Apr 10

Impact of Endurance Running on Cholesterol

Exercise Impact Infographic

Exercise Impact Infographic

(Huff) (huff) (huff)… “I’d better be right about this…” I thought.

I was on the fifth mile of a seven mile training run, and was not love’n it. It wouldn’t have been so bad had I been following the training schedule, but I wasn’t. I was woefully undertrained. I was holding off endurance exercise as long as possible for my research because I had speculated all along that it would impact my lipid numbers.

Indeed, it was my plan all along to have a long Low Exercise Phase followed by long High Exercise Phase. This way each group of blood tests could be distinct from each other to compare.

I was certainly all set to find out. In just a five month span my wife and I had several runs scheduled, including four half marathons and one full marathon. So if there were differences to be found, I was pretty confident they would be showing up!

Let’s take a look at the timeline before delving into the results.

My wife and I as Groot and Rocket for the Disney Avengers Half Marathon

My wife and I as Groot and Rocket for the Disney Avengers Half Marathon

  • August 22nd – Training and exercise phase starts
  • Sept 19th – Blood test (followed two days after the 7 mile training run mentioned above)
  • Sept 24th, 25th – 10k and half marathon – Couldn’t do blood tests as we were in Paris
  • ** => October 3rd – 12th – Extreme Drop Experiment and Ketogains Seminar presentation <= **
  • ** => October 5th, 7th, 10th, 12thBlood tests for Extreme Drop Experiment <= **
  • October 21st, 24th – Blood test
  • November 5th-6th – 10k and half marathon
  • November 7th – Blood test
  • November 12th-13th – 10k and half marathon
  • November 14th – Blood test
  • November 21st – Blood test
  • December 20th – Blood test
  • January 4th-8th – 5k, 10k, half marathon (canceled), full marathon
  • January 9th – Blood test
  • January 10th – Restart low exercise / sedentary phase
  • January 26th – Blood test
  • February 9th – Blood test

** NOTE: I had to intentionally remain sedentary throughout Ketogains experiment given I assumed it would impact my lipid numbers and create confounders. Thus, the below graphs exclude the blood tests of October 5th, 7th, 10th, 12th 2016 given they didn’t include the exercise/training within.

Endurance Running Effect on LDL-C

Okay, now let’s get to the graphs. As usual, I present the left and right axis in relative terms so you can see the obvious relationship. Thus, the one of the left starts at the bottom with -10 and goes upward to 490 with the one on the right starting at 120 and going to 400.


And now we’ll flip the left axis to show the inverse correlation, so it will now start with 490 at the bottom and go up to -10.


Voila! You can now see a number of things:

  • In the Low Exercise Phase in the first 2/3rds of the graph you can see the tight inverse correlation between my three day dietary fat (in dashed orange) and the resulting LDL-C score (in solid blue). Of course this is very old news to me now, but if you’re just joining us and you’re finding yourself stunned, you probably haven’t watched my recent presentation at Low Carb Breckenridge or read my series of posts regarding these patterns.
  • Given the pattern on the left, we can see how our expected trend line pattern is as it comes into the High Exercise Phase on the right 1/3rd. And as is immediately apparent, the LDL-C trends comes in generally lower than we would expect on the Low Exercise Phase.
  • The two largest gaps are the first data point at the very beginning phase and the last one at the end.
    • Per my story above, the first one is the blood test following a sudden entry into the running schedule without much conditioning before it. It was miserable and I was especially sore, to no surprise.
    • The last one was a Monday blood test following four days and three races: 5k / Thursday, 10k / Friday, full marathon / Sunday. Naturally I was extremely sore and spent following this as well. (I also did an experiment inside the marathon as well which proved interesting)

My original hypothesis definitely had some considerably evidence behind it now. But before I break it out, let’s look at the other markers…

Endurance Running Effect on LDL-P


Again, LDL-P appears to have a far stronger correlation when applying a two day gap between its three day window of dietary fat and the resulting blood test.

You know the drill, let’s flip that left axis to show the inverse correlation…


Like LDL-C, we see the first and last data points providing the largest gaps from the original Inversion Pattern.

