There’s a special group of people that may be answering one of the most powerful medical questions of our time.
The Hypothesis
The “Lipid Hypothesis” suggested cholesterol in the blood independently caused heart disease.
From Wikipedia:
The lipid hypothesis is a medical theory postulating a link between blood cholesterol levels and occurrence of heart disease. A summary from 1976 described it as: “measures used to lower the plasma lipids in patients with hyperlipidemia will lead to reductions in new events of coronary heart disease”.[1] Or, more concisely, “decreasing blood cholesterol… significantly reduces coronary heart disease”.[2]
More cholesterol, more heart disease. Simple.
It has since morphed and changed a bit. Now some point to Low Density Lipoproteins as the problem (LDL-P, the “boats”) while others still insist it is the cholesterol found inside them (LDL-C, the “cargo”). Regardless, if you have a lot of LDL-C, you likely have a lot of LDL-P, so it is pretty much the same for most people anyway.
This is “deadly” and “needs immediate treatment” to lower the LDL-C/-P with prescription drugs. Even with the newer guidelines putting less emphasis on LDL, there’s no lack of insistence by doctors around the world on taking drugs to lower it when at high or even moderate levels. In fact, what was considered high has been continually dropped (from 130 mg/dL to 100, and now to 70). Naturally, this has resulted in more and more drugs prescribed.
Case Closed… or is it?
Last year we had a massive Consensus Statement from the European Atherosclerosis Society. In very declarative language, they state the evidence is quite overwhelming and clear: LDL is the bad guy.
Interestingly, this appears to be in the wake of many papers that are pointing to several new channels with higher associations to CVD such as Remnant Cholesterol, something I’ve written about here before.
In fact, even this EAS statement didn’t get very far before it got a paper that sought to show its many problems from the Karger group, A Critical Review of the Consensus Statement from the European Atherosclerosis Society Consensus Panel 2017.
There’s even been a quiet subtraction of LDL as a target for treatment in the new guidelines from 2013 AHA/ACC.
So what’s going on here? Is LDL a problem or not?
Looking at LDL-C risk association where HDL-C is High and Triglycerides are Low
When looking at only LDL, then one can find a loose correlation with CVD/CHD. But when looking at LDL alongside HDL and triglycerides (TG), it becomes substantially less meaningful. HDL & TG together are just a far stronger measurement compared to LDL alone.
Over the last 4 months, I’ve been pinging LDL-lowering experts, organizations, and social media at large for studies showing high LDL is giving high CVD to normal, non-treated people who have high HDL and low triglycerides. The search has been unsuccessful thus far. I even turned it into a hashtag campaign on Twitter: the #LCCholesterolChallenge. Or you’ve seen the graphic I’ve posted to help attract attention to the challenge.
Instead, I’ve found studies that show the opposite — that high HDL and low triglycerides are associated with low CVD and low all-cause mortality.
Take this Framingham Offspring study, where I even marked it up to showcase where I (and many other hyper-responders) stood in the risk category. (Colored markings and overlay mine)
In other words, if you grab everyone who had a moderately low TG (less than 100), a moderately high HDL (more than 40 for men, 50 for women) — then even if their LDL was above 130, their risk was nearly identical to someone with LDL of below 100 (0.7 and 0.6, respectively).
In this observational cohort study of 2906 men aged 53 to 74 years free of IHD at baseline, we see this relationship as well. (Colored markings mine)
You see how on the left we have people with an LDL of 170 or less vs those with an LDL of 170 or more? That’s literally just 20 mg/dL away from one of the two criterions for a diagnosis of familial hypercholesterolemia. In other words, and LDL of 170 will likely get your doctor talking to you about multiple drugs to lower your cholesterol.
Enter the Lean Mass Hyper-responder
About a year ago I wrote about this emerging profile that was becoming very central to my research. It represents a kind of endpoint to very high fat-adaption as shown in higher circulation of VLDLs, resulting in high LDL. As a class, these individuals have the highest LDL-C and LDL-P of everyone in the low carb community.
Yet they defy expectations of what we’d imagine with high LDL — the insulin-resistant, junk food couch potato. Rather, they are typically lean, fit, and have very low fasting insulin. Many of whom insist this is the best they’ve ever felt and performed in their life. I see their bloodwork on a near daily basis and it is stunning how many of them have great metabolic markers, extremely low inflammation, CIMT, and CAC scores.
I called this profile “Lean Mass Hyper-responder” (LMHR) and I had no idea how just how many of them there were when I wrote the article. Now I know they are a sizable population in the low carb community.
Many LMHRs are concerned about their cholesterol and are taking steps to change it. However, many others are completely fine with it and have no interest in living any other way. (For the record, we try to help everyone meet their goals and urge community respect for their decision, whatever it may be).
Final Thoughts
So clearly, the ideal group of individuals to test the Lipid Hypothesis are those who are:
- Free of all major CVD risks, such as hypertension, hyperinsulinemia, high waist circumference, high triglycerides, and low HDL (to name a few).
- Have extremely high LDL-C and LDL-P
If the Lipid Hypothesis is an independent risk factor, then LMHRs should be showing signs of progressive atherosclerosis and higher mortality from heart disease — and rapidly, for that matter.
I think once we get a decent sample size of LMHRs and a solid follow up period of time, we’ll have a strong answer to that question.
[UPDATE: 2020-11-01 – It has been some time since I revisited this article, but I’m pleased to share we are nearing the launch of a clinical study for LMHRs through the CitizenScienceFoundation.org and we’ll hopefully get new data on this shortly.]
I found this most encouraging: “In other words, if you grab everyone who had a moderately low TG (less than 100), a moderately high HDL (more than 40 for men, 50 for women) — then even if their LDL was above 130, their risk was nearly identical to someone with LDL of below 100 (0.7 and 0.6, respectively).”
After being keto for a year, my HDL is an all time high of 51 (never before been higher than 44), and my TG was 99 (even though I wasn’t quite 12 hours fasted). Without your work I would have no idea how to back up my hunch that my “high cholesterol” isn’t the problem the doctors make it out to be. Thanks Dave!
