A new study from the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center and collaborating researchers challenges the long-held view that low-carb ketogenic diets automatically raise heart disease risk due to higher LDL cholesterol. The findings arrive at a moment when keto dieting is popular in Thailand for weight management and health improvement, and they may influence dietary guidance for millions of people.
The research followed 100 individuals on long-term ketogenic plans and found that higher LDL cholesterol—often labeled the “bad” cholesterol—did not reliably predict increased cardiovascular risk in this group. Some participants remained metabolically healthy despite elevated LDL levels, known as lean mass hyper-responders (LMHR). This prompts a re-examination of conventional cholesterol risk models.
A key takeaway is that traditional markers such as ApoB and LDL-C did not consistently align with the amount of coronary plaque. Utilizing advanced cardiac imaging, the study showed that existing plaque burden was a stronger indicator of future plaque progression than cholesterol levels alone. This suggests we may need to shift focus toward direct vascular assessment rather than cholesterol alone when evaluating heart risk.
A leading co-author, a physician from Baszucki Group, indicated that risk assessment could move away from LDL-centric metrics toward imaging technologies like coronary artery calcium (CAC) scoring or CT angiography for better precision. Meanwhile, a colleague from a major European university highlighted a gap in current understanding and underscored the need for refined tools to gauge cardiovascular risk more accurately.
For Thailand, where cardiovascular disease remains a major health concern, these insights offer a measure of reassurance for people pursuing low-carbohydrate, high-fat regimens to address conditions such as diabetes. The study implies that metabolically healthy individuals may not need to abandon ketogenic practices solely due to high LDL levels, though personalization is essential.
Experts also caution against overgeneralization. A senior clinician notes that the study involved a relatively low-risk population observed for one year. Therefore, applying these conclusions to broader, more diverse groups should be approached with caution and under medical supervision.
Historically, cholesterol debates have shifted as evidence evolved. Thailand’s growing interest in ketogenic nutrition sits at the intersection of traditional dietary patterns and modern science, and this research could influence local guidelines and conversations about safe eating patterns.
Going forward, more research is needed to determine whether the LMHR-focused findings hold true beyond this specific group. Thai readers should consult healthcare professionals to tailor dietary approaches to individual health profiles, while staying informed about the latest evidence.
In summary, the study suggests that a low-carbohydrate ketogenic diet may not inherently raise heart disease risk for metabolically healthy individuals, but it does not provide a carte blanche to ignore cholesterol. Regular medical checkups and, when appropriate, advanced imaging can help monitor cardiovascular health as science progresses.