Unexpected ApoB Results on Keto? Watch This! 🍪 | Nick Norwitz | The Proof #Shorts EP #323

Episode Overview

• The discussion explores the phenomenon of "lean mass hyper-responders"—lean individuals on a ketogenic diet who experience a dramatic increase in ApoB and LDL cholesterol.
• It breaks down the metabolic mechanism explaining why reintroducing carbohydrates can significantly lower these cholesterol markers.
• The role of liver glycogen depletion is identified as the primary trigger for increased VLDL and subsequent LDL production in a low-carb state.
• The conversation highlights how understanding this specific metabolic pathway allows for counterintuitive dietary interventions to manage cholesterol.

Key Concepts

• Lipid Energy Model: In a state of carbohydrate restriction, especially in lean individuals, the body shifts to a fat-based energy system. This increases the trafficking of fatty acids to the liver, which then packages them into VLDL (Very Low-Density Lipoprotein) particles for distribution. These VLDLs eventually become LDLs in circulation.
• Liver Glycogen Depletion: The key driver of this process is the depletion of stored glycogen (carbohydrates) in the liver. This signals the body to ramp up the production and transport of fat for energy.
• Carbohydrate Reintroduction: Adding carbohydrates back into the diet replenishes liver glycogen stores. This removes the initial signal for high VLDL production, thereby reducing the amount of LDL particles subsequently formed and lowering overall ApoB and LDL cholesterol levels.
• Lean Mass Hyper-Responder (LMHR) Triad: This refers to the specific lipid profile often seen in these individuals: very high LDL-C, high HDL-C, and low triglycerides.

Quotes

• At 00:00 - "Why for a lean individual who is adopting a ketogenic diet that has very high ApoB, why would adding carbohydrates back into the diet result in a plummeting of ApoB, LDL cholesterol?" - The host frames the central question of the clip, addressing a paradoxical observation in lipidology.
• At 1:37 - "...that's what allows me to make the prediction that Oreos will lower my LDL." - The speaker highlights how a deep understanding of this metabolic pathway can lead to non-obvious conclusions about how certain foods affect cholesterol in this specific context.

Takeaways

• For lean, insulin-sensitive individuals, a ketogenic diet can cause a significant spike in LDL cholesterol due to a shift in energy metabolism.
• This increase is primarily driven by the liver's response to depleted glycogen stores, not necessarily a sign of poor health in this context.
• Reintroducing a moderate amount of carbohydrates can effectively lower LDL and ApoB by replenishing liver glycogen and reducing the need for fat transport via VLDL.
• Cholesterol response to diet is highly individual and context-dependent; a "high" LDL reading requires understanding the person's metabolic state.