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Crossfire

My cholesterol went up on this diet. Does it matter?

What the experts say

Simon HillMSc, BSc · nutritionist and physiotherapist · host, The Proof

Yes. Count the particles and lower them.

What it rests onHe concedes the mechanism the other side uses, that small dense particles are more easily retained in the artery wall, then argues they also deposit less cholesterol per particle, so the retention advantage does not survive the arithmetic. On saturated fat he argues the defences fail on the replacement question: it looks harmless only against refined carbohydrate, and he attributes the 5 to 10 percent figure to the AHA, ACC, EAS and ECC.

Source: theproof.com ↗
Shawn BakerMD · orthopedic surgeon and strength athlete

Usually not, and if it spikes, adjust the diet rather than panic

What it rests onReported lipid patterns in people eating this way, plus the argument that health gains are available without pushing fat intake high enough to hold ketosis. His own page also allows that statins may be appropriate for some people.

Source: carnivore.diet ↗

Overview

Baker is describing people already eating a strict animal-only diet, usually having come to it for symptom relief and often reporting improvements in other markers at the same time. Hill is describing primary prevention in a general adult who wants to keep plaque from forming.

The disputed premise is narrower than either headline: it is whether an LDL rise accompanied by high HDL, low triglycerides and larger particles carries the same risk as the same LDL rise without them.

Where they agree

More than the poles suggest. Both tell people to test rather than to assume. Both accept that lipid-lowering medication is legitimate for some people. Both respond to a sharp rise by cutting saturated fat, which is Baker's first mitigation step and Hill's standing advice. Neither says to ignore the number.

What would settle it

An outcome trial rather than a lipid comparison: plaque progression measured by imaging, or events, in people with high LDL on a low-carbohydrate diet with otherwise favourable markers, against matched controls.

Hill has pre-committed to imaging endpoints by building his own plaque argument on six trials that measured plaque directly, and Baker's page rests on marker patterns rather than outcomes, so an imaging endpoint is the comparison both sides have implicitly accepted.

Practice does not pick a winner here

You do, and your call is dated, kept, and yours to change. Follow the people you already trust and what they publish turns into a short daily practice.

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