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.


Skip to comment form

  1. Annlee

    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. 🙂

    1. Dave

      The caffein is more off-and-on. I don’t drink coffee or energy drinks of any kind. When being lazy, I’ll have a Coke Zero and/or stevia-sweetened ice tea. But lately I’m avoiding both and trying to stick to water. It’s tough, because I definitely consider sweetened drinks one of my biggest lifelong addictions.

      I’m interested on what (if any) impact this would have on my lipids — but skeptical that it would be of any significant degree.

  2. 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.

    1. Dave

      Interesting — I’ll have to check into that. Maybe I’ll work in an experiment using lots of ice tea at some point.

  3. 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 no doubt attract more data. You would also have the added benefit of controlling the input data more closely.

    1. Dave

      Yes — that’s been suggested before. I think I’ll see if I can work up a post soon where I detail a lot of the things I’ve eaten both in and out of experiments. Hopefully that would be helpful.

  4. 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 now switched to just 5 or 10 minute hill interval running twice a week and not the long cardio 10k type workouts

    1. Dave

      That’s a pretty long subject for me. While I know branch points are often pointed to as reenforcement to the Lipid Hypothesis, it seems to ignore pathogens and ROS follow the same rules of physics. So cellular turnover there, and for that matter, atherosclerosis is not that unexpected mechanistically.

      I certainly believe extreme athleticism has problems, but I’m skeptical cutting out 10ks would be a net gain, for example. I’m more likely to think it would be helpful more than hurtful.

  5. bill

    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.

    1. Dave

      Yes, I’m excited to watch the interviews!

      It’s a really great group of people in the organization as well.

  6. Marie

    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.

    1. Dave

      My HDL-P has been consistently slightly below range. And as HDL-C rises with total fat, HDL-P likewise rises with total fat — but on the same *particle* pattern (5 days with a 2 day gap) as LDL-P.

  7. 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 of them. I lift weights, run, and row. As far as the rowing and running I do a combination of interval training, slow and steady cardio, and high intensity… So I called her out on the exercise stuff, she didn’t have any response.

    She ordered another set of tests for 3 months out. I’ve got another 15 or so lbs of fat I could drop, figure I’ll focus on that for the next couple months, then likely figure out your protocol to hack my cholesterol score for the test.

    Anyway, I do wonder about my HDL and how she could possibly think that exercise would impact it. Any guesses? Looking at your results here, it does not seem to budge…

    1. Dave

      Hi John –

      You are likely a hyper-responder like myself. Which means while being keto, you’ll likely have higher LDL-C markers.

      But I’m less concerned about your LDLc than I am your HDLc, which is usually much higher on a ketogenic diet.

      I literally just completed a five month experiment that compares a large set of data where I was distance running with the previous set where I was mostly sedentary (9 months). My HDLc was not significantly different.

      Thus far in my own numbers and in the other N=1 research other people have sent me, upping total dietary saturated fat appears to be the most effective way to increase HDLc.

  8. 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 wanting me to change my diet! After reading others who’s LDL’s & Triglycerides have dropped????

    I do need to add I never started this to loose weight, I’m 5″ 9″ 175 lbs. had problems with joint pain, so bad I was in therapy last year at this time. I’m in the best shape of my life (in my mind) and no joint pain with a slew of other bennies from Keto, Just a little concerned.

    So to be clear the question is, Can I eat to much Fatty stuff?

    JD Duval

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