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Dec 30

A Simple Guide to Cholesterol on Low Carb – Part I

If you’re on a Low Carb High Fat diet (LCHF), there are a few things you should know about cholesterol and how it is related to this lifestyle. In this guide I plan to cover the topic in very simple terms. It is by no means complete and is intentionally simplified to make it easier to read and understand for the layperson.

Our Energy on a High Fat Diet

Before talking about cholesterol, we have to talk about the energy you get from fat when on LCHF. Of course the main reason for food is to supply your body with energy. But how does that energy get to everywhere it needs to go in your body?

Like every other living thing, your body is made up of cells. Your heart is made of cells. Your brain is made of cells. So are your fingers, knees and toes. Almost all these cells need energy. And the vast majority of these cells ultimately get their energy from the blood circulating around your body.

Bloodstream

The most commonly talked about source of energy is carbohydrates (carbs). Your body turns carbs into glucose to put in the bloodstream. From there the glucose can circulate throughout the body, allowing hungry cells to grab some for themselves, and this is done with the help of insulin.

Glucose

The other major energy source for your cells is fat, and by that I mean fatty acids. And like glucose, your cells also get their fatty acids from the bloodstream. Only there’s an important catch: glucose can swim in the bloodstream easily, but fatty acids cannot.

Fatty acids and the bloodstream are like oil and water, they don’t mix well. To fix this, your body cleverly does two things:

  1. It packages three fatty acids into a combo pack molecule called a “triglyceride”.
  2. And it makes a kind of boat for these triglycerides to travel in called a “lipoprotein”.

In fact, the kind of lipoprotein that delivers all these fatty acids is known as a very low density lipoprotein — or VLDL. After it delivers its energy, it remodels to a low density lipoprotein — but you probably know it already by its abbreviation, LDL.

Trigs vs Glucose

Common Confusion with LDL

Odds are you have most likely heard of LDL being used to describe cholesterol on a blood test. “Your LDL is high…” for example. So what gives?

Here’s the thing about cholesterol, like its triglyceride cousin, it also doesn’t swim well in the bloodstream. In the medical world, these molecules are commonly referred to as lipids. And lipids are actually repelled by water, so they are commonly called hydrophobic (hydro = water, phobic = repel). So when someone tells you they love to go to the beach but hate the water, mention they must be hydrophobic like cholesterol!

Yet what if the body has reason to have cholesterol available in the bloodstream as well? (We’ll get into that more in Part II) And while we’re on the subject, there are a few other things the body wants available to cells that are also hydrophobic, such as fat soluble vitamins (like Vitamin E).

So should it make a separate lipoprotein container for each of these molecules? No! It effectively packages all of them into the same boat: the lipoprotein.

Lipoprotein

That’s the genius of the human body. It has a kind of FedEx for all the hydrophobic elements needed by the cells. And most of whatever isn’t used gets recycled by the liver for many other possibilities, such as hormone or bile salt production.

Common Confusion with Triglycerides

The odds are likewise that you’ve heard “triglycerides go down on a low carb diet”. Indeed, blood tests for those going LCHF are almost universally lower in triglycerides. But a measurement of anything in the bloodstream is counting what is traveling around in that moment and not yet in use.

For example, Type 2 Diabetes has a common symptom of having very high glucose in the blood. This is because these diabetics are insulin resistant and have trouble getting the glucose out of the blood and into their cells. They may eat the same quantity of food as someone who isn’t diabetic, but glucose in the blood will spike higher and last longer by comparison.

If you have reduced your carbs and now get your energy mainly from fat, without question your cells are absorbing more of it from the bloodstream now. So even if you’ve increased the total amount of triglycerides going into the blood due to the diet, it is still brought down by the amount getting taken back out and used by the cells.

Common Confusion With Ketones

Another common assumption with LCHF is that you “get the majority of your energy from ketones” since you are in a state of ketosis. It’s certainly true your body makes many more ketone bodies from breaking down fatty acids, which will likewise feed your cells. This is especially important for proper brain function as ketones have special access that lipoproteins do not.

Yet while ketones are both produced and used much more on LCHF, they are still a secondary source of energy. The primary source of energy is still fatty acids brought to cells in LDL particles.

Ketones

More Cholesterol is Trafficked on a Low Carb High Fat Diet

Now that you understand your body has need to move around more triglycerides to fuel your cells while getting the majority of your energy from fat, you may have already connected the dots.

