Important Update
As explained in this post, the Questions page will be closed and comments on CC will no longer be individually responded to. This is due to the limited bandwidth of Dave and Siobhan due to new and ongoing research efforts (see post for more details).
For questions, especially if you had posed one that hasn’t yet been answered in the comments, we encourage either reaching out to us on Twitter (@realDaveFeldman and @Siobhan_Huggins) or asking in/tagging us in the Lean Mass Hyper-responder and Cholesterol Code facebook groups (each with 9000+ members!) as these continue to be great resources for discussion.
As always we thank everyone for their interest, support, and many fantastic discussions had over the years in the comments – we hope this will continue via the groups and social media as we continue on through the next steps of this journey.
Sincerely — thank you!
This thread is dedicated to questions for CholesterolCode.com. Again, we are not doctors or medical professionals and nothing we say here constitutes medical advice.
These are my hubby’s recent lab results, w/o statin. Dr. Wants him on statin because his TC is high. This all looks great to me! 61 y/o Black male, down 30 lbs.
==== CholesterolCode.com/Report v0.9.2 ====–
…7.5 months on LCHF (20g to 120g carbs) ::: …
Total Cholesterol: 283 mg/dL 7.32 mmol/L
LDL Cholesterol: 187 mg/dL 4.84 mmol/L
HDL Cholesterol: 85 mg/dL 2.2 mmol/L
Triglycerides: 56 mg/dL 0.63 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.13 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.543 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 187 | Iranian LDL-C: 152
Total/HDL Ratio: 3.33
TG/HDL Ratio in mg/dL: 0.66 | in mmol/L: 0.29
Hi Garnetta–
Indeed, I would agree these labs look good. Moreover, I’d bet your husband is lean and/or fit because his numbers almost match a Lean Mass Hyper-responder’s cut points.
Consider (1) reading this: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/ and (2) checking out our Facebook group for LMHRs: https://www.facebook.com/groups/LeanMassHyperResponder/
General side question. Back in the days of the Lipid Hypothesis, this talk of fat solidifying in the arteries, or blood, first off, does fat EVER even touch the blood or enter the arteries? Assuming you haven’t been stabbed or something? Because fat is ALWAYS packaged into lipoproteins, correct? Also if that were true, why does the saturated fat our own body makes not “solidify” and cause some sort of blockage? All sounds silly to me. But I ain’t no doctor… just the Pirate Nutritionist…
not a licensed Pirate or Nutritionist.
Actually, fatty acids are released from your fat stores (adipose) on a very regular basis. But there are “carrier” proteins like albumin that quickly attach to them to help ferry them to nearby tissues or to the liver. A better way to phrase your question is: do fats in the bloodstream remain unaccompanied for long? And the answer is no! 😉
I have personally seen fat globules in blood. It’s quite surprising to draw someone’s blood and see lipids floating around in it. I think the times I have seen this the patients have had hypertriglyceridemia, but cannot say for sure. I’m sure if you Googled this you could find images.
I worked in a cellular immunity lab and drew my own blood daily for source material. Often I would have a cilantro and butter (LOTS of butter) sandwich at lunch and then do a blood draw about an hour after. My blood would be orange with swirls of slightly more yellow.
A person with type 1 diabetes has an inability to effectively metabolize glucose (carbs are broken down into glucose but need insulin to shuttle the resulting glucose into the cells to be used for energy).
Is there a similar metabolic dysfunction in some people that fats/FFA (due to a hormone or enzyme deficiency) cannot be shuttled effectively into the cells and be used for energy?
Yes — although it almost always comes with higher triglycerides in the blood (Hypertriglyceridemia). Which is why having high triglycerides is almost universally a cause for concern. https://en.wikipedia.org/wiki/Lipid_metabolism#Lipid_metabolism_disorders
dave I posted my test results on another page of yours I dont use twitter and cant seem to respond to you I am diabetic and my blood sugar is alway high before I eat after a 18 hr fast, later it is down around 120 to 100 before 150 to 180
2 .75 months on hflc diet really close to Keto, My results say TC 301 – 41, (342)
\HDL 55 + 8 (47), triglycerides 60 – 116 (176), and LDL 229 – 30(259), TC/HDL ratio was 7.3 – 1.9 = 5.4 hope you can follow this my glucose was 189 went 168
Thought glucose would be lower and also thought TC and LDL would be lower
31 days on Keto but started IF about three months ago I did ketone test and said no ketones how could that be.
Hi Charles, 31 days is a very short time period to be assessing blood markers, particularly if you’re actively losing weight. You might want to consider giving it more time to see if these positive trends continue.
How would you classify someone that sees a meaningful jump in their cholesterol when switching from SAD to LCHF, but doesn’t hit your LMHR limits? I am a lean, tall guy (6’4” & 183 lbs plateaued for 18 months now). I am 31, and my CIMT, CT Calcium, & Echocaridogram were all flawless taken after 18 months of LCHF lifestyle (>325 Total Cholesterol). Full disclosure, I do 5 days LCHF & 2 days higher carb on the weekends since my goal is just fitness maintenance. I did 8 weeks straight keto with weekly blood work (weight held at 183) and my lipids didn’t improve further, so that’s why I settled on the 5-2 schedule as a lifestyle that maintains my weight targets. I don’t eat sugar during my 2 days of higher carb since my TRIGs showed crazy response (350-400 on Monday’s after weekend cheats eating sugar) to sugar early on. I am trying to look to the scans of plaque as the hard endpoints to monitor for changes, but I’m curious if you have other markers to follow. My glucose, insulin, homocysteine are all normal.
