Note from Craig–In addition to helping Dave wrangle data behind the scenes, I will occasionally be dropping in as a guest writer to contribute some additional content. This blog was an invaluable resource when I first found out I was a hyper-responder, and I’m looking forward to helping others understand their own cholesterol situations. Hope you enjoy! |
Background
I started on Keto five months ago as an experiment in endurance running. Tall and slim, I’d get funny looks whenever someone heard I was on a diet. But, if they didn’t have to eat it, nobody cared much about what was on my plate. Then, the cholesterol bugaboo appeared.
| Total Cholesterol | 358 |
| Triglycerides | 66 |
| HDL-C | 114 |
| LDL-C | 231 |
(Frequent readers may find this pattern familiar.)
Suddenly, everyone was “concerned about my cholesterol” – my doctor, my mom, distant relatives. I wasn’t worried during the test, since I heard it was possible to manipulate, but the seed of doubt had been planted. I now needed a lot more evidence to prove to myself, and others, that I wasn’t doing myself harm with this experiment.
I redoubled my efforts reading and watching everything I can find on the links between diet, health, disease. I was especially worried about heart disease (what they say might kill me), and metabolic syndrome (what I think is most likely to kill them). Fortunately, a certain N=1 pioneer had already made a lot of progress on this path, and he was generous with his advice.
This article is one software engineer’s opinion on what blood tests are worth your while when you get your annual poke in the arm. These tests will provide the necessary feedback for those interested in “debugging” and “optimizing” the complex system that is their body.
If you can’t measure it, you can’t improve it.
– Peter Drucker.
Asking for Tests
| Ideally, you want your doctor to order the tests you’re seeking so that your insurance pays for it. But different doctors can have different reactions to these requests. Some will happily rubber-stamp your request without question, others will ask why you are interested in these tests and how you found out about them in the first place. If you find your doctor won’t order the tests you’re asking for, you can usually order them privately through a service like http://RequestATest.com.
If find yourself needing to explain ‘why’, here are some arguments that your doctor might find persuasive. You will use this data to make informed decisions about your lifestyle. “I am actively tracking my food, sleep, stress, and exercise and I want to know how my body is doing. Even though I feel much better on my diet, I’d consider changing if there was good evidence something was going wrong.” You want to establish a broad baseline of health and disease risk. “I’m concerned that conventional diets contribute to obesity and disease. I choose my diet to help with that, and I want to see if I’m making progress across the board. Then, I can tell if future changes help or hurt.” Your body uses a higher percentage of energy from fat compared to typical diets. “There’s a good reason that my numbers might be unusual. I want to see if my body is working well, but differently, or if something is going wrong. I also want to be careful when considering treatments, since they are rarely tested on people with my diet.” Treating complications later is much more costly than testing now. “A diabetes diagnosis more than doubles your average lifetime medical expenses, while a heart bypass surgery is over $100,000. I want to accurately assess my risk now, so I can take action to improve my chances of avoiding these outcomes.” |
The Tests
Every time:
- Insulin
- Hemoglobin A1c
- C-Reactive Protein (High Sensitivity, Cardiac)
- Comprehensive Metabolic Panel (14)
Tracking your lipids:
- NMR Lipoprofile (Nuclear Magnetic Resonance)
- and/or Apolipoprotein A1, B
Tracking your risk of metabolic syndrome:
- GGT
- Ferritin, Serum
- Uric Acid, Serum
- Homocyst(E)Ine, Plasma
Tracking your general health:
- Vitamin D, 25-Hydroxy
- Cortisol
- Cbc With Differential
- Iron And Tibc-Iron Binding Capacity (TIBC)
Only once if normal:
- Apolipoprotein Lp (a)
- Thyroid Panel
Apolipoprotein A-1, B
Apo A-1 is the distinctive protein of HDL. Apo B is the distinctive protein of VLDL, IDL, LDL and Chylomicrons.
Measures the composition of your lipoproteins (the mass of the apolipoprotein), unlike cholesterol tests, which only measure their contents. The lipoprotein particle tests are much better correlated with outcomes than cholesterol, but those two metrics are often discordant on a low-carb diet. I’d certainly want to have both results before making any decisions about “my cholesterol”.
$49 at RequestATest
Apolipoprotein Lp (a)
Apo (a) is the distinctive protein of lipoprotein(a), a subclass of LDL.
Lp(a) appears to be an independent risk factor for CVD beyond other blood lipid markers. It is largely determined by genetics, so testing it at least once will inform the importance of other more readily available LDL numbers. This result could raise the stakes of any lifestyle tradeoff you make.
$49 at RequestATest
Cbc With Differential
Measures the composition of your red and white blood cells.
Red blood cells deliver oxygen for burning. White blood cells are part of the immune system that protects your body from infection. This test helps give a broad picture of your health.
$29 at RequestATest
Comprehensive Metabolic Panel (14)
Measures various minerals and nutrients (including electrolytes) involved in your body’s processes.
This is a common test used to screen for a variety of conditions and nutrient deficiencies. This panel comes in (8) and (14), so be sure you specify the number. This test helps give a broad picture of your health. You can also use it to tweak your nutrition, for example, adding more salt if sodium is low.
$29 at RequestATest
Cortisol
Cortisol is a steroid hormone that your body releases in response to stress.
Chronic stress is extremely taxing on the body and can contribute to pain, hunger signaling, and heart disease. Measuring your stress allows you to judge the effectiveness of your stress-reducing efforts, like exercise and sleep.
$45 at RequestATest
C-Reactive Protein (High Sensitivity, Cardiac)
CRP is a protein produced by your liver as part of the inflammatory response.
Inflammation is a process your body uses to fight foreign invaders. Appropriate when you scrape your knee, but problematic when prolonged. High CRP can be a warning sign that your body is reacting to something in your diet (gluten or vegetable oils) or body (damaged arteries).
