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Sep 12

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  • If you know little to nothing about cholesterol, you can check out my Simple Guide to Cholesterol series. It’s full of illustrations and is written for laypeople. Enjoy!
    • Likewise, I have this video that goes over the basic markers for cholesterol while on a low carb diet. (Pictured to the right)
  • If you’re wanting a video version of my research:
    • The most current presentation is from Breckenridge in last February.
    • (Coming soon) A new one will be up eventually from the Low-Carb Cruise that brings the research up to the date of this post.
  • If you have seen your cholesterol rise considerably on a low-carb high-fat diet (like myself):
    • You may want to first visit the FAQ.
    • I would strongly encourage you to read through this blog and my own journey revealing the Inversion Pattern. Key moments were the Identical Diet experiment and the Extreme Cholesterol Drop experiment that I wrapped around the first presentation of my data for the Ketogains Seminar.
    • And finally, you may be interested in my recent discovery with regard to controlled carb swapping. (But note it is very preliminary)

58 comments

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  1. Elizabeth

    Hello! I would love to share your presentation with my father, but he is deaf. Do you have a transcript we can access or is it possible to add CC to the you tube video? Thank you!

    1. Dave

      I don’t… but I may be doing a reprisal of that presentation for the coming Ketofest. If I do, I’ll see if I can work up a text for it as well.

  2. Chris

    Hi Dave, thanks for your work. I’ve enjoyed your twitter feed and will be perusing your site here. I tweeted you about a patient of mine who has familial hypergyceridemia with Trg in the thousands. Currently Crestor and Tricor for this. he is motivated and now has a recent dx of DMT2 with a hgb A1C of 6.7. He is seeking dietary intervention. I’ve been a proponent of low carb high fat diets for many of my DMT2 patients and am having success coaching this, but had some pause in this gentleman given his Trg. He is reticent to start metformin and anxious to intervene w diet. I already started talking to him about LCHF. I am new to LCHF and as a intervention. While high Trg has not been implicated in mortality, non-alcoholic pancreatitis can be a serious complication and high saturated fat diet can be concerning for this. I’ve seen anecdotes about LCHF lowering Trg but would like to see some data on this. Thanks. Chris PA-C

    1. Dave

      Hi Chris–

      – I’m not as familiar with hypergyceridemia — do you mean hyper*tri*glyceridemia? (I’m assuming this due to your mention of the TG in the 1000s) Also, you prefixed with “familial” — if genetic, what is the family history with this disease?

      – Certainly, I’d be very concerned about high TG, and yes, low carb is extremely effective in most cases of bringing it down. I’ve likewise seen many labs (some within my own family) where there were high TGs while using statins, even if having lower LDL.

      – The higher TG in combination with higher glucose is even more troublesome as my guess is there is a very high abundance of energy parked in his system. Does the patient have a lot of visceral fat? There’s a decent chance he already has fatty liver and may be hyperinsulinemic.

      – It’s extremely encouraging he is seeking dietary intervention as I definitely think this should be the first choice.

  3. Kaiden

    I have two sets of test results. I did the protocol backwards (5000 calories first, then 500 calories). They weren’t NMR. They do contain some other numbers I found interesting. The high-day test did come back with elevated BUN. Is this common (i.e. because of the high amount of protein)? Either way, I’ll ask my doctor to rerun the test after a week of fasting.

    1. Dave

      Hi Kaiden-

      That’s interesting. But it’s hard to speculate without seeing the labs. Can you post the numbers?

  4. Andrew

    Hi Dave,

    I was recently turned-on to your Biohackers podcast interview & on one hand, am excited to tap into a LCHF / Keto community however am now slightly in panic mode after my first NMR, which is the second cholesterol test since going LCHF. Your thoughts would be wonderful. Below are my NMR results from Monday, June 5 2017:

    – Total Cholesterol: 233, down from 254 on 10/6/16 (first test on LCHF) up from 202 from my last test before going LCHF
    – HDL-C: 67, down from 71 on 10/6/16 (first test on LCHF) up from 55 from my last test before going LCHF
    – LDL-C: 154, down from 166 on 10/6/16 (first test on LCHF) up from 130 from my last test before going LCHF
    – Triglycerides: 60, down from 86 on 10/6/16 (first test on LCHF) & even with my last test before going LCHF
    – LDL-P: 1,724 (no previous record)
    – HDL-P: 28.9 (no previous record)
    – Small LDL-P: 634 (no previous record)
    – LDL Size 20.9
    – LP-IR Score: <25

    A little background: The Saturday & Sunday leading up to Monday, June 5 2017 were very active where I burned probably close to 1,000 calories each day mountain biking in fairly warm weather. I'm wondering (hoping) the high LDL-P is my liver releasing cholesterol for repair / maintenance? Also, this weekend was a little more carby than usual. Finally, high blood pressure is prevalent on my Mom's side of the family with her dad suffering from both stroke & heart attack. I think both parents are taking cholesterol lowering medications. In terms of next steps, I think another NMR is in order, perhaps not after exerting as much energy in the days leading up? At least to rule it out. What are your thoughts?

