A Simple Guide to Cholesterol on Low Carb – Part II

In A Simple Guide to Cholesterol on Low Carb Part I, I gave a very broad overview of LDL particles and their important cargo along with common misconceptions about this subject within a low carb, high fat diet.

Without question, the guide was the most visited post on my blog. And many of my followers have remarked on how helpful the graphics were in getting across the information. So I decided to get ambitious with Parts II and III and tell it more as a visual story. In short – more graphics, less blog text. Enjoy!

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Luke
6 years ago

Simple and to the point. Look forward to the part 3.

Robbie
Robbie
5 years ago
Reply to  Dave

I’m still looking forward to part 3.

chris
chris
4 years ago
Reply to  Dave

Love this! This is honestly how they should have taught us in med school, learning so much more through your cartoon compared to some of the expensive classes i took! Waiting for part 3!

K T
K T
3 years ago
Reply to  chris

He could make an installment in the “Ridiculously Simple” series 🙂
To be honest, I really don’t think nearly this much was understood when I was in med school. As a surgeon, it’s not all that useful for me professionally- just to chastise my trainees when they present the old paradigms!

Stephen
Stephen
2 years ago
Reply to  Dave

Did you ever do part III?

PATRICK RAY
PATRICK RAY
9 months ago
Reply to  Dave

We need Part 3 still!

Hyper-Responder Neville
Hyper-Responder Neville
6 years ago

Using cartoons to explain lipid metabolism is so cool! really great work.
In case anyone’s interested (apart from the above series ^), this is probably one of the best explanations of this topic [https://www.youtube.com/watch?v=998r-MyEEPc] that i have come across.

Giancarlo
Giancarlo
1 year ago

Very interesting video, thank you !

Wim Tilburgs
6 years ago

Great article shared it in the Dutch Low Carb community.

Nicole recine
Nicole recine
6 years ago

Thanks so much for this Dave. Am I right in understanding that the LDLs become small and dense when they are lacking in cholesterol and have a lot more trigs to drop off?

Donnie Lacy
Donnie Lacy
5 years ago
Reply to  Dave

I have been eating keto for 7 months now. I am also a T1 Diabetic. My Trigs are 100 and my HDL is 40. I have heard that a 2:1 ratio is where you want to be regarding Trigs:HDL. My remnant cholesterol is now 21 (was 28 on my last lab). However, my LDL particle sizes are the small, dense kind in large numbers. Anything to be concerned about here? Is it possible to reduce this in order to have more large, fluffy particles?

michael pollard
michael pollard
6 years ago

Can’t see any way to subscribe.

Dr Z
Dr Z
6 years ago

Excellent site and excellent illustration!!

Any info on Wellbutrin use and elevated cholesterol? Long and complicated history, but would love any leads if you have come across any associations in your research. Thanks again and keep it up! This information needs to get out!

Megan

Dr Z
Dr Z
6 years ago
Reply to  Dave

Hi Dave,

Thanks for the response.

Here is a brief hx:
At the time the 36 y/o female (now 40 y/o) pt started on 300mg/d bupropion (Rx’d by different dr) and within one month lost 5 pounds, going from 122-117 at 5’4″. She maintained that weight for 1.5 years as she was recovering from a foot injury that prevented her from being very active — even walking was not an option for about 6 months. Once the foot was healthy she resumed her previous exercise routine: weights, moderate cardio and in general significantly more mobility simply due to no longer being limited. The only dietary change she made was reducing alcohol intake. She said that she was drinking 2-3 beers/night, so she cut back to only twice per week and only 2 drinks at a time. After the reduction in alcohol and increase in activity level, she lost 10 pounds in 6 weeks. She stopped having her period and started to suffer insomnia, more depression and fatigue.

Dietary wise: honestly, it’s not terrible or specifically high fat, low carb, etc, but she definitely could stand reduce sugar intake. She admits to eating chocolate, daily, and often gets a pastry with her coffee in the AM. Otherwise, she adheres to a whole foods diet. Not heavy on meat, however. Nor is she big on the carb front (excluding the pastries and chocolate habit).

I ran some labs and sex hormones are in the tank — all postmenopausal. DHEA-s normal, testosterone – normal Thyroid markers are all low: TSH, T3, T4, free T3, free T4, all below RR. Anti-bodies are negative. Cortisol production is low, however, conversion to cortisone is high.
The cholesterol is the interesting bit:
Total: 308
HDL-C 151
Direct LDL-C 182
Tri 75
Non- HDL-C 157

She does carry the E3/E4 genotype
C/T MTHFR genotype
She also tested high on her Beta-sitosterol and campesterol absorption markers

I have 2 years worth of labs tracking her trends and the cholesterol numbers have slowing increased, the 308 was the most recent. Two years ago she was at 256 total.