$59 at RequestATest
Ferritin, Serum
Ferritin is a protein that stores Iron.
Elevated ferritin can be an indicator of high iron or metabolic syndrome. Recent research suggests that it may even play a causal role in CVD. You can also mitigate high ferritin with regular blood donations. This test helps give a score in your struggle against metabolic syndrome.
$29 at RequestATest
GGT
γ-Glutamyl Transferase is an enzyme found in many parts of the body.
Elevated GGT is a diagnostic marker for diseases of the liver and pancreas. This test helps give a score in your struggle against metabolic syndrome.
$29 at RequestATest
Hemoglobin A1c
Hemoglobin A1c measures the glycation of your red blood cells and is a used to diagnosis diabetes.
Glycation is when blood sugars stick to a protein or lipid in your body, causing trouble. HA1c is an approximation of your average blood glucose of the past 3-months. This test helps give a score in your struggle against metabolic syndrome. Amy Berger’s low-carb testing series covers HA1c in detail.
$29 at RequestATest
Homocyst(E)Ine, Plasma
Homocysteine is a non-protein α-amino acid.
Homocysteine in the blood can make you more vulnerable to endothelial damage, so it’s a risk factor for CVD. These results could raise the stakes of any lifestyle tradeoff you make.
$69 at RequestATest
Insulin
Insulin is a control hormone that regulates the metabolism and storage of nutrients.
Elevated Insulin is part of the vicious cycle of metabolic syndrome. Although not as informative as a full Kraft Test (multiple insulin measurements tracking the response to glucose intake), fasting insulin provides a much better snapshot than glucose or HbA1c. With the prevalence of diabetes in society today, it’s a wonder this test is not standard. Amy Berger’s a low-carb testing series covers Insulin in detail.
$49 at RequestATest
Iron And Tibc-Iron Binding Capacity (TIBC)
Iron is an essential nutrient used to produce red blood cells.
This test measures your levels of iron and proteins that transport iron. This test helps give a broad picture of your health.
$29 at RequestATest
NMR Lipoprofile (Nuclear Magnetic Resonance)
The NMR lipoprofile measures the number and size of your lipoproteins.
Not all lipoproteins are created equal, and those on a low carb diet often have much more favorable size distributions. This gives the most detailed snapshot of your lipid system is working.
$99 at RequestATest
Thyroid Panel
The thyroid gland regulates energy use in your body in a multi-step process. This panel measures the levels associated with each step of that process.
How well your body metabolizes nutrients affects energy levels, heart rate, weight regulation, and temperature. This test helps give a broad picture of your health. Amy Berger’s a low-carb testing series covers Thyroid in detail.
$49 at RequestATest
Uric Acid, Serum
Uric acid is an end product of purine breakdown and is found in urine.
Excess uric acid levels can cause gout and kidney stones. Your levels are affected by diet and kidney function, but also may be an independent risk factor for diabetes. This test helps give a score in your struggle against metabolic syndrome.
$29 at RequestATest
Vitamin B12 And Folate
Vitamin B12 is an essential vitamin used for making red blood cells and DNA.
Excellent B12 levels should be a expected on a diet rich in animal products. This test helps give a broad picture of your health.
$69 at Requestatest
Vitamin D, 25-Hydroxy
Vitamin D is a fat soluble vitamin needed for mineral absorption (calcium, magnesium, phosphate, zinc) and metabolic function.
Your body converts cholesterol to Vitamin D in the skin when exposed to sunlight. However, since we get much less sun exposure today, it often requires active supplementation to achieve adequate levels.
$59 at RequestATest
They say Lp(a) is genetic, but mine has decreased by about 28% in 3 years, and this also seems to go up for long fasts.
Bob,
By genetic, I mean there are some people that have little or no Lp(a). For those that do have some, it seems very likely that it could be just as dynamic as the other apolipoprotiens.
Craig.
Thank you for this list! I had very similar lipid results last spring and my GP was adamant I should take Statins. Of course I would not take such a controversial drug without a lot of research on my part. I am a fit, active 64 year old female. When I asked my GP for access to CAC and further bloodwork, she looked at me and said she was not familiar with the tests, would not be comfortable ordering them and referred me to a cardiologist. That was 3 months ago. I went ahead and paid for a CAC (750 dollars later, score 80) and now, armed with suggestions from your list, I’m heading to Seattle to get bloodwork done there and pay privately.
Since May I have faithfully followed a ketogenic diet with carbs less than 20 and mod. Protein. About 75-80% of my diet are fats (following Dietdoctor and other sites, like this one on what would be healthy fats).
Now I am curious to see what the bloodwork shows. Some tests I can easily get through GP so these are the ones I am ordering from online lab –
C Reactive Protein
NMR Lipoprofile
Apoliproprotein A-1,B
Apoliprotein Lp (a)
Hemoglobin A1C
I’ve had annual bloodwork done for years as I have been diagnosed hypertensive since early nineties. (CBC, electrolytes, thyroid, common blood work always normal). My BP is well controlled (thinking I might be able to get off meds for that as BP is lowering and I’m tracking daily results. GP does not see the need for HgB A1C as my fasting blood glucose has never been high. Do you think I should bother with the HgB A1C?
I’m quite distressed about the CAC score – doesn’t seem fair given I have always been active and other indicators always suggested I am healthy. To know that 75% of women my age have lower CAC scores is distressing. I do seem to have a pretty strong family history of heart disease but they all smoked or were subject to 2nd hand smoke. I wish I had known about CAC tests before now as I would have certainly had one done years ago.
