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Jan 19

Remnant Cholesterol – What Every Low Carber Should Know

[UPDATE 1/20/18: the simple form mentioned below has been updated and can be found on the Report Page.]

I want to introduce you to something called Remnant Cholesterol. And if you’re on a #LCHF/#Keto diet, this will be especially relevant.

It is very simply calculated: you just subtract HDL Cholesterol (HDLc) and LDL Cholesterol (LDLc) from your Total Cholesterol. For example, if your Total Cholesterol were 300, your LDLc 200, and HDLc 80, then you’d have a Remnant Cholesterol (RC) of 20. That’s 300 – 200 – 80 = 20.

You can be forgiven if you thought Total Cholesterol was simply LDLc + HDLc. I thought so too before I was into keto since I was always told, “cholesterol is divided into two types, LDL and HDL…” — wrong! That little gap of cholesterol left over is very, very meaningful. When fasted, it is the cholesterol found in Very Low Density Lipoproteins (VLDL) and Intermediate Density Lipoproteins (IDL). When not fasted, it includes those two and Chylomicron Remnants.

Why This is a Problem

You see, these lipoproteins mentioned above aren’t supposed to be hanging around in the blood for very long. VLDLs pop out of the liver ready to drop off fat-based energy in the form of Triglycerides (TG) from the getgo. They bounce around your vascular system binding to tissues that need the energy and get smaller and smaller from less cargo in the process. From there they are remodeled to IDLs, which are then cleared by the liver or remodeled again to an LDL. This succession of stages to the final LDL takes under 90 minutes. So how long do LDLs hang out? 2-4 days!

This is worth reemphasizing because it’s key to understanding Cholesterol Remnants. Again:

  1. VLDL half-life is 30-60 minutes
  2. IDL half-life is less than 30 minutes
  3. LDL half-life is 2-4 days

So given this, we’d fully expect that the vast majority of lipoproteins that originated from the liver would be in that final LDL stage, even if they started out as VLDLs, right? Yes, of course!

A Simple Traffic Analogy

So imagine it this way… you have two jobs. When you leave the house in your car, you have a lot of food which you then drop off to people around the neighborhood who are hungry. This is supposed to take 1-2% of your time.

The other 98-99% of your time is spent doing the other job — patrolling the same area to help out in other ways. You might be doing citizen arrests of robbers (binding to pathogens) or helping out repairing houses that need it (non-hepatic endocytosis).

But what if there’s a problem with the roadways such as a traffic jam or you’re having a tough time finding people to take any of the food you’re offering (exceeded personal fat threshold). So now you’re spending much more time in that first job because there’s a widespread problem throughout the neighborhood that’s holding you up (and your fellow delivery drivers as well).

How They See It vs How I see It

I’ve been obsessively reading these Remnant Cholesterol papers for a while now. And this is a common opinion among them:

Remnant cholesterol, also known as remnant lipoprotein, is a very atherogenic lipoprotein composed primarily of very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL).

So VLDLs and IDLs themselves are “very atherogenic”?

Let me offer an entirely different viewpoint.

As many long-time readers know, I certainly see the lipids and their containing lipoproteins in our bloodstream as primarily an energy distribution system. That first tiny little stage of delivering energy as VLDLs or Chylomicrons is arguably the bulk of their “work.” Sure, it is done so quickly that it might seem like it is a small part of it. But when you see their largest payload is fatty acids (in the form of triglycerides) and their most reliable “activity” is hydrolyzing it off to the tissues that need it, you realize these guys just aren’t procrastinators, they get the biggest job done early and quickly…

… except when they don’t.

I offer two major reasons VLDLs and IDLs would be slowed down from remodeling to LDLs:

  1. VLDLs aren’t effectively distributing fat-based energy (triglycerides) and thus has longer residence time before it can move on (remodel) to its next stages.
  2. The lipid system is being employed to a higher degree in fighting or repairing a disease state. I won’t be covering this point here, but I’ll return to it in another post.

The first point is well illustrated in many who have hypertriglyceridemia, a commonly associated CVD risk. Often they have a much higher proportion of VLDLs. Why? Not surprisingly, these are likewise associated with hyperinsulinemia and metabolic syndrome.

