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May 11

Cholesterol Research Breakthrough

A few important caveats before getting started:

  • This is very preliminary. While it’s true I’ve both produced and reproduced these results, it’s still very early to draw significant conclusions, which I detail further below.
  • This does not constitute medical advice. I realize many may read this and act on it, but I urge you to consult with your doctor and/or trusted medical professional — particularly if you are diabetic or insulin resistant.

Going Low Carb / Keto

Before I started the ketogenic diet, my carb intake was probably north of 250g a day and my fat intake was likely around 75g. After going keto, I brought my carbs down to around 20g with my fat shooting up to around 220g. (My protein remained relatively constant at 25% of my calories.)

To illustrate this, I’ll be using this simple graphic to show a sliding scale from left to right as 100% carbs & 0% fat to 0% carbs & 100% fat.

carbs_to_fat_percent

So let’s overlay the quantities of my carbs and fat both before and during the diet.

carbs_to_fat_quanitites

Sure enough, after adopting this lifestyle, I felt better than I ever have before it.

But then I got my cholesterol scores seven months after starting which showed an extraordinary jump in both total (TC) and LDL cholesterol (LDL-C). And this is where I learned I was one of the fraction of those going low carb who see a dramatic rise in total and LDL cholesterol known as a hyper-responder.

cholesterol_before_vs_after

To be sure, my HDL going higher is presumed good and my triglycerides going lower is presumed good. But the doctors care much more about LDL-C and will insist my higher levels on a low carb diet should be of great concern.

The Assumed Solution

Up to this point I’ve given the same advice to fellow hyper-responders as I’ve read from doctors and researchers: If you want the one surefire method for reducing your cholesterol, you will likely have to give up being low carb.

Let’s look at that graphic again and apply this to myself:

carbs_to_fat_target

If we assume at least a rough linear relationship with fat and cholesterol, then I’d pretty much have to go almost entirely back to where I was before starting keto. By some basic calculations, I could estimate a total cholesterol of around 200, LDL of 140, HDL of 42, and TG of 130 if I get back to about a 50/50 mix of carbs and fat (as shown by the “Best Goal?” overlay above).

This makes perfect mechanistic sense, given how the lipid system works. If eating more fat means my body is trafficking more fatty acids for energy, then necessarily it must traffic more cholesterol in these same lipoproteins.

Weighing the Choice

Let me illustrate this another way to get across the relationship:

scale_even

As fat rises, so does Total, LDL and HDL, with Triglycerides falling. Total and LDL-C going up is supposedly bad (red), HDL going up and Triglycerides going down is supposedly good (green).

scale_fat

Reversed, we see Total, LDL and HDL drop with Triglycerides rising. Total and LDL-C going down is supposedly good (green), HDL going down and Triglycerides going up is supposedly bad (red).

scale_carbs

Three Clues

So given this assumption, I expected my own data would likewise reveal this as well. When taking my blood tests, I’ll always have some variations of carbs, even if they are generally low. Moreover, I’ve had some variation in the ratio of carbs-to-fat. Yet while these were tiny shifts, there wasn’t a linear relationship appearing.

I didn’t put too much thought into it until a series of recent experiments and what it revealed to me. Let’s revisit everything I’ve done to date, excluding only the “extreme” experiments (such as the Extreme Drop I did that spawned the protocol).

markers_to_date_positive

As usual, I’ll be flipping the left axis so you can better see the inverse relationship between three day dietary fat and LDL-C. Past this point, all graphs will have this same inversion with the left axis.

markers_to_date

Above, the darkened lines of orange and blue lines show where I did the distance running and thus lowered my LDL-C marginally. Just after that, I’m going to take the blue highlighted area at the far right and break it down further.

markers_zoomed_in

From here, I’ll highlight each of the experiments I did over this period of time. This is further detailed on my Experiments List page.

markers_with_notes

During first major experiment I had eaten only eggs and cheese for 10 days, changing the quantity in the middle. But unlike other experiments, I had moved it from a moderate quantity to a low quantity. This yielded a sustained gap like I hadn’t ever seen before in my series. I also felt general malaise; didn’t enjoy it much for the second half. But the big first clue came in the form of my fasting blood glucose being unusually correlative with my mood. Lower FBG = worse mood.

The second major experiment was with fasting, which I posted on recently. This too yielded a major clue given it coupled tightly as would otherwise be expected with LDL-C.

