Can Losing Weight Worsen Lipids?

So what conclusions do I have regarding patients on low-carb and paleo regimens who show the response of drastically aggravating LDL-C and LDL-P (apoB) together? 

Every trial, many of them quite large has associated those markers with atherogenesis and CV morbidity and mortality. But some folks are “outliers” and defy that rule. Could the low carb crowd be outliers and in them we can ignore LDL-C and LDL-P? 

The advocates of those diets say there is no study showing harm of elevated LDL-P and LDL-C in patients who have eliminated or drastically reduced their insulin resistance and inflammatory markers by low carbing. 

That is true but what they want to ignore is that there is no data anywhere that shows they are an exception. T

heir belief is that by reducing all other atherosclerotic risk factors and normalizing their arterial wall and endothelial biology that, apoB-containing lipoproteins like LDL cannot enter the arterial wall. 

Although LDL-C and LDL-P in plasma are high none of the cholesterol content of the apoBparticles gains entry into the arterial wall. Is that plausible???? Sure! 

But is that also erroneous or wishful thinking? Sure? Does one want to bet their CV health or life on a plausible theory? Some do and some do not. Seems to me the first step is to do what this woman did: adjust the nutritional regimen. 

Now for those who want to live in a ketotic state – ketosis will not happen on this patients regimen, the options are then threefold – (1) stop repeating these measurements, keep your fingers crossed and go about life or (2) reduce saturated fat in the diet to whatever level does not cause cholesterogenesis or (3) start apoB-lowering therapy, specifically statins or statin/ezetimibe depending on absorption/synthesis markers. 

Sometimes options (2) and (3) are needed together. Statins are not only among the most effective drugs ever created (have saved more lives than anything but antibiotics and vaccines) but are also among the safest. I sometimes get a laugh out of those condemning drugs, especially statins, in favor of some therapy that has little outcome or safety evidence like supplements or various diets. Even diets may have adverse consequences

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