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Dec 09

December Ninth, Twenty Fifteen

 

On December 9th, exactly two years ago, I received a document that would change my life forever. It was an advanced cholesterol test known as an NMR (Nuclear Magnetic Resonance).

I had only taken one before that, about two weeks earlier at the end of November. That first test had put me into a depression. I saw that my LDL cholesterol (LDL-C) had skyrocketed from my average of 130 to 239, and my LDL particle count (LDL-P) was a whopping 2,705. I had never measured my LDL-P before then, but I knew the “reference range” for it was below 1,000.

I decided to schedule the December 9th test, hoping it might suggest this first one was a lab error. And for 15 long days, I dropped everything I was doing to read and learn all that I could about cholesterol and the lipid system that trafficks it. Surprisingly, I found this system had quite a lot in common with networks in my own field of software engineering. In fact, I started to wonder if I was simply projecting my own beliefs where they didn’t belong, as a way to cope with this miserable time.

When my results came in for the December 9th test, there was a resounding “click” in my head!

You see, while I was experiencing this terrible depression, my appetite waned. I resolved I wouldn’t eat one more bite of saturated fat than I was truly hungry for. This led to my eating about 1/3rd of the calories I normally do, even while still being on a ketogenic ratio. So overall, my dietary fat dropped significantly. Thus, if my dietary fat was way, way down — then my LDL-C and LDL-P would have presumably dropped, right?

Instead, my total and LDL cholesterol had gone even higher!

Now I realize this won’t make sense to a lot of you, but that was very relieving. As an engineer, I immediately understood two things:

  1. This was indeed an energy distribution system above all else. Cholesterol is a passenger, not a driver.
  2. I had a lot of work ahead of me!

Here I am a couple years later, and I can remember that moment like it was yesterday. I was alone and determined when this all began, but now I’m proud to share this journey with so many others who are helping to change the paradigm.

 


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Adam
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Adam

Hi Dave, I want to thank you for your priceless research. My life changed in a similar way in June 2012, ‘numbers’ confirmed six months later and again in August 2014. After that I didn’t see much point in testing further, because my body and my mind told me I was doing great and I figured it didn’t matter what those damn stubborn LDL figures said. That, and I was tired of the guilts from the docs who told me I shouldn’t believe what I was reading on the internet. Even though I had to tell them what an apolipoprotein is.

I’ll probably test again considering I’m now able to test privately, but avoiding a lecture and the mandatory statin prescription is expensive, so it’ll wait until I’m feeling flush with cash, if that ever happens.

As is not unusual, all but the total and ldl-c went in the ‘right’ direction. Of particular interest to me was Lp(a) which reduced by a third on high fat.

Thanks again. Your work is incredibly valuable.

Adam.

Rob
Guest
Rob

Hey Dave,
36 yo male
6’6″ 250#
W/H Ratio .51

Low carb 3 years

In 2016 my cho #’s
Total 217
Trig 44
Hdl 68
Ldl 140

In 2017 #’s
Total 242
Trig 47
Hdl 57
Ldl 176

I have 2 questions..

1) My diet stayed pretty much the same du ring these 2 tests. Why is it that my hdl went down so much? I may have exercised a little less in 2017, could that be it? Or does hdl also fluctuate quite a bit?

2) Also, is it pretty much universal that the Freidwald method for figuring ldl is very inaccurate if low trigs? Using the iranian method my ldl should be closer to 139 in 2017.

Really appreciate all your work. Thank you for your time.

Dave
Guest
Dave

Ok, so here is a quick lowdown on where I am and the reasons why I am panicking slightly as my numbers are not looking good.

• I am 39 yo, weigh 189lbs (85kgs) and have a BMI of just under 25 (although not carrying much fat at all, approx. 15% body fat).

• LCHF for 5 yrs – slowly fell off the wagon about 18 months ago due to 2nd child and working away from home a lot with no control of my food (military). When I was home my wife generally prepared food for me coming in from work that was relatively LCHF.

• I have never smoked and rarely drink alcohol.

• Keto for last 10 weeks with great results for weight loss, but not had that energy spike or mental clarity often spoken, I suspect I am .

• Tested blood ketones and they are normally between 0.5 – 1.5mmol but on occasions are either side of that band.

• Father had heart attack at 56, gall stones about a yr later and gall bladder removal shortly afterwards. Has had 2 attacks of acute pancreatitis in last yr.