The third clue came from the two experiments to follow. In the first, I had one cup (250 ml) of whole milk with each meal, in the second it was a single slice of bread. What astonished me was how tightly the Inversion Pattern held even going up to 78g of carbs / day. This proved the biggest clue of all as I’d have expected the gap between between the three day average and LDL-C to have widened.

teaser_full

The Calculation

There’s a big part of this story I can’t fill in yet. It’s how each of these clues along with a theory I’ve been working on for a long time led me to the next major experiment. I’ll detail it in a future post once it has been tested against, which will take several more experiments to achieve.

I’ll just say that the theory + these clues led me to calculate a range of 90 to 130g of carbs needed to hit this mythical “Sweet Spot”.

The Shakes and Bread Experiment

With this calculation in hand, I wanted to devise an extremely controlled experiment. Indeed, this would be one of the most intensive I’ve ever done.

I wanted to:

  1. Have a keto ratio of food that was nutritionally complete, yet somehow very consistent and quantifiable
  2. Have a common carbohydrate food as the intervention variable, but likewise as simple as reasonably possible

I figured out I could achieve (1) by having a ketogenic meal replacement drink, and for (2) I would just have simple slices of bread. I managed to find one that was both 100 calories a slice and allowed me to get within the net carb range I was looking for at 5 slices a day.

I would do five days of the shakes alone, then five days replacing 500 calories of the shakes with 500 calories of the bread. The first five days I’d be at around 30g of net carbs, with the second five at around 95g. This way I could really hit that target range while being extremely controlled on exactly what I ate.

To further ensure control, I ate to a very specific schedule of 11am, 3pm, and 8am in all but the first two days.

swap_graphic

A Striking Result

Before getting to what happened, it’s worth noting the data advantage I enjoy coming into this experiment. If you’ve been following my work for a while, you are already aware. But if you’re just joining us, you should know I’ve done 63 blood draws in 18 months and effectively have my own Inversion Pattern mapped now. So unlike anyone else I’m aware of, I’ll know when one or more variables are having an impact on my lipid system given the anticipated coupling you see in my graphs. Even in the outliers, there is little significant deviation from the mean, and until this graph below, no repeating patterns of a gap.

Below I highlight the blood test I took following the 5 days of keto shakes, which couples as we’d expect to the Inversion Pattern. Then, a clear gap forms between the higher expected LDL-C and the actual resulting LDL-C.

shake_and_bread

In other words, swapping out 500 calories of the keto shake for 500 calories of the whole wheat bread resulted in a lower LDL cholesterol than we’d expect.

Best of Both Worlds?!?

Right about now you’re probably thinking, “Sure, but isn’t this what you took so much time to explain at the beginning? That increasing carbs will result in better cholesterol numbers?”

Actually, there’s a huge number of differences here between the assumption above and this outcome. Let’s start with a closer look at the other lipid numbers.

lab

Not only was my total and LDL cholesterol the lowest I’ve ever had while on keto at 220 and 140, respectively — but my triglycerides were an impressively low 46, and my HDL was an extremely high at 71. Which is to say, this is the best looking cholesterol lab I’ve ever had.

(As an aside, I’m extremely thankful I did three full tests inside this five day intervention period to help rule out a lab error. Indeed, had this been the only test I performed, I’d have had a hard time reconciling it.)

Reproduction Test

After getting this final lab test four days later on 4/21, I immediately had a blood draw and attempted to reproduce it. However, I ate my “normal” keto diet instead of the shakes, but while likewise adding the bread with each meal to target nearly the same macros as I had on the shake-based diet.

Sure enough, the reproduction appeared to work as well.

markers_all

LDL-P

I ended up getting the particle count data late from the lab. There’s some analysis I’d have covered here regarding 3/23 and 4/7, but I’ll have to save that for a future post.

Like LDL-C above, LDL-P clearly shows the same divergence on its own inversion pattern (three days, with a two day gap).

discovery_ldlp

Revisiting the Assumption

Let’s look to the relationship graphic we had above, but with the new results added.

sweet_spot

Clearly we can see only a small change in total dietary carbs got me the “Sweet Spot” I highlight above. But again — and this is important to emphasize — it didn’t appear until I passed a certain threshold. Remember, just before this experiment I had done another (“One Slice of Bread”) experiment where I averaged 78g of carbs with no diversion in the Inversion Pattern.

In other words, this strongly suggests there is a threshold, a tipping point, a drop off with regard to my lipid numbers. That’s the reason I wanted to illustrate this analog relationship as I do above, because this strongly suggests it may be wrong.

With this in mind, let’s revise the concept.cliff

Here I’m illustrating how the shape of this cholesterol relationship appears different. With a sudden drop off point, it implies I can get the best looking lipid numbers by getting to the other side of this threshold.