    1. Dave

      Okay, a few things…
      1) You are possibly a “Lean Mass Hyper-responder” as I’m calling it now. (I’ll be doing a post on this soon, but for now you can reference my comment here: https://www.reddit.com/r/ketogains/comments/6jjpby/deranged_lfts_on_keto_xposted_to_keto_subs/djisdpp/)

      2) Actually, given your intensive exercise, I would speculate that your non-exercise test scores would likely be higher in LDL-C, and marginally higher in LDL-P if my theory/research is consistent on this. (See my blog post on distance running and its impact on my numbers here: http://cholesterolcode.com/impact-of-endurance-running-on-cholesterol/) I tell you this in advance because I want you to be ready for this possibilty if this turns out to be true.

      Moreover, the carbs you had may have actually lowered your LDL-C/-P further given my more recent experments with carb swapping in the attempt to test glycogen store influence on lipids. (See here: http://cholesterolcode.com/cholesterol-research-breakthrough/)

      3) If you’ve read the links above and even a tiny fraction of my research/data, you’ll have noticed I’m exposing how agile the lipid system is. It is far more regulated than current medical literature believes it to be — at least, I can say this confidentally in the context of low carb given others’ reproduction of my protocol as well.

      So with regard to risk, that’s an individual choice. As I often say, when I first learned about my high cholesterol numbers, I was a 9 on a 10 scale of concern. Now I’m more like a 5, but I’m not a 0. I understand why it functions this way with regard to fat-based energy management and how cholesterol is along for the ride. (And on that note, please consider reading my Simple Guide series for laypeople on low carb http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/)

      I hope this was helpful. 🙂

      1. Andrew

        Very helpful & thoughtful, thank you. I have read everything you posted & then some. A couple follow up questions. 1. do you have your weekly menu posted somewhere or are you following some other regiment or cookbook? Finally, aside from the normal lipid panel & NMR, do you have your list of recommended blood tests posted somewhere? BTW I submitted an interest form to be in your Ketofest cholesterol study 😀

        1. Dave

          Glad to be of help!

          – I don’t have a weekly menu posted, per se. My primary source of tracking is photographic as I literally take pictures of everything I ingest. However, I get behind on my text-based food logging (currently MyFitnessPal) and mainly have it maintained for all periods just before blood tests. The key is the photos and all the context as I can always catch my text logs up perfectly. (But more importantly, I need all my work to be independently auditable)

          It’s worth noting that my diet is better than most, but not ideal, and I try to point that out. Many assume because I’m so disciplined in recording data that I must likewise be disciplined in quality food selection and strongly Paleo. But my diet is probably around 20-25% “fast food” keto, such as lettuce-wrapped burgers from Carl’s Jr. Probably 40-50% I cook myself, such as cage-free scrambled eggs or my keto pizza. The remainder is restaurant or keto snack-ish such as individually wrapped colby jack from a convenience store (sure it’s cheese, but more processed/preserved, of course).

          – As blood tests go, I won’t bother doing a single one that doesn’t include an NMR, fasting insulin, and high sensitivity C Reactive Protein (hsCRP). Those are the minimums for me.

          But usually, I get the above three and a Comprehensive Metabolic Panel (CMP), a Complete Blood Count (CBC), Cortisol, hbA1C, ApoA1, ApoB, Uric Acid.

          I occasionally add Ferritin, Iron Panel, Homocyst(E)Ine, Vitamin B12 And Folate, Vitamin D, and GGT.

  5. Lars Behme

    Dave, I am going to schedule my next blood test, I find the calorie intake for your protocol challenging :). I am T2D, off meds, but am keeping my carbs below 10g a day – any hint/ suggestion on how to beef it all up while keeping the carbs at that level (if it “has” to be 3%) ?
    thanks for your time.
    \Lars; Ireland

    1. Dave

      Hi Lars-

      The total amount of calories is individual — you just want to find an upper limit. It’s something you find yourself.

      Keeping under 10g of carbs a day while upping total calories would probably be unrealistic. You’d have to use a lot of factory-based oils as the primary fat-sourced, which I wouldn’t recommend. 🙂

  6. Lars Behme

    True, I did a test run, and managed around 1780 cals… natural carbs, even the mascarpone was made from farm made double cream which raw milk was used for – where I actually know the cow it came from… I was truly sick munching away – Let’s see how I will manage that huge amount :), and if the blood sugar is a wee higher (didn’t rise over 5 today) so be it. Factory based oils don’t usually hit my table (The blessings of living in rural Ireland and knowing the farmers, I guess).- Thanks Dave, good words.
    \Lars

    1. Dave

      Yes — please don’t do anything that is making you sick or feel nauseous. I really want to stress that!

      And yes, I’d expect the blood sugar to be higher relative to when you are on a lower caloric load (even fat has small amounts of glycerol backbone that likewise get processed to glucose, so there’s no avoiding some small spike).