My thoughts are the bupropion which inhibits norepinephrine and dopamine re-uptake, in time, overly taxed the adrenals, which lead to the menstrual and thyroid dysfunction. I suspect she was hyperthyroid for a bit. And the the end result is increase in cholesterol as it is the precursor to sex hormones. I can’t find any literature on this, however. She presents almost anorexic, but is not. Her lowest weight was 106 and was extremely lean, if I were to guess, single digits. She has gained about 10 pounds, yet still no cycle and is still suffering from the symptoms that drove her into my care: fatigue, insomnia, depression and unintentional weight loss. The logical or trial run approach would be to take her off of the bupropion, but she says she has tried that (slowly tapering) but ends up feeling worse.

Anyway … thanks for reading and for any thoughts or other minds that I could reach out to. It is disconcerting that so many medications are prescribed without truly knowing how they can impact the human system. Prior to the buproprion this pts cycles, sleep, energy, etc. were normal. Her only issue was depression and she says the bupropion has helped quite a bit.

Thanks again for your incredible site and work in this field!

Dr. Z

Dr Z
Dr Z
6 years ago
Reply to  Dave

Hi Dave,

Thanks for the article link. Great information! And thank you for your thoughts on my question. Even though you may not have any formal medical training you are 100 times more informed than many medical providers that I know! I figured I would ask for any input that you may have simply due to your extensive research on the subject. So thanks again for your wisdom and time in responding to me.

Megan

Oh, and she does have an MTHFR variant that causes her to not methylate as efficiently … but what that means in the cholesterol world. Who knows! 🙂

Joe
Joe
6 years ago

Hello Dave….

We chatted quickly on Twitter the other night, we had similar numbers and weight loss on LCHF. Here are my numbers again, before LCHF and one year later on LCHF. You said that you are taking no steps to lower your cholesterol at this point but told me to comment here for further explanation…Very interested!

Thanks….Joe

Jan 2016 Jan 2017

Weight 206 173

Cholesterol 223 373

HDL Cholesterol 65 92

Triglycerides 101 79

LDL / Cholesterol 138 265

Chol / HDLC Ratio 3.4 4.1

Non HDL Cholesterol 158 281

Joe
Joe
6 years ago
Reply to  Dave

Thanks Dave…

Very interested in what you have to say, I will keep an eye out.

Gale
6 years ago

Hey Dave,

Just wanted to say what a great job you did presenting at the Low Carb Conference.

Keep up the great work.

Gale Bernhardt

Eric
Eric
6 years ago

Dave

Love your work also loving LCHF. Got Lab work back after being LCHF for several months. Stopped 10mg Lipitor after taking for 15 -20 years six months ago.

HDL-C 71 was 46 on HCLF +10mg Lipitor
LDL-C 170 was 95 on HCLF + 10mg Lipitor
Triglycerides 65 was120 on HCLF + 10mg Lipitor
HDL-P total 34.5unmol/L first time measured
Small LDL-P 625umol/L first time measured
Large LDL-P 1552umol/L first time measured
Total -C 254 was 161 on HCLF + 10mg Lipitor

Only number that I don’t like is the Small LDL-P which is just slightly out of range it’s 625 and reference high is 527. I know your not a MD but what’s your take?

Thanks

Eric

Eric
Eric
6 years ago

Do you have any concern over Large LDL-p?

Eric
Eric
6 years ago
Reply to  Dave

Dave

Thanks again! I am still losing weight since diet change have gone from 187 to 165 in 9 months very steady slow decline. I wonder if while losing weight some how LDL-p numbers go up?

Eric

Eric
Eric
6 years ago
Reply to  Dave

Just found your interview with Ketogains https://www.youtube.com/watch?v=QUjbvK2U1D8 My A1c was 5.7 when I started changing my diet. Did your A1c lower over time how long did it take?

Thanks Again!
Eric

Eric
Eric
6 years ago
Reply to  Dave

Dave

I’m suprised your A1c is not lower. I read on Dr. Attia’s blog his hemaglobin size was small giving him a higher A1c reading than his acutal blood glouse average. He compared his A1c to the Average BG from the Dexcom CGM he was wearing. Implying the CGM average blood glucose reading is more accurate. I wonder if your hemaglobin size also is small?

Thanks

Eric

Lita Santos
Lita Santos
6 years ago

OMG I’m so glad I found you. Just heard your Breckenidge talk. I’m Jill. I’m her. 7 months on keto and took the cholesterol test and almost fell off my chair. I couldn’t believe it had shot up so much. total cholesterol went up, LDL went up, HDL went up but not by much. My ratios were worse I couldn’t see a way to explain it favourably. I wrote to Dr Ken Sokardis, Gary Taubes, Jimmy Moore, Dom De’Agostino, Stephen Phinney, Malcolm Kendrick and a few others. Most wrote back some with good news others not so much. How can I email you please? I’ve encouraged my mother and sister onto this diet – I’ve even started a degree in Nutritional science and now I am feeling so deflated. Scared to eat fat. Scared not to and put on all the weight I lost. I don’t know what to do.