SAD: Total Chol = 180-240 mg/dL
SAD: LDL = 118-176
SAD HDL = 37-47
SAD TRIG = 100-124
LCHF Total Chol = 325-375
LCHF LDL = 200-300
LCHF HDL = 45-60
LCHF TRIG = 100-150
LCHF hsCRP = 0.3 mg/L
Hmmm… I don’t know that I’d recommend the direction you’re taking if your TGs are hovering from 100-150. It’s almost universal for those into fitness on LCHF to get TG well below 100. Moreover, they often have HDL of 60 or higher. Check out this chart I recently posted: http://cholesterolcode.com/wp-content/uploads/2018/06/graph_ldl170.png
Now to be sure, if you are mainly doing the carb weekends to allow for more indulgences, then just own that (I have a family member who is that way about drinking). But I’d consider dropping down the carbs or the fat a little more to keep from spiking the TGs.
Hi Dave.
Would you be worried by the following after 3 years LCHF. I’m female, 65, 5 ft10 and 62 kg. Work out 5 or 6 days a week
Cholesterol-360
TGs-71
HDL104
LDL-239
Just referred to lipid clinc after GP horrified
These are very consistent with a profile I watch quite closely: Lean Mass Hyper-responder. See these links…
1- The original post: http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/
2- My very recent presentation on #LMHRs: https://youtu.be/LEQjcQj_rwg
3- And why I think they may be the ones to truly disprove the LDL Lipid Hypothesis: http://cholesterolcode.com/cholesterol-endgame/
Wow, Sheelagh, my profile nearly mirrors yours! (My TGs are 72 and LDL 271; HDL same as yours. I am a 60-year-old woman;5’6” and 125 pounds.My GP was puzzled as last year’s test was much more “doctor friendly” and he only has me scheduled for another test in 6 months. (He said to try reducing animal fats, but I am ZC so that’s not happening.) Good health to you! Thanks for sharing – glad to see Dave’s reply.
What is ZC?
I think ZC means Zero Carbs
My total over 400 now ldl 262 trys77 hdl 87 the last two numbers are what count
Hello,
I did the 3-day protocol before this one. The numbers improved significantly.
March 29, 2018
–==== CholesterolCode.com/Report v0.9.2 ====–
…13 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 272 mg/dL 7.03 mmol/L
LDL Cholesterol: 213 mg/dL 5.51 mmol/L
HDL Cholesterol: 57 mg/dL 1.47 mmol/L
Triglycerides: 82 mg/dL 0.93 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 2 mg/dL 0.05 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.04 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.199 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 199 | Iranian LDL-C: 182
Total/HDL Ratio: 4.77
TG/HDL Ratio in mg/dL: 1.44 | in mmol/L: 0.63
Here are the previous numbers from December 2017.
–==== CholesterolCode.com/Report v0.9.2 ====–
…8 months on LCHF (20g to 120g carbs) ::: 2 hours water fasted…
Total Cholesterol: 369 mg/dL 9.54 mmol/L
LDL Cholesterol: 245 mg/dL 6.34 mmol/L
HDL Cholesterol: 43 mg/dL 1.11 mmol/L
Triglycerides: 508 mg/dL 5.74 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 81 mg/dL 2.09 mmol/L >>> High Risk Quintile
Remnant Chol to HDL: 1.88 >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.714 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 224 | Iranian LDL-C: 500
Total/HDL Ratio: 8.58
TG/HDL Ratio in mg/dL: 11.81 | in mmol/L: 5.17
Wow! Very impressive, Beth. Thanks for the added data.
I am trying to do the 3 day protocol and am having trouble doubling fat. Can you give me an example of what you ate?
Hi Dave,
I’m puzzled about my results and need some guidance on what I may have done wrong that caused my Triglycerides to increase. I consistently ate around 3700 calories with fats ranging in the low 300s, throughout the three days prior to having my blood drawn.
*** Previous results, Dec. 2017
–==== CholesterolCode.com/Report v0.9.2 ====–
…7 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 335 mg/dL 8.66 mmol/L
LDL Cholesterol: 250 mg/dL 6.46 mmol/L
HDL Cholesterol: 70 mg/dL 1.81 mmol/L
Triglycerides: 77 mg/dL 0.87 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 15 mg/dL 0.39 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.21 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.318 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 250 | Iranian LDL-C: 220
Total/HDL Ratio: 4.79
TG/HDL Ratio in mg/dL: 1.1 | in mmol/L: 0.48
*** Current results, Jun.2018, after doing the 3 days cholesterol code protocol
–==== CholesterolCode.com/Report v0.9.2 ====–
…6 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 313 mg/dL 8.09 mmol/L
LDL Cholesterol: 214 mg/dL 5.53 mmol/L
HDL Cholesterol: 72 mg/dL 1.86 mmol/L
Triglycerides: 135 mg/dL 1.52 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 27 mg/dL 0.7 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.38 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.088 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 214 | Iranian LDL-C: 231
Total/HDL Ratio: 4.35
TG/HDL Ratio in mg/dL: 1.88 | in mmol/L: 0.82
Any idea, suggestions where I may improve for the next round of lab work?