  7. Latife

    In relating your calling ‘Lean-Mass-Hyper responders’ and exercise part, I am bit confused and want to ask some questions. Let say I am a lean person and have lower glycogen stores. I regularly do exercises after low carb high fat dinner (about 2 hours after dinner). Also during day I am quite active physically doing kitchen, garden, shopping works etc. (or playing with kids). in this case my body uses fat or glucose? How long takes my body to use glucose or glycogen? If I have lower glycogen stores and think my body uses it during HIIT exercise and after about 12-14 hours fast isn’t it possible my body mobilising energy from triglycerides that increases my LDL? What is the reason my LDL or cholesterol decrease after exercises?
    Thanks in advance!

    1. Dave

      Hi Latife–

      That’s a lot to unpack!

      – First, we are already using some amount of glycogen and some amount of fat at all times — but the ratios change, of course, depending on availability and demand.

      – I’m not an expert on the exact amounts (I refer you to the *real* experts, Volek and Phinney), but I believe it is extremely rare to completely deplete your glycogen stores. That’s usually done at times like marathons where one “hits the wall” at around the 17th mile, for example.

      – The more fat-adapted you are, the more your body appear to have a higher ketone/trig usage relative to a glucose preference when not needed for immediate HIIT or sprint-like activity.

  8. Ian

    Hi Dave
    Thanks you for your blog and the video of your latest research.

    Just a question about the lipid response to fat intake. In your studies (fasting, 5000 calories, etc) were you able to test the ldl subfractions (1 to 6)? Reason for asking is – maybe the LDL overall drops on high fat intake but the profile becomes more atherogenic (or vice versa). Hope that makes some kind of sense.

    regards
    IanA

    1. Dave

      Hi Ian-

      Sorry for the late reply — this one slipped past me.

      Yes, I have always gotten NMRs for subfractions. Your question is probably better answered in my Breck presentation – http://cholesterolcode.com/about/

  9. b. holiday

    Hi Dave. I want to report my results. I ate 4000 calories on Monday, 400 grams of fat. 5000 calories on Tuesday, 500 grams of fat. 5000 calories on Wednesday 500 grams of fat. 5000 calories on Thursday, 500 grams of fat. Tested blood glucose and ketones every night around 8PM. Blood sugar in 70-80’s. Ketones from 4-7.8.

    Last meal around 4pm on Thursday. Blood test 8:15 am Friday.

    LDL-P >3500 High.
    LDL-C >429 High.
    HDL-C 74
    Triglycerides 147
    Cholesterol, Total 532 High.
    HDL-P (Total) 34.3.
    Small LDL-P 219
    LDL Size 22.3
    LP-IR Score: 51 High.

    Do these numbers look good, or very bad? I am getting very mixed messages.

  10. Dave

    Hi b—

    Your numbers are unusual for the protocol. Can you post your food logs here?

    (I should warn I’m deep in the Ketofest experiment now, so might be spotty on reply…)

  11. Gina

    First, thank you for the blog and all of the information you have been providing to us. I am also a hyper responder. When I started a ketogenic diet, my total cholesterol steadily rose to the 500+ range. After three years of being on the diet and improving all of my health markers, including a 100+ weight loss, my total cholesterol has slowly been going down and it’s currently at 345. I am not concerned over my cholesterol as I don’t believe in the lipid hypothesis but I am very interested in lipids, especially how LDL works.

    Excuse my ignorance but since this subject really is fascinating to me, I want to make sure that I am not missing anything important. I am just not understanding what this protocol is for or what it is showing about cholesterol that we didn’t already know and why the results are meaninful. I have read through the blog and I also have a basic understanding of how lipids work. I am just not understanding what your research is showing.

    If you eat a whole lot of calories, a few days before your blood test and it makes your cholesterol go down, what does that mean? Why would that be of any importance? You normally wouldn’t eat 5000 calories or more a day, so the fact that doing that causes your cholesterol to drop, is almost a fluke result. In other words, it’s not a true, everyday, result that you would get otherwise. I don’t see why anyone would do that unless they are trying to manipulate results for insurance purposes or to get their doctors off their back.

    Most importantly though, I want to know what it means and why it’s meaningful? “Cholesterol” is so dynamic that basically anything can change it. I think that lipidologists know this and it hasn’t changed the country’s obsession on cholesterol so showing this effect on multiple people wouldn’t cause them to think cholesterol is any more harmful.

    1. Craig

      Gina,

      Unfortunately, most doctors aren’t as informed about TC/LDL as they should be regarding both it’s predictive power as a risk factor and its dynamic variability. Instead of educating them, it’s often easiest just to give them a ‘good’ number and move on. If you have a LCHF-friendly doctor who is more interested in measuring insulin resistance, inflammation, and atherosclerosis, you don’t need the protocol.

      The research so far has shown that the lipid system is highly dynamic, and more is going on than the conventional wisdom suggests. There is still a lot more to figure out, and we don’t know for sure if having high LDL-p is causal for disease in-and-of itself. So if you’re interested in learning more, you’re in the right place. 🙂

      Craig.

      1. Gina

        Thank you Craig.