  1. Your cells need energy
  2. On a high fat diet, their primary source of energy is triglycerides
  3. To get the triglycerides to your cells, your body sends them in very low density lipoproteins (VLDLs), which eventually remodel to low density lipoproteins (LDLs).
  4. All very low density lipoproteins (VLDLs) are made containing both triglycerides and cholesterol (but mostly triglycerides)

What are the Risks?

If you read the above and are struck with fear, I don’t blame you. It has been well drilled into our heads that more cholesterol in the blood = higher risk of cardiovascular disease and stroke.

But if you’re early in your research on this topic, let me help you skip ahead with one very crucial point (which I alluded to above). Making something available is not the same as using it.

Here’s a simple analogy – life rafts in the water and being used are typically a sign of trouble. Yet all ships sail with them on board. This is a good idea in case of an emergency, of course. But if you were only counting life rafts whether in use or not, then you’d assume a lot of ships entering view was by itself a sign of trouble.

Cholesterol is like the life rafts on the LDL ships. Even if it travels with your triglycerides, it is a much smaller passenger (in quantity) and mostly recycled back at the liver. You don’t actually care how much cholesterol is in your blood — you care how much cholesterol leaves the bloodstream and causes a build up of plaque in your arteries (atherosclerosis). And this is at the core of the inflammation debate with cholesterol. Is it a life raft for damage to the blood vessels? Or is the sheer presence of it risk alone? (You can probably guess where I fall on this one.)

In Part II we cover part of the journey of cholesterol in more detail through a very visual comic form. (Part III is coming soon…)

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67 Comments on "A Simple Guide to Cholesterol on Low Carb – Part I"

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Samantha Baker
Guest

Great post Dave, love it! Makes it all so simple to understand. Bravo!

bill
Guest

Fun!

Joe
Guest

Thank you for the time you put into this excellent and simple summary. Looking forward to the series so I can share it with my less geeky friends in the hope that their eyes can be opened. Will likely also share with my doc who I have brought on board with LC but not HF. Gave him Big Fat Surprise for Christmas and hope it will have the same effect as Why We Get Fat!

Dave Winebrenner
Guest

I can see the particle count people circling the wagons now Dave:)

I am with you on this!

Awesome first part.

Diana
Guest

Terrific explanation. looking forward to part 2

Wim Tilburgs
Guest

Great explanation. Will share it. Looking forward to part 2

Charles Grashow
Guest

Dave

You said – “In Part II, I’ll discuss my own research and data, and why it has alleviated my concerns about having high cholesterol while on a low carb diet in greater depth.”

SO – if high cholesterol on a LC diet is not really a concern why do all of these experiments with regard to cholesterol?

Angela
Guest

Great explanation! And way to leave me hanging. 🙂 Looking forward to part 2

Doug
Guest
Perhaps part II will answer my question, but you say: All low density lipoproteins are made containing both triglycerides and cholesterol (but mostly triglycerides). (Emphasis mine.) What are your sources for that? The trig/chol ratio in an LDL particle seems to be something that is highly variable, and IMO, clearly not true for folks with high LDL-C and low trigs – your point about the traffic vs content notwithstanding, at a given point in time, those people’s LDL are carrying mostly cholesterol. Also, mostly trigs in your LDL makes for small dense LDL, which is generally accepted to be a… Read more »
Deborah Burdette
Guest

Thank you….I’ve always refused the medication for cholesterol and triglycerides……

Chad Nordstrom
Guest

Great job!! Enjoying your efforts and posts. Thanks for sharing all this.

Karen
Guest

What about HDLs I am interested in how HFLC increases HDL Levels, my skin and joints has never been better since being on this diet

Rob
Guest

Great post Dave! I like the different way of looking at it. It all makes complete sense. I’ve had 10 NMR’s myself since starting LCHF in 2011, and my numbers have been high. I would be curious what Dr. Thomas Dayspring had to say, since he says”particle number, end of discussion”. I’m with you though Dave!