• I never exercised more than was required to pass my fitness test but have decided something has to change and have ramped this up and doing about 4+ hrs a week of slow and steady ~70% Max Heart Rate.

• Had cholesterol test in 2012 and then the next one in Nov 2017 –

Test results 2012

Total – 216
HDL- 42
LDL 150 (estimate based on calculation)
Tri – 113

Test Results 20 Nov 17 – Doctor didn’t listen about VLDL measurement request

Total – 247
HDL – 59
LDL – 169 (estimate based on calculation)
Tri – 101

Test Results 28 Nov 17 – Doctor STILL didn’t listen about VLDL measurement request but did do a hsCRP and a few other random things.

Total – 237
HDL – 43
LDL – 166 (estimate based on calculation)
VLDL – 28
Tri – 141
hsCRP – 1.8
Glucose 77 mg/dL
Sodium 138 mmol/L
Potassium 4.0 mmol/L
Calcium 9.5 mg/dL

I now appear to be going the other way with a 40% increase in Tri and a 30% drop in HDL… Any ideas where to go from here or what it all means?

Test results 12 Dec 17 – Doctor had a severe case of know-better-itis, so threw money at the problem and ordered a Lipoprotein Subfractionation blood test myself and paid for it.

Lipoprotein Subfractions (nmol/L)
LDL Particle Number 2043
LDL Small 419
LDL Medium 594
LDL Large 4456
LDL Pattern B
LDL Peak Size (angstrom) 217.4

Total Particles (nmol/L)
HDL 20059
Non-HDL 2655
HDL Particle Subfractions
Small 15603

LDL Particle Subfractions
Very Small-d 91
Very Small-c 84
Very Small-b 79
Very Small-a 116
Large-b 309
Large-a 351

IDL Particle Subfractions
Small 283
Large 264

VLDL Particle Subfractions
Small 35
Medium 27
Large 3

I was so worried about my lipid levels and the fact I was mainly LCHF for the last 5 yrs so had a Calcium Heart CT Scan 2 weeks ago – My CAC came back with a score of 0, which is good… And bad. I am only 39, so technically a little young for a CAC so this could provide a false positive, although I am not sure that is entirely the case as I think my cardiac health is good, although I have absolutely no proof of that and my numbers certainly don’t appear to show that.

I am at a point now where I have 2 young children and I am really beginning to fear my risk for CVD is so high that I will end up dying before seeing them grow up, which really concerns me. I have thrown myself into Keto and have been doing well, but no matter what interpretation you make of my lipids, they are not great to say the least.

So my questions if someone would be great enough to help me find some answers as this is causing me quite a bit of stress –

1. Are my cholesterol numbers bad or am I just being paranoid and/or missing something obvious?
2. What foods or actions help to reduce Triglycerides and LDL?
3. What foods or actions help to increase HDL?
4. Why am I NOT seeing lipids moving in the right direction?

Thanks in advance for any advice or help as I am pretty scared about my future with my children.
I now appear to be going the other way with a 40% increase in Tri and a 30% drop in HDL from previous readings… Any ideas where to go from here or what it all means?

Ade
Guest
Ade

Hi Dave, firstly thanks for all this great work you are doing!

I’m a 49 years old bloke in the United Kingdom.
3 years ago I had a cholesterol test showing my total cholesterol as 6 mmol/l / 232 mg/dl.
I was told it was a little high and I needed to exercise and lose a little more weight.
I’m 5′ 11″ and was over 13 stone.

So I started doing more exercise and changed my diet, initially trying to stick to paleo but in reality more focused upon getting enough protein and sometimes slipping to have pizza.
I tried to eat no bread, pasta, rice, cakes or biscuits. I did lose some weight and added muscle as I hoped. This was a low carb and high protein diet effectively.

Then 18 months ago my exercise venue was shut down and my exercise dropped off.

This past summer, conscious of my reduced exercise and still wanting to reduce my body fat I came across keto and switched to a LCHF diet.

Going keto I felt pretty good and lost some belly fat but also some muscle mass.
I think this was due to not eating enough protein and the lack of exercise.

Also I found that my appetite shrank on LCHF and ultimately recently I was eating between 700 and 1,000 calories per day generally. Whereas I understand my maintenance level should be around 2,000 calories per day.

So when it came to get a new cholesterol test a month ago the result was 9.1 mmol/l / 352 mg/dl.
This got me referred to my doctor for a more detailed blood test which I had 10 days later.