  12. Joe

    Hi Dave,

    Your research is really fascinating- I as well had higher LDL numbers when I started the low-carb/Keto diet. The only thing is when my doctor tests my cholesterol he absolutely insists that I take the test non-fasting. When I look at the numbers with a layman’s eye, the numbers are always outside of the normal reference ranges- I.e: Either the ldl to high or the hdl is too low or both. He never seems concerned an always tells me everything is OK

    Do you take your tests on a full or empty stomach? Do you think there is any clinical value to doing the test on a full stomach?

    Thanks,

    Joe

    1. Dave

      I always take my labs at around 14 hours fasted. I make sure that span of time exists between the meal I ate on the night before and the blood draw the morning of.

      The reason is that one group of the LDL particles that originate from food, called Chylomicrons, will be almost entirely cleared by that point. Thus, I can count my scores to be consistent with the other half of LDL particles that come from storage and originate as VLDLs.

  13. Jan Bardot

    Hi Dave,
    I just met you at San Diego LCHF. My name is, Jan an empath, the retired professional athlete, massage therapist and you read my NMR. I loved your presentation and your passion for getting the true data out about what cholesterol numbers really mean. Thank you very much.

    Please let me know the dates in advanced so I can plan. As I said to you yesterday I am now single with no children which gives me the freedom to travel.

    Looking forward to hearing from you.

    Jan

    1. Dave

      Yes, Jan — it was awesome meeting you!

      I may have some studies coming up. Keep an eye out on this blog in case I post something on it in the near future. 🙂

  14. RS Weir

    Hi Dave:
    Not sure if this is the right place to ask this question…but here goes.
    I’ve been on a keto program for the last five years. Virtually no carbs other than leafy greens, cauliflower etc.. Yet fasting glucose is 96. However, fasting insulin is 2 which gives a very favorable HOMA_IR of .47.
    I am curious as to why the glucose remains in the 90s. I would think that with no carbs I could get it lower.
    Does the low carb, high fat, moderate protein diet produce such low insulin that consequently glucose cannot be driven down below 90 without long periods of fasting?
    Thank you.

    1. Craig

      Check out Dave’s comment from today at 11:32 in The Game of Glucose. Your muscles learn to ignore the glucose so that its only used by tissues that require it.

  15. Matt Allington

    Hi Dave.

    Matt here (twitter @exceleratorbi). I would love to work with you to help visualise your data. I am a professional data consultant and made keto guy.

    1. Dave

      Glad we were able to connect, Matt. 🙂

  16. Mary

    Former Reliability Engineer here.
    This stuff is fascinating.
    Would love to see someone decompose dietary “risk factors” and associations into a ranked list of 1st order, 2nd order, 3rd order effects. Does anyone think that’s possible?
    After the 1st order effects, genetics, microbes, frank poisons, (known and unknown exposures), accidents, available calories ( non starvation), exercise levels, even background radiation, a lot of medical science “risks analysis” especially from nutrition, looks pretty specious to me. Presumably the goals are to not die sooner or more painfully than needful and to function well. The first goal is more clear than the last goal
    Many biological deaths are marked by (could be modeled as) cascading failures from the disruption of homeostatic processes ( don’t screw around with electrolytes and oxygen uptake). A. Be careful with your experiments B. We don’t know squat about proteomics, or the microbiome for that matter , and C., the whole science of endocrinology appears to be a bit thin on the subject of nutrition.
    There are differences in phenotypes that affect metabolic efficiency for some compounds. (12 phenotypes for alcohol metabolism) Homeostasis will mask a good bit of variation. Everyone has some organ reserve. You might not realize damage until you’ve lost a good bit of cellular machinery. Then your numbers are going to go seriously south without a good way back. So be careful.

    1. Dave

      Thanks for the thoughts, Mary.

      Indeed, I share some of your concerns and will try to be careful with the experiments as you suggest.

  17. Kathy Kennedy

    Hi Dave,

    Glad to have found your blog. I had suffered for well over 15 years with horrendous digestive problems. After much trial and error, I tried a no starch diet and the results were incredible. It was the first thing that actually helped me. I eventually discovered that eating as close to zero carb as possible has given me the best symptom control to date. I am probably not in ketosis because I eat a fair amount of protein. I do what works for me.

    I read that the body handles saturated fat differently on low carb or keto diets, so I didn’t worry about it, although I have had high cholesterol in the past. But at my physical in June, I got these results:

    Total Cholesterol: 561 mg/dl
    Trigycleride: 97 mg/dl
    HDL: 109 mg/dl

    I retooled my diet to lean meat, 2 eggs per day on average, fish,a little cheese, and monounsaturated fat and fish oil. And that is seriously about it, diet-wise, plus a piece or two of dark chocolate. I can tolerate beer because no fiber. No fruit, no vegetables of any kind, because I can’t digest them and any supposed health gains are canceled out by poor quality of life. I might be one of your lean mass hyper responders because I am 5’5″ and 107 pounds or so. Pretty physically active–lift weights and lots of walking. (15,000-20,000 steps/day)

    Anyway, I don’t really know if it pays to be tested again. I will not take statins under any circumstances, and I simply can’t eat carbs. I figure I am doing the best that I can under the circumstances, but you seem to have studied this way more, so if you have any thoughts, I would be interested in hearing them.