Hi Dave: I am still getting caught up on the discussion here after listening to you talks on the Keto Dudes podcast. I am a 52yo 121 lb. 5’2″ female. I sit in a chair all day but am active when not at work. I started eating keto at the end of March and am still in the fat loss stage of my ketogenic journey. Prior to going keto, I noticed a poor trend in my cholesterol panel although they remained within normal limits when last checked in 2017. Since I did not get a baseline lipid panel prior to starting Keto, I thought it was best to wait some time before having my numbers checked. I now wish I had requested the labs before as she just ordered labs (glucose and cholesterol panel). While I do want to see where things are now, I am a bit worried. I don’t necessarily want to biohack, I would like to time my blood draw to show the best possible outcome limiting as many confounding factors as possible. I normally IF 6 days/wk and do a 24h fast 1 day/wk. Would it be best to have the draw done after a day of (~16h) IF or following a longer (~24h) fast? Other than coffee and MCT oil, are there any other food/drink that I should avoid?
Hi Juls! I am someone who did the Intensive Dietary Management program with Jason Fung and Megan Ramos. I went through some of what you are going through and Megan’s advice was to not fast for a week before I got my blood work done. She said most people she says three days. I got 11.88 I think on my total cholesterol which freaked out everyone but I truly believe that fasting messed with the numbers. Doing a hack on my next test I brought down to about 6.45. However, they still wanted to give me statins! I have no other risk factors for cardiovascular disease. So I forced them to give me a CT Scan and the test came back with NO evidence of coronary artery disease. I am in Canada so your experiences may be different but I am here to say don’t let a high LDL or total cholesterol fill you with fear!!
Hi Hayley! I just got back from my blood draw and am now reading your response. Thanks for your advice. It reassures me that I did the right thing in holding off on my weekly 24h fast (although I have fasted within the 7 day prior, it has been 5 days). I had to look up the conversion for Canada. I have family history of cardiovascular disease but have been really healthy without risk factors. If the value turns up high, I believe my doctor will be open to monitoring it before jumping to suggest medication. However, if she does suggest it, I plan to push back. Thanks again. I’ll post my results when available.
Hi Juls,
along with avoiding coffee, MCT and coconut oil, just try to eat as you normally would, and track if you can (just taking pictures of what you eat would be fine). If possible try to time your IF window the day before the blood test so you hit about 12-14 hours fasted when you get the blood draw, and make sure that 12-14 hour fasted is water only (no tea, coffee, etc). Definitely avoid fasting longer than that as it can mess with the results as demonstrated in Dave’s Fasting Disaster post.
Considering your height and weight I wouldn’t be surprised if you fall into the camp of a Lean Mass Hyper-responder, so just be aware beforehand.
Hello Siobhan. Thank you for your response. I did my test earlier today and am still awaiting results. My fast prior to the blood draw was just shy of 14 hours. I have not had coffee and/or MCT oil for the 2 days prior. I don’t know if it matters but other than yoga, I have not done much exercise in the past 2 days due to a sore ankle. I did practice prior to my test today.
Thanks for the warning on the probably lean mass hyper-responder. I’m going to have to look that up. I am guessing that something is up with my tests as my doctor has generally released results by this time and still hasn’t.
P.S. I just watched the presentation on LMHR. I love the simplified explanation. It definitely helps. BTW, results still not made available to me.
Here are my results:
Total Chol: 302 mg/dL
TG: 102
HDL: 88
LDL: 194
Nice! That’s pretty much what I would have expected as far as results go, as I mentioned before 🙂
Siobhan: In looking at your posts on LMHRs, I was expecting my TGs to be much lower. Prior to keto, they were generally below 50. I only stopped coffee and MCT oil for the 2 days prior. I wonder if that could be a confounding factor still. Also, my morning glucose (fingerstick) that morning was 91. Yet, 3 hours later after a moderate ashtanga yoga practice the serum glucose was higher at 99. Would this be the result of the body ramping up in anticipation of more intense exercise, as I generally do on the weekends and after work?
Yes, I suspect the coffee was a confounder. There may be a bit of a withdrawal period for coffee, so it’s suggested you quit for at least 2 *weeks* prior to the blood test. Same for coconut/MCT oil (cut these for at least a week).
It is pretty typical for blood glucose to up after exercise, or before if you have a routine, but even without that blood sugar fluctuates throughout the day, or it could have just been variation in the reading from the monitor.
I find the finger sticks surprizingly can vary 10 to 15 mg between 2 sticks close together. Not expected.
Roger FYI: “Meter Accuracy Reality. … In order to be considered “accurate” and thus approved for use in at-home testing scenarios, the FDA requires that blood glucose meters provide: 99% of blood glucose measurements within 20% of lab results. 95% of blood glucose measurements within 15% of lab results.Feb 5, 2018”
Is there such a thing as a lean mass familial hyper cholesterol anyway responder ? Being apoe3/4 I looked in terror at my doctor who told me I might as well eat lard as my risk of heart disease was highly based on my ldl, yet my triglycerides are the lowest they’ve been and how is highest , I’m fit with no inflammation markers and skinny. But my cholesterol goes down (slightly) on keto, not up
Ldl 5
Hdl 1
Trig 1
Two days ago. Fasted 12 hours, black coffee only.
Tennis 4-8 hours a week. 39, 5’4, 136 lbs.
keto for 1 year. Lazy Keto, but I am high fat and I don’t cheat bc I get nausea if I taste sugar.
LDL: 202
HDL: 95
TG: 59
Hey Dave and Siobhan,
I am an Apoe4 carrier and a lean mass hyper responder.
As an Apoe4 carrier, with high LDL (Low trigs, high HDL), I have been trying to research what kind of diet would be most protective for my cardiovascular and neurological health.
Dr. Gundry and Dr. Bredesen, who specialize in Alzheimer research and Apoe4 suggest that a ketogenic diet is preferable, but the fat source should be monosaturated as opposed to saturated (animal) fat.
Do you have any insight into the benefits of mono vs saturated fats? Does the science support their recommendations? In your opinion, are Apoe4 carriers better off avoiding butter in favor of olive oil?
I’ve yet to see any real justification for it, honestly. From what I’ve seen mentioned in passing it partially comes from slightly higher LDL with satfat and apoe4, but as for what that does for CVD risk… I have my doubts that it worsens it, although I can’t say for sure. A lot of it also seems to come from research involving high saturated fat, *and high sugar/carb* – which is obviously not a wise combo, regardless of what genes you have. Yet more from epidemiology which is far too confounded by other variables (processed food? trans fats? high fat high carb?) to be worth much (as far as conclusions go).
From what I *have* seen apoe4 carriers are more predisposed/vulnerable to modern disease but – as Ivor Cummins points out – this would put emphasis on avoiding insulin resistance in general. FWIW Dave is an apoe4 carrier, from what I remember, and he eats plenty of saturated fat.
So, in my opinion, I haven’t found much of anything convincing as far as reasons to avoid animal/saturated fats for apoe4 carriers. That could always change in the future, but my stance is “unconvinced” as of now.
