If it were a given that eating lots of fat leads to extremely high levels of cholesterol, my irises would look at bit strange by now at the very least.
Now excuse me while I go eat about a pound of eggs and cheddar cheese for breakfast. (not a joke)
You slice it in small pieces. And add some wine. And a friend to call 911. /s
I assumed the excess protein would be undigested, but can't back that up with a citation.
I don't think someone here is lying. There may be some level of exaggeration, as in my experience a lot of cheese (particularly hard cheeses) can lead to extremely painful stools, but calories really aren't as meaningful as one might assume, especially when switching from a diet that directly supplies carbohydrate and one that doesn't.
The human body needs a certain amount of glucose in the blood, but it can't get that from fats (at least as far as I am aware). It can obtain it from protein through a process called gluconeogenesis, but that's a relatively expensive process that requires more ATP than what ultimately results from it. The human body also treats that process in a more demand-driven manner than one where exogenous carbohydrates are consumed. This isn't an absolute, but it's generally less supply-driven. If protein can't be used for glucose or building tissue, it's more likely to become waste eventually.
See "rabbit starvation":
https://hekint.org/2022/01/26/rabbit-starvation-protein-pois...
Heterozygous FH will typically put someone at a total cholesterol roughly around 500mg/dl, and homozygous will get them closer to the 1000mg/dl mark. Dietary factors for most people will affect their lipids up to +/- 40mg/dl, and medication is generally required for anything beyond that.
For the gentleman with cholesterol nodules, that’s a not-unheard of symptom of homozygous FH and the associated cholesterol levels. I’m sure his diet is exacerbating it, however I would be genuinely surprised if that were the primary cause of his count being > 1000mg/dl. (With homo-FH and an extremely restricted diet, he’d still be unlikely to get below 900mg/dl)
It's quite possible that it's a combination of diet and genetics, but people can quite easily get to incredibly harmful LDL levels with diet alone.
Edit: here's a case study of someone getting to TC of 488.7mg/dL. I think you'll struggle to get higher quality data than case studies because these kinds of diets are (thankfully) fairly uncommon and no ethics board is going to sign off on an intervention study that's likely to raise blood lipids by this kind of level.
https://academic.oup.com/jes/article/5/Supplement_1/A37/6240...
> …significantly higher than his baseline of [sic] level of 210 to 300
so they measured before and 8 months after the diet change to find a 4x increase in cholesterol
I've likely had orders of magnitude more cheese and butter than this guy, and I've yet to have yellow nodules or the 10 heart attacks I apparently should have had by now. Both of us are N=1 case studies, so basically meaningless outside of identifying a particular clinical condition.