    Thanks,
    Kathy

    1. Dave

      Hi Kathy!

      My gosh — your comment somehow slipped through the cracks! I’m likewise emailing you with a heads up about this reply. Sorry about that!

      Naturally, when I saw your numbers, I thought Lean Mass Hyper-responder (http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/). You didn’t list your LDL-C, but I presume it is over 300 or 400+. This, along with your activity level definitely suggests a good setup for a LMHR.

      While it is possible LMHRs are at greater risk due to higher LDLp/c, I’m extremely skeptical for a lot of reasons that I’ll be posting on (and doing videos on) at a later point. But the core reason is that it makes perfect mechanistic sense and results in some of the lowest inflammatory markers I’ve seen.

      I try to be a good scientist and not comment on risk I can’t be sure of, but if I were making an even money bet with all my savings given everything I know to this point — I’d be betting that LMHR isn’t just low risk, but that it is probably the opposite. It might be a superior health profile and with lower all-cause mortality.

  18. Ted

    I’m curious if you have considered Dr. Thomas Cowan’s theory on the causes of heart attack. His explanation, while not an explanation of how dietary cholesterol or blood lipids work, it shows that the root cause of heart attacks is not blocked arteries, it’s capillary dysfunction, stress and poor para sympathetic response.

    https://cdn.shopify.com/s/files/1/1021/7291/files/What-Causes-Heart-Attacks-Cowan-reprint.pdf?10079655763935097707

    1. Dave

      While I’ll have to come back around to this paper given available time at the moment — I certainly feel in general agreement with your summary of this as stated. Certainly endothelial damage/dysfunction is an extraordinarily relevant component.

  19. Ann

    Hi Dave.
    I’ve been on lchf keto for around 18 months, I’m 55 and recently passed menopause (still getting hot flashes, so not settled and my weight hasn’t really budged (bmi 28.5)) but feeling good and fit and healthy. However, got cholesterol reults today – first since being keto and they are:

    TRIGLYCERIDES 1.4 mmol/L
    CHOLESTEROL 10.8 mmol/L
    HDL CHOLESTEROL 2.6 mmol/L
    LDL CHOLESTEROL 7.6 mmol/L
    Non-HDL Cholesterol 8.2 mmol/l
    HLD as % of total – 24

    My hsCRP was nice and low at 0.5 mg/l

    So, trigs and inflammation not bad, but rest much higher than expected (and comparable to last reading prior to lchf when total cholesterol was about 5.)

    I had fasted for 11 hrs prior to test.

    I guess I’m a hyperresponder. Would backing off from keto be likely to lower the total and non-HDL?

    Although not too worried about being out of “normal” range, I would like to be lower than this and any suggestions from your experience would be welcome.
    Thanks
    Ann

    1. Dave

      For a long-term drop, I generally suggest “swapping” in carbs, preferably from healthy sources. Some people mistakenly ADD carbs into their diet and this will likely increase their lipids even more (and I’ve had a few readers do this and confirm this happened to them).

      The catch is that the exact amount to hit the threshold of change isn’t easily known. You can read more about this on my experiment here: http://cholesterolcode.com/cholesterol-research-breakthrough/

  20. Antonia Montoya

    Dear Dave,

    First of all I want to thank you for dedicating your time to research and for sharing it openly, it has been really helpful and a big insight for me in my current situation.

    My name is Antonia Montoya and I am from Colombia, South America. I am a women, 32-years old, 5’6” and my current weight is 147 lbs. I have been on a low carb diet for the past 5 months and I have lost around 19 lbs.

    Last week I had my blood work done and I was really shocked with my cholesterol levels. I have always had an elevated LDL (maximum 162), but never to these levels.

    I would mean a lot to me if you could take a look at my charts and give me your insight. (Please take a look at the reference values used here, they might be different from the USA ones). By all means understand that you are not a medical doctor, but your insight is very valuable to me.

    FREE T3:
    Now: 2.3
    Jan/17: 3.23
    Ref Values: 1.71-3.71 pg/ml
    Technique: CMIA

    FREE T4:
    Now: 1.02
    Jan/17: 0.94
    Ref Values: 0.70-1.48 ng/dl
    Technique: CMIA

    TSH:
    Now: 2.9827
    Jan/17: 3.5859
    Ref Values: 0.3500-4.9400
    Technique: CMIA

    TRIGLYCERIDES:
    Now: 65
    Jan/17: 143
    Ref Values: Accepable under 200 mg/dl

    TOTAL COLESTEROL:
    Now: 377
    Jan/17: 252
    Ref Values: Accepable under 200 mg/dl

    HDL:
    Now: 103.2
    Jan/17: 77.7
    Ref Values: Accepable over 40 mg/dl

    LDL:
    Now: 269.8
    Jan/17: 145.7
    Ref Values: Accepable under 130 mg/dl

    FASTING GLUCOSE:
    Now: 80
    Jan/17: 77
    Ref Values: 70-110 mg/dl

    CREATININA:
    Now: 0.84
    Jan/17: 0.82
    Ref Values: 0.51-0.95 mg/dl

    RATIO HDL/T Ch:
    Now: 0.27
    Jan/17: 0.31

    RATIO TRIG/HDL:
    Now: 0.63
    Jan/17: 1.84

    On behalf of the Low Carb-High LDL community, thank you again! I’ve donated a small amount in sign of my appreciation.