Broken Systems are Atherogenic, Not Lipoproteins

To put it simply, a problem arrises when the fat-based energy has few places for the VLDL to park it. Those places it does park often can’t stay there long if one is well past their personal fat threshold. The fatty acids keep spilling back out into the bloodstream, binding to albumin, and finally making their way back to the liver to… wait for it… get repackaged into a VLDL again. You see the cycle?

VLDLs, IDLs, and LDLs are not independently atherogenic, but a body that is undergoing oxidative stress, chronic inflammation, or hyperinsulinemia can be. Yes, lipoproteins participate in this process as that is one of the many “hats” they wear in trying to fight it off and/or repair it. But trying to identify a single lipoprotein to label as the bad guy misses the point of the larger perspective on what’s happening inside the body to begin with.

Remnant vs LDL Cholesterol

Here’s a couple of example RC studies:

From this study: CONCLUSIONS: Both lipoproteins [RC and LDL] were associated equally with risk of IHD and MI; however, only nonfasting remnant cholesterol concentrations were associated stepwise with increased all-cause mortality risk.” (See graphic at right from the study)

From this study: CONCLUSIONS: Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.”

I’m hesitant to name any single lipid marker as the “best” one to measure. But if I had to choose right now, I’d be pointing to Remnant Cholesterol (RC). As of this writing, I haven’t found a single study that includes RCs in matchups with other lipids where it isn’t the clear winner in predicting all-cause mortality.

At a minimum, one should be looking at Remnant Cholesterol over LDL Cholesterol. That’s why I added a new tool for people to check their Remnant Cholesterol here on the site. Feel free to do yours and share the results in the comments section.

What This Means for Low Carbers

While I have read through a lot of these studies, I still consider this early in my research on it. I’m naturally thinking through the mechanics and how it applies to those who are LCHF and thus powered by fat.

Here’s a summary of my notes thus far:

  • Given the data I have so far from the followers of this site, those going LCHF/Keto will more likely to see an improvement in their RCs, even if they are a hyper-responder.
  • Ironically, the reference range for RCs as they apply to those on a fat-based diet may actually be inflated. In other words, I’d expect RCs to actually be higher for appropriate mechanistic reasons given the higher proportion of distribution by VLDLs when LCHF/Keto.
  • Like triglycerides, RCs seem to be a great “cheat detector” within my own group of family and friends. Anecdotally, when they fall off the wagon and have too many carbs while still being very high fat, their RCs tend to go up.

Final Note on Fasting vs Non-Fasting Remnants

Lastly, I should warn that much of the newer research on Remnant Cholesterol compares populations who have had non-fasted lipid numbers. I suspect this will not work for those on LCHF/Keto. I’ve already found in my own data and those of others that when on a fat-centric diet, you can often have higher triglycerides relative to a carb-centric diet when taking lipids while not fasted. Hello! You are literally observing triglycerides from the food you just consumed as part of the total amount found in the blood.

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421 Comments on "Remnant Cholesterol – What Every Low Carber Should Know"

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Joe
Guest

TC 254
LDL 163
HDL 83
TG 38

RC 8 mg/dl
RC/HDL 0.1

AIP -0.699 didn’t forget the negative this time

TC/HDL 3.06
TG/HDL 0.46

Silvio Ferro
Guest
Thx dave for another great blogpost. For the last months I also Did a lot op bloodtesting. And was plating with your calculator and I discovered my “best” cholesterol was one month ago. 12/12/2017.Tot chol225- Ldl 137 – HDL:77 – TG 56. Remnt cholesterol: 0.28mmol/L remnt chol to Hdl 0.14. This was 3 days After a 30Km trailrun -500hm. On keto But After the run I indulged on carbs! Just half a Day. Rest of diet Before and After race was Keto No cal deficit “Worst cholesterol” 2 days ago: Tot chol: 308 Ldl:232 Hdl:53 TG:114. Remnt chol 0,59 mmol/L… Read more »
Joe
Guest

Did it again using the Iranian formula instead of Freidwald, and got identical results.

Lisa B
Guest

I am a 56 year old female on LCHF:

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 306 mg/dL 7.91 mmol/L
LDL Cholesterol: 197 mg/dL 5.09 mmol/L
HDL Cholesterol: 100 mg/dL 2.59 mmol/L
Triglycerides: 46 mg/dL 0.52 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 9 mg/dL 0.23 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.09 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.697 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 3.05
Triglyceride/HDL Ratio: 0.46

Bill
Guest

Will your formula for RC work when LDL is calculated? I’d think for those with either very high or low TG your formula could be misleading, on the optimistic side for LCHF people with low TG.