Endurance Running Effect on Triglycerides

Now let’s get to Triglycerides. Note that triglycerides are a lot “noisier” with far less correlation than the above metrics. But you might be surprised to know that this is the marker I was most interested in throughout this phase. More on that in a moment…


Now let’s flip that axis on the left…


Even with all that high deviation, we can clearly tell there is a massive pull down of trigs following the major endurance events (half and full marathons) creating huge gaps in the trend lines.

HDL-C Trends as Expected

I genuinely didn’t know what would happen with HDL-C and sure enough, the answer was nothing unusual…


Less LDL-C and LDL-P Suggests Higher Repair

Early on in my research I learned about “receptor mediated endocytosis” which is basically cells engulfing lipoproteins entirely. This is commonly done so cells can use the parts that make up an LDL particle for their own repair, which includes cholesterol and phospholipids. This led me to assume (rightly, as it turns out) that there would be a drop in my lipid measurements if my body were in the process of cellular repair such as from muscle maintenance following a run, removing more of the LDL-P from circulation.

The two biggest gaps above with LDL-C and LDL-P happened to be the first and last data points. And indeed, these were the two toughest periods for me, the first where I jumped right in the middle of the training schedule and the second following the grueling marathon week. Both times I was noticeably sore on my way to the blood draw.

This is also why I’ve held off on resistance training and plan to make it a phase by itself. I suspect more intensive muscle repair will likewise draw down LDL-P and LDL-C from the expected pattern.

I’m sure many will read this and feel it reinforces the reason to get exercise in order to remove these elements from the blood stream. But I don’t necessarily buy into that. I think many other things about exercise are far more relevant to cardiovascular health such as increased sheer stress.

The Critical Triglyceride Connection

So why was I so particularly interested in triglycerides? Because my body is primarily fueled by it, hello!

As I state over and over and over again, the lipid system is first and foremost about “energy distribution”; it’s primary job is to distribute triglycerides. Yes yes yes, it wears many other hats and I know all about them — but it can be easily debated that from an activity, payload, and contact standpoint its most destined of all jobs is distributing energy from fat. (Sure, we have some amount of these fatty acids being broken down for ketones as well, but they are still in second place for cellular usage ATP-to-ATP relative to trigs brought by LDL particles)

And that’s why I speculated that my trig scores would be extremely low following the big races, which is exactly what happened! Bear in mind I would have preferred taking the blood test in the minutes following the race, but had to wait until the following day given the blood labs aren’t open on Sundays when all the long races took place. As such, there was probably an even higher level of trigs in my bloodstream due to the food I ate following the race that afternoon and evening.

To recap:

  • Trigs following 11/6/16 races: 27
  • Trigs following 11/13/16 races: 42
  • Trigs following 1/8/17 races: 31

Unsurprisingly, all three were the lowest triglyceride scores I’ve ever had (my average is 91).

So one more time… if you want to understand cholesterol, start by understanding how your cells get their energy! Otherwise you’ll keep looking at the passengers and not the drivers.

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28 Comments on "Impact of Endurance Running on Cholesterol"

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I don’t recall that you’ve mentioned caffeine. Do you drink coffee/tea/etc.? If so, do you expect any particular impact due to any effects on lipid metabolism?

Neat stuff. 🙂

Mark Littlewood

The research I have read indicates that coffee raises LDL C by about 10% and Green Tea lowers it by about 10%. My personal experience was that this was pretty much the case. A little self experimentation should answer your question.