Brian Williams
Brian Williams
6 years ago
Reply to  Lita Santos

Hello Jill,

I have exactly the same situation. The important things are the two ratios: TotCl/HDL and TG /HDL

As long as they are ok, I don’t worry about cholesterol. You can improve HDL with fish oil EPA & DHA.

I use this for my guidelines: “Cholesterol Conundrum – Know Your Metrics” on Youtube https://www.youtube.com/watch?v=YRFRRqe0vrE

Good luck,

Brian

Pat
Pat
6 years ago

Do you follow Dr. Peter Attia at all? He has had quite a change of position on Ldl(a)-P in the last few years mainly I think through lots of feedback from Dr Tom Dayspring. Large particle number=arterial damage. Any comments?

Pat
Pat
6 years ago

Hi Dave–Do you follow Dr. Peter Attia’s Eating Academy blog? Nice detail and for sure he has an increasingly negative standpoint re Lp(a)-P. I think from more in-depth conversations with Dr Tom Dayspring. It is indeed a hot area of research but Dr Attia seems to be settiing the tone of high-P=artertial damage (no matter the particle (i.e. any Cholesterol). Any thoughts?

Ben
Ben
6 years ago

Very cool illustration. One detail seems to need attention, though. Perhaps I’ve missed something somewhere, but from what I understand, small LDL particles and vLDL are not the same thing. I used to think they were, until I was called out on it, and did more some research on it.

Further research showed me that there are actually five major groups of lipoproteins: (1) chylomicrons, (2) vLDL, (3) LDL, (4) IDL (intermediate density lipoprotein) and (5) HDL.

LDL particles vary in size and density, as we know. Larger, less-dense particles are referred to as Pattern A LDL, whereas smaller, dense particles are referred to as Pattern B LDL (or “LDL-P small”).

vLDL is a completely different lipoprotein than LDL, and tends to have a direct relationship with trigylcerides. Higher triglycerides = higher vLDL, and smaller triglycerides = lower vLDL. However, I’ve seen cases in which small LDL particles can be high, even when trigylcerides are low.

I’d be interested to know your thoughts on this. Thanks!

Ben
Ben
6 years ago

Thanks for the clarification. It just seems easy to misunderstand from your sixth slide, which states that there are two types of LDL, and it seems to say that one form of LDL is vLDL. The 7th slide seems to state that the other form of LDL is the chylomixron. Glad to hear that this is not truly what you were trying to communicate.

Deb
Deb
4 years ago
Reply to  Dave

What is apoB?

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
4 years ago
Reply to  Deb

The identifying protein on lipoproteins like VLDL, LDL, and chylomicrons.

Brian Williams
Brian Williams
6 years ago

Hello, this is a great series! Any idea when Part 3 will be out?

Thanks!

Rafael
Rafael
6 years ago

So basically I don’t have to worry about having a 321 mg/dl cholesterol and a 240mg/dl LDL right now?

greylearning.com
6 years ago

Foods like oatmeal, apples, prunes, and beans are high in soluble fiber, which keeps your body from absorbing cholesterol.

Antonio
Antonio
4 years ago

I sense in your comment that one should be worry about cholesterol intake, which is the mantra that the medical establishment has been imbuing to the public for decades. My first question would be: Why would I need to worry about intake cholesterol? Does cholesterol cause any harm to the body? If the answers were yes, then I would be diligent in taking my oatmeal, apples and prunes everyday. But what if high levels of cholesterol is not the cause of heart injury and metabolic syndrome? This site is dedicated to throw light on this issue.

rebt.com
6 years ago

Foods like oatmeal, apples, prunes, and beans are high in soluble fiber, which keeps your body from absorbing cholesterol.

stan straub
stan straub
6 years ago

I have been on LCHF for about a year. I have lost weight, feel good. I had a cholesterol PARTICLE test done. My doctor who ordered it then called, and said “we need to do something about your cholesterol”. Before I started LCHF, my cholesterol levels were moderate, NOT high (according to the standard cholesterol test and my doctors opinion). Now they are high. But I’m not able to interpret the results, and I’m a little fearful. My doctor won’t help me interpret the results…..he just sees “high”. If I give you the results, can you help me with deciphering them? I sent them to Dr. Andreas Eenfeldt at Dietdoctor.com and he said “As far as I can see these numbers are relatively average for the population. Hard to give a more useful reply without knowing your other health situation and what the numbers looked like before LCHF, etc.”. Not too helpful.
These are my results. I would sure like some peace of mind, one way or the other, if you would be so kind as to help me.

