Chris Kresser: I just kind of made that term up, so there’s no hard-and-fast rule, but the concept behind it is that some people are hyper-responders to saturated fat. When they eat saturated fat, they see their LDL and total cholesterol rocket up, and then they might also see a really big increase in LDL particle number, and that’s the thing that’s of bigger concern to me because there’s still a lot of gray area here. If the person is healthy and has no other risk factors and the only thing they have is a high LDL particle number, we don’t really know what the additive risk of that is because most people in studies that have high LDL particle number also have many other risk factors. We know that nine out of 10 people who have high cholesterol and have a heart attack do have another major risk factor, so that tells us that high cholesterol alone isn’t often enough to cause a heart attack.
However, on the other side of that coin, if we took two identical people and we said, OK, they’re the same in every single way except one person has an LDL-P of 2,500, which is really high, and the other person has a normal LDL-P. Just understanding the mechanism that atherosclerosis is a gradient-driven process and if you have a high number of LDL particles in the blood stream, it’s more likely that one of them is going to damage the thin endothelial lining of the blood vessel and initiate the process of atherosclerosis, then the person with high LDL-P is probably at relatively higher risk than the other person.
Now, how high that relative risk difference is, we don’t know, but if someone is interested in totally optimizing their heart health, then it may make sense to have them limit saturated fat if they respond to it in that way so that their LDL-P can normalize. And so in that case, yes, I would suggest typically choosing not the fattiest cuts of meat, making sure to use monounsaturated fats when they’re added, like olive oil, eating more avocados and olives and things like that. I definitely would remove coconut oil because it’s the most saturated of fats. It’s 97 percent saturated. Although it’s MCT, it still can have that effect on cholesterol from what I’ve seen. And if they’re eating leaner meat and leaner protein, they could maybe supplement with some glycine just to make sure they’re getting enough of that.
It really depends on the person. You have to try that diet for a while, and then you have to retest, and then if you retest and their numbers are much, much better, you could have them add a little bit of saturated fat back into their regimen and then retest again a month later and see how they do. Unfortunately, that’s really the only way to figure it out because there’s no hard-and-fast rule for every person.