Again, this is still very preliminary, but the testing so far supports it.

Other Observations

Naturally there’s much more to share about what happened than my changing lipid numbers. These are just the highlight while at 95-97g of carbs:

  • No Ketosis (of course). Ketone levels (BHB) were around 0.1-0.2 throughout, including morning (Keto average 1.2)
  • Very high postprandial glucose often 110-150 MG/DL two hours following a meal
  • Higher fasting glucose at 102 MG/DL (Keto average 92)
  • Slightly more tired following meals
  • Insulin averaged 5 UIU/ML (Keto average 3.8)

None of these came as a surprise to me given the higher carbs save the fasting insulin, which I expected to be higher.

What This Means

This may be the start of a solution for hyper-responders who seek a better lipid profile, while still staying low carb.

Instead of adding back hundred of daily carbs, I was able to stay just under 100g even if I was giving up ketosis. But again, I have a more distinct advantage than most due to knowing my own lipid patterns so well, so I can more easily identify where this carb threshold is and isolate it.

As far as the theory that led me here, that will have to wait for a later post.

However, while I’m happy if this may ultimately provide hyper-responders like myself with a new choice, not much has changed for me personally with regard to the risk assessment. I don’t know for sure that this lipid profile is a lower risk for all cause mortality today anymore than I would have a month ago. In short, I’m more interested in what this means on a system-wide level for the body’s regulation and control than I am for its personal impact on my life… at least, for now.

Next Steps

  • I’ll be pausing for a little while as I ramp up some contract work to rebuild my research funds. Up to this point I’ve been paying for the last 18 months of blood, medical, and technology expenses from my savings — save a few generous contributions from individuals through my donate button on the site. Thanks for the support!
  • I’m currently back to my “normal” keto ratio and expect to do another blood test following the pause to confirm my numbers have returned to the original Inversion Pattern. If so, we’ll know these changes were indeed transient.
  • Following that, I plan to experiment with other sources of carbs (fructose, lactose again, etc) to determine if the ratios hold regardless of the type of sugar.
  • I’m also tempted to do more lopsided intake of carbs where the same general macros are hit, but with a single meal being carb-heavy where the others are generally keto.

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176 Comments on "Cholesterol Research Breakthrough"

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Michael Babcock
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This is fascinating stuff, however . . . The assumption here has to do with having a total cholesterol and a LDL-C that is lower is better and that the standard cholesterol lab result targets are a good thing. Do we know this? Given that pretty much every other marker improves on a ketogenic diet, just maybe that rising total cholesterol and rising LDL-C is actually an improvement as well. Is there actually any research that shows anything detrimental about higher cholesterol and LDL-C numbers? Can we say with authority that raised LDL-C is definitely bad? Back to the other… Read more »
Sergi
Guest

As another hiper-responder, this is really interesting. I will have to test this out (my latest numbers are 2400 LDL-p and 1100 small LDL-p).

Have you consider fiber as one of the reasons why increasing carbs using 500 cal of whole wheat toast reduces LDL-P so drastically?

Bob Niland
Guest
I only recently began following your blog, so might have missed some key details in the back traffic, but did do some searching. Overall, you appear to be rediscovering material that is known to the community of Dr. William Davis (cardiologist), and compiled in his former Track Your Plaque program (now named Cureality, and soon to be Undoctored). Knowing your ApoE status is part of the puzzle. Another couple of tests I don’t see discussed are Lp(a) status, and any calcium [Agatston] score (CT or EBT calcium scan; not a CT angiogram). Dr. Davis used to have specific advice for… Read more »
Charles
Guest
http://www.cureality.com/blog/post/2006/11/06/the-track-your-plaque-rule-of-60.html The Track Your Plaque recommended targets for conventional lipids (i.e., LDL, HDL, triglycerides) are LDL 60 mg/dl, HDL 60 mg/dl, and triglycerides 60 mg/dl: 60-60-60. Not only is this set of values easy to remember—60-60-60—but is grounded in science and the results of clinical trials. LDL 60 mg/dl The LDL target is based on experiences such as that of the Reversal Trial, the PROVE-IT Trial, and the Asteroid Trial, all of which showed that LDL cholesterol values in the range of 60 mg/dl dramatically enhance the likelihood of stopping plaque growth or achieving regression, reducing risk of heart attack… Read more »
Michael Babcock
Guest

