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Low-Carb Diet Reverses Metabolic Syndrome, Independent of Weight Loss
Study Insight

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Quick Summary tl;dr

This study investigated whether low-carb eating could improve Metabolic Syndrome independent of weight loss, as compared to calorie-controlled diets lower in fat and higher in carbs.

The low-carb diet decreased triglycerides, increased HDL, and improved LDL better than the medium-carb and high-carb diets, and in just four weeks.

The low-carb diet reversed Metabolic Syndrome in 9 of the 16 participants. The lower fat high-carb diet only did so in 1 of 16.

Low-carb and ketogenic diets have many proven metabolic benefits, including improving insulin sensitivity and reversing diabetes or decreasing triglycerides and increasing HDL. However, some stipulate that the metabolic benefits associated with ketogenic diets are a consequence purely of weight loss.

So, the following question arises: is there a metabolic advantage of eating low-carb that exists independent of weight loss, as compared to eating a low-fat or moderate-carb diet?

Calorie-Controlled, Low-Carb, Medium-Carb, and High-Carb Diets

To answer this question, researchers ( Hyde et al, 2019) took 16 obese individuals and put each on three separate 4-week long calorie-controlled, weight-maintenance diets: low-carb (LC) [6% carbs], medium-carb (MC) [32% carbs], and high-carb (HC) [57% carbs]. The high-fat LC diet was richer in animal products and the low-fat HC diet included five servings of fruits and vegetables per day.

The macronutrient details of the diets are shown in Table 1, copied below. All diets were, on average, 2,950 Calories (green), and energy from carbohydrates (yellow) was swapped for energy from fat (orange). Therefore, the LC group ended up eating over 3-times more total fat and 2.5-more saturated fat. Remember that for later.

Low-Carb Diet Reverses Metabolic Syndrome, Independent of Weight Loss - Study Insight

Metabolic Syndrome

Importantly, each of the study participants also had Metabolic Syndrome, a conditioned that affects 1 in 3 American adults and is defined by the occurrence of at least three of the following five features: a large waistline, high blood pressure, high triglycerides, low HDL cholesterol, and high glucose. Metabolic Syndrome, as its name suggests, raises a person’s risk of developing other metabolic diseases, including heart disease, diabetes, fatty liver, and Alzheimer’s disease, to name just a few.

Benefit 1: Decreased Triglycerides

Triglycerides are fat in the blood. Therefore, you might think that eating fat would raise triglycerides more than eating carbs. Fat is fat, after all, and carbs are not. However, it’s not so simple. On a low-carb diet, fat burning increases and more fat is pulled from the bloodstream. Conversely, on a high-carb diet, carbs are turned into fat via a process called de novo lipogenesis.

On the high-fat LC diet, triglycerides decreased by a substantial 32% from baseline, whereas on the low-fat HC diet, they increased by 12%. Also, despite the fact that the average participant ate 2.5-times more saturated fat on the LC diet as compared to the HC diet, they had much lower levels of saturated fat in the blood.

Literally, the group eating more bacon, butter, eggs, and heavy cream, and less fruits and vegetables, had lower levels of saturated fat in their blood. That’s not medical advice, but it is a fact.

A low-carb diet with bacon and eggs led to 32% lower levels of triglycerides (fat) in the blood. An isocaloric high-carb diet increased triglycerides by 12%.

Low-Carb Diet Reverses Metabolic Syndrome, Independent of Weight Loss - Study Insight

Benefit 2: Increased HDL

HDL cholesterol particles can clean up blood vessels and have antioxidant properties. High HDL is good and protects against heart disease. In my opinion as a PhD scientist and metabolic health practitioner, I’d much rather have a high HDL than a low LDL any day. And, fortunately for my fat-loving palate, HDL was significantly, 18%, higher after the LC diet than it was after the low-fat HC diet.

A low-carb diet leads to higher good HDL cholesterol than a low-fat diet.

Benefit 3: Decreased Small Dense LDL

LDL unfairly has a bad reputation. LDL can contribute to heart disease once it’s become small and dense, which tends to happen when there’s more sugar in the diet. Pattern A LDL is characterized by very little small dense LDL, whereas pattern B is characterized by more small dense LDL. Pattern B LDL contributes to heart disease, so you want to be pattern A, not pattern B.

At baseline, only 3 of the 16 participants were pattern A. But after the LC diet, 9 were pattern A. The low-fat HC diet only turned 1 participant from pattern B to A. Importantly, this change was independent of change in total LDL. In other words, total LDL did not change significantly as the result of any of the diets, but the type of LDL became better when fewer carbs were eaten.

Cutting carbs improves LDL. This doesn’t mean it decreases LDL, but that it prevents LDL from becoming small and dense.

Benefit 4: Reversed Metabolic Syndrome

After just four weeks, the high-fat LC diet reversed Metabolic Syndrome in 9 out of the original 16 participants. It’s possible, or even likely, that all 16 would have successfully reversed Metabolic Syndrome had weight been allowed to naturally decrease or had the study duration been longer than one-month. By comparison, only 1 of the 16 participants reversed Metabolic Syndrome after the low-fat HC diet.

Low-Carb Diet Reverses Metabolic Syndrome, Independent of Weight Loss - Study Insight

A low-carb diet reversed Metabolic Syndrome in 9 of 16 participants in just four weeks, independent of weight loss.

Conclusion

This study revealed that a high-fat low-carb diet has metabolic advantages that are independent of weight-loss and can be observed in only 4 weeks.