Bill
Guest

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 386 mg/dL 9.98 mmol/L
LDL Cholesterol: 233 mg/dL 6.03 mmol/L
HDL Cholesterol: 138 mg/dL 3.57 mmol/L
Triglycerides: 52 mg/dL 0.59 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 15 mg/dL 0.39 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.11 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.782 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 2.8
Triglyceride/HDL Ratio: 0.38

pete
Guest

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 288 mg/dL 7.45 mmol/L
LDL Cholesterol: 164 mg/dL 4.23 mmol/L
HDL Cholesterol: 117 mg/dL 3.03 mmol/L
Triglycerides: 37 mg/dL 0.42 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 7 mg/dL 0.18 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.06 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.858 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 2.46
Triglyceride/HDL Ratio: 0.32

Amanda Atkins
Guest
PRE LCHF –==== CholesterolCode.com Report v0.7 ====– Total Cholesterol: 217 mg/dL 5.6 mmol/L LDL Cholesterol: 128 mg/dL 3.3 mmol/L HDL Cholesterol: 40 mg/dL 1.04 mmol/L Triglycerides: 239 mg/dL 2.7 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 49 mg/dL 1.27 mmol/L >>> High Risk Quintile Remnant Chol to HDL: 1.23 >>> High Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: 0.414 >>> Highest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL RATIOS– Total/HDL Ratio: 5.38 Triglyceride/HDL Ratio: 5.98 1yr of LCHF –==== CholesterolCode.com Report v0.7 ====– Total Cholesterol: 166 mg/dL… Read more »
John
Guest

Keep in mind that results may change a lot depending on whether you have direct LDL measurements or only calculated LDL. In my experience with low-carb/keto your measured LDL is likely to be higher then calculated (therefore your calculated remnants will be lower). In my case:
TC 223
LDL (measured) 123
LDL (calc) 111
TG 49

RC 0 (based on LDL measured)

Thorsteinn
Guest

@john, was that Friedenwald or Iranian method of calculation?
I understand Friedenwald tends to overestimate LDL in LCHF.

Says the doc: https://www.docsopinion.com/2017/01/02/ldl-cholesterol-overestimated-low-carb-high-fat-lchf-diet/

Leo
Guest

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 226 mg/dL 5.84 mmol/L
LDL Cholesterol: 151 mg/dL 3.9 mmol/L
HDL Cholesterol: 45 mg/dL 1.16 mmol/L
Triglycerides: 151 mg/dL 1.7 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 30 mg/dL 0.78 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.67 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.166 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 5.03
Triglyceride/HDL Ratio: 3.36

Amanda Atkins
Guest

Are you already on LCHF? – it took me a year of LCHF 60% fat ( no veg oils) 22% protein% 5% whisky 13% carbs ( 1350 calories) to convert between the two numbers I’ve posted.

Bill Graves
Guest

Units of measurement:

687
Total Cholesterol (TC)

567
LDL Cholesterol (LDL-C)

91
HDL Cholesterol (HDL-C)

145
Triglycerides (TG)

(Copy and paste everything below for reuse)

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 687 mg/dL 17.77 mmol/L
LDL Cholesterol: 567 mg/dL 14.66 mmol/L
HDL Cholesterol: 91 mg/dL 2.35 mmol/L
Triglycerides: 145 mg/dL 1.64 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 29 mg/dL 0.75 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.32 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.156 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 7.56
Triglyceride/HDL Ratio: 1.59

Stephen Blackbourn
Guest

Thanks Dave, very interesting.

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 218 mg/dL 5.64 mmol/L
LDL Cholesterol: 117 mg/dL 3.03 mmol/L
HDL Cholesterol: 90 mg/dL 2.33 mmol/L
Triglycerides: 53 mg/dL 0.6 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.12 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.589 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 2.42
Triglyceride/HDL Ratio: 0.59

Cristina
Guest

Hi I am a healthy (I have to asume?) 70 years old lady, still no medication, yes I can loose a few kilos

My LDL bellow it is calculated, have been doing LCHF for 2 years

–==== CholesterolCode.com Report v0.7 ====–
Total Cholesterol: 329 mg/dL 8.5 mmol/L
LDL Cholesterol: 213 mg/dL 5.5 mmol/L
HDL Cholesterol: 104 mg/dL 2.68 mmol/L
Triglycerides: 53 mg/dL 0.6 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 12 mg/dL 0.31 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.12 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.65 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL RATIOS–
Total/HDL Ratio: 3.17
Triglyceride/HDL Ratio: 0.51