The more I learn about conventional dietary guidelines, big Pharma, big Food industry, AHA and our Canadian Heart Association being sponsored by questionable donors, the more angry I get. And frustrated, impatient with physicians who know sooooo little about nutrition and current research on CVD but still have no qualms perscribinh heavey duty drugs. My GP never once asked about lifestyle, my diet, excercise – just wrote out the script! Ok, I’ll stop ranting but my way of the future is to take control of my own health and learn as much as I can, and continue my own N=1 experimente Thanks again! Great site. I will support this site with monthly contribution and encourage others to do so as well. Great service so freely given.
Bonnie
Hi Bonnie,
Methinks you were ripped off with the CAC test….. in my neck of the woods it is $99 self-pay!
BTW, here is an interesting site that estimates your arterial age based upon your CAC score: https://www.mesa-nhlbi.org/Calcium/ArterialAge.aspx
Unfortunate, I am mostly in the same boat as you with the ignorance of doctors. My doctor never heard of most of these tests either… but I was lucky enough that he had heard of a CAC scan and was willing to write me a prescription for one. For most of the blood tests, I use RequestATest.
In my layperson opinion, you should definitely get a Hb A1C test and also a fasting insulin test periodically. You can get A1C self-test kits on Amazon for about $40 for two of them. Since A1C changes very slowly (~3 months due to average life span of red blood cells), it is not necessary to take it all the time. But it is a general marker of your metabolic health.
I also do a fasting insulin periodically, because metabolic problems will show up there before they show up in the A1C. RequestATest also offers that one. Another good insulin test is the Kraft insulin assay, but I haven’t done this test since my fasting insulin is very low. It measures the insulin response to a glucose stimulus over several hours. You can get it here: http://meridianvalleylab.com/Kraft-Prediabetes-Profile
The Kraft insulin assay test is amazing, but requires multiple samples over a 4-hour window. However, a single sample at the 2-hour mark is a decent approximation. With a bit of timing, you can do that yourself with a single test at your lab.
Check out the insulin response graphs based on Kraft’s work at look at the 2-hour mark:
https://www.dietdoctor.com/high-insulin-precedes-type-2-diabetes
Bonnie,
Glad to be of help! Thanks for your support!
For the NMR and A-1,B tests – if the NMR is available in Seattle that should be enough. The A-1, B tests are mostly a way to get particle counts if NMR where isn’t available (some countries / regions).
HA1c is much more valuable than fasting glucose. For example, if you have big glucose swings from carby food, that will show up in a way that fasting glucose doesn’t. Or not enough sleep, or stress, or any other reason for chronically elevated glucose.
It sounds like you only switched to Keto a few months ago. CAC 80 is more a measure of the 60 years of conventional dieting. I wouldn’t be too discouraged, I think you are likely doing yourself a world of good! Dave had a really good analogy for plaque and calcium. It’s your body’s way of spackling the wear in your arteries from prior damage. You’d much rather have the spackle than a hole! Stable (or very slighly growing) CAC is a sign that there isn’t much additional damage happening. See if you can get a test for ~$100-200 next time and test again in a year or two.
You’re preaching to the choir on traditional guidelines. The best we can do is educate our friends and family to slowly make a difference.
Craig.
Thank you for the feedback. That will save me a few dollars. One more question, if I get an A1C done, should I also get a fasting insulin? Or is that redundant?
Bonnie
Absolutely get both. A1C relates to your average blood glucose. Insulin relates to how hard your body is working to maintain those levels.
Well, this doesn’t look good.
LDL HDL. TRIG. T.CHOL.
2012 4.9(189.5) 2.0(77) 1.3(115) 7.5(290)
2013. 6.3(244) 2.2(85) 0.5(44). 8.7(336)
2014 5.5(213). 2.0(77) 1.08(96) 8.3(321)
April 2017 7.5(290) 1.98(76) 1.72(152) 10.3(398)
As noted above in my last message, I did a calcium scan and got a score of 80. Over the last 4 months, I have been faithfully Ketogenic with less than 20-24 carbs a day, most days less than 20. I’ve lost 12 lbs (although not my primary goal – feels great and I’m now more in line with my adult weight over decades)
BUT – then I travelled to Seattle for a Cardiac Panel and now see my LDL is increased! The LDL results looks Scarey! WHAT CAN I DO NOW?? I have so many questions but it seems clear to me (intuitively anyway) that such a fast rise in LDL cannot be good. That doesn’t sound like homeostasis or being in balance. What is wrong and how do I fix it?
Cardiac Lipid Panel from Requestatest Aug 2017
LDL-P 3492 (>2000 Very High)
LDL-C. 383. (>189 Very. High)
HDL-C. 85
TRIG. 88
T.Chol. 486
LDL and HDL Particles: HDL-P (total) 36.5
Small LDL-P 374.
LDL Size 22
Insulin Resistance LP-IR <25 and <45
(I don't really understand this test but it seems I am low risk – i think these numbers represent percentiles)
HgB A1C 5.4
Lipoprotein (a) 5 (How do genetic factors influence this?)
C-reactive Protein, Cardiac 2.39 (average relative risk for CHD is 1.00-3.00)
Homocysteine 11.0 (average)
One comment on the lab results "small LDL-P and LDL size are associated with CVD risk, but not after LDL-P is taken into account" took away my satisfaction with my particle concentration and size.