I had never actually tested to see if I was in Ketosis at all so got some ketostix – and tried but a zero result from them.

The results of the doctor’s blood test were:

Total Cholesterol: 8.9 mmol/l / 344 mg/dl
Triglycerides: 1.3 mmol/l / 115 mg/dl
HDL: 1.4 mmol/l / 54 mg/dl
LDL: 6.9 mmol/l / 267 mg/dl

So pretty much no change from 9.1 to 8.9 as expected.

This was flagged up as maybe reflecting familial hypercholesterolaemia.
I told the nurse it was actually likely due to my keto diet but she knew nothing about ldl-p for example.
I asked if I could arrange a follow up blood test (as I had seen your experiments) but she stated that it would have to be in at least 3 months time as it would take at least that long for a dietary change to impact the cholesterol score.

I was told if my Cholesterol level didn’t come down below 5 mmol/l / 193 mg/dl the doctor would want me to take statins. Which is not an option as far as I am concerned.

So I decided to try a few things on my own before resorting to abandoning keto and forcing myself to eat wheat again permanently.
I can’t afford full blood tests privately at the moment so have opted for home testing kits (from the chemist) that purely (and perhaps not accurately) test the total cholesterol score.
Hoping to get a general reduction showing from a sequence of tests even if the figures were not accurate.

For the 3 low days I made sure I was on around 750 calories though in reality I had been like that for some time.
Total calories: 728 : 64% (50g) fat, 25% (43g) protein and 11% (20g) carbs.
Total calories: 743 ; 50% (42g) fat, 44% (83g) protein and 6% (11g) carbs.
Total calories: 1,006 : 41% (33g) fat, 33% (60g) protein and 26% (47g) carbs. (a bit of a slip here as I got dragged to the pub and had two pints of beer).

Despite the beer carb slip the hour before I started to fast pre blood test, the following day 4 blood test resulted in a cholesterol score off the chart.
The cholesterol score chart of the testing kit goes from 150 / 3.9 to 300+ / 7.8+
My score was definitely over 7.8 mmol/l / 300 mg/dl. So a reasonable control starting point.
I suspect it was around 9 mmol/l / 350 mg/dl as per my two prior blood tests.

My subsequent 3 high days were as follows:

Total calories: 3,972 : 78% (346g) fat, 14% (136g) protein and 8% (84g) carbs.
Total calories: 3,647 : 79% (318g) fat, 13% (120g) protein and 8% (70g) carbs.
Total calories: 4,360 : 85% (413g) fat, 8% (91g) protein and 6% (68g) carbs.

I really struggled with the amount of food but learnt to boost it with double cream.

So the next morning was my second home blood test with the following total cholesterol result of 7 mmol/l / 275 mg/dl. So the inversion pattern and the feldman protocol drop was showing up for me even if my total cholesterol at this stage was still far too high (for the doctor).

So I decided to try adding carbs with approx. maintenance calories but aiming for 100g carbs:

Total calories: 2,018 : 48% (104g) fat, 31% (155g) protein and 21% (104g) carbs.
Total calories: 2,093 : 49% (112g) fat, 30% (152g) protein and 21% (107g) carbs.
Total calories: 1,957 : 47% (100g) fat, 32% (152g) protein and 21% (102g) carbs.

Followed by another home blood total cholesterol test result of the same 7 mmol/l / 275 mg/dl.
It may well have dropped slightly (the test chart is a little vague).
I had expected a decent drop given your carb swap experiment but perhaps I just wasn’t eating enough at 2,000 calories?

I decided to continue a further 3 days at an even higher carb count to see if that would cause the drop would happen:

Total calories: 1,854 : 34% (68g) fat, 25% (109g) protein and 42% (196g) carbs.
Total calories: 1,840 : 39% (79g) fat, 23% (105g) protein and 38% (174g) carbs.
Total calories: 1,894 : 34% (70g) fat, 27% (127g) protein and 39% (185g) carbs.

Followed by another home blood total cholesterol test result of again 7 mmol/l / 275 mg/dl.

Now these home test kits are not especially reliable, but I did use the ones that had had the best reviews and thought to be the most reliable (best of a bad bunch?).
So I was expecting to see some movement on the chart even if the numbers were not particularly accurate.

Next, I decided to have 3 days back on low carb high fat but at around the same calorific intake:

Total calories: 1,790 : 70% (141g) fat, 24% (110g) protein and 6% (26g) carbs.
Total calories: 1,881 : 66% (139g) fat, 28% (130g) protein and 6% (30g) carbs.
Total calories: 1,942 : 80% (173g) fat, 17% (82g) protein and 3% (12g) carbs.