Thank you for all your great work helping us all understand this cholesterol issue and getting closer to clarifying the cholesterol myth.
Hmmm… That’s a trickier case to discuss given you did the protocol without having a nearby baseline. It’s possible your TG was higher due to a higher degree of liquid/processed fats in order to meet the goals of the protocol (such as fat bombs, fat shakes made with heavy whipping cream, etc)
But more recently, we’ve come to ask about coffee (or highly caffeinated beverages) as it has been coming up a lot when people have high TG and *not* low HDL.
Here’s my goto tweet on it that will soon be a blog post… https://twitter.com/DaveKeto/status/1003003409442541568
I know the “Feldman protocol” is to increase calories to 5000 calories a day for 3 days, but is there a sliding scale for smaller women. I am 5″2″ and 130. I am sure I CAN eat 5000 calories in a day, but without carbs, it is going to be hard. How low can I go and still see the inversion pattern?
Oh goodness — no, you don’t need to meet 5,000 calories. If you read the protocol page closely ( http://cholesterolcode.com/extreme-cholesterol-drop-experiment/ ), I explain my intake only as an example — but the actual intake is very individual. Find what your own upper limit is so long as it doesn’t make you ill or nauseous.
Thanks Dave!!! I clearly have not read close enough. I will study the rules before attempting. I hope this yields great results.
Hi. I am wondering if “the cholesterol drop protocol” will work for someone (me ) that have been eating “wrong” (good LCHF meals but also to much ice-cream, liquorice and chocolate) for about 6 months? I also have autoimmune reactions in my body. The doctor want to put me on statins, and even if I am confident in my decision not to take them- I would like it if I did not have to defend my choice. I am eating better now (vLCHF/Keto might change to carnivore). I am 50, woman, tall, almost 20kg (=BMI26 )above desired weight, I am not fit and do not have the energy to exercise(just small walks and light gardening). Do I risk making my numbers “worse” after eating vLCHF for four weeks with the “three day protocol “before my next bloodtest?
Hi Liv–
Unfortunately, it’s a question I can’t answer very easily as there’s not that much data on it yet. But moreover, I’d much prefer you had a “baseline” test before doing the protocol anyway. I think it’s better to practice a diet for a while (at least several months) and get bloodwork that reflects the “normal” levels of that diet before considering something like the protocol (which is more for experimentation and demonstration)
–==== CholesterolCode.com/Report v0.9.2 ====–
…1 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 290 mg/dL 7.49 mmol/L
LDL Cholesterol: 208 mg/dL 5.38 mmol/L
HDL Cholesterol: 68 mg/dL 1.76 mmol/L
Triglycerides: 68 mg/dL 0.77 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 14 mg/dL 0.36 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.21 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.359 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 208 | Iranian LDL-C: 180
Total/HDL Ratio: 4.26
TG/HDL Ratio in mg/dL: 1 | in mmol/L: 0.44
Also: Lpa 191 mg/L (was 484 mg/L when diagnosed with FH), hsCRP: 0.74
Hi Dave,
I’m a 33 year old female who was diagnosed with FH when I was 22 based on my lipids and family history (father died of MI at age 56, sister had similar lipids to mine). My cardiologist put me on statins despite my extreme reluctance (I did some research and was not comfortable with the lack of studies using statins in such a young population). I had to stop my statin 4 years ago when trying to conceive and have not restarted as we want to have another child. After a month on a low-carb diet, my lipids were as shown above (better than they ever were on a stain, with the exception of LDL, which is basically the same).
I’ve been a pharmacist for 6 years now, and I have become very educated on the fallacies of the lipid hypothesis and controversy with statins. I’ve been following various experts on the issue (including yourself) and have started to wonder if I even have FH! I’m trying to get the genetic test covered for me but it’s proving to be very difficult. The cardiologist had tested for clotting abnormalities and I had none.
Have you come across anyone with FH who has #’s like this?
Could it just be that cholesterol “runs high” in my family but we do not have FH?
Doctors keep saying to me “who cares if you confirm the genetic mutation or not, that LDL level still needs to be treated”! I, of course, know that is untrue. But maybe their question has some meaning, i.e. does it really matter if I have FH given my current results? If a genetic test confirms my FH but my lipids are fine (and actually resemble those of a LMHR) then what does that change?
I know the research on FH is very confusing and hard to draw conclusions from and so you may not have firm answers to these questions, but I am very interested to hear your any thoughts you may have on this.
Thank you so much for the very important work you do and for the crucial information you are providing!
Lisa
Hi Lisa–
It is indeed possible if you’ve *always* had high LDL that you may have genetically confirmed FH (I hate that I have to say “genetically confirmed FH”, but docs keep just Dx-ing it on cholesterol numbers alone!)