I don't know what to do. Maybe I should just quit eating
Hi Bonnie, I’ve been lurking in the keto community for a few months, and feel your frustration. I’m 65, female, a LCHR probably a TOFI, and thought I was doing it all right as well. However, I now have CAD. There’s little info here for us, as I’m now trying to REVERSE my disease, which may or may not be the same thing as preventing it. I’ve learned a lot here, but also on my own. I developed exercise induced angina which has worsened over the last 5 years. I finally got relief with EECP, which is a miracle intervention the biohackers need to know about, but I’ve just started reaching out to them about it. Although it reversed my symptoms, the foolish conclusion in the medical world is to use it LAST, after stents and surgery. Knowing what I know now, I’d do it at age 45 if I had any risk factors. Heart disease, which is the whole point of what everyone here wants to avoid is linked to 1. lipids 2. inflammation 3 endothelial health. So my answer to you is to look hard at improving 2 and 3 just like you try to improve 1. In a sense, I’m lucky, because the angina gives me warning that many who die of heart attacks don’t have. See: “EECP in the treatment of endothelial dysfunction: preventing progression of cardiovascular disease” Journal of Geriatric Cardiology June 2010 Vol 7 No 2. Understand that heart health also includes the poorly understood microvasculature of the heart, especially in women.
This is part of what improved my function because EECP generates new microvessels. Some of the articles also mention estrogen in the form of estradiol, add some K2 so any calcium they have you take goes to bones and not arteries. I’m interested in what else you discover as well. Best of luck!
Hey,
How do I jump on this bandwagon? I’ve also responded poorly, cholesterol-marker-wise, to low-carb/keto diets, and need help figuring out what to do about it. My latest particle count is 2152. My HDL is 132, which I now understand is NOT good. I am insulin resistant and was overweight until I went on this diet about 10 years ago. (no longer :o) Even now my A1c hovers around 5.6- 5.7.
So the icing on the cake is, I have parkinson’s disease and want very badly to be able to stay in ketosis–studies suggest it might be neuroprotective. (And, interestingly, my neurologist said: “Hmm. Your symptoms seem to be worsening very slowly. Huh. Excellent.) (Of course, I am a study of one, so I get it–it means nothing.)
And of course it doesn’t help if I drop dead of heart attack. Anyone have any ideas?
Thanks in advance!
Amy,
It sounds like you are doing great now! Low-carb has helped: Insulin sensitivity, weight, A1C, parkinson’s.
How do you jump on the bandwagon? If I were you, I’d KCKO (Keep Calm, Keto On) and read up on some of the excellent journalism and books that have pretty much debunked the lipid-heart hypothesis for additional peace of mind. (Big Fat Surprise, Good Calories Bad Calories)
There is a huge difference between a biomarker being associated with worse outcomes in one study and it being shown to be causal. It’s like saying “People 50x more likely to die in an ambulance than in their home — Let’s junk all the ambulances to save lives”. Or, if “People who were 5′ tall live 20% longer than those that are 6′ tall — Let’s cut off the feeet of tall people to improve their longevity”.
In your case, your lipoprotiens are exactly doing their job, delivering fat energy to your cells. I’d be totally happy to have HDL of 132 (I’m around 115) and LDL-P of 2100 (I’m was 1600 last checked, but probably am higher normally).
Another huge piece of mind for CVD risk is to get a CAC score. You can sometimes get that for $99 out of pocket, and it’s a much better predictor than any other single test.
Craig.
Thanks for your quick reply!
My understanding is that (sadly) the latest info on HDL is that anything over 100 might be, paradoxically, a bad thing. (Who’da thunk it!)
I know, I know, read those books, and Peter Attia and Thomas Dayspring et al. and I’m not convinced I’m gonna die tomorrow, but I’m not convinced I’m not, either. I guess I’d feel better if I could get my LDL P down to 1600 or so…hedge my bets. I also have some inflammation markers, high Lp-PLA2, Lp(a)-P. And yes I want to get a CAC score! Excellent idea!
I am keto-ing on, but being a bit frantic about it: cut out the MCT and most of the cream and butter. Keto is VERY VERY hard with only olive and avocado oil. And no MCT to cancel out the occasional raspberry! :o(
– amy
Amy: I believe from other reading that the MCT is a different structure saturated fat than the dairy, such that you may be able to keep MCT even if you are cutting out diary.
Amy,
What are your numbers for inflammation? Those usually go down on a low-carb diet. That’s something I’d watch and look for it to be going down. Are you watching your omega-6 PUFAs? Some people also have intolerances to eggs, dairy, or certain nuts.
There is a lot of noise and confusion with HDL, particles about what’s “good” and “bad”. Sadly, much of it is misinformed or exaggerated. Maybe high particles are the real danger (I think not), but atherosclerosis is a slow process that takes years, even with the worst lifestyle. What’s awesome is we know the right metrics to test to see if its getting progressing or holding stable (inflammation, CAC). You have the time and the power to do an experiment to see how keto is working for you!
You could try embracing the butter, cream, coconuts, and associated particles of keto and then check your metrics again in a year. Use that year to read up and observe how you feel. That’s essentially my strategy.
Craig or others:
Any thoughts on Quest vs Labcorp? I had a sky high ferritin test with one and shortly thereafter, the other normal (basically an impossible result if both were accurate). I am thinking about rerunning a ferritin at both on the same day. Any thoughts on the cholesterol and other test kits online from Amazon?
Colleen,
Ferritin does bounce around – inflammatory reactions, especially infectious etiology, result in elevated serum ferritin. This helps drive the acute inflammatory response to eradicate the infection. Whenever I see an elevated ferritin, I run a repeat # a couple months later.
Labcorp and Quest in the US are very comparable -Practically, I would consider the results apples to apples. – note that even the same blood sample at the same lab can be up or down up to 5% (I have seen up to 10% on several tests) on repeat tests the same day.
Colleen–
I wondered about the MCT! I cut out straight coconut oil, but continued w/MCT until recently. Maybe I’ll go back to it. It does help.
Craig–
I try to avoid omega 6 PUFA’s (I mean, OK, we do eat Duke’s mayo once in a while, yes) but I take a teaspoon of ultimate omega 3 every day and eat a fair amt of fish. And yes my meats and dairy are grass fed blah blah I know the drill! :o)
You know, I wish I had my own lab! I’d love to tweak my diet–test my blood….tweak again–test again. Because the whole: try butter, go off butter…try MUFA…try plantain… etc…it’s hard to know what’s working best when you can really only test once a year or so.That’s a long time.