Chris Jones
Guest
Hi Dave, this is all very new to me as I’ve started a LCHF diet last week but just got back the results for my cholesterol tests and they are high. That prompted the question “how am I supposed to reduce fat intake if I’m on a LCHF diet?”. Based on the misinformation surrounding the whole “fat makes you fat” nonsense, I don’t fully trust what the doctor is telling me regarding reducing fat to improve cholesterol numbers. So after reading this post a couple times, I came to the following summary. Please tell me if I’m misunderstanding: – The… Read more »
Nicole Recine
Guest

I love this! This helped me understand why Peter Defty told me cardio may help lower my trigs. I just need to use them. On to part 2 🙂

Drifter
Guest
Dave, Thanks for taking on this topic…Several things, in case you haven’t seen it, here is Dr. Rocky Patel’s post where he describes how his particle count was “high” when he went LCHF, however his arterial plaque actually reduced during that same period. That to me is the holy grail so evidence like that from clinicians seems particularly important. He also has a good discussion of the inflammation markers he uses and some good discussion in the comments section. Unfortunately he doesn’t seem to be blogging or podcasting anymore, but here is the post: http://azsunfm.blogspot.com.br/2012/09/font-definitions-font-face-font-family.html Also, I haven’t seen you… Read more »
Ray Klepper
Guest
Dave, Thank you so much for your continued pursuit of this topic. I am a physical therapist and have been relentless with my self education regarding nutrition over the past 2 years. I am scheduled to speak with a cardiothoracic surgeon who is very into nutrition and primary prevention as well. His interest is how to best lower LDL without a statin. I’m not sure how he will respond when I bring up the idea that LDLc is a terrible biomarker per Dr.Dayspring and per other articles, data and experience. What I would like is to use your examples to… Read more »
Rob
Guest

Hi Ray and Dave–I’m a speech therapist at a major hospital in DC and am developing nutritional advice for stroke patients along with help from clinical dietitians. Unfortunately they are very usda guidelines focused and tend to recommend way more grains and carbs than I do and they definitely steer patients away from saturated fats. Any luck developing good advice for lowering patients risk of cardiovascular disease? Feel free to email me or connect me to Ray. Thanks.

Pat
Guest

I see your previous comments re: Dr Attia so no need to respond!!

Andrea Mikler
Guest
Dave, just found your site today and can’t stop reading. I love your analytical engineering aproach to it. When are you going to write about HDL? I am very interested to know the mechanism of my HDL increasing on ketogenic diet to the point that is much higher than my LDL. I have been on low carb for about 4 years with the last year being mostly keto. My Total chol in 2013 was 200, HDL was 94, LDL 100 and Trigs 0.38. My last test in Sept. 2016 Total chol. 238, HDL 125, LDL 103, Trigs 0.5. What does… Read more »
Andrea Mikler
Guest

Oh just noticed I converted cholesterol numbers from mm/l to mg/dl but did not convert triglycerides. They went from 34 to 44.

Dave Braatz
Guest
Might need another category: My cholesterol and triglycerides have always been high, but I remained skeptical of taking statins. From 2001 to 2017 (N=22), my TC averaged 260; TG avg 356; HDL avg 37; LDL avg 169; glucose 94 (all after 12-hr fast, and on HCLF diet). In 2010, my blood after a 4-day water-only fast showed TC=312; TG=271; HDL=34; LDL=224; and glucose=62. I assumed my TG dropped because my glucose fell, but I was surprised at the jump in my TC. I went keto in 2017, and my June bloodwork (non-fasting; LCHF) showed a huge spike in TC to… Read more »
David
Guest

This is a subject close to my heart cheers.
Thanks

Scout Dawson
Guest

Dr. Michael Eades linked to your website, so I thought I would check it out. This ‘beginner’s guide’ is amazing and really informative. The cholesterol thing is something I have always been quite confused about (and I did wonder why long-term keto’s had “high” blood pressure after many years).

This has cleared up any worries I had. Time for a steak? 😉

Roger
Guest

Dave,

Your work is awesome! I use your data to disrupt conventional medicine every chance I get. That said, what is your generic advice for FH patients?

Thanks,

Roger

Leslie
Guest

This article is very good in helping me understanding cholesterol. I started a LCHF way of eating about 5 weeks ago. I lost some weight but didn’t have much to lose. I went to my yearly appointment and they checked my labs. My TC was 290 and my LDL was 210. I am 37 years old, 5’4″ and weigh 117. I don’t know if that information matters. From my understanding, these numbers don’t mean anything and I would have to have my particles checked to see if there is a real issue. thanks in advance for any information.