May I know what type of saturated fats Dave eats? Because on Mark Sisson’s article titled “Is Keto Bad For Cholesterol?” He wrote that beef fat is 50% and that most of the saturated fat in ruminant fat is stearic acid which converts into monounsaturated fat. So if Dave was consuming meat saturated fat as opposed to coconut and milk fat, then most of it became monounsaturated.
https://www.marksdailyapple.com/keto-and-cholesterol/
Hi, he does indeed get the bulk of his saturated fat from animal foods (meat from fat, dairy, eggs, etc). The stearic acid conversion thing sounded familiar, due to my conversations with Brad who had mentioned similar before. One thing he noted was that the conversion (mediated by SCD1) isn’t a constant – it changes depending on context. So, if you eat a lot of saturated fat SCD1 will go up and conversion of stearic acid to MUFA will increase, but if you eat less SFA conversion will decrease. Apparently this keeps homeostasis between different types of fats being stored in our body to maintain a certain ratio between them.
Interestingly, Brad wrote a blog post on SCD1 and mentioned at the end it’s upregulated by dietary sugar (perhaps insulin signaling?). So, it appears it’s certainly not a 100% conversion and what percentage will be converted may depend on the overall diet composition and other context pieces.
Additionally, saturated fat in ruminant fat isn’t 100% stearic either, there is also palmitic so that may need to be factored in too. I don’t know that it’s always mostly stearic either, how much palmitic depends on where the fat is afaik (e.g. kidney fat has more stearic but iirc subcutaneous fat has more palmitic).
I’m definitely no expert on these topics though, and would definitely differ to Brad and others who’ve looked into it more than I have on these topics. This is just what I’ve picked up in passing and follow up questions.
Hi.
I am uk based but think I fall into LMHR.
Been low carb 3 years, work out 5-6 days a week and am 5ft 10 and 62kg. Waist to height ratio 4.4. Had an insurance medical(wish I hadn’t) and shocked to find cholesterol 360 but T/G 71 and HDLP 104. Worrying level of LDL 239.
Reassured to find your site but now awaiting an appointment at a specialist lipid clinic and think I know what they will say. Stop diet and taken a statin- even though I’m female, 65 and this would be primary prevention!. Would like to be brave enough not to go but have a medical background and years of the old way of thinking difficult to shake off. Will take the Farmington study you highlight with me but would you suggest anything else that might sway them
Sheelagh
Hi Sheelagh,
Apologies for the very late reply on this, we ran into some issues with accidentally comments and were luckily able to recover them albeit a bit late…
It certainly does look like you fall into the camp of a lean mass hyper-responder 🙂
We have a few highlighted studies you might feel will be useful to bring (or just read for yourself), right here:
http://cholesterolcode.com/top-ten/
Especially #10 , #3 , and #1.
As two of them point out that, in women, the higher the cholesterol the lower the death from all causes. With no real cut off point… which is interesting to note, and raises some interesting questions.
Additionally, another one mentions that in those with genetic causes of high LDL it isn’t the LDL level that determines their risk of heart disease, but rather their level of insulin resistance and fasting insulin.
But the other thing is whether or not you take the medication they prescribe is entirely your personal decision. So, I would really just recommend in general that people do their own studying and decide for yourself if you want to take it or not.
maybe the game starts now ….
http://www.mdpi.com/2308-3425/5/3/36
Ah yes, the proteoglycan theory.
Hi Dave, Can you explain to me why in the last decade my TG’s hover between 0.7 & 0.9 and my HDL between 1.4 & 1.65. And, I have a CAC score of 230…LDL by the way in the same time has been between 3.0 & 3.9
No, that’s an extremely context-specific question. But I can tell you that lipid panel looks good to me. HDL and TG look quite optimal.
Listened to your podcast recently on Ketogeek. My quick story – I am a 52-year-old female runner and started keto in Feb 2018. I was religiously keto for 4 months and as I slowly dropped the baby weight from 4 pregnancies, I allowed a few extra carbs into my diet but have kept it low carb. It is now October and I am down to 137 lbs at 5′ 6.5″ which is almost 20 pounds less than where I started! My goal is to get a little closer to my pre-kid weight but I am very close. I feel great and hope it will help my ultra running goals. But enter the dreaded blood test! I have not had a blood test in a few years so I can only compare to 5 years ago and my numbers are crazy high.
2/12/13 9/28/18
Cholesterol/HDL Ratio <5.0
2.9 3.2
Cholesterol
50 mg/dL
54 81
LDL Cholesterol
<130 mg/dL
89 168 H
Triglycerides
<150 mg/dL
61 68
The second set is the new numbers. My HDL & triglycerides still look good. Also, my fasting glucose was 84 down from about 90 a few years ago.
The QUESTION – how do I deal with my dr if she wants to put me on meds? I would like to avoid this if possible. I am taking a heaping tablespoon of MCT oil in my coffee each morning so I can stop this. Any other discussion points with my doctor? I see her tomorrow. THANKS!
Something to keep in mind is that your doctor is working for you as a health consultant. She can suggest what she thinks is best, but it is ultimately up to you whether to follow that recommendation.
What I did when I was in your position was I did my own research – not just from one source, but from many different sources – and came to my own conclusion about whether medication was right for me. Just recently I also brought some of the studies mentioned in this article, as well as this one, to my doctor as a conversation starter.
These are the 2 studies you mentioned in the podcast with PA, but you didn’t get to go into detail on them. They present the data and conclusion exactly as you described it. Frustrating that you couldn’t get there.
Has Peter helped you (since the podcast) to get access to other data that can be analyzed.
Keep up the good work,
Mark
If LFH were to serially test there CAS say yearly and it is not increasong @ oh maybe non, it would be the fastest way to get support fir your theory. Invidence og CV events will not prove it till i die of old age. (74 years of age)
Hi, my name is Deni. I’m a 57 year old woman. I’ve been on the Keto diet since August 2018. I had my blood drawn on 10/12/18. I had been doing intermittant fasting (16:8) for at least a week before my test, though I would have a tbls of butter & MCT oil in my coffee every morning, so not a true fast. I fully expected great results especially because I was feeling amazing, had dropped 13 pounds, and was more active and energetic than I’d been in a long while. My results: LDL 185, HDL 79, Tri 58.
Also, my TSH is 5.19 (My voice definitely has changed)
I meet with my doctor this week and I know she is going to want to put me on drugs but after researching online and reading and listening to your studies as well as so many others, I have a real peace of mind and will not take drugs. I want to continue this course I’m on and give my body more time to adjust to all these changes. I feel too good to go back. I feel better than I did at 30!