LDL-P = 1836
LDL-C = 208
HDL = 47
Tryglicerides = 65
Cholesterol = 268
HDL-P = 26.1
Small LDL-P = 371
LDL Size = 21.7
LP-IR Score = 33

Thank you so much.

Tigris
Tigris
6 years ago
Reply to  stan straub

This is the rabbit hole many of us have fallen into, finding out that establishment nutrition/health practitioners have serious flaws in their understanding of cholesterol, but not sure what to do about it.

If your concern is CVD, from my understanding of the research, the best test is to get a calcium score from a CAC. LDL is only very weakly predictive and possibly only so because its a marker for insulin resistance.

For me, my wife is in the category of concerned and not (yet?) well-read. Getting the CAC test (assuming my result is good) will be sufficient for her to let me KCKO. As far as my doc, I’m not sure if I want to switch, educate, or ignore. I’m gathering some data using the Feldman protocol so that my next appointment will be more interesting.

Michael Lawson
Michael Lawson
6 years ago
Reply to  stan straub

Your numbers are very similar to mine. I too have been LCHF for about a year and half now and feel great because of it. My reason was not so much weight loss ,but to get relief from post concussion syndrome, which it helped greatly.

I was concerned about the LDL-P being high after reading Dayspring/Attia thoughts on this, but Jimmy Moore says high LDL-P isn’t necessarily a problem as he has carried an absurdly high LDL-P (over 3000) with a CAC of 0 and CIMT scan showing no arterial blockage.

This doc also shares the same sentiment on LDL-P:
http://azsunfm.blogspot.com/2012/09/font-definitions-font-face-font-family.html

My numbers:
http://i.imgur.com/lyzQ7nr.png

Craig
Admin
Craig(@tigris)
6 years ago
Reply to  Michael Lawson

Thanks for sharing that your numbers and that link, it was a great read. Certainly relevant for my situation.

Antonio
Antonio
4 years ago
Reply to  stan straub

My numbers are almost identical to yours and I, too, feel great with unintended weight and waist circumference lost. One other thing that gives me peace of mind is that there are no studies (which are not drug or genetic studies) that link high LDL or total cholesterol with heart injury, when Triglycerides (congratulations on your number) and HDL are good. (I am parroting Dave here).

Pieta
6 years ago

Hi,
I am a medical doctor from South Africa. Hyper-responder on LCHF. Cholesterol now at 9mmol/l (360)
would like to partake in your study.

Pieta

Vaduvur Kumar
6 years ago

Part 1 & 2 are really informative.

carmelchamba.org
6 years ago

Foods like oatmeal, apples, prunes, and beans are high in soluble fiber, which keeps your body from absorbing cholesterol.

kk lim
kk lim
5 years ago

Hi Dave,
My mum have been on LCHF for close to 10 months now and a comparison of her lipid panels shown below (before and after LCHF):

(in mg/dL)
Total Cholesterol : 313 to 444
Triglyceride : 242 to 102
HDL : 50 to 60
LDL : 214 to 364
TG/HDL : 4.84 to 1.7

1. Is she what you would consider a “hyper-responder”?
2. Obviously the worry here is the upshoot in her LDL. But I told her that all her other important markers have improved – increased HDL, reduced Triglyceride, improved TG/HDL ratio. Her BP is normal and she has reduced her BP medication by half (50% less frequent intake of BP pills).
Are her worry confounded? Or am I too optimistic?
3. She also conducted a lipid sub-fraction test and she has about 27% small LDL (percentage excludes VLDL). Her VLDL number is 51 mg/dL. I.e. she has overall Pattern B particle size. Is that something to worry about?

Thanks.
kk

Chuck W
Chuck W
5 years ago

Dave,

Enjoying your blog, videos, and cartoons!

I had a couple questions regarding lipoproteins:

Are VLDLs/LDLs _delivering_ cargo to fat tissue, _picking up_ cargo from fat tissue, or a little bit of both?

During conditions of fasting and/or low carb dieting, what is the primary energy transport from fat tissue to other tissues of the body? LDLs? HDLs? Free fatty acids?

Thanks!
-Chuck W

Craig
Admin
Craig(@tigris)
5 years ago
Reply to  Chuck W

Chuck,

Glad you found us! Fat is continually cycling through the body.

To adipose (fat tissue):
1. VLDLs deliver TG from the liver to various parts of the body, including adipose.
2. Chylomicrons deliver TG from the gut to various parts of the body, including adipose.

From adipose:
3. Adipose releases FFA (free fatty acid), which gets picked up by Albium and returned to the liver. Other tissues can tap into this stream of energy, but I’m not sure the exact uptake mechanism.