Vladimir Prieto
Guest
============ BEFORE LCHF ============ –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 185 mg/dL 4.78 mmol/L LDL Cholesterol: 120 mg/dL 3.09 mmol/L HDL Cholesterol: 46 mg/dL 1.19 mmol/L Triglycerides: 98 mg/dL 1.11 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 19 mg/dL 0.49 mmol/L >>> Medium-Low Risk Quintile Remnant Chol to HDL: 0.41 >>> Medium Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.03 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 119 | Iranian LDL-C: 127 Total/HDL Ratio: 4.02 TG/HDL Ratio in mg/dL:… Read more »
Roger
Guest

Units of measurement:

212
Total Cholesterol (TC)

125
LDL Cholesterol (LDL-C)

74
HDL Cholesterol (HDL-C)

63
Triglycerides (TG)

(Copy and paste everything below for reuse)

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 212 mg/dL 5.48 mmol/L
LDL Cholesterol: 125 mg/dL 3.23 mmol/L
HDL Cholesterol: 74 mg/dL 1.91 mmol/L
Triglycerides: 63 mg/dL 0.71 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 13 mg/dL 0.34 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.18 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.43 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 125 | Iranian LDL-C: 106
Total/HDL Ratio: 2.86
TG/HDL Ratio in mg/dL: 0.85 | in mmol/L: 0.37

Tim Newton
Guest

66 yr old male, national level marathoner, 3 years LCHF

Total Cholesterol (TC) 8.05
LDL Cholesterol (LDL-C) 4.78
HDL Cholesterol (HDL-C) 2.94
Triglycerides (TG) 0.71
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol:
311 mg/dL
8.05 mmol/L
LDL Cholesterol:
185 mg/dL
4.78 mmol/L
HDL Cholesterol:
114 mg/dL
2.94 mmol/L
Triglycerides:
63 mg/dL
0.71 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol:
12 mg/dL
0.31 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL:

0.11 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.617 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 184 | Iranian LDL-C: 153
Total/HDL Ratio: 2.73
TG/HDL Ratio in mg/dL: 0.55 | in mmol/L: 0.24

Don
Guest
Dave, you say “At a minimum, one should be looking at Remnant Cholesterol over LDL Cholesterol” but isn’t this the same mistake many other researchers have made – eager or desperate to find simple cause for CVD they jumped from measurement correlation to causation without acknowledging the rest of the picture? I think you are absolutely right that lipos are simply transport vehicles with additional immune system functions (like neutralizing toxins, malignant cells, viri, etc.), and it was ridiculous that experts chose one size as the bad one when there is *continuous* variability of size for all the lipos, so… Read more »
David Roberts
Guest
Hi Dave, Thanks for the very interesting article and the tool. My numbers after 1 year of LCHF / Keto are: –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 298 mg/dL 7.7 mmol/L LDL Cholesterol: 236 mg/dL 6.1 mmol/L HDL Cholesterol: 48 mg/dL 1.25 mmol/L Triglycerides: 71 mg/dL 0.8 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 14 mg/dL 0.36 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0.29 >>> Medium-Low Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.194 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL… Read more »
Andrea Mikler
Guest
“I’ve already found in my own data and those of others that when on a fat-centric diet, you can often have higher triglycerides relative to a carb-centric diet when taking lipids while not fasted. Hello! You are literally observing triglycerides from the food you just consumed as part of the total amount found in the blood–==== ” WOW, thanks Dave:). This was the first time I had my lipids taken when non-fasting and the numbers freaked me up little bit. Never had tryglicerides higher then 0.5 mmol/L. But it makes sense! CholesterolCode.com Report v0.8 ====– Total Cholesterol: 278 mg/dL 7.19… Read more »
Linda
Guest
Have been Keto since Sept ’16, no cheating, ever! I’m suspecting I’m a hyper responder as my Total & LDL has increase significantly. –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 286 mg/dL 7.4 mmol/L LDL Cholesterol: 151 mg/dL 3.9 mmol/L HDL Cholesterol: 128 mg/dL 3.3 mmol/L Triglycerides: 35 mg/dL 0.4 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 7 mg/dL 0.18 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0.05 >>> Lowest Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.916 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of… Read more »
Nancy
Guest

I want those results! Are you a marathoner? I see those HDL numbers with triathletes or hyper exercisers.