But Craig you brought up the best idea. I am going to get a CAC. I think that will put my mind at ease. Or not.
I’ve been fairly strict keto for 1.5 years. Like Dave I’m fairly lean (7-8% BF) and muscular. Had a few cholesterol/blood draws in that time and my cholesterol is high but not as high as some folks here, but I’m not absolutely worried about it at the moment. One thing I am worried about is my inflammation markers. Of the 4 measured (CRP, Fibrinogen, Lp-PLA2 and Myeloperoxidase), all were within optimal range expect Lp-PLA2, which everytime I’ve measured has been greater than detection limit (>600 ng/mL). I’ve never done the cholesterol drop test to see if this changes with dietary fat. Is anyone familiar with this test and know where I can learn more about it? Anyone else have similar experience? I’m happy to include more numbers if that helps.
There is the basic info at RequestATest.
http://requestatest.com/lipoprotein-associated-phospholipase-a2-testing
Lipoproteins are multi-use (primarily TG delivery), so a high marker associated with them (Lp-a or Lp-PLA2) doesn’t mean inflammation was the cause. Especially, if CRP is low eating LCHF, as it is in your case.
In general, inflammation is a response to make your body inhospitable to outside invaders. If it is chronically high, it either means your body is constantly overreacting, or there is some persistent aspect in your environment that is perceived as an invader.
We’re always happy to collect more data. I can email you privately if you’d prefer to keep them anonymous.
Did you get the high-sensitivity version of CRP?
Craig
Based on that short description, Lp-PLA2 is just a passenger on LDL, not really a marker of inflammation as my doctor/lab indicated, which makes me feel better. Thank you.. I have had the hs-CRP measured at the 2 times I’ve done the Lp-PLA2 test. First inflamation was 600
Fibrinogen – 286
Myeloperoxidase – 151
Is Lipoprotein-Associated Phospholipase A2 included in the panel of test you listed in your article?
I don’t think so. While I find Lp PLA2 interesting, I’m not completely sold it its value given the level of existing study data on it thus far.
Hey Craig,
I was following a keto diet since March of 2017 fairly strict until mid Sept of 2017.
My bloodwork was taken a week after starting Keto and it was as follows
TC 224
Tri 81
HDL 44
VLDL 16
LDL 164
All other tests were normal
My next bloodwork was taken on 10/30/2017
Mind you the month prior I wasn’t as strict keto and was also,coming off antibiotics and also not sure if Sam-E could have had any effect on the bloodwork but was also taking that for 2 weeks that month.
I also demanded an LP(a) test and CRP test
Results
TC 231
TRI 99
HDL 54
VLDL 20
LDL 157
LPA – 266 NMOL
CRP 0.6 MG
I am quite aware of the whopping L.p.(a) … I am happy my LDL went down a little and my HDL went up a little..I think the CRP is good. Not happy my VLDL went up a little.
The LP(a) though has me very concerned on staying on a keto path. I am considering going full vegan/low oil diet to decrease my LDL as they carry the LP(A) … I’m not sure what to do
Do you think having an L.p. a that high should draw my attention to controlling my cholesterol even though the whole cholesterol concept has been debunked? Or does that go out the window for people with a genetic predisposition like this ? Obviously this has me extremely concerned about which lifestyle/diet to adhere to…Keto or the completely other side of the spectrum…being something like Dr.Furhman or Caldwell type vegan/low fat/no sugar diets.
I am a 37 year old male , weighing 176 and 5 ‘9. Btw.
Appreciate your time in advance.,
Hey Dave,
I was following a keto diet since March of 2017 fairly strict until mid Sept of 2017.
My bloodwork was taken a week after starting Keto and it was as follows
TC 224
Tri 81
HDL 44
VLDL 16
LDL 164
All other tests were normal
My next bloodwork was taken on 10/30/2017
Mind you the month prior I wasn’t as strict keto and was also,coming off antibiotics and also not sure if Sam-E could have had any effect on the bloodwork but was also taking that for 2 weeks that month.
I also demanded an LP(a) test and CRP test
Results
TC 231
TRI 99
HDL 54
VLDL 20
LDL 157
LPA – 266 NMOL°°°°° good is <75NMOL
CRP 0.6 MG
I am quite aware of the whopping L.p.(a) … I am happy my LDL went down a little and my HDL went up a little…I think the CRP is good. Not happy my VLDL went up a little.
The LP(a) though has me very concerned on staying on a keto path. I am considering going full vegan/low oil diet to decrease my LDL as they carry the LP(A) … I’m not sure what to do
Do you think having an L.p. a that high should draw my attention to controlling my cholesterol even though the whole cholesterol concept has been debunked? Or does that go out the window for people with a genetic predisposition like this ? Obviously this has me extremely concerned about which lifestyle/diet to adhere to…Keto or the completely other side of the spectrum…being something like Dr.Furhman or Caldwell type vegan/low fat/no sugar diets.
5
I also take 1000mg of high quality fish oil and 400mg of Coq10 and European Milk Thistle
Just started taking 500mg of pure Niacin too for the LDL and LP(a)
Take a multivitamin /magnesium/L-Arginine and Carnitine/inisotol
I am a 37 year old male , weighing 176 and 5 '9. Btw.
Appreciate your time in advance
This is an immensely helpful post, thank you so much! I’m a LMHR, but already have CAD. What about calcium for women? I was advised years ago to take large doses of calcium (for osteopenia), which I did, and only recently was advised to reduce it. At the time I asked if it was not atherogenic and was told “No, different mechanism.” No one told me to take K2, I now see I’ve had high calcium the whole time I was developing disease, and eating it like candy, please comment? Also, what about LP-PLA2?