I don’t haven numbers or ratios, but I my guess is VLDL are going to be doing the bulk of the work during fasting. Especially during periods of energy demands, like exercise.

Craig

Chuck W
Chuck W
5 years ago
Reply to  Craig

Craig,

Thanks for the reply, I had trouble finding this info from other sources.

So from the perspective of the adipose cell, release of FFA is the only “way out” for fat energy?

Thanks,
-Chuck W

annie
annie
5 years ago

Hi Dave –
I think that I’m a hyper-reponder as well and would be in a study if possible.
I realize that you’re not a Dr but you do have lots of experience reading the #s and I would love your opinion.

I’m 55, female and have been on a keto diet for 7 months. I’ve lost 35 lbs and am within 5 lbs of my maintenance weight. My bloodwork prior to keto was all great. Last week I had my first blood work since keto and some of the #’s are now through the roof.
Cholesterol 302
TG 60
HDL 78
VLDL calc 12
NonHDL Chol 210
LDL-P 2274
LDL-C 218
VLDL size 70
HDL-P 27.9
My Lipidologist (who is on keto but has normal bloodwork) thinks I’m possibly a hyper-absorber.

I’m seriously concerned about CVD and would love to hear your thoughts

Annie
Annie
5 years ago

Thank you, I appreciate your response!

Jim
Jim
5 years ago

Just watched your presentation at Low Carb Breckenridge and thought it was great. I will be starting (again) a LCHF diet in January and will get some blood work for your “study”. I am going to lef.org to purchase the CBC panels for $35 each. I think that is the best price around for blood work. Do you know of another I should look into?
Just started following you on Twitter as well. Thanks for your work

jim
jim
5 years ago

Thanks for the info…and here is what Life Extension does for the $35…they do an annual sale too where you can buy a years wort of tests: http://www.lifeextension.com/Vitamins-Supplements/itemLC381822/Chemistry-Panel-Complete-Blood-Count-CBC-Blood-Test

jim
jim
5 years ago

Just noticed they call it this: Chemistry Panel & Complete Blood Count (CBC) .. Sorry for the confusion

Craig Daniel Doussett
Craig Daniel Doussett
5 years ago

Awesome

Liz
Liz
5 years ago

I’ve put my numbers into your calculator (total cholesterol 7, triglycerides 2.38, HDL 1.1, LDL 4.8 and the result seems to be “high risk”, which seems ominous! However, not sure what the implications are or what I can do about it. Been LCHF for 7 months. Was 198lbs, Hba1c of 68, cholesterol 5.6 (not sure of breakdown, but triglycerides around 7, despite long-term fenofibrate and simvastatin. In December (still on drugs, but low carb AND relatively low fat – due gall bladder flare) Hb1ac was 32, total cholesterol 3.7 and triglycerides 1.6. Since Xmas, have upped the fats, but still low carb (aim for about 50gms or less a day). I have stopped the fibrate and statin and the latest results (Hba1c up slightly but still “normal” at 35) are those given at the top of this post. Should I be concerned? Should I do something to improve the profile? If so, what? All help gratefully received!

Liz
Liz
5 years ago
Reply to  Dave

Many thanks for taking the time to reply. I can’t afford private medical care and I’m in the UK, where few GPs know anything about low carb! (in fact, having succeeded in putting my own Type 2 into remission (my Hba1c is 35) I’m about to start helping run a group for Type 2s in our medical centre hopefully inspiring them to change to LCHF! (naturally, against the standard govt guidelines, as we all know what those advise!)
On a personal note, I know I should exercise (I do none effectively) and I’m going to tweak my diet (remove fruit to a large extent – though I only eat red berries anyway) and try and up the omega 3s. Thanks again for your reassurances.

Julie
Julie
5 years ago

Hi Dave, thank you so much for the awesome research that you are doing. I’m a 56 yr old female. I’m a runner but have not been running much the last 3 months. I’d been training for a marathon and got up to 15 miles and crashed on energy levels. I also lift weights and do yoga. I’m not lean. 5’0 124lb. I’ve been doing keto for almost 5 months. BMI 24. I’ve only lost 3 lbs. I just got my fasting bloodwork results. glucose 59, ketones 2, A1C 5.0, CBC WBC 7.7, total cholesterol 494, Trig 79. HDL 153, LDL 322, non-hdl 341. I’m not sure why I’m not loosing weight, and get out of ketosis very easily. I eat very low carb, do intermittent fasting. And have started back on marathon training. Started back up with 6 miles and struggling on energy levels. Read your article on adding more carbs in. I’ve done low carb high protein for several years prior to LCHF

Julie
Julie
5 years ago
Reply to  Dave

Thanks Dave for taking the time to reply. I will look more into electrolytes. I do the Trace Minerals 40,000 volt, and Concen Trace Mineral Drops. I also take potassium and magnesium. I’ll check my salt. Thanks for the suggestions.