Michelle Parent
Guest
Hi, I started LCHF on 1 MAY 2017. Below are my reports from about one month in (first report) and about 5 months in (second one). I turned 50 in the middle of the two times the blood was drawn. I take methotrexate for psoriatic arthritis, so I have autoimmune issues (that is only one of my diseases). So I am not alarmed by the amount of total cholesterol. Thankfully neither is my doc so I have not had a statin pushed on me. –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 284 mg/dL 7.34 mmol/L LDL Cholesterol: 215 mg/dL 5.56… Read more »
Helena
Guest
Hi Dave, Thanks again for your investigations into this bewildering field! Predictably, I’m not sure how to interpret my remnant cholesterol results. Most of my indicators are “medium-low risk quintile” – except for the atherogenic index of plasma, which is in the “lowest risk third”. Also, the LDL cholesterol number is calculated, rather than a direct measurement. Are there any tests that measure it directly? Also, is age a factor in calculating these risk levels? Units of measurement: mmol 09.49 Total Cholesterol (TC) 6.71 LDL Cholesterol (LDL-C) 2.26 HDL Cholesterol (HDL-C) 1.14 Triglycerides (TG) –==== CholesterolCode.com Report v0.8 ====– Total… Read more »
Lucas
Guest
–==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 237 mg/dL 6.13 mmol/L LDL Cholesterol: 163 mg/dL 4.22 mmol/L HDL Cholesterol: 62 mg/dL 1.6 mmol/L Triglycerides: 59 mg/dL 0.67 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 12 mg/dL 0.31 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0.19 >>> Lowest Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.378 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 163 | Iranian LDL-C: 136 Total/HDL Ratio: 3.82 TG/HDL Ratio in mg/dL: 0.95 | in mmol/L:… Read more »
Ragamuffin_girl
Guest
======== PREKETO ======== Total Cholesterol: 219 mg/dL 5.66 mmol/L LDL Cholesterol: 142 mg/dL 3.67 mmol/L HDL Cholesterol: 58 mg/dL 1.5 mmol/L Triglycerides: 94 mg/dL 1.06 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 19 mg/dL 0.49 mmol/L >>> Medium-Low Risk Quintile Remnant Chol to HDL: 0.33 >>> Medium Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.151 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 142 | Iranian LDL-C: 143 Total/HDL Ratio: 3.78 TG/HDL Ratio in mg/dL: 1.62 | in mmol/L: 0.71 =========… Read more »
Riccardo Brizzi
Guest
Here are my results – i seem to have zero RC – that is good right? I have also got these results which I am told are very bad ApoA 169 ApoB 161- not sure if these relate or not. LCHF for about 5 years – maybe eat too much fruit – mainly berries. –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 328 mg/dL 8.48 mmol/L LDL Cholesterol: 269 mg/dL 6.96 mmol/L HDL Cholesterol: 59 mg/dL 1.53 mmol/L Triglycerides: 97 mg/dL 1.1 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 0 mg/dL 0 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0 >>>… Read more »
karlos
Guest
–==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 296 mg/dL 7.65 mmol/L LDL Cholesterol: 198 mg/dL 5.12 mmol/L HDL Cholesterol: 87 mg/dL 2.25 mmol/L Triglycerides: 57 mg/dL 0.64 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0.13 >>> Lowest Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.546 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 198 | Iranian LDL-C: 162 Total/HDL Ratio: 3.4 TG/HDL Ratio in mg/dL: 0.66 | in mmol/L:… Read more »
mandip
Guest

-==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 210 mg/dL 5.43 mmol/L
LDL Cholesterol: 131 mg/dL 3.39 mmol/L
HDL Cholesterol: 66 mg/dL 1.71 mmol/L
Triglycerides: 98 mg/dL 1.11 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 13 mg/dL 0.34 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.2 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.188 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 124 | Iranian LDL-C: 130
Total/HDL Ratio: 3.18
TG/HDL Ratio in mg/dL: 1.48 | in mmol/L: 0.65