I had another thought after sending the previous post. I do see that your trig/HDL ratio is significantly better at your “sweet spot.” I’d love to see you discuss the balancing of different health markers. Yes, your “sweet spot” might improve the lipid markers but your insulin and glucose not so much. Which set of markers do you seek to optimize or how do you balance the various markers?

eric25001
Guest

P!ease read cell metabolism DEC 2014 Time RESTRICTED FEEDING

What hours did you eat?
Seems time is an important factor
Eric

Jorn Vikse
Guest

You are doing a fantastic job with these experiments, and the documentation. I haven’t read all of your post, but I will. Have you discovered the reason for this «hyperesponder» fenomena. I understand that apoE is involved. But the fat you eat is shuttled in chylomicrons, and surely this is not measured in your lipid tests ?
The standard answer to why ldl-c raises in respons to fat is downregulating of the receptors. Can this really account for these big differences you observe ?

Thanks again for your work.

Solomon
Guest
Great Job Dave is doing. Jorn, the summary of Dave’s work is this: For the Keto adapted person, the Lipoproteins are in the main, energy distribution particles. The more fat you consume the less of it that you need. And the important factor is the body uses the sum of the last 3 day’s fat consumption to determine how much particles it should produce. For particle numbers, there is a two day delay for the three days used. More fat, less LDL is what the data is bearing out so far. This new insight says, you can still get ‘great… Read more »
Eric
Guest

Look at my circadian clock. Org
Eating keto in a time restricted feeding seems the logical evidence based way.
Salk institution has the data and evidence
Eric

Rob
Guest

“This does not constitute medical advice. I realize many may read this and act on it, but I urge you to consult with your doctor and/or trusted medical professional — particularly if you are diabetic or insulin resistant.”

I wonder if all nutritionists will have to put that caveat on their blogs from now on after the Noakes trial

Latife
Guest
I appreciate your work and feel lucky having you, thanks a lot. I am hyper-responder too. But I was doing intermittent fasting, like 20/4, 22/2 and have done 46-8 hours fasting few times. I was fast when had test and my cholesterol was really high ( 10.6= about 429). I was on low carb, high fat diet at the that time. So intermittent fasting and HFLC! I should have another test without being fast and see how fasting effects on my cholesterol. I am not worried about having high cholesterol after reading and watching your work. I would like to… Read more »
DrDan
Guest

Insulin represses the expression of the orexigenic peptides NPY and AGrP. By going into ketosis, I guess that the arcuate nucleus no longer gets the message via insulin that you’ve just eaten. You’d therefore produce more NPY than expected … and NPY increases VLDL-TG secretion by the liver. Taking some CHO would increase insulin, reduce NPY and reduce increases VLDL-TG secretion.

Seth
Guest

I think this might be interesting, but I didn’t understand the acronyms. Can you say what is: NPY, VLDL-TG and CHO?

Thanks.

Craig
Admin

CHO – Carbohydrates.
TG – Triglycerides.
VLDL – Very Low Density Lipoproteins (from the Liver)
NPY – Neuropeptide Y
AGrP – Agouti-related peptide

eric25001
Guest
Not what 9 hour period during the 5 to 10 day window but do you eat in 9 hour windows now? Does 3000 calories mean 1000 excess? What about maintenance? 135 grams of protein? Too much for me to maintain be and ketone levels. What about six months or more? Years? My day average is 180 fat and protein is 3 days of 66.25 grams and one of 12.5 grams along with 3 days of 30 grams carbs and one day of 50 grams. Two eating styles that might be interesting to compare all meat diet for years and or… Read more »
Alberto
Guest

Why not forget entirely about cholesterol and focus on your Calcium (CAC) Score, that is scientifically proven to have a much more accurate correlation with cardiovascular disease? I’m a hiper responder who chose to go all in in keto, without looking back. CAC score: zero!

Peter Bastian
Guest
Dave…I just watched Ivor Cummins video on cholesterol and CAC testing. I am pleased to see you have done a CAC in conjunction with your research on the lipid system. For us regular folk, Ivor seems to suggest what Alberto says. Bypass all this lipid panel stuff, and go straight to CAC for CVD risk assessment. To our surprise and joy, the concept of “walk-in” CAC clinics already exists. We have been KETO for 5.5 months, but we’re otherwise healthy adults prior…we were on the low-fat bandwagon. Due to other issues, I have had a number of tests done, including… Read more »
Kanel
Guest

Because this research is not only important for Dave, but for all of us. Finding out the truth about the lipid system and its connection (or lack of connection) to heart health is vital if we want to see a change in the current dietary advice and health care.

Peter
Guest

Have you measured your CIMT Carotid Intima Media Thickness?

