Does a low-carb diet increase LDL Cholesterol?

 Worried About Cholesterol?  

A quick checklist of 5 useful formulas (Beyond total and LDL cholesterol) !

Author: Deborah NG SJ

For many years, LDL and total cholesterol have been treated as targets to be pushed as low as possible.

However, did you know that individuals diagnosed with cancer often show lower LDL levels years before diagnosis?

Also, did you know that LDL may decline due to chronic inflammation, metabolic stress, or increased cellular demand?

A research paper reviewed 19 cohort studies, involving over 68,000 adults aged over 60, showed that (1):

💥Low LDL cholesterol was often linked with higher all-cause mortality (death rates) compared with higher LDL, especially in older adults.

💥In many cases, those with lower LDL lived shorter lives, and people with higher LDL actually lived longer.

💥When it came to heart-related deaths, most studies found no clear link between LDL levels and cardiovascular mortality.

So, let’s dive in to evaluate whether your LDL type is good or bad, accompanied by these markers: 

1. TG / HDL Ratio — 

Metabolic Health & Insulin Sensitivity

Target: < 0.3

What are Triglycerides (TG)?

Triglycerides are fats that circulate in your blood after eating. They store unused energy from food.

What is HDL (Good Cholesterol)?

HDL helps remove excess cholesterol from blood vessels and transports it back to the liver for disposal.

Here is an image of what a typical high triglyceride blood level looks like:

The milky appearance in the blood sample comes from excess triglycerides. LDL does NOT cause this cloudiness — triglycerides do.

High TG and Heart attack risk

From a large Norwegian population study of 86,261 participants, for every 1 mmol/L increase in triglycerides, females tend to have (2):

• 26% higher risk of death from ischemic heart disease (heart attacks)

However, when researchers adjusted with HDL:

• The strong triglyceride–heart death link in women disappeared
• This means high triglycerides and low HDL often occur together

Values below < 0.3 are typically seen in:

• Metabolically healthy individuals

• Low hepatic VLDL output

• Minimal formation of small-dense LDL 

2. ApoB / ApoA Ratio — Particle Load vs. Clearance Capacity

Target: < 0.6

If LDL-C tells us how much cholesterol is being carried:

• ApoB tells us how many particles are doing the carrying or how heavy the traffic is.
• ApoA tells us how well cholesterol is cleared from the body.

When is high LDL-C not concerning?

When ApoB/ApoA is low, particle traffic is low relative to cleanup capacity,  even if LDL-C looks “high.” :

Research showed that ApoB/ApoA was a stronger predictor of heart disease than LDL cholesterol alone (3).

ApoB/ApoA-I performed better than LDL-C, confirming that particle number matters more than cholesterol amount.

A ratio below 0.6 indicates:

• Fewer cholesterol-carrying particles vs high removal capacity
• Lower probability of cholesterol retention in arterial walls (The key driver of plaque)

3. TG + ApoB + CRP  

(Stressed particles + artery-entering particles + inflamed environment)

Target below < 1.8 

High-sensitivity C-reactive protein (hs-CRP) is a blood marker of low-grade systemic inflammation.

Instead of worrying about how much cholesterol you carry, it is more important to assess how “inflamed and reactive” the arterial environment is. 

Findings from 27,939 healthy individuals indicated that hs-CRP (4) is a stronger predictor of heart disease risk than LDL alone, even among subjects without cholesterol issues.

Standalone CRP = <0.5 suggest:

💢 Minimal inflammatory signaling

💢 Lower likelihood that lipoproteins will become oxidized or retained

More importantly, hs-CRP often rises with TG/HDL risk even when LDL-C looks normal.

💛CRP determines whether particles are likely to cause damage

4.  LDL-C / ApoB

 (Target > 4.0 or Big Buoyant LDL)
(Amount of cholesterol carried ÷ number of artery-entering particles)

LDL is a particle created by the liver to transport nutrients around the body to heal and strengthen all cells, tissues, and organs.

In this context, higher LDL is NOT automatically a bad thing.

To determine whether LDL-C is more or less concerning, we need to assess LDL particle size (5) because larger LDL particles carry more cholesterol per particle.

         

Large LDL particles, when paired with low ApoB and low CRP, are like:

*Big cargo lorries (high LDL) traveling on a smooth, wide, and uncongested road  = LOW risk

           

👍 Higher LDL/ApoB → fewer particles (Big Trucks), but less on the road

💥 Lower LDL/ApoB → many small cars, heavy and jammed traffic

💢We don’t fear big trucks on an empty road. We fear traffic jams on damaged roads.

5.  The Most Important Formula: 

Putting All Together

(ApoB × TG) / (ApoA × HDL)

Target: < 0.2

This formula integrates 4 independent pathways

into 1 directional signal:

1. ApoB - Particle Load

2. TG - Particle Stress

3. ApoA - Clean up capacity

4. HDL - Transport Efficiency

How to understand this formula

👉ApoB × TG
 = Risk pressure: how heavy and risky the traffic is

👉ApoA × HDL
= Protection power: how strong the cholesterol clean-up system is

💖Final Number: A value below 0.2 means:

• Risk pressure is low

• Clean-up power is strong

• High Metabolism and low inflammation risk

                              

Low-risk traffic ÷ strong clean-up = lower artery risk

Risk is not about how much cholesterol you have, 

It is about whether traffic > overwhelms cleanup! 

6.  Summary (Formula checklist)