kim
Guest
LCHF since May 2017. VLDL 26. APOE 3/4…….such a confusing topic, thank you for dumbing it down so well that it almost makes sense. HS-CRP .59 mg/L and HbA1C is 5. I’m wondering if it makes sense to have my Lp(a), LDL-P and ApoB tested. I would very much appreciate your opinion on those tests or just be happy I’m in the lowest risk quintile? Many thanks for your work and blog! Kim -==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 314 mg/dL 8.11 mmol/L LDL Cholesterol: 159 mg/dL 4.1 mmol/L HDL Cholesterol: 143 mg/dL 3.69 mmol/L Triglycerides: 62 mg/dL 0.7… Read more »
Tim
Guest
Hi Dave, I’ve read your articles and watched your videos with interest but find it a lot to absorb. I’m a 56 year old Male. Currently 283lbs, 6’5″. The following is my blood work from the begging of last month (Prior to going on the Keto diet: Score from Dec 9, 2017 –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 208 mg/dL 5.38 mmol/L LDL Cholesterol: 150 mg/dL 3.88 mmol/L HDL Cholesterol: 41 mg/dL 1.06 mmol/L Triglycerides: 85 mg/dL 0.96 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 17 mg/dL 0.44 mmol/L >>> Medium-Low Risk Quintile Remnant Chol to HDL: 0.41 >>> Medium Risk… Read more »
Johan Ness
Guest
Following the process and keeping total cholesterol constant (no hyper responder), this happens when carb is changed to fat: Hi-carber has high number of VLDLs. Body takes the fat, IDL forms and finally LDL is left with cholesterol in it. In LCHF, number of VLDLs is low, and if amount of cholesterol is same, it means more cholesterol is packed into VLDL-particle. So the size of the forming LDL must therefore be bigger (more cholesterol in it) and the number is low. Hi-carber has smaller size of LDL-particles and the number of those is big. So this may have unpleasant… Read more »
Mike
Guest

Dave

I graphed out my last several years of tests including the remnant calculation and it looks like for me that remnants directly follow my triglyceride levels. The graphs are virtually identical. Is this what you are seeing?

Thanks

Tim
Guest
Hi, Dave. Interesting. It makes sense that VLDL and IDL can be involved in heart disease, as well as LDL. My previous model for heart disease was small/dense LDL, remnant cholesterol adds another layer. In my reading sdLDL seems to come about through excess carb input and insulin resistance. That is excess carbs (above about 50g/d) gets routed by the liver into glycogen and triglycerides via VLDL formation. These VLDL tend to be of the larger type which is more atherogenic. Insulin resistance adds another stream of FFA to the liver which also results in VLDL build. So together you… Read more »
Tim
Guest

One thing that bothers me is that many authors support the view that lipoproteins get “trapped” in the endothelium. This bothers me for two reasons, 1 Goldstein/Brown showed the entry of cholesterol in LDL is a very choreographed process via receptors, coated pits, invagination, lysosomes etc. Nature is not doing this casually so why should it do it for other lipoproteins. 2. Initial cholesterol deposits appear at the media/intima boundary very far from the lumen, so even if they are “trapped” it is extremely unlikely they can make such a long journey and leave no trace.

-James
Guest
Realizing this site is for Keto/LCHF folks mainly, it is a wealth of information. Regarding remnant cholesterol, can you say if it’s important to not ‘just’ those in the LCHF community? I plugged in numbers (non-NMR) from some of my labs over probably 10 years, and those with the highest remnant values were during an Ornish style pilot study (TC 180). The lowest remnant values were from a period of time where my TC was 300+ eating a lot of saturated fat and protein, but with higher than LCHF carbs still very low triglycerides. Labs soon on more of a… Read more »
Mel
Guest

These were my results immediately after an 18 pound weight loss over 6 days [due to an acute illness – flu/pneumonia/sepsis] 0mg/dl remnant cholesterol:

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 169 mg/dL 4.37 mmol/L
LDL Cholesterol: 151 mg/dL 3.9 mmol/L
HDL Cholesterol: 18 mg/dL 0.47 mmol/L
Triglycerides: 173 mg/dL 1.95 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 0 mg/dL 0 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0 >>> Lowest Risk Quintile

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.618 >>> Medium Risk Third

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 116 | Iranian LDL-C: 179
Total/HDL Ratio: 9.39
TG/HDL Ratio in mg/dL: 9.61 | in mmol/L: 4.15