Curious to know if your doctor recommended any medications?
I’m going through the same thing. Elevated total cholesterol but HDL is high.
I am so glad to have found this site. I have been following LCHF way of eating for the past 7 years & have been watching my cholesterol gradually rise until last month where I found it had skyrocketed. Total cholesterol 11.5 mmol HDL 2.34 mmol Triglycerides .06 LDL 8.9. Needless to say my doctor was horrified however was a little placated by the HDL & TG levels. Of course, because it has been hammered into us over the years that cholesterol is so “bad” I am a little concerned myself. Should I be trying to do something about this?
Hi Anne! It looks as though you’re a Lean Mass Hyper-responder, AKA someone who is lean and/or active and powered by fat! Unfortunately the science is still ongoing regarding the question of whether someone with high cholesterol (but great markers otherwise) should worry, although there are some hints that this may not be a high risk profile in-and-of-itself. But that’s obviously not a guarantee. There’s also this bit regarding women and cholesterol which is something I’ve found fascinating (seemingly less over all death in women with higher cholesterol).
I think the best bet is to look into the research and see what conclusions you draw (not just research from this site, but from multiple viewpoints). There’s a lot of great discussion going on at our Lean Mass Hyper-responder facebook group on all sides of the issue, that you might find helpful, as well.
Thanks Siobhan – I have been doing a lot of research & whilst a lot of it is very technical & involved I have gleaned a little helpful information. I am 64 & have always tended to have a “higher” TC (usually around the 7 mmol/l mark but not sure what HDL was as no-one ever worried about anything but the TC back then!). I have always managed to regulate it with diet so when I went low carb 7 years ago I noticed a continual increase but it wasn’t until this last test a month ago that it went so high. I had been eating a lot more double cream & I suspect that may have caused the spike along with a small weight gain. I have given up the cream & have actually lost weight again so maybe that may have some influence on my LDL. I will continue my experiment & re-test in the New Year. Thank you again for your response & links.
Dairy and liquid fats can be such a bother! I experienced the same when I dropped dairy (lost weight, then regained when I reintroduced).
Generally though as people get leaner their baseline LDL goes up if they’re on a high fat low carb diet, and then on top of that the results are heavily influenced by what you’ve eaten in the past 3-5 days before the blood draw (that’s why I try to picture log my food before blood tests!)
The next test should provide a bit more information though 🙂
I am seriously worried as my cholesterol is off the charts, more so than what I hear from others:
HDL: 72
LDL: 277!!
Tryglicerides: 113
Cho total: 372!!
At least inflammation is 0.3, phew. But does this mean I need to quit keto?
I am a couch potato so I might not fit this “lean mass” profile. I am 44 years old, female, 5’5 and 134 lbs.
What to do next?
Many thanks I’m advance
Hi Denise!
Were you 12-14 hours fasted when you got this blood draw done? I ask because the only thing that stands out is the slightly higher triglycerides than I’d expect for that profile in a low carber.
For what it’s worth LMHRs are generally “lean and/OR active” so you don’t have to be an athlete or stick thin to qualify. I’ve seen plenty of Lean Mass Hyper-responders with bodyfat at around <23% if female. There are definitely sedentary/less active Lean Mass Hyper-responders around, as well.
If your triglycerides are normally <70 mg/dL or so when 12-14 hours water-fasted I would say you qualify.
Hi Siobhan,
I should provide more details:
I was fasted and had given up coffee for the 10 days prior to the test. Calories were normal for that week (I eat about 1300-1500 depending on the day). I am still losing some weight: I started keto about 4 and a half months ago, lost aprox 18 lbs. Right now, at this calorie intake, I am losing about a 1/2 lbs a week.
My last physical (roughly 8 months before starting keto) looked a lot better:
10/25/17
-==== CholesterolCode.com/Report v0.9.3 ====–
…40 years on Standard American ::: 10 hours water fasted…
Total Cholesterol: 222 mg/dL 5.74 mmol/L
LDL Cholesterol: 140 mg/dL 3.62 mmol/L
HDL Cholesterol: 73 mg/dL 1.89 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: 0.12 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.56 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 140 | Iranian LDL-C: 106
Total/HDL Ratio: 3.04
TG/HDL Ratio in mg/dL: 0.63 | in mmol/L: 0.28
Then I started keto about the end of August, do about 25g net carbs a day, dont count fiber. I went in for my physical on 11/15/18:
(I think i fainted when I read these)
–==== CholesterolCode.com/Report v0.9.3 ====–
…4 months on LCHF (20g to 25g carbs) ::: 12 hours water fasted…
Total Cholesterol: 391 mg/dL 10.11 mmol/L
LDL Cholesterol: 291 mg/dL 7.53 mmol/L
HDL Cholesterol: 77 mg/dL 1.99 mmol/L
Triglycerides: 113 mg/dL 1.28 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 23 mg/dL 0.59 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.3 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.192 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 291 | Iranian LDL-C: 280
Total/HDL Ratio: 5.08
TG/HDL Ratio in mg/dL: 1.47 | in mmol/L: 0.64
My doctor and I were in shock, we re did the test, this time, I quit coffee for 10 days prior just in case. I got almost exactly the same, this was done on 12/8.
-==== CholesterolCode.com/Report v0.9.3 ====–
…4 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 372 mg/dL 9.62 mmol/L
LDL Cholesterol: 277 mg/dL 7.16 mmol/L
HDL Cholesterol: 72 mg/dL 1.86 mmol/L
Triglycerides: 113 mg/dL 1.28 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 23 mg/dL 0.59 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.32 >>> Medium Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.162 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 277 | Iranian LDL-C: 269
Total/HDL Ratio: 5.17
TG/HDL Ratio in mg/dL: 1.57 | in mmol/L: 0.69
——–
The big question is what to do next:
I have started exercising (hiking 3 times a day, walking 7-10k steps daily).
I added an omega 3 supplement
I am taking probiotics
My fats: I get at least half my fats from olive oil, avocado, macadamias. The rest is from meats and dairy. Rarely do bacon and pork rinds. Never coconut or MCT oil.
Ordered 23 and me test, I wanna find out if I am Apo2 or worse, Apo4.
That is all I can think of. I feel better than ever, except for those numbers. What to do next? (any other test you recommend for cardiac risk?). I am concerned. Is this normal or am I somehow defective and should not do keto? 🙁
My doctor is giving me 3 months do get those lower somehow or else…statins :-0
BTW oh my gosh, thanks SO MUCH for listening 🙂 and I should mention most times my ketones are about 0.8-1 when lowish, 1.5 to 2 when highish.