Not as familiar with taking calcium as a supplement specifically. But as it happens, I do take K2 (MK7). To what degree it matters I’m semi-skeptical.
The Lp-PLA2 test I feel is a bit “young” right now and its real value isn’t fully field tested. I believe I’ve gotten it around three times (usually lands in the low 200s).
Thank you! This is a big deal for women in particular, and I think potentially dangerous, as all the internists and Ob/gyns put women on calcium. I’m working on a new blog to address some of the more obscure things I’ve learned about CAD and this is going to be an area of research for me. The K-2 interaction with bone deposits for mostly small white women I’m thinking is critical when they dose us up on all that extra calcium for so many years because my understanding of one of it’s functions is that it directs calcium toward bone and away from vessels. The fact that this isn’t addressed between the specialized caregivers is more than concerning.
Any thoughts why the NMR LipoProfile test from Request A Test does not have HDL Size and Large HDL-P. It appears that this is an option based on LapCorp’s site (https://www.labcorp.com/sites/testmenu/files/123638.pdf) and was part of the report back in the LipoScience days (https://ww5.allinahealth.org/ahs/allinalabs.nsf/page/ColorreportGraph.pdf/$FILE/ColorreportGraph.pdf). Is this info too costly to obtain? Is it not useful?
Reading Peter Attia’s article on HDL (https://peterattiamd.com/the-straight-dope-on-cholesterol-part-vii/), I’m curious about HDL size and other info. Are there other tests that include this? Looks like the CardioIQ Lipoprotein Subfraction may cover: http://requestatest.com/cardio-iq-lipoprotein-subfractionation-testing.
I’d appreciate some help with selecting tests. I have CAD, and exercise-induced angina, I’m a LMHR, eating keto, starting some 8/16 fasting. My goal is to reverse my disease and beat the longevity odds while remaining very active and living well. Therefore I want every bit of information about my health I can get from labs.
Craig suggests NMR “and/or” Apolipoprotein A-1, B I’ve got a list of tests from a keto cardiologist which includes fractionation (CardioIQ lipoprotein fractionation ion mobility) and (subfractionation) Cardio IQ Lipoprotein Subfractionation, Ion Mobility) but does not include NMR. What does the NMR test add to or duplicate about these? The doctor did not request Apolipoprotein A-1, B, did not request Apolipoprotein Lp(a) but did add, at my request, LpPLA-2. Can you please illuminate distinctions and overlap if any?
Assistance greatly appreciated!
I did an NMR test recently my first one but do have lipid test results (HDL, TG, LDL-C, etc.) from past years. See below for the results. If someone can answer why my HDL is getting lower & TG is increasing slightly, that would be great.
LCHF since 3/2017. All tests done with 12-14 hours fasting. Do HIIT 5 days/week
TC – 225 (5/2017). 259 (4/2018). 250 (7/2018)
LDL-C – 117 (5/2017). 168 (4/2018). 165 (7/2018)
LDL-P – 1423 (7/2018)
smallLDL-P – 371 (7/2018)
LDL Size – 21.4 – Pattern A (7/2018)
HDL-C – 95 (5/2017). 80 (4/2018). 72 (7/2018)
HDL-P – 40.2 (7/2018)
TG – 58 (5/2017). 53 (4/2018). 63 (7/2018)
VLDL – 13 (5/2017). 11 (4/2018). 13 (7/2018)
I come out in lowest risk category in Dave’s reporting tool but can’t answer the question as to why HDL is dropping and TG is rising? I even reduced my coffee intake for 3 weeks before my last test (7/2018). Not looking for a medical opinion but a plausible cause(s).
Not sure on why your HDL has gone lower, but as per my research, much of this could be variations of your diet in the days just before your blood draw. Needless to say, an HDL-C of 72 is considered extremely good, and a TG of 63 is likewise highly associated with positive health. (See study graphics here: http://cholesterolcode.com/cholesterol-endgame/ )
Thanks Dave. Appreciate your input. I would like to get CIMT and CAC tests done. Any suggestions on which lab facilities to get these tests done? I’m being quoted $140 for CIMT in the Seattle area but don’t know if that’s a good price or not? I can also get an ultrasound test done via https://www.lifelinescreening.com/screening-services/abdominal-carotid-artery-disease-screening which is for $149. Debating which one make sense? Appreciate it.
My CIMTs I get for $75 each, but I think my doc gives me a discount. So $140 doesn’t sound outlandish. Can’t speak to as many of the other ultrasounds tests outside of CIMT, but you might want to ping Bret Scher on that.
Hello Dave,
I have been following a carnivore based diet–keyword “based” for a little over 90 days. I haven’t been strict about it, but for the most part I primarily try to stick to fatty grass fed meats, pasture raised eggs, some bacon, some pastured chicken, some pork, raw HWC, raw cheddar cheese, coffee, water, electrolytes, celtic sea salt, etc. Anyhow, I’d like to test myself and see how I’m doing. This will be my first test while following this WOE. Prior to this, WOE I was following paleo, whole 30, some keto, primarily eliminating grains, sugars, refined carbs–did have some cheat meals/days here an there. This message is primarily to ask if I need to prepare in any way, besides just the typical water fast prior to my fasting insulin test? I plan on ordering the 4 tests your have above, under “every time”. Do you recommend I do other tests, considering it’s my first time? Also, I don’t have a doctor, so I’ll be ordering via Request A Test and while I search for a doc I’ll be posting my results here or on FB forums under carnivore or other keto forums. Please provide guidance. I’m very interested and would like your advise and support.–Pati
Which insulin test is correct for someone who appears healthy metabolically but wants to ensure fasting insulin is within the normal range? When I go to order the test, there are several available under insulin including: insulin, insulin diabetes antibodies, insulin like growth factor 1&2, insulin like growth factor binding proteins. thanks!