Followed by another home blood total cholesterol test result of again 7 mmol/l / 275 mg/dl.

So I didn’t see a drop or raise on any of these last three diet changes.
I’m don’t know if I blame the home testing kit (which has a range from 3.9 / 150 mg/dl to 7.8 / 300+ mg/dl) or just that my body doesn’t adapt.

So now I’m going to just enjoy Christmas and eat what I want.

During this past month I’ve been doing more and more research which has resulted in me being more relaxed about the LDL score.

Though I would appreciate any comments about my doctor blood test results (TC = 344, Tri=115, HDL=54, LDL=267).

My understanding is that the best simple blood test indicator of CVDR nowadays is ratio of Tri to HDL?
So mine would be 115 / 54 = 2.12 which seems okay and indicates my LDL-P should be okay too (larger rather than smaller LDL).

If I can get my trig lower I would be happier still – maybe I will be able to do a carb swap experiment in the new year with more detailed blood tests to back it up.

If the doctor is still not happy around March I will get a more detailed blood test to check for insulin resistance and inflammation markers etc.

One last thought, I have had quite a lot of stress this past year and understand that can cause LDL to rise (how and why that can happen I have no idea).

David Roberts
Guest
David Roberts

Hi Dave. Thanks so much for the work you have been doing 🙂 Groundbreaking!

I’ve just had my 1st basic cholesterol test results since starting a Keto diet 12 months’ ago. I’m a little different from most people, as I have had high lp(a) in the past and have had Dientamoeba Fragilis / parasites infection from Aug 2015 to Sept 2016. Since then I’ve had HPA Axis Dysfunction / Adrenal Fatigue. Is there an email address I can send you a pdf of my blood test results? I’d like to make them available to add to your research.

ChayNYC
Guest

Hey Dave: Migrating the basics of my previous Twitter conversation to this space.
My TGs are low.
So what determines whether the body ups its LDLp or LDLc to provide transport to carry energy?
Can we narrow this down even further and ask whether it’s ALWAYS the body’s 1st choice to use LDLp to ferry fuel?
If LDLp is the most optimal transport vehicle, it must chemically be more suited to the task, right?
For everyone, right?
If this logic is correct, then why would some people inherently produce lots of LDLc, if it serves no function (unless your research has found LDLc to be essential in other ways)?
What’s so confusing is that certain literature has cast LDLp as the “evil” LDL.
(That message is: If your LDLc is high, you’re sort of safe. It’s high LDLp you need to worry about.)
Has your research determined that LDLp is, in fact, the best type of LDL for transport?
The fluffy cloud-like image of LDLc frankly suggests a passive entity, not the sort of streamlined substance eager to take energy to its destination.
Thank you, Dave, for all you do!

Ade
Guest
Ade

?

LDL-P is a measure of the number of LDL particles not a type of LDL.
LDL-C is a measure of the amount of cholesterol mass in the LDL particles not a type of LDL.
There are two types of LDL: pattern A (large particles) and pattern B (small particles).
A low LDL-P result equals more large particles (pattern A) which is deemed good.
A high LDL-P result equals more small particles (pattern B) which is deemed bad.
Eating sugar and carbs leads to pattern B and eating saturated fats leads to pattern A.

Hope that clarifies and happy to be corrected if I’m wrong.

David Roberts
Guest
David Roberts

Hi again. I’ve decided to put my blood test results below so everyone can see them and add to the data on cholesterol and Keto / Low Carb.

27/2/12 cholesterol results:
TC 6.2
TG 1.2
HDL 1.2
LDL 4.4
Lp(a) .87

From Feb 2014 to Feb 2015 I was on Crestor statin due to the above Lp(a) and LDL and TC.

30/10/14 Cholesterol results
TC 3.3
TG 0.6
HDL 1.11
LDL 1.9

My hand wouldn’t close properly after using Crestor, so I went off Crestor in Mar 2015

In Aug 2015 – Sept 2016 I had Dientamoeba Fragilis parasites, which gave me among other symptoms, gut pain every day. I took lots of antibiotics to get rid of them, but now have Adrenal Fatigue and haven’t exercised much at all since Aug 2015. My body fat is about 20%.

Cholesterol results 2/4/16
TC 5.6
TG 1.4
HDL 1.07
LDL 6.4

Started Keto diet Dec 2016, most of the time cows milk / dairy free.