Hi Siobhan! Have you had a chance to look into this? Any advice greatly appreciated. Many many thanks and happy holidays
Hi Denise — I hope you don’t mind me jumping in for Siobhan as she’s enjoying the holidays off. 🙂
Firstly, your trigs being at 113 are surprising given your profile, but not what I’d consider a bona fide red alert. I would just assume it would be lower, that’s all.
Second, bear in mind if you lessen the amount of food you eat (particularly fat) in the few days before the blood test, this will likely result in an increase of both TG and LDL.
Lastly, if you aren’t already, consider tracking your food closely and sharing it on keto forums. This can help to better narrow down the possible influences.
Apologies! As Dave stated I was on holiday – I’d pretty much go with what Dave said. Considering your trigs were lower before and assuming you haven’t changed much, it could very well be just a one-off number. Triglycerides can be a bit noisy, so with a followup test I’d guess it’ll go back to normal if none of the other possibilities (improper fasting, etc) were likely. This has happened to me as well.
Second, I’ll reiterate what Dave said – I was asking out of curiosity, as they are *slightly* higher than I would have expected considering the profile, but not something I’d be concerned by if I saw it on my own panel. But, I always try to doublecheck that it isn’t potentially being caused by something else before assuming it’s nothing.
What I’d likely do in your shoes is just re-test, making sure confounders aren’t involved e.g. making sure to properly fast, no coffee on the morning of the test, etc, and confirm it doesn’t go higher, and/or returns back to your normal. Track your food for the week before the test so if it doesn’t go back down you can troubleshoot if needed/desired.
Hi Dave, So happy I stumbled on your work. I am 58, 128lbs. I do regular HIIT training and meditation. I eat a whole foods, low carb, high fat (MCTs) diet. I have high LDL-C, high HDL and low TGs and low C-RP. No signs of CVS. I’ve had a full cardiac workup, no signs of CVD. I refused statins. I can’t find a study that shows I’m in danger of a CV event. And no study that shows statins will lower my risk of a cv event. I saw what statins did to my Dad. Convinced his CVD,leg and back pain were caused by statins and eating a low-fat high, sugar diet. And guess what? He died of a heart attack. Thank you for pursuing this LDL-C issue. For now, I’m going to keep doing what I’m doing.
Hi i’m Chris at 43 i had open heart surgery i underwent a type A Aortic Dissection ( dacron aortic arch with a mechanical heart valve installed). I was persistant with recovery and two years later i had my first ever exercise stress test the Bruce Protocol stress test It was a breeze i did 20 mets on the Bruce Mets Scale that’s as high as it goes. Around the same time i was prescribed 20 mg lipitor i’m considered to be in a high risk category therefore LDL cholesterol is to be maintained under 2 mmols I was 5’8″ 155 lbs. Four years later i had a severe case of Infectious Endocarditis it ruined my Mechanical Heart Valve and popped a stitch so now there’s a 5.5cm Psydo Anurism on top my heart . Infected heart tissue flaked off and settled in a artery in my foot blowing out that artery which had to be surigically removed . Luckly it settled in my foot and not gone to my brain or i wouldn’t be here right now. At this moment i am awaiting open heart surgery to try and redo my Type A aortic dissection . There no lifting an no strenuous activities .
Around my 52 birth day in July 2018 a friend told me about the keto diet . I read everything i could find and still do fine tuning it . November 8 of 2018 i trashed my Lipitor 20mg cold turkey i feel great lots of energy mental clarity great blood work results other than total cholesterol and LDL which my Dr is freaking out about . Since my LCHF lifestyle I’ve dropped 5 prescription meds . Still taking amolidipine 10mg and coversyl 6mg both for blood pressure BP kept around 110/60 and also 14mg warfarin daily due to the mechanical heart valve . I want to be in shape for the next open heart surgery.
I kept most of my bloodwork ever done over the last 9 years . Its now been 7 months on a LCHF diet and loving it
7 months LCHF
Latest bloodwork was on Feb 8 2019
Hba1c 4.6
lipid profile
Cholesterol 302
LDL 224
TRIG 61
HDL 71
Remnant cholesterol 7 MG/DL lowest risk quintile
Remnant cholesterol to HDL 0.1 lowest risk quintile
Atherogenic index of plasma -0.426 lowest risk third
Conventional Markers Frieldwald LDLC 219
Iranian LDLC 183
Total/HDL ratio 4.25
TG/HDL ratio mg/dl 0.86
Wow – that sounds like quite a stressful ordeal – I am glad you are still with us, today!
I am glad you’re feeling better, and have more energy, that must feel great. 🙂
As for your panel, it looks like you are, or are a borderline, Lean Mass Hyper-responder. You might want to check out the Lean Mass Hyper-responder facebook group as there’s a lot of great studies, and discussion there.
As of March 5 2019 i had a Cardiac Calcification Score finally putting to rest my fears of any high cholesterol and high LDL numbers . There was no sign of plaque in my arteries . I’d lie to now have a cholesterol particle size test done but it seem as if no one in Yarmouth Nova Scotia is familiar with the lab test.
Regards Chris
You should be able to order it through a lab ordering service. There are a couple listed at the bottom of this post, as well as in the comments.
Hi, I’m in Nova Scotia as well and can’t seem to get a CAC score…..curious to know how you got one?
Hi there I’m sure you read my post prior. I have no use for a General Practitioner . Believe me if i need a aspirin or band aid i’ll supply my own . The only reason i have a GP is to renew my meds from my Surgeons at the Halifax Infirimary They are incredible . I threw my LIPITOR in the garbage after doing my own research 3.5 years ago. My cholesterol numbers are Great in my option and opinion of the ATHEROGENIC INDEX OF PLASMA so my GP was constantly bitching about it “Follow the Numbers supplied by Big Pharma ” .
So prior to my next Gated CT scan app at the Infirmary i asked the Cardio clinic to tack on a CAC Score since they were already doing a CT scan . So they did .I have no plague 0 so I have no Place therefore nor need for any statin .It finally shut the GP up about my Cholesterol Numbers . I also got myself a prescription of metformin due to the longevity study i researched .Most GP would not even know what a CAC score is they only follow the numbers ; Its shame they don’t start looking at the Disease and not following Big Pharma … I’m sorry i couldn’t answer your question fully ; But be persistent hopefully the GP will finally clue in … Or keep in mind if you have a CT scan of your Chest to ask them to perform one .