You can get a 23andMe to see if you have the SNPs associated with FH. But something else that may have also appeared by this point within your family for existing carriers (as well as yourself) are xanthomas https://en.wikipedia.org/wiki/Xanthoma .
But yeah, it’s also possible you don’t have FH, yet do have a higher genetic setpoint for fatty acid circulation (which, as you might have expected, I don’t care about so long as it’s working).
And of course, you know your profile is right there at LMHR Territory. Hopefully, you’ve seen my recent presentation on it at Ketocon. Particularly take note of my part on Cellular Lipid Malabsorption. http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/
An update:
–==== CholesterolCode.com/Report v0.9.2 ====–
…4 months on LCHF (20g to 120g carbs) ::: 13 hours water fasted…
Total Cholesterol: 9 mg/dL 0.24 mmol/L
LDL Cholesterol: 7 mg/dL 0.18 mmol/L
HDL Cholesterol: 2 mg/dL 0.05 mmol/L
Triglycerides: 1 mg/dL 0.01 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 0 mg/dL 0 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.699 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 7 | Iranian LDL-C: -32
Total/HDL Ratio: 4.5
TG/HDL Ratio in mg/dL: 0.5 | in mmol/L: 0.2
So after being on the diet for 4 months vs 1 month, my LDL is the highest it’s ever been at 6.99.
I have a few questions.
1. From what you’ve seen, is it typical for LDL to increase more over a few months into Thebes LCHF diet? When I first got my bloodwork done it was 5.38 1 month in. I’m just wondering if I should expect it to level out or could it keep increasing?
2. My T3 level was low at 2.8 on the first test and now it’s even lower at 2.3 pmol/L. Have you found that this happens to others on the diet? I’m wondering if that could also be affecting my LDL. I’ve even been supplementing with iodine (but a very small amount).
3. I submitted bloodwork for the genetic test for FH and am awaiting the results. This all just got me thinking – how would one know that they have FH vs. being a LMHR? Most people don’t get their cholesterol levels checked early in life. So someone could very well have high-ish levels like I did (and not know) which then go up even higher on the diet but would look like a LMHR. Should all LMHR ‘s have a test to confirm?
4. I have to get bloodwork done again in 1 week before I see the cardiologist. I don’t want that high LDL to be the focus of the whole consultation. I don’t know that I can eat enough calories to do the cholesterol drop! What would be the expected outcome if I incorporate some more carbs for the week?
Thank you!
Hope you don’t mind me chiming in in Dave’s stead while he catches up on a few things, I’m sure he’ll chime in if he has anything additional to add 🙂
1. Yes, in some people this can happen, especially if you’re going from slightly overweight to lean, or went into it already lean in the first place.
2. Low T3 on keto can be adaptive, not necessarily detrimental, according to some research. It has to do with protein sparing, among other things. See here.
3. Genetic testing is likely the best way, generally with LMHRs we see people who had normal levels before keto, who suddenly have very high numbers once switching to a fat centric diet (if they’re lean and/or active). One way to test would be to see if the numbers are diet centric, as Dave has done, although that can be a bit involved. It would certainly be interesting to see how many LMHRs have FH, but afaik with the info we have right now it isn’t shockingly high – although it’d be great to get solid numbers.
4. For the Feldman Protocol, generally it’s suggested to just eat as much as you can without making yourself feel unwell – that varies per person. So long as there is a large gap between normal calories and protocol calories, a drop can generally be seen. That said, if you do decide to go the carb route make sure you do a carb **SWAP** not carb **ADDING**. This part is very important!
Thanks so much for the info Siobhan! The thyroid article was very informative. On the FH note – have you had others with FH write in who are also doing low carb? I’d love to be able to connect with others in the same boat as it is rare to find. Perhaps you guys could create a thread for that? Just a suggestion!
Yes I’ve seen a few in passing. We at CC don’t have a group but there is a facebook group for those with FH on LCHF:
https://www.facebook.com/groups/1797840067173262/
what is FH
FAMILIAL HYPERCHOLESTEROLEMIA
There’s one more thing I want to ask. If LDL may not be a concern in LMHR’s because it is basically being used and not sitting around causing all sorts of nasty things to happen, then would you think that the same might apply for FH people on LCHF? Which is to say that LCHF might be beneficial for FH as it forces LDLC to be used up (as much as it can despite the receptor problem) instead of hanging around for too long? I realize there is no evidence at all for this but I would be very interested to hear yours and Dave’s thoughts.
It’s not so much that LMHR are using their LDL up, but rather that the LDL may not be high for detrimental reasons, e.g. it is high due to energy metabolism, as opposed to high from being in a “sick state”. There’s some evidence this may be true for those with FH as well, as the difference in those with FH who had a heart attack and those who didn’t was not their level of LDL (which was about the same in both groups) but rather their level of insulin and insulin resistance (both further markers indicating something not great is going on, e.g. illness, metabolic syndrome, etc).
See #1 on this list.
So, it seems so long as the over all environment is healthy, even in those in FH, that may be the important thing. I don’t know that for sure, but it seems plausible at least.