Jenny
Jenny
5 years ago

I’m ready for part III! Maybe you can also explain glucagon’s role in fatty acids?

Alex
5 years ago

I just saw both posts part 1 & 2 and they’re amazingly simple! Great job Dave! Looking forward for part 3 =D

Michael Tranchina
Michael Tranchina
5 years ago

I love your “disruptive” research Dave…I have been looking for answers to the cholesterol puzzle for many years…You have broken the code…I am not surprised that a systems engineer would be the one to do this…

Unless I missed it, I am trying to better understand the “inputs” that affect HDL-C blood levels…I am following your energy model with the LDL- and LDL-P, but I am still not clear on the factors that affect HDL-C?

Dawn
Dawn
5 years ago

Sorry I am a little confused about some terminology, I hope you can help me.
Is LDL-C the Cholesterol or is it LDL in my blood work?
I wish I could include a graphic with my question. But I will try to explain why I am asking. In your cartoon picture on this site you show “everyone boarding a blue circle” that is being called Low Density Lipoprotein” also know as LDL and the passengers are Triglycerides, Cholesterol and Fat soluble vitamins.
Then in this presentation at https://www.youtube.com/watch?v=jZu52duIqno&t=2178s&list=WL&index=16 at min 12:33 you ask “What is the cholesterol in this?(the boat)” and you then label the life-rafts LDL-C.
I am really trying make some sense out of this because i think it could be very helpful I have been low carb since before it was popular (like 20 years now) and my lipid numbers aren’t great but they do fluctuate. I am so interested in this!!!
Last test for me 3/1/17 chol 292, LDL 222, HDL 56, Tri 70. now learning I probably didn’t fast long enough (not a full 12 hours) and wonder now how much being a coffee drinker mattered too.

Dtree
Dtree
5 years ago

Hi Dave.

First of all- this is an amazing resource that you created- thank you so much. It really is the best explanation of the science that I’ve ever seen on this topic.

Question: Male, 35, 6’1, 185 lbs with 14% body fat per recent dexa. Life long athlete and weight stable for 10 years +. Currently 4-5 cardio sessions per week plus 3-4 weight training sessions. Started keto 12 weeks ago for general health and some GI issues.

Baseline lipids: Total: 164; HDL 63, LDL 88, Trigs-64;
After 12 weeks of keto: Total-235; HDL 64, LDL 161, Trigs 52;

If I understand correctly this is somewhat expected on keto, especially if someone is a hyper-responder. I’m not sure, however, what criteria classifies me as such (besides the 3 you list). I.e. how do I know that this rise in LDL is just due to a higher transport needs for Trigs (for energy) vs. genetic pre-disposition?

What test would you recommend to do in order to properly assess if I’m at a higher risk of CV issues, and what would you be looking for on that test? Or is the fact that my trigs went down a good enough indication that I’m ok?

Again, thanks so much for this blog. Currently devouring every article on it and sending links to friends and family.

Dtree

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Dtree

Hi there, I’m handling comments while Dave is on a hiatus for a few weeks for his anniversary.
First off – glad you’re enjoying the site and that it has been helpful for you!
Based on your lower bodyfat percentage, and switch over to a fat based diet I’m not especially surprised by your lipid profile change – it fits pretty well with others in a similar situation that I’ve seen, and with Dave’s demonstration of how the system may be working. You’ll also notice that if you run your previous and current numbers through the report tool that your remnant cholesterol has gone from 13 to 10, so both in the lowest risk category but of different degrees. More on remnant cholesterol here.

As for checking for a genetic predisposition, one thing you could do to help figure that out, is just to change the energy input. In other words, you could try to do the Feldman Protocol, and see if you get a drop. If you do, it’s likely that your numbers are simply a reflection of how you’re getting energy to your cells. Not a guarantee, but would help to suss out which it is.
Just be sure to avoid common confounders like coconut and MCT oil, heavy coffee drinking or coffee drinking on the morning of the test, and make sure to fast 12-14 hours before each test.

Dtree
Dtree
5 years ago

Hi Siobhan.

Thanks so much for the response- makes a lot of sense. I will definitely plan on implementing the Feldman protocol to test that hypothesis in the next 2 weeks. I’ll post here with the results.

In terms of additional tests: Is it advisable to have an NMR done? Or will the confirmation via Feldman protocol be a sufficient indication (along with very low CRP-.3) that CV risks are likely low? Any other test you’d recommend looking at?

Thanks so much for taking the time!
Dtree

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Dtree

Awesome! We do appreciate people sharing their results 🙂

As for the NMR, personally I’m in the camp of “more information is better so long as it doesn’t overly confuse things”. The most reliable risk marker I’ve seen for CVD is available from the standard lipid panel (remnant cholesterol) but I also don’t like relying on one marker alone. An NMR, and fasting insulin would help provide a little more information on risk, if you’re worried about it (if you’re curious about why, check out Ivor Cummins work).