Due to covid my yearly Gated CT scan is 4 months Late but it will happen and Its been a couple years since my last CAC Score i’ll ask for another one and my Surgeons will walk me through it Again …The staff and My Surgeons at the Infirmary / Dalhousie school of Medicine are incredible .I have all praise for them and their Cardio Vascular Staff…
Of particular note are Christine Herman ,Jeremy Wood , Idris Ali ….Thank you and your staff…
Regards
Chris Cottreau
thank you for all the great information and studies you have posted. 🙂 Just got my labs back and my DR was seriously wondering why i wasn’t as disturbed as he was , by my Cholesterol results.. Well, I did actually expect a change but this was big. Mind you, I am 54 yo – 118 pounds – 16% BF, i spend 2 hours in the gym, lifting, 4 days a week, own and operate a plant nursery, so clearly active – I don’t smoke, drink alcohol, or eat anything other than animal kingdom. Here are my numbers:
HDL=110
TG = 40
LDL = 227
I have been in ketosis for over 3 years and carnivore for 7 mos….. If i have understood all that you wrote, my take away is that the reason for the large number of LDLs is more than likely due to carrying the higher volume of FAs around. Did i get that somewhat correct?
Yes, that’s the current leading hypothesis for the rise we see in Lean Mass Hyper-responders (as you are – or standard hyper-responders) is that more VLDL are sent out to shuttle around more triglycerides, due to their being a higher demand for global transport of fat-based energy, and so there is higher turnover and resulting higher LDL. 🙂
Thanks for great info
I’m definitely a hyper responder, and at the same time a cardiologist, so you can guess that maintaining my low carb diet is such a challenge!
I have a question about my fasting glucose. It is always around 100. Do you have any explanation why it is so high?
Do you think maybe its the Dawn cycle whereas your liver is creating the extra carbs at wakeup time to get your body ready for the day . If your super low carb your liver will break down amino acids to make the carb …. GYLCONEOGENESIS ?
So interesting!
I follow a carb cycling diet so that I eat about 100 grams of carbs on non-training days and 300 gr on training days. I do weight lifting 4 days a week.
Is it possible for somebody like me to be a hyper responder? Because I don’t really follow a strict low carb diet.
Here are my numbers:
Chol: 318
TG: 82
HDL: 71
LDL: 229
Thanks for reply
OK- I’ve just successfully completed the Feldman Protocol.
Background, I’ve been prediabetic until just this past January, when my HbA1c went to 5.7 from 6.1 after starting a LCHF lifestyle. In January, I got my annual lipid panel, and I came back approaching hyperresponder territory, and I got “The Talk” about my high LDL numbers. My 2017 test unfortunately only measured total cholesterol and HDL, which were 226 and 55 mg/dl respectively. Then January of 2019 (after 6 months of LCHF), 272 total, 56 HDL, 187 LDL (calculated), and 147 TG. Then “The Talk,” and a promise to re-test in 3 months. So here it is, and 3 months ago I cut out coffee completely, and started drinking black tea with 1/2-and-1/2. Three days ago (Wednesday, today is Saturday), I started the Feldman Protocol, eating 4000+ calories/day of at least 75% of calories from fat. Saturated fat varied, but averaged around 20% of calories.
Today’s results, why I’m happy to share- 230 total, 58 HDL, 134 LDL, but 190 TG. So it worked, I’ll get the follow-up to “The Talk” at my next appointment (Friday).
Looking at remnant cholesterol, I was healthier 3 months ago, but still in a riskier territory. And looking at TG, I’m not sure why it went up. I was expecting it to go down. I was 12 hours fasted for this latest test.
And for the record, I’m mid-40’s, BMI of 21, and I exercise regularly.
Just wanted to add another data point, please feel free to send any questions my way, I’ll check this comment thread for any responses.
Thanks so much for the added data, Nathan! Great story.
I wouldn’t put too much stock in the higher TG at the end of the protocol — you might have hit your overage point. See how it looks on the next non-protocol (regular) blood test for comparison.
I am a 45 year old male and have been on a LCHF diet for the last year. I decided to go on LCHF diet once I reached a weight of 208lbs. I am 5’10”tall. I have lost 30 lbs and have been able to keep it off. I feel better now than I have felt in a long time. I recently had my blood work done. My HgA1c is 5.3 and fasting insulin is 4.7. I recently had my first lipid panel done since going LCHF. My TG are 64 and my HDL is 64. However, my total cholesterol is 302, VLDL calculated is 13, and LDL calc is 225. My results prior to starting LCHF were total cholesterol 181, TG 95, HDL 46, LDL-direct 120. I am a relatively actively person (I run/walk 3-4 days per week and work outside doing yard work on the weekends). Needless to say I a bit surprised by those numbers. I am wondering if I am a hyper-responder? I am getting ready to go to my primary care doctor and am guessing they will want to put me on a statin which I am not excited about. I am wondering if I should have advanced lipid testing to determine particle size or a cardiac ct scan. Any suggestions? Thank you
Certainly sounds like a hyper-responder profile! If in your position, I’d also want to get a baseline CAC (cardiac CT scan), plus check into other markers of risk like hs-CRP, and insulin just to keep an eye on things, as you have been doing. And of course it’s always worth noting that it is your doctor’s job to suggest what they think will help you reach your health goals, but it is yours to decide if you think it will help or not.
My fasting insulin is 4.7. My hs-Crp is 0.5. I had a CAC score of 0. Also my NMR results are the following. LDL-P 2563, LDL-C 242, HDL-C 56, TG 75, total cholesterol 313, HDL-P 32.8, small ldl-p 820, ldl size 21.5, , ldl size 21.5 (21.5). I was very happy to have a CAC score of 0. What do you think? Any suggestions based on this new data?
Hi – seems you are ahead of the game. 🙂
The NMR and the rest look like pretty much what I would expect. Ultimately it is up to you to decide what to do, as the research on this sort of profile is still being done. While I can’t say what you *should* do, what I would do in your position is read up on the research and go with what makes you most comfortable longterm. For example there is Dave’s presentation on risk here, a view from a more skeptical point of view from Dr. Nadolsky here, and Dave’s #CholesterolScience playlist – all great condensed resources.
If you wanted to discuss with other people with similar lipid profiles/results you could also check out the CholesterolCode facebook group if you haven’t already, as well.
I hope that helps get you started!
Hi Dan. My name is Cathy Blair and I recently came across your post. I have almost the same profile numbers as you in all categories. I was wondering what direction you’ve taken to lower the ldl-p and other numbers that were out of line… I don’t do Facebook and was hoping to glean info from you. Thanks much!
