a cholesterol-lowering drug, the side effects are vast and real, please take careful consideration before doing so and get multiple opinions from different doctors and do the research.
    • LDL Function  – carries cholesterol, fat soluble vitamins/antioxidants, choline, lecithin, co-q-10, phospholipids and more  from the liver to other tissues for repair and delivery to cell membrane.
    • High blood sugar may shred the lipoprotein coat behind recognition (every cell has LDL receptors). When sugar glycates the lipoprotein coat, and vegetable oils oxidize the lipoprotein coat, it becomes unrecognizable to our LDL receptor on our cells and they don’t let them in, so they stay in our bloodstream, exposed to further oxidation, and eventually finding a home by crashing inside our arteries.
    • HDL – returns excess cholesterol from the tissues to the liver.


  • Role of diet:
    • According to Dr. Dayspring:
      • With individual variability (likely related to genes) low carbohydrate or ketosis producing diets can lead to significant hepatic cholesterol synthesis.
      • Ingestion and small intestinal absorption of saturated fatty acids in some patients can drive cholesterol synthesis, i.e. lead to a hypersynthesis of cholesterol.
      • The vast majority of cholesterol absorbed by the gut has an endogenous (produced by body cells) not exogenous (as in eaten) origin.
      • In reality dietary cholesterol has little to do with CHD risk.
  • Estimates say your diet accounts for about 15% of cholesterol in your body.
  • Coconut oil increases cholesterol but also the particle size of LDL.
    • Aforementioned Case study:
      • “The only modifications I’ve made because of my high lipids are eating steel cut oats regularly, adding chia seeds to my diet, and eating apples regularly (to increase fiber levels); cutting out most dairy; and watching my saturated fat intake a little more closely–all aimed at getting my high LDL-P down.”
        • LDL-C dropped from 230 to 92
        • LDL-p dropped from 2643 to 948 (<1000 is the goal)


  • Dietary interventions to manage lipids and lower LDL when low carb:
      1. Decrease some of your saturated fats
        1. E.g. lay off the bulletproof coffees with copious amounts of butter
        2. No dairy for a while
        3. Is coconut oil a different beast?
      2. Implement intermittent fasting (IF) and/or avoid grazing
      3. Increase MUFA and PUFA (and NO harmful vegetable oils), as well as EPA/DHA
        1. Olive oil, avocado oil, avocados, PUFA from whole foods not oils; wild salmon, sardines, etc.
        2. Ground flaxseed, sunflower & pumpkin seeds, soaked chia seeds.
      4. Eat more plant-based foods (greens! fiber!)
        1. Plant-based foods often neglected on keto diets- avoid this!
      5. A little more carb may help! Including adequate fiber.
        1. Low-glycemic, unrefined, whole-food sources.
        2. Still aim for <150g day (depends?)
        3. Avoid simple carbs and refined sugars.
        4. Soaked oats, sweet potatoes, buckwheat groats, psyllium husk, apples. (some grains, some fruits are not evil!)
      6. Consume foods with K2
        1. Animal based proteins like chicken liver and chicken legs, egg yolks, natto. Pasture raised organic is best!
        2. Might need to watch the saturated fat sources like grassfed butter and cheeses.
        3. Trans fats and vegetable oils can block absorption of K2!
        4. Statins may also block and/or inhibit absorption of K2.
      7. Watch your nuts & nut butters!
        1. Easy to go overboard with nuts when LC and grain free. Hidden ingredients in these as well (bad oils, sugars, etc.)
      8. Natural supplement ideas:
        1. L-Carnitine
        2. Fish oil (EPA & DHA) – we like Nordic Naturals!
        3. CoQ10 – reduced form preferred: CoQH-CF (allergy research group)
  • Further listening: Dr. Peter Attia and Dr. Tom Dayspring podcast series on cholesterol (a deep dive, 5-part series):



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