Dtree
Dtree
5 years ago

Perfect, thanks so much!
Last question- I promise:
I understand the mechanism of lowering LDL by switching to carbs (Feldman protocol). But what is the mechanism for lowering the LDL by increasing the calories with high fat? Wouldn’t additional fat increase the LDL available to transport TGs?
Thanks!

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Dtree

This is because the body balances two sources of fat energy – dietary fat you just ate (transported by chylomicrons), and fat from storage (transported by VLDL, which turn into LDL once they drop off the triglycerides). As access to dietary fat goes up, need for stored fat to be transported goes down.
Chylomicrons are cleared from the system by the 12 hour mark, and when you get bloodwork done you are (or we recommend you are) 12-14 hours fasted. At that point you’re measuring the VLDL (Remnant cholesterol) and LDL.
If you increase the amount of dietary fat you take in, you decrease the need to use fat from storage, and LDL goes down as a result. The nitty gritty is explained in an article I wrote here.

Dtree
Dtree
5 years ago

Brilliant article!! Thank you!

Shantanu
Shantanu
5 years ago

This is simply brilliant! Thanks for demystifying cholesterol and more important, removing the scary halo around it.

I am now in month 14 on keto. I just got back blood results and they were consistent with this blog post. I started in Mar 2017 with an HDL 35 mg/dl, LDL 152 mg/dl and TG 62 mg/dl. Last week’s (Apr 2018) results: HDL 64, LDL 136 and TG 44. This my highest HDL and lowest TG in the 10 years for which I have records. Remnant cholesterol has gone down from 12 to 8.8.

Also, I’ve lost 60 lbs and feel the best I have in years.

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Shantanu

Glad to hear the site has been helping you on your health journey, Shantanu!
Congrats on the weight loss, and health gains!

Dr. David J
Dr. David J
5 years ago

Too many cartoons – part #1 was def better & easier to make sense of

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Dr. David J

Thanks for the feedback Dr. David! This is meant to be a “Simple Guide” so if there’s any part in particular that was confusing or needs expanding on or clarification please do comment with that, it would be appreciated 🙂

Dr. David J
Dr. David J
5 years ago

This initial thought was from someone who has read & studied a lot over the last year about all aspects of low carb lifestyle, ketosis, diabetes & metabolic syndrome + obesity, just so you know. My thought was simply that if someone like me is having some difficulty following everything you say, a lot if not most of your other readers must also have difficulty. I’ve read almost all the books written on these topics from Jason Fung’s 3, Phinney & Volek, Nina Teicholz, Dr. Perlmutter, Jimmy Moore, Dr. Bruce Fife, Dr. Mercola, Wilson & Lowery . . . I’ve got them all & they are all saying the same thing. So, thank you for confirming the science for me & making some of it easier to understand. I just think it was a lot easier to follow with only some cartoons. Great work though & from the look of it, no doubt a lot of work!
PS: The size of the print in those cartoons is so small, it’s hard to read which of course affects the reader’s willingness to keep going.

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
5 years ago
Reply to  Dr. David J

That’s a completely legitimate thought for sure! Feedback is highly appreciated, especially from someone who has already done their research into the nutrition science environment as a whole. Thank you! 🙂

Sherrie
Sherrie
5 years ago

How can you lower you remnant cholesterol? The calculator has me at medium risk – 25 remnant cholesterol. And 0.47 CHOL to HDL. – I’ve been doing LCHF for about 4 months having my #’s go up. Was at total cholesterol 258, LDL 177, Trig. 62 and HDL 69. Now Total 281, LDL 203, Trig 125 and HDL 53. Doctor wants to put me on a statin but I’m resisting. I just want to make sure I’m making the right choice but it’s all overwhelming and hard to find doctors that support Keto.

Naren
Naren
5 years ago

Hi Dave.

great article very easy to understand for a non medical person

I just wanted to tell you my case
i am currently on keto since 2 months and i have blood test done, please check below and let me know if i need to take any precautionary measures

in mg/dl

HDL 35
LDL 279
VLDL 19
Total Cholestrol 334
Triglycerides 96

Naren
Naren
5 years ago
Reply to  Dave

Hi Dave, thanks for the reply I am not sure…and i don’t think they got any blood tests done till now, but is it possible to find out if my parents have historically low hdl and if is it a genetically modified?

and in my case what is the solution to push up the HDL?