I’m a 48 year old male. 70.9Kg, 1.76cm tall with a waist circumference of 75cm. I’ve been Low Carb (and Carnivore latterly) since November 2018. I feel great in lots of ways, as expected.
I had my bloods taken last week. The doctor called within 36 hours to say I needed them to be retested to ensure the readings were accurate: My total cholesterol is 15.4 mmol/L with an HDL of 2.19 mmol/L, an LDL of 12.17 mmol/L and my Triglycerides are 0.7 mmol/L.
I have approx. 7% body fat. I train hard 5-6 days a week (mostly resistance, some HIIT) and have done so for 30 years. My average carbs are <= 5g a day (1% of my daily intake in grams, not calories). My Ketone levels rarely go above 1 mmol/L, and my fasting Glucose is typically 5mmol/L.
All this seems to suggest I am LMHR.
However, I was told that there were concerns with my kidney and liver function. My Serum urea level (XM0lt) was high at 9.6mmol/L (with the acceptable range being 2.5 ~ 7.8). Also, my liver function test showed Serum alanine aminotransferase (XaLJx) was high at 62 IU/L (with the acceptable range being 0 ~ 55). Should I be concerned about these two readings?
FWIW, my doctor said she wasn’t at all concerned by the elevated ALT and Serum urea levels. My own research made me conclude that the ALT level was raised because I had exercised VERY hard two hours before my blood test. Similarly, the serum urea level was likely because I was slightly dehydrated.
Yes — it’s my understanding on both. Exercise can, of course, impact inflammatory markers like C-Reactive Protein as well.
what does OR and CI stand for on the tables?
Odds Ratio (multiplier vs the baseline being compared to) and Confidence Interval (roughly – the range within which there should be only a 5% chance this number did not reflect the real world, or universal, value).
Dont really know how this works. I am 51 yrs old. Just got my first low carb oriented blood work and am looking for references to compare to or just low carb oriented references to look at. LDL-P 1710 / LDL-C 150 / HDL-C 60, TRI 56/ total Cholesterol 221/ HDL-P(total) 35.4/ Small LDL-P 426/ LDL Size 21.3/ Glucose 90/ LP-IR Score 36. My CAC is 110 which I did about 7 months ago. Will do it again in Jan 2021 to check if lifestyle change made a difference on progression
Hi, you can run your numbers through our report tool – this looks at calculated risk according to a couple different studies. They’re not necessarily low carb, but they do take into account additional context (e.g. HDL and triglyceride levels). You might also want to check out the Cholesterol Code facebook group, as there are many additional resources posted there, as well as a lot of great discussion. If you saw your LDL increase significantly from low carb you would be what’s referred to as a hyper-responder.
There are many people with videos/presentations on how to interpret lipid data in low carbers – Bret Scher, Nadir Ali, Ivor Cummins, Ken Sikaris, Sarah Hallberg, etc. Dave, of course, also has a presentation discussing the lipid energy model which may be relevant as it discusses the potential impact of fat metabolism on lipids.
Although we’re not doctors and can’t give medical advice, I can say that generally, what we’ve seen in low carbers/metabolically healthy people is that LDL-P tends to be LDL-C x10 +/- 15% or so (which yours is), and small LDL-P tends to be <30% of total (yours also fits this general trend). The LP-IR is interesting - usually in what people have submitted so far I see <25, but this can also vary a bit so I like to see a general trend just in my own results.
You didn't post this information - but were you 12-14 hours water only fasted for this test? This can impact the results, so I always like to double check fasting time out of curiosity.
yes water only 13 hours. thank you for your response
No problem – if you’re looking for anything else in particular feel free to check back and I’ll see what I can do to help out
Hi Eric.
My info is similar to yours. im 51 – CAC of 192 in Jan, Started Keto thereafter as well as 6-8x a week inter. Fasting.. Also started a K2 MK7 regimen (180mcg K2 as well as magnesium, vit D3 and vit C). – are you doing that as well, or just the diet? Curious on your results in 2021 but was wondering if you were doing the vitamin thing too.
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 50 • Coffee: 4 cups/day •
• 8 on months on LCHF (20g to 120g carbs) •
• 18h water fasted • Cholesterol Rx: false •
Total Cholesterol: 281 mg/dL 7.27 mmol/L
LDL Cholesterol: 210.4 mg/dL 5.44mmol/L
HDL Cholesterol: 53 mg/dL 1.37mmol/L
TG Cholesterol: 88 mg/dL 0.99mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.141 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Medium Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 18 mg/dL >>> 0.2 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 210 | Iranian LDL-C: 196
TC/HDL Ratio in mg/dL: 5.3
TG/HDL Ratio in mg/dL: 1.66 | TG/HDL Ratio in mmol/L: 0.72
my next blood test is on. Feb-2021.
Bit worried about my high LDL levels.
High, I’m 46, lean and muscular (around 12% BF), strength training for the past 20 years. I’ve my blood test done after 8 months on keto-carnivore and as a result my LDL skyrocketed.
I do IF since 5 years ago, every day 16/18 hours sometimes more. Before I went carnivore my diet was carb/fat cycling, high protein, only hole foods and animal sources.
As a result, I’m trying to learn as much as possible of LMHR phenomena, I’m feeling and performing fantastic on this diet and enjoy it.
This is my pre and post labs:
LCHF Carb/Fat cycling:
Total Cholesterol: 350
LDL: 248.6 mg/dL
HDL: 80 mg/dL
TG: 92 mg/dL
Keto Carnivore:
Total Cholesterol: 679
LDL: 570.8 mg/dL
HDL: 92 mg/dL
TG: 63 mg/dL
Thanks for sharing your results and the context around them! Although I’m not a doctor and thus can’t give medical advice I can comment on what we’ve seen in people thus far – both results look pretty close to a Lean Mass Hyper-responder profile, although the more recent one is more prominent. This would make sense if your carb consumption dropped off (as it would with carnivore) and relying more on fat, based off of the trends we’ve seen. • • • Cholesterol Rx: false •
If you haven’t already you may want to check out the presentation on LMHRs from Dave, the Lean Mass Hyper-responder facebook group and you might want to keep an eye on the Citizen Science Foundation which is currently working on funding and putting together a study on Lean Mass Hyper-responders.