    Best wishes,

    Antonia

  21. Dave

    Hi Antonia–

    Your scores actually are pretty common for a hyper-responder. Your HDL, which was already really good at 78, improved to 103. TG dropping to 65 likewise shows much higher utilization, so I’d expect you’re actually being very good about keeping your carb count low and maintaining energy balance and/or deficit.

    Your LDL is actually identical to mine on keto at 270. While I try to be a good scientist and not claim certainty about risk without having empirical evidence, I *can* say that I got to where I am with my research by understanding how this system works, allowing me to alter the numbers easily. And if my understanding is indeed correct, then there’s a perfectly sensible reason we see higher cholesterol on low carb given we are trafficking more fatty acids for energy which “ride share” with cholesterol in low density lipoproteins (LDL). Be sure to check out my Simple Guide series for more info on this: http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb-part-i/

    Moreover, there’s actually a counter case to be made that women *in particular* should be celebrating higher cholesterol given they have an “X” of higher cholesterol = lower all cause mortality. I’ll be turning this into a post soon, but there’s some copy/paste from a recent comment I made that includes recent, large scale studies to this effect….

    —-

    Japan Health Study (91,219) Norwegian HUNT study (52,087).

    Key lines from the Japan study:
    “Overall, an inverse trend is found between all-cause mortality and total (or low density lipoprotein [LDL]) cholesterol levels: mortality is highest in the lowest cholesterol group without exception. If limited to elderly people, this trend is universal. As discussed in Section 2, elderly people with the highest cholesterol levels have the highest survival rates irrespective of where they live in the world.”
    https://www.karger.com/Article/Pdf/381654

    Key lines from Norwegian study:
    “Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95%”
    https://www.ncbi.nlm.nih.gov/pubmed/21951982

  22. Dean

    Hi Dave,

    I’ve been diving into your research and trying to fully understand it. I am a 49 yr old male who has been diagnosed with high cholesterol most of my adult life. I have been on 10 mg of statin for years. I am also on LCHF and continue to get high cholesterol numbers.

    I feel silly asking this, but I seem to be missing a simple point of your research. The event that led you to this was being on LCHF and getting high cholesterol numbers. However, your inversion experiment shows that the more fat you eat, the lower your cholesterol number are. If that is the case, then why is cholesterol rising on the LCHF?

    Thanks.

    -Dean

    1. Dave

      Hi Dean— Short version: I’m powered by fat (triglycerides), which ride shares with cholesterol in low density lipoproteins. Generally, the leaner and more athletic you are, the higher your LDL because you need even more energy mobilized by fat for availability to tissues. This is why the leanest and the most athletic low carbers can have the highest LDL (http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/).

      1. Dean

        Thank you Dave – I appreciate your response. Since my initial question, I spent a bit of time on Ivor’s site as well as Peter Attia’s site – I think it’s all starting to come together.

        Thanks for sharing your research, it is certainly insightful.

        -Dean

  23. Helena

    Hi Dave,

    One of the factors that’s mentioned as a possible cause of elevated cholesterol numbers is weight loss. Is there any information available on how long after weight stabilization that persists?

    Since Jan. 18, 2017, I have been on a ketogenic LCHF diet, and have lost 20kg, which was close to 30% of my body weight when I started (No, I’m not anorexic, just short & small-boned!). Currently I’m within two kilo of my target weight and am beginning to work on stabilizing my weight.

    I had blood work done on Nov. 4. Below, I’ve compared the results from my last previous test, which was on Jan 5, 2016 to those of Nov 4, 2017:

    Total cholesterol 6.76 / 9.49 mmol
    Triglyceride 1.15/1.14 mmol
    HDL cholesterol 2.14/2.26 mmol
    LDL cholesterol Calc 4.09/6.71 mmol
    Non-HDL cholesterol Calc 4.6/7.23 mmol
    Total cholesterol HDL-C ratio 3.2/4.2
    Hb A1c 0.058/0.052

    The dramatic rise in my cholesterol numbers freaked me out slightly, and I’ve been researching what I can find on the web. There’s a huge amount of info, and it ranges all over the place. Predictably, it’s left me confused! As well as the question of elevated cholesterol due to dieting, there’s also the apparent protective effect of high cholesterol for old women – I’m 73.

    But before I make any decision on diet & lifestyle, I’d like to have a reasonably accurate picture of my cholesterol status. An NMR would be a good next step, but it’s expensive, so I’d like to wait until it’s likely that the post-diet cholesterol spike has settled down.