Mark Littlewood
Hi Dave, Great talk and interesting data. As you can gather from my previous comment I am a bit of a data scientist myself with an interest in this area. One thing that readers might benefit from, which unless I am mistaken is not on the site although I admit I have only had a cursory look around, is an example of what you ate on the 3 day test. A lot of people may find the figuring out of fat to carb ratios a bit time consuming whereas a sample 3 day diet would be a useful shortcut and… Read more »
Mark Littlewood
In this article you also touch on sheer stress. As a 10k runner myself or should I say ex 10k runner this interests me. These days I lean in the direction that increased blood circulation causes sheer stress at major junction points and this damage promotes repair and plaque build up. The irony is that if we do zero exercise that too appears to be unhealthy. Some research has shown that the sweet spot is only slightly above couch potato ie the walk to work and back type. What are your thoughts on this ?. By the way I have… Read more »

You’re one of the interviewees:
Many great interviews will be available for free,
including Ivor Cummins, Eric Westman, Thomas
Seyfried, Sarah Hallberg, Tim Noakes, among others.
Here’s the link: http://lipedemaproject.org/
Check out the great people they have interviewed.
It’s free each day, starting April 19th.


Hi, this probably isn’t the best place to ask, but couldn’t see where else to! What effects have you noticed on HDL-P in all your experiments. I just found out mine is low, despite HDL-C being high, on a LCHF diet. I also think my LDL went up on LCHF – only just had an NMR once, so can only compare total and calculated LDL-C between diets. I have a family history of dementia but don’t know apoE4 status.

John Burton
Hi Dave Very interested in all of this… I’m a recovered T2DM – dx’d on July 5 2016. Went keto, dropped 80+lbs, most recent hba1c came back as a 5.2. They also did the lipid profile and and the LPN called me very concerned – HDL 38 LDL 236 Tryg 138 She was insistent that this is horrible and I must reduce my meat consumption and increase exercise…. She is blaming the meat consumption for the LDL and saying a lack of exercise is the reason for the low HDL. In any given 7 days I workout 5 or 6… Read more »
JD Duval
Hi Dave, I have a similar problem, but different question. TC 395 HDL 42 LDL 317 TriG 214 Glucose 81 A1C 5.5 Everything else seems normal. Everyone says you can’t eat to much fat, however I’ve been on Keto for more than 9 months and my cholesterol doesn’t get any better. I will admit I really like butter, put it on everything. I have probably been consuming a half stick a day along with whipping cream & coconut oil in coffee & eggs. I eat meat, chicken, brauts & pork. Like John I have my Doctor upset with me and… Read more »
George Henderson (@puddleg)
“there would be a drop in my lipid measurements if my body were in the process of cellular repair such as from muscle maintenance following a run, removing more of the LDL-P from circulation.” This might help with the why of LMHR,.the evolutionary rationale. if you were fasting and hunting lean you would have higher LDL-p – and you could expect to be injured or suffer wear and tear eventually, where it becomes useful. In that model, it’s a “just in case” arrangement, favoured by natural selection because burning more fat means more danger or damage. Conversely, being overfed means… Read more »
Matt Morris

How would weightlifting play into this experiment…would you expect it to have a similar affect? I would think that weightlifting requires more repair work, so it might have a more pronounced effect on the ldl, but doesn’t require as much total energy, so maybe a lower effect on the triglycerides?


[…] I’m not surprised by the lower LDL-C and LDL-P as I’ve covered this before with my own data. As the theory goes, on one end he’s being powered by fat, necessitating […]

Hi Dave. In private correspondence you referred me to this article which you felt best explained your theory of lipid and cholesterol. No doubt the hard exercise phase underscores your concept that dietary fat and plasma cholesterol are essentially inverted in the short term. Your explanation of the lipoprotein system as a lipid delivery system first and foremost with cholesterol as a passenger makes eminent sense so increasing fat may indeed result in less plasma cholesterol through the same cholesterol ride sharing with more fat so as the LDL stored fat is absorbed so is the cholesterol and plasma levels… Read more »

Should I do my normal 4 mile run the morning of my blood test?

Siobhan Huggins

It may not be a good idea if you’re seeking the most accurate results – the run could impact various values on the test including CRP, LDL, and LDL-P if you get an NMR Lipoprofile. It may be better to take it as a rest day the morning of, and the day before, and take a relaxed walk instead.


[…] unchanged in the Ketofest experiment. I knew exercise was potentially a confounder given Dave’s experiments with distance running, but I had a full training schedule this year leading up to my first marathon earlier this month. […]