Thoughts on the role of LDL in cardiovascular disease; origins of LDL denialism among diet promoters; and why LDL denialism is understandable and beneficial for some but comes at the expense of others

I am writing this post because someone asked for me to comment on the ideas of major low-carbohydrate diet advocates, specifically, the idea that LDL cholesterol does not cause cardiovascular disease.

Now, I myself do not personally consume a low-carbohydrate diet (although I have at many times in the past). Furthermore, I take a statin. Therefore, my beliefs could not be any different than the beliefs of those who consume low-carbohydrate diets. What's more, I spent many years "debunking" low-carbohydrate diet promoters, and I ultimately did my PhD in a closely related area.

Yet I want to provide a sympathetic if nuanced perspective on the causes and outcomes, benefits and harms, of LDL denialism within the alternative nutrition world of low-carbohydrate, ketogenic, carnivore, etc. diets. Because there are always good reasons that people embrace pseudoscience--sometimes arguably quite compelling reasons--and I want to articulate some of these in a very clear and schematic way below.

It is important to note that just because I am suggesting that low-carbohydrate diet promoters may have compelling reasons for embracing pseudoscience, I do not endorse embracing pseudoscience. It might shock many of my followers to hear that I am quite neutral about whether anyone embraces pseudoscience, as I think pseudoscience can sometimes make important contributions to science, and has both benefits and harms. I personally don't embrace pseudoscience (at least not intentionally), but I am tolerant for some of these reasons and others to people who do.

But that's for another post. Without any further ado... 

LDL matters for cardiovascular disease but insulin resistance matters more. Insulin resistance is largely the result of excess visceral adiposity, that is, liver and pancreatic fat. This fat is lost through overall weight loss. Reduction of visceral fat is therefore more important than reduction of LDL cholesterol for cardiovascular disease risk.

The low-carb promoters believe that insulin resistance is best treated by LC diets. LC diets tend to raise LDL, which the medical establishment claims is unacceptable and unhealthy, not realizing that, actually, higher LDL and lower insulin resistance still might be more healthy than baseline, on the whole--even if keeping both low is best.

The medical establishment therefore rejects LC diets, even though they are net beneficial. The LC crowd then polarizes and in response denies the role of LDL altogether, making insulin resistance into everything that is important.

This LDL denialism is an articulated, exaggerated manifestation of the hostile feelings that many LC promoters possibly rightly feel toward the dismissiveness that mainstream medical doctors have toward the complex but likely on net beneficial effects of LC diets. It is a means-ends, pseudoscientific approach that denies the real impact of LDL on cardiovascular health. Pseudoscience is deployed to achieve better health, which it may in fact do at least for serious LC diet adherents.

LDL denialism however has negative externalities, promoting statin skepticism among lay people who are consuming an ordinary diet for whom the original considerations driving LDL denialism do not apply. They are not fixing their insulin sensitivity; they are just not taking their LDL medication, which barring major side effects (some people have them), is net beneficial.

What this means is that this particular kind of pseudoscience benefits some within the low-carb community at the expense of others outside of it. It would be very nice if people could just be honest and rational, but unfortunately worldviews come about for psychological rather than purely rational reasons.

In conclusion, LDL denial within the low-carb/keto community is an interesting case study on the causes of pseudoscience and the benefits and harms of that pseudoscience. I originally got into "debunking" on the Internet to debunk this pseudoscience. Where I went wrong was that I became interested in COVID and began debunking COVID pseudoscience. I was drawn to doing this because I hadn't known that the medical establishment actually did sometimes promote pseudoscience. This was fascinating to me and has led to consequences of its own...