Michael B
Guest
Dave – I’m curious if you’ve done any analysis of RC related to your “Incredible Changes in LDL Cholesterol Through a Simple Diet Experiment?” The lab results below are from last April (2017) – I was one month shy of my 67th birthday. When I saw my Doctor for the annual physical then, she offered me statins before the blood test, based on results from the previous year – TC 243, LDL 170, HDL 58, TG 75. I’d read so much about cholesterol that I just blurted out: “Are you kidding?” [She wasn’t.] (I actually had written and posted an… Read more »
Fisher
Guest

This doesnt look good…got some adjustments to make. Thanks for all your N=1 research. Single individual with enough pasdion can make a difference! Your work is very motivating.
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 254 mg/dL 6.57 mmol/L
LDL Cholesterol: 189 mg/dL 4.89 mmol/L
HDL Cholesterol: 37 mg/dL 0.96 mmol/L
Triglycerides: 139 mg/dL 1.57 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 28 mg/dL 0.72 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.76 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.214 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

Andrew F
Guest

My results (mg/dl):-
TC 287
LDL 189
HDL 85
TG 55

RC 13mg/dl / 0.34mmol/L
RC/HDL 0.15

AIP -0.548

TC/HDL 3.38
TG/HDL 0.65mg/dl = 0.28mmol/L

Andrew F
Guest

Btw, im 43, regular gym 4xwk (weights), follow a cyclical ketogenic diet for the past 6 months with 1 xhalfday selective carb load, interestingly all my cholesterol readings are improved in a positive way, TC⬆️, LDL⬇️, HDL⬆️, TG⬇️

H Martin
Guest
Can you help me make heads or tails of this? I think it’s good but I get a little stopped up with all the data. The first scores were just before I started LCHF and the second are after about 3+months. 9-26-17: Total Cholesterol: 243 mg/dL 6.28 mmol/L LDL Cholesterol: 159 mg/dL 4.11 mmol/L HDL Cholesterol: 73 mg/dL 1.89 mmol/L Triglycerides: 55 mg/dL 0.62 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile Remnant Chol to HDL: 0.15 >>> Lowest Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP:… Read more »
Jacqueline
Guest
Hi, these were my figures from five years ago – note that I get an error in the calculation – measurements were done in mmol/L (European) so probably because of lack of ‘precision’. –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 252 mg/dL 6.52 mmol/L LDL Cholesterol: 151 mg/dL 3.9 mmol/L HDL Cholesterol: 112 mg/dL 2.9 mmol/L Triglycerides: 35 mg/dL 0.4 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: -11 >> Lowest Risk Quintile Remnant Chol to HDL: 0 >>> Lowest Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.86 >>> Lowest Risk Third Go to… Read more »
Jacqueline
Guest
Hi again, whereas these are my more recent values (albeit two years old) following taking my doctor’s advice that as a peri-menopausal woman I should eat more carbs! Consequence was I have gained 6 kg (currently 57 kg/164 cm, BMI 21) as a 54 year old peri-menopausal woman eating LCHF since at least 2005. –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 302 mg/dL 7.81 mmol/L LDL Cholesterol: 159 mg/dL 4.11 mmol/L HDL Cholesterol: 109 mg/dL 2.82 mmol/L Triglycerides: 62 mg/dL 0.7 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 34 mg/dL 0.88 mmol/L >>> Medium-High Risk Quintile Remnant Chol to HDL: 0.31 >>>… Read more »
Leah Solliday
Guest

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 379 mg/dL 9.8 mmol/L
LDL Cholesterol: 297 mg/dL 7.68 mmol/L
HDL Cholesterol: 65 mg/dL 1.68 mmol/L
Triglycerides: 66 mg/dL 0.75 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 17 mg/dL 0.44 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.26 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.35 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 301 | Iranian LDL-C: 256
Total/HDL Ratio: 5.83
TG/HDL Ratio in mg/dL: 1.02 | in mmol/L: 0.45

James
Guest

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 252 mg/dL 6.52 mmol/L
LDL Cholesterol: 120 mg/dL 3.1 mmol/L
HDL Cholesterol: 129 mg/dL 3.34 mmol/L
Triglycerides: 61 mg/dL 0.69 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 3 mg/dL 0.08 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.02 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.685 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 111 | Iranian LDL-C: 89
Total/HDL Ratio: 1.95
TG/HDL Ratio in mg/dL: 0.47 | in mmol/L: 0.21

James
Guest

I a 50 year old male, non-smoker, no medications-just a few supplements, no blood pressure issues or diabetes. CAC was 0 at 44 years old and now it is 10, sadly even with the above profile since age 44 and doing everything right I still developed a CAC score. I have a hs-crp of 1.7 (marginally elevated) but a lot of financial stress in my life. Think stress has a lot to do with CAC IMHO.