thanks
naren

Elizabeth
Elizabeth
5 years ago

I got to say I love the low carb Community. You’ll understand why when you see my results and my question.
Before keto tc 204, hdl 51, ldl 120, tg 168
After 2 years keto tc 197 hdl 62 ldl 119 tg 76
After 5 mo. carnivore tc 182 hdl 56 ldl 113 tg76
Here are the other numbers ( no base line sorry)
Vldl 28 total LDL particles 903 rlp 121 small dense LDL lll 243 sn D’s LDL lv 70 total hdl particles 6994 large buoyant hdl 2388 Apo B100 82 Apo A1 157 Lp(a) 6.4 Metabolism syndrome traits 0 CRp 3.68 fasting insulin 9.4 homo cysteine 16.1 farthing glucose 90. my lovely zero carb Health Group pointed out that there may be a possibility of MTHFR variant and I just heard from one of my brother’s that he has been tested and found that he yes indeed has that very thing. I will be 62 next month and I have eaten a standard diet interspersed with periods of Adkins on and off for 40 years, I have been 60 to 70 lb overweight my entire adult life, and lost about 50 on keto. I have gained back 5 lb on Carnivore however I expected to because sarcopenia.. my question to you is do these look like decent numbers? I take 112 mcg. Thyroid daily and my thyroid numbers are . 61 TSH 11.7 t4 and 72 t3
Thank you

Dr. Maria Lima
5 years ago

Hi Dave!
Awesome job! I wisk we have it also in Spanish!
Maybe is it possible to yranslate it? Co working with Diet Doctor?
It would be great enlightening for Spanish Spoken people. We are so hungry of learning and have right info!

Thom Manning
Thom Manning
4 years ago
Reply to  Dave

Hi Dave

I’m part of the LCHF email group that I believe and most of your “LDL” images. I also speak Spanish so maybe I can collaborate with another expert to create this Spanish version of the cartoons?

Robert Monahan
Robert Monahan
5 years ago

I know I am insulin resistant and have metabolic syndrome as a result of adipocyte and other physiological changes induced by radiation therapy as a child..I am very lean and take testosterone replacement plus synthroid. If triglycerides are very high after fasting (still above 500 after 12-16 hour fast, no coffee or tea), is this a VLDL issue? Doctor is recommending statins even though the LDL is 74 and LDL-P is ~1000? HDL is low of course..~30. The only way I have been able to get triglycerides down below 500 and HDL up above 40 is via low fat diet. LCHF improved the LDL-P with no improvement to Trigs. Is there a way for me to do high fat and to keep trigs down if there is a VLDL / insulin resistance issue?

Robert Monahan
Robert Monahan
5 years ago
Reply to  Dave

This site has allowed for the best understanding of this issue that I have come across in the last 20 years. Thanks for creating this space! The only piece I’m not sure of is MCTs. Do they count as part of the fat bomb, liquid fat category, or are they independent of the VLDL (mobile adipocyte) non-usage issue that comes with the insulin resistance? I’m struggling to see how to get enough calories if I’m low carb/keto and have limited fat sources.

MELYNDA SWOYER
MELYNDA SWOYER
5 years ago

I have struggled with hyperlipidemia. I am a nurse practitioner so of course the plan of care has always been “use a statin”. I don’t tolerate them. I have tried using lowest dose 2-3 times a week etc. While it lowered my cholesterol and LDL I noticed my triglycerides always went up! I couldn’t make sense of it. This spring I was off meds while on vacation – had steak 3 times in a week. Labs done – Total cholesterol was 300 with LDL of 200, trigs were 100. I immediately decided no beef and tried to eat very little chicken etc. Mostly plant proteins – which are high in carbs. But it’s scary to see those numbers so made an effort to implement traditional methods. By the way I am very active – I typically bicycle gravel around 30 miles a week, sometimes more, walk every day at least 3-4 miles. In July – after 6 weeks of Zetia – cholesterol lowered to 230, LDL to 130, trigs 200. But I couldn’t lose weight, felt like crap. Went off meds. Added back chicken, beef maybe once a week, lowered my carb intake – felt much better. And I immediately lost 5#. Anyway – watched your video with Zdogg. Everything made sense. Looking forward to new changes – increasing fat , lowering carbs even more.

Bryan
Bryan
5 years ago

Excellent description. Thank you!

Liz
Liz
5 years ago

Thank you so much Dave for all this amazing information. My LDL and total cholesterol jumped up after being on a low carb diet for 8 months. I’m not lean – still have quite a bit of weight to drop – so I don’t fall into your lean hyper responder category. But I’m hoping as I read more of your site I will figure out whats going on for me.

Thanks again – it’s wonderful of you to do all this research and share it with the rest of us (saving me from completely panicking about my numbers!!)

Chris Irvin
4 years ago

absolutely loved how simple this was to understand. Is there a part 3?

Siobhan Huggins
Admin
Siobhan Huggins(@siobhanh)
4 years ago
Reply to  Chris Irvin

A part 3 is intended, yes 🙂

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