Hyper-Responder FAQ

[August 2017: Heads up — this FAQ was originally written over a year and a half ago and is now very much out of date given my current data and research. I’m currently in the process of setting up a new one to replace this entirely. Please return soon for the update]

What is a Hyper-Responder?

The term, “hyper-responder” has been used within the ketogenic / low carb, high fat (keto/LCHF) community to describe those who have a very dramatic increase in their cholesterol after adopting a low carb diet.

This increase can be anywhere from 50% to 100% or more of their original, pre-diet cholesterol numbers. There is quite a bit of debate as to how much or how little this affects risk for atherosclerosis and general heart disease given keto/LCHF is very anti-inflammatory.

How many of those practicing a keto/LCHF diet are hyper-responders?

Because the keto/LCHF community is relatively small, the total number of hyper-responders as a percentage of the whole is unknown. But estimates vary between 5% to 33%.

Is having high cholesterol on a keto/LCHF diet dangerous?

This is the important question, of course. The short answer is – we don’t know.

In my personal research, I find most lipidologists are confident that high levels of LDL-P (total LDL particles) are strongly correlated with a higher risk of atherosclerosis (buildup of plaque in the arteries) and can point to several modern studies that show this. It’s also worth noting that prominent voices in the field of cholesterol, such as Dr. Peter Attia and Dr. Thomas Dayspring, likewise consider high LDL-P as a potential risk factor for atherosclerosis.

However, those who argue against this will point out that these studies did not include people practicing a low carb diet. It is commonly asserted—but has yet to be determined with absolute certainty—that the presence of higher LDL-P is inconsequential if it isn’t coupled with the inflammation that is commonly remedied through following a keto/LCHF diet. Ivor Cummins is one such voice and regularly provides counter-analysis in articles and videos (such as Cholesterol Conundrum).

There is much more to unpack with this debate regarding “small, dense LDL” and triglyceride-to-HDL ratios, but I’d prefer to place that in a page all its own. (Coming soon.)

Are there any factors that might predispose one to being a hyper-responder?

In my research to date, these are the four most commonly referenced factors to becoming a hyper-responder:

  • Familial hypercholesterolemia (FH) – A genetic disorder that presents early with higher cholesterol, and in particular, high LDL. However, this is less likely if the hyper-responder had “normal” ranges of cholesterol before starting the low carb diet given FH would have likely shown beforehand as well. (See here for more information.)
  • One or two copies of the ApoE4 gene – this gene has long been identified with higher risk for elevated cholesterol. Anecdotally, many hyper-responders find they have one or two copies of the ApoE4 gene; 3/4 or 4/4 pattern. (I myself have the 3/4 pattern, which I found through my test with 23andMe. See here for more information.)
  • Hypothyroidism – when the body’s thyroid slows down, it leads to a slow down in the production of LDL receptors. These receptors are important for usage, and, ultimately, clearance of LDL from the bloodstream. (See here for more information.)
  • Hyper-synthesizer. Generally in reference to someone with insulin resistance who experiences an abnormally high production of cholesterol. (See BJJ Caveman’s lecture notes for more information.)

How do hyper-responders reduce their cholesterol numbers while remaining on a Keto/LCHF diet?

[UPDATE: This section was originally written over a year ago and is now out of date given my new data. It will soon be rewritten with updated information very soon.]

Currently, the most common opinion among the keto/LCHF community is that the increased cholesterol (and in particular, LDL-P) is due to high sensitivity in some individuals to dietary saturated fats. Many who have reduced overall saturated fats in their diet and focused instead on monounsaturated fats (MUFA) or polyunsaturated fats (PUFA) have had success reducing their LDL-P and overall total cholesterol. (Prominent examples include here and here.)

However, there are theories that link other factors to higher LDL-P, such as poor dental health, an imbalanced gut microbiome, and too little dietary fiber.

In my personal data, saturated fat intake appears to reduce my overall LDL-P instead. I’ll have a deeper dive into this data and my theory behind it in a later post.

Where can I learn more about hyper-responders?

I’m actively compiling links in the Research and Links section of this site. Note that this is an ongoing process as there is still much to be discovered about this topic and the mechanisms behind it. Thus, I expect this site will have routine updates as more information and studies emerge.

I’m a hyper-responder as well and will be sharing my data/story in the blog section.