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Lowcarb and ketogenic diets can help improve weight loss, blood sugar control, and insulin sensitivity, among other benefits.​​ However, their effects on lowdensity lipoprotein (LDL) cholesterol remain a significant concern for many clinicians, preventing some of them from recommending these potentially beneficial diets. While these diets do not significantly increase LDL cholesterol for the average person, some individuals, especially if lean and physically active, may see a dramatic rise in their LDL by over 50% and be considered an LDL hyperresponder.

The Lipid Energy Model (LEM) provides a potential explanation for the increase in LDL cholesterol that some people experience when they start a low carbohydrate diet. It specifically explains why leaner people with better metabolic health markers seem to be more likely to experience the most extreme lowcarb lipid triad (LDL ≥ 200, HDL ≥80, triglycerides ≤ 70), a phenotype called the Lean Mass HyperResponder (LMHR) phenotype.

The LEM states that people eating a lowcarb diet depend on triglycerides (fat) more than glucose for energy. Therefore, the liver produces more triglyceriderich, verylowdensity lipoprotein (VLDL) particles. These particles go into circulation and deliver the triglycerides to tissues — such as muscles — that need them for energy. When a VLDL particle releases triglycerides, it eventually transforms into an LDL particle. Therefore, this hypothesis suggests that increased LDL is the downstream result of an individual requiring more energy delivery from triglycerides.

Recommended readings:
Lipid Energy Model: https://www.mdpi.com/22181989/12/5/460
LMHR observational cohort study: https://doi.org/10.1093/cdn/nzab144



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