It is important to note that all studies have limitations. For example, the population in this study had pre-existing Metabolic Syndrome. Therefore, one cannot conclude that a low-carb diet is best for metabolically healthy people. However, given that 1 in 3 American adults has Metabolic Syndrome and 88% are metabolically suboptimal and at risk of developing Metabolic Syndrome, the data may be generalizable to a large proportion of the population. ( Araújo et al, 2019)

Furthermore, the study included only 4-week interventions. In this time, the low-carb diet was able to decrease triglycerides, increase HDL, improve LDL phenotype, and reverse Metabolic Syndrome better than the isocaloric medium-carb or high-carb diets. But it is possible that had the participants remained on the low-carb diet longer, more benefits would have been observed. In fact, by the end of the 4-weeks of low-carb, other positive trends were already being observed such as decreased liver fat, decreased blood pressure, and improved insulin sensitivity.

Imagine what might have happened to participants had they been allowed to lose weight and stay on the low-carb diet for more than one month?

Low-Carb Diet Reverses Metabolic Syndrome, Independent of Weight Loss - Study Insight

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Dr. Nicholas Norwitz
PhD in Ketogenics and Metabolism, Oxford University

Nicholas Notwitz

Dr. Nicholas Norwitz is a new shining star in nutrition science. This 25-year-old Ivy League Valedictorian obtained his PhD at Oxford University in just two years and is now pursing his MD at Harvard Medical School. His research expertise is ketosis and brain aging; however, he has published scientific papers on topics ranging from neuroscience to heart disease to gastrointestinal health to genetics to bone health to diabetes.

You can find Nick on Twitter at @nicknorwitz.

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Comments (6)

I've been keto for three years and I'm not planning to go back to eating carbs... but my last test result came back with LDL up more than I'd want. Should I be worried? My HDL is great and my triglycerides have never been lower.

Dear Jackie, I don’t personally think a person with a high LDL, High HDL, and low triglycerides should be worried. I can’t give you direct medical advice, but I can say that no studies to my knowledge have ever shown lipid lowering medications benefits anyone with high HDL, lower triglycerides, and who are non-smokers. One thing you could consider, if your doctor is a statin pusher, if you ask her/him if they can find such a study. If they can, I’d be interested in reading it. For example, Ballantyne, CM. Circulation looked at the effect of a statin, simvastatin as part of the 4S trial and while the statin reduced event rate significantly in people with high LDL, low HDL, and high triglycerides, whereas the effect disappeared when they looked at people with high LDL, high HDL, and low triglycerides. It’s also worth considering the statins inhibit the enzyme, HMG-CoA reductase, that it critical for making ketones in the liver and brain (astrocytes). Statins, especially the lipophilic ones, like Lipitor, cross into the brain. They can also inhibit complex IV of the electron transport chain, decrease CoQ10, vitamin K2, and antioxidant enzyme (MnSOD and catalase) levels. They come with more than one metabolic downside, especially in metabolically healthy individuals. With all that said, there are non-statin options like Zetia and PCSK9is. I actually had a discussion about that on YouTube two days ago. It’s somewhere in that and I discuss some of the nuances of these two drugs. Hope that helps. www.youtube.com/watchFilter

I'm a bit confused about how people on Ketogenic diets can have such low triglycerides when they eat so much fat. Where does the dietary fat go? How come my friend eats all this fat and her triglycerides are like 50 mg/dL, which is really low her doctor says.

Another great question. When you eat fat, the fat molecules get packaged into very large lipoprotein particles called chylomicrons. These get cleared from the blood within minutes. VLDLs, which turn into LDLs, are a different lineage of particles that comes from the liver, rather than the gut. VLDLs are the ones with lots of triglycerides, but once they deliver the triglycerides, the LDLs that they become don’t actually have all that much triglyceride in them. Thus, when you get a 12 hour fasted lipid panel, all the chylomicrons are gone and even if the LDL are high, those LDL aren’t all that rich in triglycerides, so the high LDL low triglyceride picture isn’t paradoxical. It’s also worth noting that carbs – especially fructose – are preferentially turned into saturated fat (palmitic acid) in the liver. So fructose and other sugar or carbs tend to increase saturated fat levels, in particular, in the blood even more than saturated-fat rich foods which are either only partially saturated fat (like dairy or meat) or in the case of coconut oil MCTs, have a different metabolism that mostly bypasses the systemic circulation.

Dear Dr. Norwitz,
I was at LowCarbUSA Boca this past weekend and thought your questions were phenomenal. I hope they have you as a speaker in the future. I also loved your YouTube videos.
My question is about Pattern A versus B. Can you explain a little bit more about what this is? Can I ask my doctor to test for it? I think he uses LabCorps, if that's helpful.
Thank you,
-P

Great question. We have a comprehensive blog on cholesterol with a video coming up soon so hopefully that will clarify the topic further. But, here’s a shortish answer. Pattern A indicates that your liver is shipping out VLDL particles (pre-LDLs), those VLDLs are delivering their triglyceride fuel, and then the large LDLs return to the liver. When you look on a distribution graph (which you can do at this link if you go to figure 1: https://www.frontiersin.org/files/Articles/528189/fmed-07-00097-HTML/image_m/fmed-07-00097-g001.jpg) pattern A looks like A single nice peak over large LDL. Pattern B, by contrast, indicates that – for some reason – the large healthy isn’t going back to port in the liver. When it remains in the blood, it incrementally condenses. In the spectrum, this results in a few peaks over medium and smaller LDLs. So pattern A is one peak, and pattern B is many peaks and indicates the LDL includes more small atherogenic LDL. The “for some reason” part of the story comes down to oxidative stress and inflammation. If you want lab tests for these, urine F2 isoprotane and hsCRP are the most available. Yes, your doctor can order a Pattern A/B test. Here’s the link to the test, test code 123836: https://www.labcorp.com/tests/123836/lipid-cascade-with-reflex-to-lipoprotein-particle-assessment-by-nmr-with-graph.