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Understanding LDL-Cholesterol Through Analogies
Boats in Your Bloodstream and Star Wars

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LDL may not have the same impact on cardiovascular risk when you’re eating low-carb.

Analogy #1 – Boats in Your Bloodstream

"Low-density-lipoprotein" (LDL) is like a boat that transports two types of cargo through the bloodstream. LDL transports cholesterol (an essential cellular building block for cell membranes and hormones) and triglycerides (fat fuel) from the liver to organs around the body that need building blocks and fuel.

LDL Levels Can Increase for Two Reasons

  1. If you’re eating a low-carb diet and burning fat as fuel, your liver sends out more LDL boats to supply fat fuel to your muscles. The empty LDL boats return to the liver to dock, restock, and go back to work.

  2. Alternatively, when you overeat carbs, it is as if you’re filling your bloodstream with sugar glaciers. The LDL boats bump into these sugar glaciers and get damaged in a process classed glycation. (Glycation, in turn, makes those LDL boats further vulnerable to another damaging chemical process called oxidation.) Once damaged by the sugar glaciers, the LDL boats can’t return to the liver and end accumulating in your bloodstream. Eventually, they shrink down and sink down to your artery walls and develop atherosclerotic plaques, a titanic health catastrophe.

Therefore, the perception that LDL is "bad" is not entirely true. More LDL may be needed when you’re burning lots of fat fuel. In fact, the kind of big fluffy LDL that sometimes increases on a low-carb diet is actually cardioprotective! ( 1,  2,  3) By contrast, LDL is bad when it gets damaged by carbs and oxidation, causing it to sink and leading to heart disease ( 1,  2,  4,  5).

Then, there is "high-density lipoprotein" (HDL). Often called "good" cholesterol (although neither LDL nor HDL are themselves cholesterol), HDL is like a rescue submarine that salvages cargo from sinking LDL, cleaning up your bloodstream and protecting against heart disease ( 6).

The perception that LDL is "bad" is not entirely true. More LDL may be needed when you’re burning lots of fat fuel. LDL is bad when it gets damaged by carbs and oxidation, causing it to sink and leading to heart disease.

Analogy #2 – Star Wars

LDL has been labeled "bad cholesterol," but that’s not strictly speaking true for two reasons. First, LDL, which stands for "Low Density Lipoprotein," is not actually cholesterol itself but a package of particles that includes cholesterol as well as fats called triglycerides that your cells use for energy. LDL is made by the liver to carry cholesterol and triglycerides to organs that need them.

LDL is a good guy.

In our Star Wars analogy, LDL is Anakin Skywalker. But, as you well know (I hope), Anakin is corrupted by the real bad guy, Darth Lord Sidious. In the blood, the Lord Sidious is sugar. Sugar from our diets corrupts LDL by binding to it in a process called "glycation," which causes it to "oxidize," or turn to the Dark Side. Thus, rises small dense LDL Vader!

It’s small dense LDL, and specifically small dense and oxidized LDL, that is dangerous for the hearts. So, while you should fear Vader, it’s not really his fault. The real enemy is the Darth Lord Sugar.

Not all LDL cholesterol is bad. It’s small dense LDL, and specifically small dense and oxidized LDL, that is dangerous for the hearts.

For more science-backed articles related to this topic, read the posts below:

Take Home Message

Low-density-lipoprotein" (LDL) is often referred to as "bad cholesterol." This is incorrect for two reasons. First, LDL is not cholesterol but a cholesterol carrier particle. Second, there are different types of LDL. In general, big LDL is good and only smaller LDL is bad (causes heart disease).

It’s the combined presence of high LDL and sugar (from carbohydrate-rich diets) that causes LDL to shrink and increases the risk for heart disease.

If your LDL increases on a high-fat, low-carbohydrate ketogenic diet, it’s likely primarily because your liver is shipping out more LDL particles to carry fat fuel to your organs. Cholesterol comes along for the ride.

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Nicholas Norwitz
MD-PhD candidate at Oxford University

Nicholas Notwitz

Nicholas Norwitz is a Harvard medical student and Oxford PhD researcher who specializes in ketone metabolism. He a rising star in the scientific community, with peer-reviewed publications on topics ranging from brain health to bone health to heart health to gut health.

Informed by his own medical history, he has an infectious passion for food as medicine and a drive to find innovative ways to teach the general public about the latest nutrition science.

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Comments (6)

This is a great explanation, thank you for the analogies! I'm keto and my LDL, HDL and total cholesterol are all way above the 'norm' but my triglycerides and CRP are looking great. I'm thinking if I'm one of those lean mass cholesterol hyper responders. Is there any other test I should get to make sure I'm 'ok'?

Reply

YES! May I ask you to be patient because we actually have a paper coming out in Frontiers in Medicine shortly on lean mass hyper responders (of which I am one). The title is "A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet." It's precisely for people like you. Stay tuned because, once it comes out, Martina and I will make a post on or website. In fact, it was supposed to be in print a while back, but the typesetters were delayed because of COVID.

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Very interesting analogies! Finally it clicks! But could I please ask you to share a little more information about HDL good cholesterol. In Star Wars analogy, is HDL like Luke?

Reply

Janna, glad you asked! HDL is known as “good” cholesterol (although, again, LDL and HDL are cholesterol carrying particles, not actually cholesterol themselves) because HDL has antiatherogenic/cardioprotective functions. This includes not only reverse cholesterol transport (removing cholesterol from arteries), but also antioxidant and anti-inflammatory properties! Something else to appreciate about HDL particles is that, unlike LDL particles, which are secreted in a single form from the liver and decay in size over time, HDL particles are secreted in different forms by the liver and these different forms likely have different functions. For example, larger HDL particles may have greater antioxidant capacity, whereas small dense HDL3c may be particular efficient at reverse cholesterol transport. Based on the probable correlation between HDL particles’ diverse forms and functions, and the epidemiological data, one could argue that an ideal HDL profile would display a multimodal distribution. Regarding your clever comment on Luke Skywalker, yes! If Darth Vader is oxidized LDL, and HDL can be an antioxidant that protects LDL from oxidation, then your extension of the Star Wars analogy works perfectly! However, it could even be extended further because there are many different types of HDL. So, HDL is not just Luke, but also Leia, Obi-Wan, and yoga (who looks to me like a gremlin had a baby with an avocado).

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Great analogies. The lipoprotein system is incredible.  I think of it like dim sum. The liver is the kitchen. It prepares the dim sum carts of different sizes(LDL,VLDL, IDL) with different goodies(TGs, FFA, Chol, Vits) to take to the customers(which are the cells). The regular waiters are the HDL. They collect and bring the dirty dishes from the carts and the customers back to the the kitchen. Delivery men from time to time, drop off kitchen supplies via pallets(chylomicrons after eating). Sometimes impatient customers will pluck stuff off these delivery pallets, but these pallets really are destined for the kitchen. Sometimes you get unwanted street vendors that sneak in and try to sell spoiled foods(pufas and excess sugar). Some customers eat these bad goodies and get sick. The waiters with carts happen to have medical degrees so they congregate and tend to the sick customers but sometimes if too many come to the rescue, they block the aisles. Police(macrophages) who are already roaming around due to the unwanted street vendors mistakenly think the MD/waiters with carts are rioting, so they eat them(macrophage foam cells).  Yeah policemen eating waiters in a dim sum joint is pretty much gonna ruin the dim sum ambiance (physiology).

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😊

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