    Thanks for your great work on this vexatious question!
    Helena

    1. Dave

      My personal opinion, given what I’ve learned to this point, is that weight loss must be very active and rapid to have a significant impact on LDL-C. In other words, if you were losing, say 1kg or less a week, I doubt it would have much impact on your LDL-C.

      Odds are, your NMR will likewise show higher LDL-P with low small LDL-P given your TG/HDL appears very strong (Pattern A).

      1. Helena

        Hi Dave,

        Thanks for getting back to me – I’ll hold off getting an NMR done until my weight has stabilized, and won’t worry too much about weight loss affecting it, since I’ve been throttling down the rate for the past couple of months.

        Another question: most of the numbers on your site are in mg/dl rather than mmol/L, and I’ve tried to convert mine so that I can get a clearer idea of where I’m at. The process has left me rather confused – I’ve used three different methods:

        Working from total cholesterol of 9,49 mmol/L, HDL of 2.26 and triglycerides of 1.14mmol/L
        – multiply by 18, which gives me 170.82. 40.68 & 20.52
        – the table at http://www.joslin.org/info/conversion_table_for_blood_glucose_monitoring.html, which gives me ~ 170, 40 & 27
        – the online converter at http://www.onlineconversion.com/cholesterol.htm, which gives me 366.97, 87.39 & 100.97

        I can see why the “multiply by 18” & the Joslin one are different – they’re both convenient, but probably not super-accurate. It’s the third one that puzzles me.

        Also, what is a “good” TG/HDL ratio range, and what is the formula for calculating the TG/HDL ratios? I’m guessing it’s simply divide TG by HDL, which gives me the TG/HDL ratios of 0.50 (rounded) in mmol/L, and the following from the converted values:
        – 20.52/40.68 = 0.50 (rounded)
        – 27/40 = 0.68 (rounded)
        – 100.97/87.39 = 1.156 (rounded)

        I suspect that, once I figure I’ve got a reasonable amount of information (it seems to be a real rabbit hole!), I’m going to see if there’s a study out there looking at these issues that I can join.

        Seeing that the baby boomers are approaching old age, it would be interesting to see how cholesterol behaves in the elderly & old – and whether anybody is actually bothering to research this! (My physician if a firm believer in the evils of cholesterol & referred me to a cardiologist who tried to put me on statins well before I went keto & my cholesterol numbers were “good” – presumably because of my age. Sigh.)

        1. Dave

          These are the conversions I get:
          – TC: 9.49 mmol/l = 366.97602 mg/dl
          – HDL: 2.26 mmol/l = 87.39366 mg/dl
          – TG: 1.14 mmol/l = 100.97431 mg/dl

          And yes, this is actually a very common profile for hyper-responders (very similar to mine).

          TG/HDL of 2 or less is commonly considered optimum.

          I know conventional doctors continue think of cholesterol as evil, and they will likewise see a lot of us LCHFers coming in with very low inflammation levels, lost weight, lower blood pressure, low a1c, etc, but will point to higher LDL as the concerning marker — to which I recommend they visit http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/

  24. Vik

    Hi Dave
    I just came across your blog and it has been very helpful. This is very informative and thank you for all the knowledge you are sharing. I need your help and some advice on my cholesterol situation if you dont mind. I am 40 yr old male and mostly been diagnosed to border level cholesterol from past 5 years. I have been working very hard at the gym and lifestyle to improve my cholesterol levels. But unfortunately this does not help me much and I bumped into the Keto diet.

    I have been on Vegetarian Keto Diet (eat eggs) from 60 days now.
    My macros has been like 75-25-5 and around 1800-2000 calories per day. My Ketones are at avg of 1.5 and Blood sugar avg at 92.

    Before 60 days non-keto : HDL – 35, LDL-153, Tri-112, Total-210
    After 60 days of keto: HDL – 35, LDL-196, Tri-140, Total-259

    Some of my concerns are:
    – My HDL never increased? (this was my main reason to start keto)
    – Should I increase my ketones?
    – I am also pre-diabetic before Keto and getting my blood sugar normal is my other goal.
    – Cholesterol numbers are concerning and What changes would you suggest me to do on the above data I provided?

    Big Thank you for everything you are doing and looking forward to your reply! Appreciate your response!Thanks!

    1. Dave

      Hi Vik

      This is indeed an unusual change — or rather, lack of change.

      As you mentioned you are vegetarian keto, you may actually not have a lot of saturated fat in your diet, instead having more M/PUFA. Saturated fat typically results in increased HDL (and often LDL as well).

      Your trigs increasing by 28 may be noise (first test might have pulled low, the second pulling high), but I’d still be curious if that continued to be slightly higher in your next test.

      Regarding increasing ketones, I’m actually not a big fan of targetting high ketone (BHB) measurements as I think it’s less relevant than most people do. Blood tests of any substrate are capturing what is in transit in the bloodstream and not yet used. Thus keto athletes can often have lower ketones test markers than sedentary because their cells are consuming them faster, leaving less in the blood for the test to pick up.