I’ve also run your current numbers through our report tool:
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 46 • Coffee:
•
•
Total Cholesterol: 679 mg/dL 17.56 mmol/L
LDL Cholesterol: 570.8 mg/dL 14.76mmol/L
HDL Cholesterol: 92 mg/dL 2.38mmol/L
TG Cholesterol: 63 mg/dL 0.71mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.525 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 16 mg/dL >>> 0.14 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 574 | Iranian LDL-C: 482
TC/HDL Ratio in mg/dL: 7.38
TG/HDL Ratio in mg/dL: 0.68 | TG/HDL Ratio in mmol/L: 0.3
———OUR COMMENTS———
**This does not constitute medical advice**
• Your triglycerides of 63 mg/dL are typically considered optimal.
• We would consider your HDL of 92 mg/dL as strong.
• The combination of your LDL cholesterol, HDL cholesterol, and triglycerides meet “Lean Mass Hyper-responder” cutpoints. This profile tends to have LDL cholesterol around 200 mg/dL or higher, HDL cholesterol around 80 mg/dL or higher, and triglycerides around 70 mg/dL or lower. Typically, LMHRs are lean and/or athletic and we propose a mechansitic reason to explain this. (For more on Lean Mass Hyper-responders, visit cholesterolcode.com/LMHR.) For a deeper explanation on our proposed mechanisms for this when powered by fat, see CholesterolCode.com/model.
Hi Dave/Siobhan,
I am 36, 54Kg male 5’7″. Since last two year i have been following intermittent fasting for around 18-20hours for 6 days/week. (Max 5% cheating days). I am quite physically active. Running/Swimming/Horse Riding/Trekking regularly.
I can’t find my report of 2 years ago but it was normal and i just got my lipid profile done and it’s totally off the charts.
Sr. Cholestrol: 232
Triglycerides: 163
HDL: 46.6
VLDL: 32.6
LDL: 153.2
Total Lipid: 803
The only change in lifestyle i have made in last two years is the fasting. I got worried and was looking up online and found your articles. Am wondering if you have any inputs on these? I am not very convinced with going to doctor and reducing these numbers by medicines. It feels as if the only thing that will change is the numbers not my health.
I am feeling perfectly fine. In-fact ever since the IF i havent’ fallen sick. I feel much better and energetic even during high activity days.
Hi Mukesh, you mention adding in fasting recently and thus seeing a change in your lipid profile. I’m not a doctor and can’t give medical advice, but two questions immediately come to mind.
* Were you water-only fasted (no coffee, no tea, no caffeine, water only during the fasting period)?
* Did you fast for 12-14 hours prior to the blood draw (no more, no less)?
Typically, in our experience, fasting less than 12 hours, or significantly over 16 hours, especially as you get closer to the 24+ mark can result in confounded (unusual for the person/suggesting something interfered) lipid results. Especially if the test was not water-only fasted (e.g. had coffee, tea, caffeine, etc during the fasting period prior to the blood draw).
Does it sound like any of these fit with your situation?
Thanks a lot Siobhan for the reply.
My schedule for last 2 years:
6:30AM – Coffee (Espresso – fresh ground/no milk/no sugar – 50ml)
11AM – fruits/nuts
3PM – Lunch (Vegetarian)
Rest of the time it’s only water and nothing else.
I got my blood drawn for test at 7:15AM. So that means i was on water fast for 16 hours (3PM was my last meal) and I had a coffee 30-45 minutes before the test.
Do you think I should try 12 hours fast and no coffee for a few days and then get the tests done again?
Hi Mukesh – if it were me I’d likely just re-test 12-14 hours water only fasted (no coffee, no tea, no caffeine) while eating to your normal for the week leading up. It is not super uncommon for coffee had during the fasting period to confound the results (e.g. higher triglycerides, sometimes higher cholesterol) from what we’ve seen, potentially because the caffeine and other compounds in it can increase lipolysis (release of fat from fat tissue) as far as the research I’ve read, and it sounds like that may have happened here. Re-testing under the above conditions may help clarify this. If you suspect a general coffee sensitivity, typically 10-14 days without coffee will normalize levels. But I’m not sure it’d be necessary in this case as I’d more likely suspect it was the coffee during the fasting period potentially confounding, as it’s more commonly an issue – but which you go with is really up to you.
EDIT just to clarify: Another thing about the coffee during the fasting period is the effect isn’t always consistent. It’s a possible confounder (which is why it’s generally recommended to avoid it during the fasting period) but some people can have it during the fasting period one time and be fine, and then get odd results when doing it the next time. Hence, for consistency, 12-14 hours water-only fasted every time helps avoid this potential confusion.
7 months into my body adapting to the keto diet, I Have been 10-20 grams of carbs a day for the whole time. I have had 2 blood tests in the last few weeks that came in with over 500 total, over 400 HDL, and 179 and 171 Triglycerides.
I raised my HDL from 58 to 80 in a week by taking 1000mg of Niacin each day and I have continued that.
I just learned the other day my body made most of that cholesterol and changing my diet probably wont do much to change those levels.
My body also had a reason for making that cholesterol. I am trying to figure out if it was a good one.
Hi Collin – we’re not doctors and can’t give medical advice so can only share our thoughts in case they may be of interest.
One thing that stands out to me from these numbers – from what I’m understanding at least) is it seems your triglycerides are 171 mg/dL and your HDL is 80 mg/dL?
I can’t comment on the effect of supplements, and am not sure if it could act as a confounder itself, but I’d be curious if this test was done 12-14 hours water only fasted? As in no food, coffee, tea, caffeine, etc in the 12-14 hours leading up to the blood draw (no less than 12 and not significantly over 14)?
As for the statement regarding your body making cholesterol and thus this not being easily influenced by diet, this does of course depend on the context but do you have bloodwork prior to going on a ketogenic diet to see if your total and LDL cholesterol was lower before then or always around the same level? If it increased from a ketogenic diet it may be related to the phenomenon of Hyper-responders, which Dave speculates may relate to the lipid energy model, which is discussed a bit in this presentation and may be of interest. With only post-keto results it is difficult to say whether this may be relevant to your situation or not, though.
Interesting. I was concerned about my high total cholesterol in 2020. It hovered in the high area for about 6mths (39% to 57% then back to 40% above my pre-HFLC diet) and I was less concerned. Then it jumped to 177% of when I was pre-HFLC when I did a blood test on a three day fast …
I am not concerned because my total cholesterol moves around with my diet and exercise. I believe it is optimizing the best it can based on the metabolic demands of trillions cells. I’m more afraid of taking drugs to monkey with that symphony than I am of letting it float around under the demands of those trillions of cells of which I am made.
I made ONE change. I will NOT eat PUFA oils or soy oil. Saturated fat ONLY. My last test said all my LDLS were quite fluffy (may 21.9, july 22.0, dec 22.4)