Just plain old “insulin” — and make sure you’re water fasted for 12-14 hours before the blood draw.
I just saw the link above goes to the general insulin test. please ignore my previous question.
I think this is for diabetics?
These tests are for anyone who wants to put their fingers to the pulse of things and check on how they’re doing 🙂
For somebody interested in conducting a variety of diet and lifestyle studies, is there anything in the post’s list of tests that should be added or taken away since it was posted or you all have had more experience?
Also, have you guys run into any self-studies where doing it longer than 7 days produced an appreciable difference (I’m trying to plan how long to try some of these ideas before retesting)?
Hi! Funnily enough, I’m working on a 2.0 version of this list right this very second 🙂
Mostly things have been added after we’ve looked into them more.
Generally for lipid related self study I do a 5 days minimum, for things like removing coffee it seems to be two weeks. I think it’d largely depend on what you were looking at.
I’ll be interested in reading about v2.0 – due to holidays, I probably won’t be try-harding until the new year.
I have a family of APOE4/4’s – both parents, and sister. So, very interested in the whole omega-3, omega-6, MUFA, SFA effects on heart and brain.
I hear you on the “depends” part – still working on the matrix of lifestyle changes to test vs time and $$$ – I dunno fully yet. For sure, effects of caffeine, alcohol, heavy dose omega-3, heavy dose omega-6, MUFA vs SFA, dairy, intermittent fasting, full fasting, …
Is there anything from labcorp or quest that tests for the various sterols – Dayspring and Attia mention it off and on? I didn’t see anything from their sites. I’d be curious to try keto vegan vs keto carnivore. Even if the standard markers may change quite a bit, does it really matter…?
Thanks for the info! Wish we could clone you self-experimentation peeps x1000!
I’ll certainly have the 2.0 out by the holidays 🙂
Hopefully the way I’m writing it will make it pretty quick and easy to choose which labs to get, depending on what you’re trying to look for plus budget.
I think the testing they mention is through Boston Heart Labs. I haven’t quite determined how to go about getting it, as it appears to be through a different lab system than LabCorp or Quest, but I haven’t looked into it a lot yet.
[…] little over a year ago, Craig wrote a post on what lab tests to get to measure your metabolic health. Although the original post still has […]
What about testosterone?
Hi, I’ve been loosely following a ketogenic diet since January 2018, after my doctor suggested that I go easy on carbs after being diagnosed with fatty liver disease and high blood sugar levels. Good news is that my liver is back to normal, I lost 35 pounds, and my blood sugar is on the low end of “normal”… and along the way stopped taking statins to control my cholesterol. Bad news? After 6 months without statins my cholesterol spiked. Then I discovered this site, tried the Cholesterol Drop Protocol, and would like to share my results.
(Male, 64 yrs, height: 5′ 8”, weight 152 lbs)
Lipid panel on statins, from 2013 through 2017 (average and range, all values in mg/dL)
Triglycerides – average 93 (range from 52 to 140)
Total Ch – average 189 (range from 149 to 245)
HDL Ch – average 56 (range from 50 to 63)
non-HDL Ch – average 133 (range from 99 to 191)
LDL Ch – average 115 (range from 81 to 172)
As you can see, the numbers jump around a lot. I can’t correlate any of them to lifestyle changes, diet changes, exercise frequency, or general stress levels, so I have to assume there is some inherent variability in either the measurement process or my own metabolic state.
I had regular bloodwork taken February of 2019. As an experiment, I followed a water-only fast for 3 days before the blood draw.. These are the results:
Triglycerides – 107
Total Ch – 298
HDL Ch – 70
non-HDL Ch – 228
LDL Ch – 207
As you might expect, I had an interesting discussion about these results with my doctor. He wants me to go back on statins, but I’m resisting. I suspect the extended fast prior to my blood draw skewed the results toward a higher total cholesterol level, so I agreed to take another lipid panel test several months later to see whether I can get better results through diet/exercise/etc, and do it without an extended fast beforehand.
I followed the 3-day high-fat Cholesterol Drop Protocol to see how that might affect the results. As I understand it, the daily goals are: 461 g fat, 194 g protein, 35 g carb, no caffeine and avoid MCT/coconut oils.
For the 3 days I consumed
day 1: 433 g fat, 208 g protein, 30 g carb
day 2: 464 g fat, 208 g protein, 30 g carb
day 3: 397 g fat, 145 g protein, 14 g carb
I think I came reasonably close to the target.
My lipid panel results after this diet are:
Triglycerides – 83
Total Ch – 247
HDL Ch – 72
non-HDL Ch – 175
LDL Ch – 158
HDL Cholesterol is significantly (statistically speaking) higher than my average value while on statins, but the other values are pretty much within the ranges while I was taking statins.
So, what should I conclude from this experiment? Total cholesterol is high, but the Total:HDL ratio is good. Aside from the possibility of familial hypercholestroerolemia I’m not terribly concerned about the results, but I don’t have a good rationale to present to my doctor.
I have asked my doctor to include a LDL particle count measurement in my next blood test – hopefully that will provide a valid basis for deciding whether to return to statins, or stay off them long-term.
I plan to follow the same Cholesterol Drop Protocol for my next blood draw. Is there anything I should do differently next time around?
Hi – yes, regarding the three day fast I wouldn’t be surprised if it interfered with your results as I’ve seen in my own experiments (as has Dave).
As for conclusions from the experiment, I don’t think we can confidently say. The research on whether high LDL paired with high HDL and low triglycerides is higher risk in general is still being looked at and collected
If you are looking for accurate numbers so you can evaluate your own risk, I would actually not do the protocol if I were in your shoes. The entire point of the protocol is demonstrating the effects of energy metabolism on the numbers, but this necessarily means the results aren’t what they would be if you were eating normally.