Also, have you measured your sterol absorption? http://www.bostonheartdiagnostics.com/science_portfolio_cholesterol_balance_test.php
Sitosterolemia was one possible diagnosis given for high plant sterol absorption leading to very high cholesterol numbers.

Lary Beck
Guest
Thank you, Dave for being there to curtail the stress of a newly discovered hyper-responder, although the data is clouded by quitting atorvastatin after 15 years at the same time. (I wonder about a rebound effect.) Been in ketosis for 3 months with average noon blood ketones at 2.0 Numbers : TC from 147 to 407 and LDL(C) from 73 to 317. I am also intermittent fasting in order to lose weight. I have not read all the blogs, but combined with your Breckenridge video, I have a basic understanding of the interactions. Btw, 13 years ago at age 57… Read more »
Karl Schmidt
Guest
Several points – 1 – I don’t think that the arrow of causation has been proven for LDL — Could be that damaged arteries alert the immune system and one of the responses to injury is cholesterol recruitment – via LDL. The LDL=bad narrative is failing – several drugs that lower LDL fail to improve CAD-mortality nor all-cause-mortality. Statins provide a very small benefit – and lowering LDL may only be a side effect. NNT for statins is 83 after taking for 5 years – no benefit if you don’t have CAD. http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ 2 -There is no study that has… Read more »
Peter H
Guest

Great post. An experiment eating ‘gluten free’ would be very interesting. I am high fat low carb without gluten. My LDL was 190 at the last count. I have cut down to one egg for breakfast instead of two. And using less meat fat. To try and bring this down. Though 190 doesn’t look too bad, compared with your 270. I should add that I am 65, nearly 6foot tall and weigh only 70.2 kilos. I am HFLC without gluten to keep my brain working.

Richard Nikoley
Guest

Very, very interesting. I’ll be citing it in a post soon.

Neville
Guest
Hey Dave, Just wanted to post my test results on a whole foods plant based diet (HCLF). Again, i haven’t been as precise as you’ve been in weighing/measuring food but here’s what my diet (kinda) looked like. – Breakfast: fruit bowl consisting of chia seeds, 4 spoons hemp protein, 1/2 banana, two handfuls of berries, 1/4th cup of granola – Lunch/Dinner Option 1: Salad Bowl consisting of ~ 80 gms spinach, 1 mango, 3-4 spoons hemp protein, 2 hand-full’s of berries, 1/2 cup granola. – Lunch/Dinner Option 2: Rice 3/4th cup rice, 2 servings of vegetable stew made up of… Read more »
Tim Steele
Guest
Hi Dave – New here, but great blog (Thanks, Allan!). Your inversion factor is interesting. I’d love to see similar labwork on people who follow other dietary patterns, SAD, WAPF, Med, etc. I recently did an Indiegogo project to raise money to test resistant starches and I had enough left over to get more people involved in an n=10 blood glucose experiment (see at potato hack.com). Maybe you could raise funds the same way…very easy to do. My only quibble with some of your experiments is that the gut flora of a keto-adapted dieter vs a carb/fiber eater would be… Read more »
Kanel
Guest

Thanks Dave! Awesome work!

Have you seen this talk by Sarah? https://youtu.be/w8jUmCe3zDs (around 15 minutes in)
She explains how low insulin level can cause elevated LDL in some people so it could help explain how you hit your “sweet spot” by increasing the insulin a little.

One thought that bothers me about all this is – basically every single marker of metabolic disease improves when going on a ketogenic diet so then why would the body decide to put you at higher risk of heart disease in the process? It does not make any sense to me.

Manu
Guest

Love your approach, Dave. I also re-added some carbs after hitting a TC of 400 with regular fasts and keto-like carb intake. Some insulin seems to lower LDL. Discoveded it via Chris Masterjohn, who wrote a lot on this topic.

.. in an insulin-sensitive person, carbohydrate stimulation of insulin has a powerful beneficial effect on LDL receptor activity.

This doesnt answer the question if it’s an issue of course.

Neville
Guest

Hey Manu, curious to know how much have you been able to reduce TC by adding carbs.

Manu
Guest

About 20%, but I only did it for a short time by now.

Leigh Yaxley
Guest
“Second, I think we were already on the same page. My theory behind the Inversion Pattern has always been mobilizing of energy via VLDLs in the absence of available incoming energy from the gut (Chylomicrons)” Dave, Maybe we are on the same page but I’m not sure because your theory doesn’t explain where the increased cholesterol has come from or where it goes to when the serum cholesterol decreases. My own hypothesis does explain this and it is nothing so very surprising. It is simply an effect of cholesterol exchange with adipose tissue, which has been amplified by changing patterns… Read more »
HN Pandey
Guest

Dave, this is wonderful!!
I have some data to share and understand your perspective. In keto, my Trigs aren’t coming down. How can I share my excel with you?