I know this was a year ago but desperate for answers. After being on Keto for 8 months I lost 30 pounds, never felt better in my life. I did this instead of statins because the side effects were awful. I loved keto, no sugar, no cravings and for the first time in 55 years felt completely in control of my emotional eating. On May 26/2019 after 8 months on Keto, had a heart attack, ( 2 stints put in), back on statins and soon will go on Rapatha. I’m completely confused, depressed and gaining weight. My cardiologist says I have F.H.
I am so sorry to hear you had to go through that! It must have been very scary for you and your family, but I am glad you came out of it and are with us today.
The difficulty is it’s challenging to tell if something like that is from the new lifestyle or from the lifestyle prior to it that “carried over” after its already happened, because heart disease is something that can develop over the course of decades. This is why I sometimes see people try to get baseline information before starting a new diet so they can see what they’re working with (e.g. a coronary artery calcium scan, or carotid intima-media thickness test). But this isn’t always feasible or something that comes to mind immediately, which is also understandable.
The confusion and depression are definitely understandable – it is a lot to process, all at once.
As for FH, that’s difficult. I see some people being diagnosed based on LDL levels alone, but as far as I’m aware if your levels used to be normal and then went up from diet I would imagine it’s not likely that’s genetic – although again a professional familiar with lipid changes from keto may be good for information on it.
If you are wanting to continue keto it may help to reach out to a professional who is acquainted with combining both heart health and keto, and knows how to help you achieve your goals/address your concerns.
Once example is Bret Scher (a cardiologist) who does remote wellness consultations and may be able to offer his thoughts, another is Nadir Ali who is based out of Houston.
You may also want to check in with the Healing Heart Disease with Keto and Fasting facebook group – there is a lot of information shared there, with many people in similar situations as yours, and it may help having a group who can help you find your footing and help you decide what next steps make sense for you, personally.
Wishing you all the best, and hopefully those resources help as well.
Hi Christine,
I hope your recovery from both the heart attack and the operation is continuing. I have similarly been previously ‘diagnosed’ as FH. I can absolutely understand your anxiety, especially as you had begun to benefit so much from going Keto…
I’m curious to know, do you have your cholesterol numbers from before your heart attach, and then most recently…?
You may gain some insight by comparing the REMNANT cholesterol values from before and after….
The fact that you were on statins before the attack, had food cravings, felt a little out-of-control with eating implies that you were a carb-loader. I know only too well what this feels like!
This makes it more likely that the arterial damage you experienced was ‘cultivated’ over a period of time. I would expect that to have shown up in your remnant cholesterol numbers. But I’m not sure of the effect that statins would have on RC values – but still it would be interesting to compare the lipid panels from before and after…
Nick
What do you mean by carb swap and not carb adding?
As in if you add in carbohydrates you proportionally take out fat to compensate, instead of keeping fat the same and adding carbs. So, a switch and not an addition on top of what you’re already doing.
Hi Dave,
I believe you mentioned the home testing kit you use in a video but I can’t find it. I would like to do my own testing. Can you reply with a name or link?
thanks!
Sure — it’s a CardioChek from PTS Diagnostics. http://www.ptsdiagnostics.com/cardiochek-home-use.html
Hi, Seeing my LDL numbers, Dr is asking me to take statins. I am bit hesitant to take it. My CRP is 0.36 mg/dl, HOMA-IR is 0.43 A1C 5.6. I am diabetic but just taking Metformin once a day.. I am 5″11 at 136 lbs with body fat of 17%
–==== CholesterolCode.com/Report v0.9.2 ====–
…4 months on Keto (less than 20g carbs) ::: 12 hours water fasted…
Total Cholesterol: 336 mg/dL 8.69 mmol/L
LDL Cholesterol: 243 mg/dL 6.28 mmol/L
HDL Cholesterol: 75 mg/dL 1.94 mmol/L
Triglycerides: 118 mg/dL 1.33 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 18 mg/dL 0.47 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.24 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.164 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 237 | Iranian LDL-C: 238
Total/HDL Ratio: 4.48
TG/HDL Ratio in mg/dL: 1.57 | in mmol/L: 0.69
Yeah, I consider these very solid numbers, IMO. Your HDL is nice and high at 75 and a great RC at 18. Plus the low CRP and insulin are certainly very relevant for health outcome.
Thanks Dave, Should I not take Statin and continue with what I am doing ? The only concern I had was with TGL over 100, for hyper responder, I see TGL to be 75 OR less.
It’s not for me to say on taking medication (or any medical advice) — that’s for you and your doctor. I just try to provide the best information and research that I have.
I understand Dave. Is it good idea to work on reducing TG to be below 100 OR close to 70 ? Here are my other numbers. Apolipoprotein – A1 – 185, Apolipoprotein – B1 – 162. Ratio of Apo B/A – 0.88, Lipoprotien – a 2.14, Homocysteine – 17.59. Have you seen Apo-B being this high for hyper responders ?
– I think TG below 100 is fine. Usually it won’t get below 70 without some fitness/athletics involved as well.