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Mansoor
Guest
Hi Dave thanks for the invaluable insight you gave me about cholesterol. After 4 months of keto I had my blood work done I realized my cholesterol was high.My weight is 70 kg and I’m 178 cm high.I’m moderately active . Total: 238 LDL : 160 VLDL:12 HDL : 66 Triglyceride: 62 I have heard if LDL cholesterol is over 130 it’s not healthy and the small dence particles are high. I don’t know how they came up with this number.In my country NMR test doesn’t exist.I really love this diet but there are alot of confusion. How can i… Read more »
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Pratik Jhaveri
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Dave Been on a LCHF diet for the last 2.5months (was in keto for a bit). Lost ~20lbs during that time. Went in for my blood test last week and was surprised to find that my cholesterol went up. Good news is that A1C dropped. A1C – went from 6.3 to 5.7 Total Chol – from 257 to 292 LDL – from 181 to 212 TG – from 194 to 215 HDL – remained same at 37 I read through your simple guide to cholesterol and was trying to understand the reasons for the possible increase. In addition, what other… Read more »
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Lisa Mayo
Guest
Hi Dave Thanks for your work. Trying to understand the numbers and conversions and just looking for some clarity of direction. If you have the time please can you check my recent blood work. I am a 54 yo female , train 3-5 times weekly weights / cardio 62 kg and 154cm. total cholesterol 8.3 trigs .0.9 hdl 2.1 ldl 5.8 hbaic5.2 fasting glucose 4.2 CRP 0.5 Thinking low trigs , CRP and fasting glucose good and HBAiC in range probably a good predictor. however high LDD and total cholesterol still a red flag but with low trigs my be… Read more »
Lisa mayo
Guest

Thanks Dave yes thought I might fit into the hyper responders group . Thanks for your teply . Also great presentation at the Gold Coast gave more clarity to my numbers and my understanding

Stefan
Guest

Great ..is there a write up where you explain HDL (Good), LDL (Bad) Cholesterol and Triglycerides. New to this an my doc always wants to put me on pills to lower my cholesterol ..like to get more informed before I swallow a pill. ( sorry about my english I am from europe) . thx
Stefan

Craig
Admin

Start with the Simple Guide.

Lou Malinow
Guest
Very well done. I am an internist, a lipidologist, and a hypertension specialist and I preach ketosis for many patients. I would make one constructive comment……a “typical” LDL particle is 4 parts cholesterol to 1 part triglyceride, so most of the baggage on the ships isn’t triglyceride (unless you’re dealing with an insulin resistant patient with high VLDL). VLDL (recipe: combine a bunch of triglyceride with a little cholesterol and wrap it with a lipoprotein called ApoB which you might refer to as the hull of the boat) has a triglyceride to cholesterol ratio of 5:1……..and that may be what… Read more »
Evie
Guest
Hi Dave…it’s a good summary when I am looking for an article about TG. After 3 months on Keto when I did blood test my TG was increasing very significant, which is strange. Before Keto, I have done also a lot of diet such as low carb high protein, food combining, etc and my blood test always good. Ratio of TG and HDL is less than 2. But SGOT and SGPT always high before and after 3 mos on keto, those are decrease significantly but TG was increase. Logically it’s not like that, TG should be low rite…that’s I am… Read more »
Ray Klepper
Guest

Hey Dave, had a question about my history with lipid testing. Can you please email me so we can discuss? TIA!

Danny
Guest

This is awesome for dumb guys like myself. Thanks!

mike
Guest

Great post and blog! I actually noticed similar results to your experiment! I was so worried about my high LDL but it dropped so much after switching to the SAD diet. I detailed my experience here: https://www.reddit.com/r/keto/comments/81on0f/dont_be_worried_about_your_high_ldlc_on_keto_my/

Thanks again 🙂

jeff daniels
Guest
you’re sharp. try taking a crack at this:In the 3 months between tests-i started keto, stopped statins . AND took weekly iv plaquex(phosphodytlcholine sessions. my ldl-p doubled to 2034, tg from 98 to 83, insulin from 10 to 3, hdl from 40 to 50-ldl-73 to 143 crp from 1.9 to 4. I am going back on statin to lower crp but am i wrong-during fasts chol. rises in blood-Dr. Furhman says that’s because it’s coming out of the plaques. I think the plaquex sucked stuff out of plaque i am dying to get an ultra sound of caratids hopefully my… Read more »