Thanks
Pandey

ginny51
Guest
Thank you, Dave! I’m particularly appreciative of what you’ve done and are proving, as surely many others are, particularly as “Jill’s Story” hits close to home for so many women. Being a woman is singled out in statistics as a “risk factor”, eg. CHADS VASC score for prescribing anticoagulation therapy. I was prescribed statins just recently, with LDL 223, “prediabetic numbers” and heart problems. If I change my “numbers” I’m in an entirely different position to listen to whatever else the docs want to get me to do. This is one big, huge, understatement, the real change in the patient/doc… Read more »
Deb
Guest

Hi Ginny51,

In regards to your lipid panel of Feb. 2, I’m curious to know how you increased your fat intake from Jan.30-Feb. 1.
Did you use saturated fat like butter and coconut oil? Did you add high fat foods like avocado?

Thanks
Deb

ginny51
Guest
Hi Deb, Sorry I didn’t answer before but I drop by occasionally and didn’t return to this post. Fat for the 3 days prior to the Feb 2 blood test was 221.4 gr / 221.5 g / and 188.6 g. I ate what Cronometer calls “Edwards, New York Style Cheesecake on 2 of those 3 days, accounting for 36.7 gr or 32% of the fat, and the other day Olive Oil 42 g, 38%. No coconut oil, and butter only 24 gr, on one day. Other items were for example: Raw Pecans, Macadamia Nuts, Walnuts, Avocado, Greek yogurt, Buffalo hamburgers,… Read more »
eric25001
Guest

Take a look at toomy web site link from diet doctor
Eat low low carb high fat web site
He reports eight years of labs from eating once a day
Hdl is above trig levels
Hmm
Looks like one time a day has potential
Eric

eric25001
Guest

Dave
Looking at the labs reported by tommy on his one meal a day and your 3 to 5 day switch on lipid blood levels then it seems reasonable to test five to ten days of one ketogenic meal a day.

I am not willing to do the same for junk food once a day or vegan or anything but my keto but what an insight if a switch to one meal per day for 5 days can switch the blood results! Eric

Leigh Yaxley
Guest
Dave, I’ve dug up a few more clues from the literature – see references [1] and [2] below. Your combination of keto shake, bread and fat were probably a close emulation of the ‘casein + oligosaccharides + fatty meal’ experiment of reference [2]. Any idea what type of protein was in your Keto shake? Key takeaways from these papers: • “Insulin acutely inhibits VLDL production via its ability to suppress free fatty acid [FFA] mobilisation from peripheral tissues” [i.e. it suppresses lipolysis in adipose tissue] • “Elevation of plasma FFA levels acutely stimulates VLDL production” • “The addition of oligosaccharides… Read more »
Sergi
Guest
After reading this I did a similar experiment last week. My last numbers (3 weeks ago) were: LDL-C: 193 LDL-P: 2475 Small LDL-P: 1252 HDL: 49 Triglycerides: 79 I ate around 2500 calories per day (no shakes or bread, so numbers are not exact), with at least 100gr coming from carbs (up to 200gr one day). My saturated fat consumption was low (<25gr), but plenty of monosaturated fat (nuts, avocado and olive oil). I also took vit D (~5000IU) and fish oil (3gr of https://www.amazon.com/Ascenta-Health-Nutrasea-Omega-3-softgels/dp/B002GP08EK). Ratios in the 30-50-20 (carbs – fats – protein). Results: LDL-C: 137 LDL-P: 1725 Small… Read more »
Deb
Guest
Hi Dave, Thanks so much for this website and all you are doing to help all of the hyper-responders out there. I must admit that a lot of what I read is a bit over my head, so I appreciate that you always sum things up!   I need some advice in knowing what to do for my next lipid panel. I had one in March, the first one I have had since an NMR in 2013 and once again my LDL is high, 231.  I have a new doctor now and of course he was very alarmed at my… Read more »
Steve
Guest
Hey Dave, I’m very new here, but your advice for hyper-responders seems very similar to Chris Masterjohn’s. Have you read (or listened to)this (particularly at 42:00): https://chrismasterjohnphd.com/2017/03/19/what-to-do-about-high-cholesterol/#transcript I’m fascinated by this subject because…. have a very low insulin score (4), and am lean and insulin-sensitive by all measures. I also have high LDL (200), high total (300), fairly high HDL (78), and low trig (78). My oxidized LDL (measured for the first time recently) is extremely high (116). My LDL particle count is 2400 and my SD-LDL particle count is 949. I’d like to get the unfavorable numbers, particularly the… Read more »
Mark
Guest

I find it interesting that Chris Masterjohn explains how LDL-C can spike in an insulin sensitive person who goes on a Low Carb diet (this has been my experience on Keto) but how do you explain the many very insulin resistant people who see the same thing ?

