
High LDL on keto isn’t risk-free: experts reaffirm LDL-apoB causality
A skeptical review of the lean mass hyper-responder (LMHR) hypothesis argues that very high LDL-C on a ketogenic diet does not erase the proven link between apoB-containing particles and atherosclerosis. It critiques two LMHR studies for short duration, lack of proper controls, and confounding factors, and questions the lipid-energy model’s validity. Across decades of evidence, LDL-C/apoB remains causally related to ASCVD, so reducing apoB—through diet, statins, or other therapies—remains the prudent course, even for metabolically healthy individuals. Longer-term, well-controlled data would be required to overturn this consensus.