Dr. Molly
Guest

I think I’m reassured. I recently switched to LCHF and I feel great. Was hoping my LDL would go down, b/c I’m a physician and am working through the “LDL BAD” brainwashing. Total 283 LDL 195 TGs 70 HDL 71 So remnants are 17

Roberto Cookie
Guest
–==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 265 mg/dL 6.85 mmol/L LDL Cholesterol: 191 mg/dL 4.94 mmol/L HDL Cholesterol: 45 mg/dL 1.16 mmol/L Triglycerides: 145 mg/dL 1.64 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 29 mg/dL 0.75 mmol/L >>> Medium-High Risk Quintile Remnant Chol to HDL: 0.64 >>> Medium-High Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: 0.15 >>> Highest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 191 | Iranian LDL-C: 220 Total/HDL Ratio: 5.89 TG/HDL Ratio in mg/dL: 3.22 | in mmol/L:… Read more »
sally
Guest

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 220 mg/dL 5.69 mmol/L
LDL Cholesterol: 136 mg/dL 3.52 mmol/L
HDL Cholesterol: 65 mg/dL 1.67 mmol/L
Triglycerides: 96 mg/dL 1.08 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 19 mg/dL 0.49 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.29 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.189 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 136 | Iranian LDL-C: 138
Total/HDL Ratio: 3.38
TG/HDL Ratio in mg/dL: 1.48 | in mmol/L: 0.65

sally
Guest
54 y.o. female followed a low fat diet for 22+ years. Took statin for 10 years until reaction in 2012, stopped statin. A1c 6.0 (has been consistent for years, even 3 months following keto with IF fasting) Wheat belly diet plus added daily egg in 2014 (arthritis & jaw pain disappeared) Open heart bypass Feb 2017 3 stents Sept 2017 AUG 2017 PALEO –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 241 mg/dL 6.24 mmol/L LDL Cholesterol: 126 mg/dL 3.26 mmol/L HDL Cholesterol: 54 mg/dL 1.4 mmol/L Triglycerides: 308 mg/dL 3.48 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 61 mg/dL 1.58 mmol/L >>>… Read more »
Haroldo Falcão
Guest
BEGGINING OF KETO (Oct, 6, 2017) –==== CholesterolCode.com Report v0.8 ====– Total Cholesterol: 224 mg/dL 5.79 mmol/L LDL Cholesterol: 100 mg/dL 2.59 mmol/L HDL Cholesterol: 69 mg/dL 1.78 mmol/L Triglycerides: 100 mg/dL 1.13 mmol/L –CHOLESTEROL REMNANTS– Remnant Cholesterol: 55 mg/dL 1.42 mmol/L >>> High Risk Quintile Remnant Chol to HDL: 0.8 >>> Medium-High Risk Quintile Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants –ATHEROGENIC INDEX OF PLASMA (AIP)– AIP: -0.197 >>> Lowest Risk Third Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma –CONVENTIONAL MARKERS AND RATIOS– Friedewald LDL-C: 135 | Iranian LDL-C: 140 Total/HDL Ratio: 3.25 TG/HDL Ratio… Read more »
Larry Levine
Guest
Thanks for any feedback you can provide! Total Cholesterol         305 Non HDL Cholesterol 241 LDL Chol                     211 LDL Medium               726 ApoB                           157 LP PLA2                     190 HS CRP                       <0.2 HDL Chol                    64 Trigs        … Read more »
Helena
Guest

Hi Dave,

This is fascinating – thanks for exploring these cholesterol rabbit holes!

Um, what’s the “atherogenic index of plasma”?

–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 367 mg/dL 9.49 mmol/L
LDL Cholesterol: 259 mg/dL 6.71 mmol/L
HDL Cholesterol: 87 mg/dL 2.26 mmol/L
Triglycerides: 101 mg/dL 1.14 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 21 mg/dL 0.54 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.24 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.297 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
HiFriedewald LDL-C: 260 | Iranian LDL-C: 244
Total/HDL Ratio: 4.22
TG/HDL Ratio in mg/dL: 1.16 | in mmol/L: 0.5