Jotham
Guest
Dave, Thank you for taking the time and all the needles to do this. I switched to a LCHF diet back in September from a HC-LF diet I was on for almost two years. I lost around 20lbs since then and I’m currently 165lbs at 5′ 10″. Overall I look and feel better than I ever have but my LDL-C has doubled since the switch which has prompted my doctor to tell me to stop the LCHF diet. Before —> After Chol 162 – 262 TG 77 – 57 HDL 43 – 48 VLDL 15 – wasn’t listed this time… Read more »
Ran Naot
Guest
HI Dave, Interesting post and very nice comments to follow 🙂 My son is APOE E4/E4, we emailed in the past and I am looking forward for your research. So I understand your stats are “Better”, but having high fat intake without keto can lead to trouble… I wonder if you monitor the point where you go to keto, could be that the step in the graph is you system going into keto ? Since you are keto adapted could be that you remain keto on more than 20g a day… The question is really what make this step in… Read more »
Craig
Admin
Hi Dave, Great work! I can’t help but notice that your sweet spot tipping point was right at the keto/no-keto level of carbs. Did you plot LDL v ketones? Personally, I’m following this even more closely after I got my first blood test after 3 months on Keto. I happened to have had a 36-hour fast in the measurement window – which probably “worsened” these numbers. Cholesterol – 342 Triglycerides – 176 HDL – 98 VLDL – 35 LDL – 209 I’m strongly considering doing your protocol for a non-fasting retest. Reach out to me if you had any tips… Read more »
Anita
Guest
I am fascinated by your experiments. I am hypothyroid (Hashi’s) and get bloodwork every 4 months. I’ve been eating very low carb for years, and my LDL was too high on my last test (HDL is high;trigs are low). My doctors don’t see a problem but ‘make noises’ about the LDL. At the time of the last test, I was eating a lot of Kerrygold butter, and I thought that might be the problem. I’ve since reduced intake significantly using olive oil instead. I have a test scheduled for next week, and I was thinking of trying your ‘carb solution.’… Read more »
Jim Cesca
Guest
Hi Dave, Fellow hyper-responder here. I’m trying to decipher the concept of eating LCHF leading to higher utilization of Triglyceride for energy, alongside the typical drop/lowering in Triglycerides on a lipid panel. Using the cruise ship analogy: Would it be the equivalent of more people being interested in taking a cruise (Trigs for energy demand), so more cruises are being scheduled more frequently (increased LDL-p), even though each ship is taking fewer total passengers (lower Trig levels)? So, even with less passengers per ship (low Trigs), the cruise ships just happen to maintain a high level of life boats (LDL-c),… Read more »
Anita
Guest

Hi Dave–

Yes, the endo thought that my very low carb eating might have been ‘controlling’ Type 2–i.e., I was getting normal blood sugars by restricting carbs (I typically eat <20g). The GTT was negative–i.e., no diabetes.

I definitely plan to do low fat/increase carbs for three days next week prior to my blood draw. I'm aiming for 150g, mainly from rice and beans and some gluten-free bread (I have Hashimoto's and avoid gluten). I'll post my results.

George
Guest

Are all the results above, all the testing, with no other changes in stress levels, sleep habits, movement, exercise, social interaction, sunlight?

Thomas
Guest
Hi Dave, I had great success with this protocol. In April these were my numbers after 4 months of continuous strict keto/IF (I’ve been mostly on keto for almost two years, with a couple month-long moderate carb excursions to test for improved insulin sensitivity): Total Cholesterol: 289 mg/dl (my previous high had been 204, after my first six months of keto) Trig: 99 HDL: 54 LDL-C: 215 (the previous high was 148, after first six months of keto) My doctor took a wait-and-see approach, and gave me two months to try lifestyle changes, then re-test. This time he ordered the… Read more »
Michael
Guest

I would love to see this experiment done with alcohol instead of carbs. I am curious to know if there might be a similar threshold.