– Yes, I see ApoB that high all the time, including with myself. Of the 49 times I’ve gotten the test since Nov ’15, I’ve had above 162 a total of 16 times. Here’s the data dump in ascending order: 163, 164, 166, 166, 167, 169, 179, 183, 184, 185, 186, 189, 191, 194, 213, 257
Thanks Dave. Makes me feel better. 🙂
Dave
Based on my conversation with Dr, he suggested me to try taking Statin 10 mg for couple of weeks and then look at my NMR. I tried that for about 3 weeks without taking MCT oil and the results are bit surprising to me. Old values are given in brackets.
LDL-P – 1990 (2741)
LDL-C 178 (243)
HDL-P 30.5
HDL-C 54 (74)
Total – 262 (336)
TGL – 151 (118)
Smal LDL-P 578
LDL Size 21
LP-IR Score – 36
My TGL went up, cannot figure out why, I might have had bit more Carbs sometimes in the past few weeks. My biggest surprise is my HDL, went down by 20 points in 3 weeks with MCT as the only thing changed other than Statin. In the last week before the test, I have increased my Calorie in take from about 1400 to close to 1900 as I wanted to put bit more weight. I still kept my net carbs to be less than 30 gm.
This actually looks fairly common for the addition of statins. Either HDL dropping or TG going up can happen, of course.
I read the inverse pattern you proposed. I wonder what’s the FAT good to lower LDL you mean. Is it one or some or all of Saturated fatty acid, Monounsaturated fatty acid or Polyunsaturated fatty acid?
I haven’t done a lot of deep disentanglements of the different fat types, but I know Chris Bair has in a great experiment here: https://www.ketochow.xyz/series/42-days-of-keto-chow-experiment/
Hi
What are your thoughts and recommendations on my numbers below. I am still around 30kg overweight.
1st Test on SAD. 12 Hours fasted
HbA1c 8,0 TC 8,5 Trig 3,6 HDL 0,8 LDL 5,5 RC 2,2
2nd Test 3 months on <30g Carbs. 13 Hours fasted
HbA1c 6,4 TC 9 Trig 1,4 HDL 0,9 LDL 7,2 RC 0,9
Hi Richard–
I ran your report (as you can do it yourself above)
–==== CholesterolCode.com/Report v0.9.2 ====–
…3 months on LCHF (20g to 120g carbs) ::: 13 hours water fasted…
Total Cholesterol: 348 mg/dL 9 mmol/L
LDL Cholesterol: 278 mg/dL 7.2 mmol/L
HDL Cholesterol: 35 mg/dL 0.9 mmol/L
Triglycerides: 124 mg/dL 1.4 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 35 mg/dL 0.91 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 1 >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.192 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 288 | Iranian LDL-C: 288
Total/HDL Ratio: 9.94
TG/HDL Ratio in mg/dL: 3.54 | in mmol/L: 1.56
As always, I caveat that I’m not a medical professional and this isn’t medical advice. Your HDL is a little better and your Trigs a lot better, but I’d hope you’d continue to see each improvement if you continue on the diet. 🙂
I’ve just been ripped a new backside by my doctor for my cholesterol results after two months on Keto and I’m spooked: results are total cholesterol 10.6, HDL 2.7, LDL 7.5 and Triglycerides 0.9. Tests say I’m indicated for familial Hypercholesterolemia????
You are likely lean and/or fit (probably both) and a Lean Mass Hyper-responder. Read and watch this: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/
Also, feel free to join the Facebook group who you’ll be surprised to learn have patterns of LDL, HDL, and triglycerides just like yours! https://www.facebook.com/groups/LeanMassHyperResponder
–==== CholesterolCode.com/Report v0.9.2 ====–
…3 months on LCHF (20g to 120g carbs) ::: 13 hours water fasted…
Total Cholesterol: 410 mg/dL 10.6 mmol/L
LDL Cholesterol: 290 mg/dL 7.5 mmol/L
HDL Cholesterol: 104 mg/dL 2.7 mmol/L
Triglycerides: 80 mg/dL 0.9 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 16 mg/dL 0.41 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.15 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.477 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 290 | Iranian LDL-C: 254
Total/HDL Ratio: 3.94
TG/HDL Ratio in mg/dL: 0.77 | in mmol/L: 0.33
50 y/o male – fit/athletic – 11% body fat (DEXA). MD wants a f/u blood panel in 3 months with advice to go on statins to get LDL down to 100…
–==== CholesterolCode.com/Report v0.9.2 ====–
…40 months on Keto (less than 20g carbs) ::: 12 hours water fasted…
Total Cholesterol: 337 mg/dL 8.71 mmol/L
LDL Cholesterol: 187 mg/dL 4.84 mmol/L
HDL Cholesterol: 136 mg/dL 3.52 mmol/L
Triglycerides: 71 mg/dL 0.8 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 14 mg/dL 0.36 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.1 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.643 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 187 | Iranian LDL-C: 159
Total/HDL Ratio: 2.48
TG/HDL Ratio in mg/dL: 0.52 | in mmol/L: 0.23
Right — You’re a Lean Mass Hyper-responder. I provide a mechanistic reason for these patterns and what they mean in this context. Read and watch this: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/
Also, feel free to join the Facebook group who also the same patterns of LDL, HDL, and triglycerides just like yours! https://www.facebook.com/groups/LeanMassHyperResponder
These are my recent results…
..3 months on Carnivore/Zero Carb/Meat Only ::: 24 hours water fasted…