I try to make sure I eat normally before a test I am getting to evaluate my own health so I can make decisions with representative information.
Beyond the presentation linked above, we also have this guest post from a “pro-lipid lowering” person, so you can more accurately see both sides of the argument. Likely, I’d look into both sides (another resource is Ivor Cummins) and decide for myself what I am comfortable with.
Not sure where to place this comment so I’ll leave it here. In Reference to Dave’s Tweet regarding your work on SNPs. I looked up the 14 listed in my 23andMe Raw Data and the following is my allele types for each.
rs5763662 C/C
rs267733 A/A
rs4530754 A/A
rs314253 T/T
rs2000999 A/G
rs7640978 C/C
rs11563251 C/C
rs8017377 G/G
rs4722551 T/T
rs364585 G/G
rs6882076 C/T
rs2710642 A/G
rs2328223 NOT PRESENT
rs2328223 T/T
Here is my most recent basic lipid panel but I do have a NMR from before this as well if anyone is interested.
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 36 • Coffee: 0 cups/day •
• 2 on years on Keto (less than 20g carbs) •
• 13h water fasted • Cholesterol Rx: false •
Total Cholesterol: 312 mg/dL 8.08 mmol/L
LDL Cholesterol: 241 mg/dL 6.22mmol/L
HDL Cholesterol: 59 mg/dL 1.52mmol/L
TG Cholesterol: 67 mg/dL 0.76mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.301 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: 12 mg/dL >>> 0.15 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 240 | Iranian LDL-C: 206
TC/HDL Ratio in mg/dL: 5.29
TG/HDL Ratio in mg/dL: 1.14 | TG/HDL Ratio in mmol/L: 0.5
Hi Patrick — thanks for your added data. I actually have many more SNPs to check up on to match (or not match) with these phenotypes. But it’s nice to see someone turn that around for us on their own data. Thanks so much!
Hi Dave,
I am a 55 yo female. 5 yrs ago, I had a very mild heart attack. No damage to heart but 4 stents (1 artery with 2 long plaques so a stent was added at the beginning and end of each plaque). The day before I had my heart attack, I had CAC test & 2 weeks later I received results in the mail showing 0% chance of heart event in next 10 years. Yep, that’s what it said. My cardiologist said he doesn’t put much weight in CAC TESTS DO NOT SHOW SOFT PLAQUE and the soft plaque is what can rupture and kill you. I was put on 40mg Atorvastatin, went through cardiac rehab, & finally started keto 2/2019.
9/2016 At time of heart attack:
TC: 228 | Tri: 140 | HDL: 61 | LDL: 139 | Chol/HDL ratio: 3.7
1-07-2019 just before starting keto & being on 40 mg Atorvastatin since 9/2016):
TC: 130 | Tri: 92 | HDL: 58 | LDL: 54 | Chol/HDL ratio: 2.2
2-04-2019 – Started healthy keto.
6/2019 (being on keto for 4.5 months & STILL LOSING WEIGHT…still on Atorvastatin)
TC: 151 | Tri: 122 | HDL: 34 | LDL: 93 | Chol/HDL ratio: 4.4
Nurse recommended adding fish oil to increase HDL. I added Sports Research 1250mg.
12/2019 (on keto for 10.5 months…almost at goal weight & #s are starting to level out)
TC: 120 | Tri: 76 | HDL: 56 | LDL: 49 | Chol/HDL ratio: 2.1
All tests were lowest ever & HDL was pretty good as well.
2/2021…blood glucose seemed to be steadily increasing. I spoke w/ cardiologist and he agreed that statins can increase blood glucose. He agreed to take me off statin.
TC: 150 | Tri: 51 | HDL: 81 | LDL: 59 | Chol/HDL ratio: 1.9
7/2021 Labs for TC and LDL didn’t make me too happy.
TC: 253 | Tri: 63 | HDL: 84 | LDL: 156 | Chol/HDL ratio: 3.01
HDL is the highest it’s ever been.
A few other things that I feel played a part in my heart attack. I have an auto-immune condition (psoriasis…inflammation), went into menopause at 44yo, and seasonal high stress job. I’m just concerned about my TC and LDL being that high…higher than when I had my heart attack. Any thoughts?
Hi Kay,
I’m sorry to hear about your health difficulties but am glad to hear you’re working with your healthcare team to take control of your health. I hope you’ve seen some health gains and are feeling good!
I’m not a doctor and can’t give medical advice, but can provide my thoughts in case they may be of interest. Regarding the 0 CAC, although I’ve seen it spoken of very highly as an important measurement, I’ve also seen criticism, as you said, there can also be soft plaque that can be present that the CAC won’t catch (especially in younger people). I think both of these can be true – I personally value it as a marker while also not focusing on it in isolation and trying to also keep an eye on the larger context. I generally prefer, for myself, to not focus on one measurement or marker but look at as many as possible as one may catch something that the others miss or may not be specialized to catch (like CAC and soft plaque).
Regarding the higher TC and LDL, we can’t say if this is concern as – again – we’re not doctors and can’t give medical advice. Whether one makes changes to lower LDL or not is a personal decision that varies by individual depending on their goals, concerns, and specific situation. We do have resources discussing this topic from two different perspectives that may be of interest to explore. For example there’s this presentation from Dave looking at high LDL in the context of high HDL and low triglycerides from a cautiously optimistic perspective, plus this post from Dr. Nadolsky looking at the same topic from a cautiously pessimistic perspective. But we can’t say what is right for you, as that’s something each individual needs to explore and decide for themselves (with the help of their healthcare team as appropriate).
I appreciate it that you elaborate this in detail with pricing. I got my screening done by HG Analytics. The prices were almost the same that you have mentioned above.