      If you aren’t already, be sure to track your food closely and I’d recommend taking your sample logs to the forums bringing them your concerns. HDL being persistently low at 35 is something I’d want to look into as it could be some other factors (such as thyroid), but I’d want to rule out diet relation first.

  25. EvgeniaBB

    How can you be sure that cholesterol drops due to a huge amount of calories and not due to the fact that excessive protein and part of the fat you consume on the days before the test? It seems that the protein you eat on usual days is largely sufficient for the body and all the extra will be converted to glucose?
    The fact that only 95g of glucose is needed to drop cholesterol also seems to support this hypothesis.

    1. Dave

      My more recent energy status experiments appear to knock this hypothesis down as when I have higher carbs but lower overall calories, my LDL goes up relative to the upper baseline. Moreover, I had an experiment last year where I ramped up the proportion of fat relative to both protein and carbs where it continued to follow the Inversion Pattern.

      1. EvgeniaBB

        That sounds interesting. Do you think the type of fat matters?
        By the way does a common cold can affect the results of the blood test? I don’t know if I have to put off the test until I feel really well.

        1. Dave

          The type of fat appears to matter for some with regard to saturated vs M/PUFA, but doesn’t appear to affect my Inversion Pattern as much. I plan to do another experiment on this next year.

          A cold might impact lipids, yes. LDL can be unregulated to fight an infection. How much and for how long isn’t as well known.

  26. Helena

    Hi Dave,

    Thanks for clearing up my conversion confusion – if I’ve calculated correctly, my TG/HDL ratio is 1.15539, which is a number to be pleased about!

    Last January, I expected that, if I lost the extra weight I was carrying, my doctor would be happy with the results. Now, even though I have, talking with her is probably going to get “interesting”.

    Though I wasn’t pre-diabetic, and not suffering from insulin resistance, I was worried about my weight and blood pressure. After ten years of battling a slow but inexorable weight gain, and developing borderline hypertension, I went on an LCHF diet. With great success. I won’t bore you with the details – if you’re interested, there’s an entry on my blog:

    http://redefininglittleoldlady.com/little-old-lady-on-ketones-or-seven-months-on-an-upside-down-diet/

    So far, I haven’t found a physician who’s willing to work with me on LCHF, so, when I was close to my target weight of 50 kilos, I made an appointment with a nurse practitioner at a local clinic. She was willing to prescribe a bunch of blood tests for me. When the result came in, she was very much alarmed and phoned me immediately, with the advice to go see my doctor as soon as possible

    I wasn’t best pleased myself. I had been merrily expecting wonderful results – and most of them were excellent! Blood pressure down from ~ 130/90 to 100/80, Hemoglobin A1c of 0.052, all the other values bright & shiny.

    But, as you said is typical for hyper-responders, the cholesterol figures were in what is routinely perceived as the prescribe-a-statin-immediately zone. For many reasons, I’m unwilling to even try statins.

    Aside from the physical improvements, I’ve never felt better. My energy is way up, and for the first time, I’ve managed to keep up a regular exercise program (two vigorous one-hour aquafit sessions a week, plus an average of half an hour’s walk daily the other five days) for more than a month or two.

    But the biggest improvement is that the low-grade depression that’s been dragging me down for years is finally lifting. So, even if I weren’t deeply concerned about the side effects of statins, it would take an awful lot of solid evidence to persuade me to change my diet significantly.

    Which is going to make for a lively conversation when I finally do go see my family practitioner! I’ll give her the link and see what happens…

    Thank you again!

    1. Dave

      Fantastic story, Helena!

      In so many ways, I’m happy to be living in this time where we can crowdsource our respective data. Like so many others, I daily get stories of (1) fantastic markers, (2) feeling better than ever, (3) having incredible, lasting energy, yet (4) having high cholesterol. But as I keep pointing out, all of these make perfect mechanistic sense in the context of being powered by fat.

  27. Dr D Taylor

    Hi Dave

    I am a UK based zero energy architect/renewable energy engineer who has been LCHF for about 14 years and have been time limited feeding (usually 16:8) and also occasional intermittent fasting.

    As I had a blood test recently I fasted for about 2.5 days prior to the blood test as my focus was on keeping blood glucose levels low. I was somewhat surprised to find that my cholesterol came back high as did my trigs.

    I was perplexed for a while then I remembered your presentation at Low Carb Breckinridge and I think that you mentioned that when you fasted your cholesterol shot up – was that also true of your Trigs?

    I am due to see my doctor this evening so I am trying to pull some thoughts together.

    I was very impressed with your research into the topic and it does seem as if you have nailed it and the thinking about LDL being an energy transporter – especially if one is LCHF/keto – seems to make sense.

    Good luck with your experiments and research.

    Regards

    DT

    1. Dave

      Yes Dr D, you probably *maximized* your potential cholesterol numbers by fasting 2.5 days. Note these are the highest LDL numbers I’ve gotten with my own 2.5 day fasting experiment earlier this year: http://cholesterolcode.com/the-fasting-disaster/

      Thank you for the kind words. Certainly the sooner everyone can know and understand this information, the better. 🙂

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