WARNING: fasting for multiple days can risk confounded lipid numbers. See http://cholesterolcode.com/the-fasting-disaster/
Total Cholesterol: 226 mg/dL 5.84 mmol/L
LDL Cholesterol: 167 mg/dL 4.32 mmol/L
HDL Cholesterol: 36 mg/dL 0.93 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: 0.64 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.139 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 167 | Iranian LDL-C: 179
Total/HDL Ratio: 6.28
TG/HDL Ratio in mg/dL: 3.14 | in mmol/L: 1.38
These are the results from last Dec…
…1 years on Keto (less than 20g carbs) ::: 24 hours water fasted…
WARNING: fasting for multiple days can risk confounded lipid numbers. See http://cholesterolcode.com/the-fasting-disaster/
Total Cholesterol: 282 mg/dL 7.29 mmol/L
LDL Cholesterol: 212 mg/dL 5.48 mmol/L
HDL Cholesterol: 46 mg/dL 1.19 mmol/L
Triglycerides: 122 mg/dL 1.38 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 24 mg/dL 0.62 mmol/L >>> Medium Risk Quintile
Remnant Chol to HDL: 0.52 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.064 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 212 | Iranian LDL-C: 221
Total/HDL Ratio: 6.13
TG/HDL Ratio in mg/dL: 2.65 | in mmol/L: 1.16
I am concerend that my HDL dropped so much in 6 months. Is this normal with carnivore or do I need to address something else? I also had a CAC done in January with a score of 0.
It is unusual, but I’d want a retest to be sure. You might want to consider checking again in three months.
My 72-year-old dad has been eating keto for about 6 months. I do think he was following the rules and doing a good keto diet. He has been on a statin for 20+ years. Because I kept complaining, he got off the stain for 3 months and then took another blood test. His follow-up test last week was the day after mine where I confirmed I am a LMHR (my numbers are Total 387 LDL 270, HDL 100, TRI 66). His LDL went up from 135 on the statin to 225 in 3 months without. I don’t know if you want all his numbers, but I calculated his remnant cholesterol at 16 for BOTH labs (1 point better than mine). So I say he is doing great and should stay off the drugs (he didn’t care what I thought). My bigger question is about his HDL. It was 46 on Statins and only increased to 51 drug-free. He says his HDL has always been low. Is that a genetic thing? Not trusting me and my advice and being freaked out by the 90 point increase in LDL, he immediately went back on the statin. He claims that his joints in his hands and wrists started hurting more the statin. Could that even be true? Are their benefits of a statin?
thanks for allowing questions
An HDL of 51 is good. Sure, I’d like it even higher, but I don’t consider that number “low”.
And yes, joint and muscle pain on statins are a common side effect. 🙁
Possibly, the mechanism of statin may be anti-inflammatory (not the LDL lowering effect) but this is one theory as to why statin may benefit that is not related to LDL lowering.
Hi Dave, I take it from these numbers that I am at high risk? How do I fix this. This was at 5 months Keto, I am now at 9 months. I am due for repeat bloodwork. My doctor wants me on a statin. I have opted not to take it. I do have a high family history of cardiac events resulting in death at early age for my grandfather 48yrs, uncle 55yrs. My mom 42 yrs and brother 58 yrs survived their attacks. I am worried. On a positive note, all inflammatory markers are within normal for the first time in decades. If you could provide some input, I would appreciate it. I have lost 99 lbs, I am 57.My blood pressure did go up on Keto, it is now down with Coversyl.
–==== CholesterolCode.com/Report v0.9.2 ====–
…5 months on Keto (less than 20g carbs) ::: 15 hours water fasted…
Total Cholesterol: 485 mg/dL 12.53 mmol/L
LDL Cholesterol: 408 mg/dL 10.55 mmol/L
HDL Cholesterol: 48 mg/dL 1.24 mmol/L
Triglycerides: 144 mg/dL 1.63 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 29 mg/dL 0.75 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.6 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.119 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 408 | Iranian LDL-C: 402
Total/HDL Ratio: 10.1
TG/HDL Ratio in mg/dL: 3 | in mmol/L: 1.31
Ah — I literally just did a blog post on this. I’m certainly not a fan of higher triglycerides and taking steps to lower it will likely result in both higher HDL and lower RC (and lower AIP!)
Here’s the blog post: http://cholesterolcode.com/high-triglycerides-on-low-carb-and-what-to-do-about-it/
Newest Blood Work – Not happy 🙁
–==== CholesterolCode.com/Report v0.9.2 ====–
…10 months on Keto (less than 20g carbs) ::: 13 hours water fasted…
Total Cholesterol: 357 mg/dL 9.23 mmol/L
LDL Cholesterol: 278 mg/dL 7.2 mmol/L
HDL Cholesterol: 45 mg/dL 1.16 mmol/L
Triglycerides: 170 mg/dL 1.92 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 34 mg/dL 0.88 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.76 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.219 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 278 | Iranian LDL-C: 311
Total/HDL Ratio: 7.93
TG/HDL Ratio in mg/dL: 3.78 | in mmol/L: 1.66
Hi again Kelly,
Could you list what you tried between the last result and this one? Are you tracking your food? Do you drink coffee? Do you consume liquid/refined oils/fats? Etc.