Blood test results from 9/12/17
TC 7.7
TG 0.8
LDL 6.1
Lp(a) 0.35

My doctor was overall happy with my cholesterol results, but wants to retest in June 2018 as he’s concerned about my TC and LDL. I have fatty bacon nearly every morning and lots of olive oil. I mentioned this site briefly and the fact that my sdLDL should be very low, which is good for cardiovascular risk. My Adrenal Fatigue is showing some signs of improving. Any comments or suggestions for my GP would be appreciated. Thanks!

David Roberts
Guest
David Roberts

Thanks for you comments Dave. It is reassuring to have someone else in the Low Carb community who has researched cholesterol a lot give positive feedback. Sorry, in my rush I left off my HDL had improved to 1.25 on the 9/12/17, so I was very happy with my results. I’m hoping to educate my GP using your website and other Low Carb health professionals ☺️

Robbie
Guest
Robbie

Dave, I’m 53 yo female. Started Low Carb High Fat (not Keto) back in June. Lost 15 pounds in the first 3 months, maintaining since then. I’d like to lose 10 more pounds. Below 25 BMI now. (5’3″ tall). Heart Disease runs in the family. Which blood tests do you recommend I get at this point? I want to be informed and armed with info when I head to the doc next year and she freaks at my LDL. I’m willing to pay for the blood tests (to a point), so which tests are most informative? Thank You!

Justin Tondt
Guest
Justin Tondt

Hey Dave,

Just reminding you about this paper:

“increasing circulating dietary cholesterol levels may drive LD [lipid droplet] expansion in adipocytes (126). Cholesterol abundance triggers transfer of CAV1 proteins from the plasma membrane to LDs to facilitate their expansion (123).” https://www.ncbi.nlm.nih.gov/pubmed/29243339

Justin

Michael Holzheid
Guest
Michael Holzheid

Please take a look at this research report: http://onlinelibrary.wiley.com/doi/10.1113/JP275075/epdf

Could this explain the caution about to much protein? Maybe it’s really the BCAAs? What I find confusing, they seemed to achieve favorable health benefits and rapid fat loss on a protein-restricted (to achieve low BCAA) and High carbohydrate diet. If the subject are eating all these carbs, they can’t be in ketosis. So, how are they burning fat?
.

Natalie
Guest
Natalie

Hi Dave,
I’ve been LCHF for over a year. I don’t really track too carefully and slip up occasionally. I am also a marathon runner. I just had my blood tests done recently and have been baffled about the results. I’m in Canada but did convert them.
Total Cholesterol 8.93 mmol/L (345)
LDL 4.32 mmol/L (167)
HDL 4.39 mmol/L (169) ….I was told this is impossible by someone/another said highest they’ve ever seen
Triglyceride 0.48 mmol/L (45)

CRP 1.87 mg/L

I have my results from 5 years ago for reference: (only in Canadian values) Marathon runner
Cholesterol 7.33 mmol/L
LDL 4.59 mmol/L
HDL 2.51 mmol/L
Triglycerides 0.50 mmol/L

I am 46 years old. I am 5ft 4.5″ and weigh 115-123 range.
My doctor never called me regarding these results but they have me a little freaked out. What is your opinion? I get confused because I hear conflicting information. Some say high cholesterol is fine but then even the LCHF/Keto groups talk about lowering int. Thanks.

Robbie
Guest
Robbie

Hey Dave, I’ve been strict LCHF for 8 months (less than 50 grams of carbs/day). Lost 15 pounds. 53 y.o. female. Here are my recent blood test results. Freaking me out a lot. After 8 months with low carbs, shouldn’t my triglycerides be way lower? And that CRP!!! It’s scary to see “HIGH” after just about every test score.

NMR LipoProfile:
LDL-P 2132
LDL-C 159
HDL-C 57
Trig – 159
Cholesterol (Total) – 248
HDL-P (Total) 41.5
Small LDL-P – 970
LDL Size – 20.7
LP-IR Score – 55

Lipoprotein (a) – 4

C-Reactive Protein (Cardiac) – 5.10 (YIKES)

Should I keep a defibrillator near by? Thanks for all you do, Dave!

Robbie
Guest
Robbie

And the LDL-P number? and Small LDL-P? Both just reflecting carbs? I feel like I’m not getting many (any) other than from berries and veggies. Guess I’ll stay away from those for a while and re-test.