Ann
Guest

Thank you so useful.I’m not alone. I will keep watching and cheering you on.

ginny51
Guest
Hi Dave, Could carb loading upset the fat loading apple cart? Or could Moderate Net carbs 70 – 85 grs somehow be on the wrong side of the fence, not close enough to keto? Got my results today. I’ve failed. My Total C and LDL peaked. (Other results fine: HDL 72 Trigs 57) I did my best and haven’t a clue as to what went wrong. On this page, May 17, 2017 I mentioned seeing a pattern: “Nov 5, 6, 7 2016 – Avg Fat 145 grs. Nov 8: Total Cholesterol 325 / LDL 246 Jan 30, 31, Feb 1… Read more »
ginny51
Guest
Hi Dave, My missing data: Proteins: 111.9 / 89.9 / 95.7 / 141.9 Carbs: 148.8 / 112.8 / 74 / 179.3 HDL: 65 / 71 / 85 / 72 Trigs: 57 / 49 / 54 / 57 — I’ve been looking at my Cronometer data since August 2016 checking Macros and Calories, which I paid no attention to before, as I was trying to find a way to keep carbs down to a certain number of grams to see if I could bring my HbA1c out of the prediabetic range. I have 5 blood tests with data (Sept, Nov, Feb,… Read more »
Keith Rathbone
Guest
Hi Dave Great work. You are a typical engineer with such attention to detail and determination to find out WHY. I have done similar to with extensive testing of BG (including CGM) to achieve low BG readings (especially for yearly tests). Unfortunately the KETO + FASTING + EXERCISE to achieve low FPG has resulted in SUPER HIGH CHOLESTEROL of 538 with LDL of 441 and HDL of 58 at the last yearly test. GP was shocked and provided my risk score of near 40% chance of heart attack in next 10 years. From attending recent conference I learned about your… Read more »
Anita
Guest
Hi Dave- It worked! And I was totally shocked because I really didn’t think it would. What’s amazing is that it ONLY affected the LDL and kept my great HDL and trigs as they are. What I did: I normally eat <20g carbs a day (closer to <10), so for 3 days prior to my blood draw, I ate 150g of carbs, which is what's recommended when preparing for a GTT, so I thought it might be a similar metabolic principle. I ate brown rice, beans, brussels sprouts, and some gluten-free bread and counted my carbs careful. I made sure… Read more »
Justin
Guest
Hi Dave, Great work as usual! I’ve been a hyper-responder with my total cholesterol around 260-280 in the past. For those blood draws, I was eating typical keto and trying to gain some weight with weight-lifting. However, I just had a blood draw while now cutting back on fat/calorie intake (still very low carb) to try and lose a little weight and continuing to weight-lift, and it came back with my total cholesterol over 500! I’m going to try having around 100 grams of carbs a day, and I’ll let you know how my results change. Not that I think… Read more »
Mark
Guest

I just tried the experiment for the past month. I calculated 100 carbs per day but just got me latest cholesterol test back and my LDL is still off the charts. Not sure what to do now, increase the carbs more or just go back to eating Keto. What do you suggest?

beags
Guest

HI again – OK so I’ve tried to replicate the LDL drop with upping carbs but no luck yet…

However trigs and HDL have improved markedly!

Where would you go from here – more carbs? Maybe I’ve not hit my ‘sweet spot’ yet?

Rusty
Guest
Hi Dave, I’m a hyper-responder. Starter Keto diet in Sept 2015. Body fat for these labs has been between 10 -13% (currently 12.5%). Test 11/30/2015 4/21/2016 10/7/2016 7/7/2017 Total Cholesterol 220 253 337 527 LDL Cholesterol 136 141 231 >350 HDL Cholesterol 75 98 95 91 Ratio Total:HDL 2.9 2.6 3.5 5.8 Triglycerides 43 71 54 68 HDL Large 7358 LDL Medium 277 LDL Particle No. 1756 LDL Pattern A LDL Peak Size 225 LDL Small 218 Total Calcium CT Score was 1.1 (on 10/13/16) I’m going to try the LDL drop with a followup NMR test soon. I’ve tracked… Read more »
Rusty
Guest

Well that didn’t work out too well. My LDL increased after the bread drop. Total dropped though.
LDL = 375 (previous was >350)
Total = 475 (previous was 527)
Although I only averaged around 3500 cal for the three days before…couldn’t scarf down anymore. Also, the previous was llisted as >350…apparently unable to calculate it above that…whereas the post bread drop was an NMR so I suppose the 375 could actually have been a drop from the >350.
Rusty