Hi Siobhan, sorry for the late reply, been extremely busy with company and work. Not sure what you mean by what I tried between tests? The only change I made in my food is to drop processed meats like pepperoni. I did not use the protocol to hack my lipid panel as my thought on that is that if that’s not how I normally eat, then my numbers would not be a true reflection based on my actual diet. Yes, I track my food faithfully. I drink 2 mugs of coffee first thing in the morning (and by morning, I mean at 1:30 a.m. (and am done w/coffee by 6 a.m.) since I haven’t slept a night since starting Keto 10 months ago. I do not do BP coffee, or drink liquid fats, etc. I do not use coconut oil, (hate it), I use butter, HWC, coconut milk, cream cheese, cheese, egg yolks, nuts and fatty meat to get my fats. Occasionally I will use avocado oil and olive oil on a salad. My macros are 20 gr total carbs, 50 gr protein, 180 gr fat, calories 1900.
I just wanted to verify whether this was a follow-up (no change between tests) or whether you tried doing any of the changes in the article linked above. 🙂
So there are maybe three thinks I’m seeing as potential issues.
Number one is the coffee – although your profile doesn’t exactly match what I typically see with people with a caffeine sensitivity causing higher triglycerides, it is a possibility for sure.
Another thing is sometimes any liquid fats can be an issue, so perhaps the hwc, coconut milk, and oils may be an issue? Perhaps worth verifying by switching out *any* liquid fat for a solid food form instead (like more fatty cheese, etc, just nothing in liquid form).
Lastly is the sleep – sleeping poorly or not enough could put a stress on your body that’s reflected by the lipid profile. I’m not sure how you would address this, but you could try the first two and see if it’s those first. Take out all coffee and all liquid forms of fat for about two weeks and get a retest. If not, it may be poor sleep quality (if that’s what you mean by you can’t sleep).
Thanks Siobhan, I will try the above suggestions, but my Dr. won’t retest again for at least 3 months. The sleep issue began when I started Keto, I get maybe 3 – 4 hours a night. I see this in a lot of people on Keto in the groups I follow. No one seems to have an answer. Others sleep the best they ever have. I also had a holter monitor on for 3 days due to my heart rate elevating with minor activity. The results show it is elevating and now I have to see a cardiologist to investigate what is going on. Luckily, the one that my Dr. is sending me to advocates Keto. I am showing tachycardia and suppressed T-Waves on my ECG. I have had to start a BP medication since starting Keto as well, but have refused to start a statin.
Thanks for all your work on lipids. It has been very helpful to me given my high LDL. Below are my latest lipid numbers with a few extra details. I was drinking coconut oil and cream in my coffee but stopped in May 2018 after seeing triglycerides at 200 even with BHB Ketones well above .5. I have had a number of NMR tests and my hsCRP has ranged from .9 to 2.7. LDL-P is over 3,000 (30% or less small dense) – Pattern A. Since LCHF, my triglycerides have ranged from 72 to 200. 200 was an anomaly. TG’s have mostly been under 100 during LCHF. I had a thyroid test in May 2018. My reverse T3 was high at 30 and my Free T3 was 2.2. (TSH 1.6; T4 7.1; Free T4 1.41). I will have a second thyroid test in July or August. I don’t have a specific question but your thoughts/comments would be interesting to know. LCHF has been great but my LDL-C and P are crazy. Of course, I fit right in on this site.
–==== CholesterolCode.com/Report v0.9.2 ====– 7/2/2018
Age: 53
Weight: 169
Height: 68″
CABG x 4 on 10/7/2016 (heart functioning is normal (no MI))
LCHF since May 2017; Keto since 12/15/2017
No Statin since 6/2017 – it caused stiffness in my thigh muscles.
HDL was always low and was 29 on 3/22/2017
LDL was 70 on 3/22/2017.
12 hours water fasted…
Total Cholesterol: 412 mg/dL 10.65 mmol/L
LDL Cholesterol (Direct): 344 mg/dL 8.9 mmol/L
HDL Cholesterol: 48 mg/dL 1.24 mmol/L
Triglycerides: 99 mg/dL 1.12 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 20 mg/dL 0.52 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.42 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.044 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 344 | Iranian LDL-C: 317
Total/HDL Ratio: 8.58
TG/HDL Ratio in mg/dL: 2.06 | in mmol/L: 0.9
Definitely a standard hyper-responder from where I’m sitting ( http://cholesterolcode.com/hyper-responder-faq/ ). Happy to hear your HDL has come way up from the lows of before.
Thanks. I am happy to see my TG/HDL ratio in a good range. Historically, even with exercise, I could never get my HDL to change by more than 2-3 points. I was clueless about Triglycerides and most things diet related. I followed a low fat, high carb diet. When cycling I would load up on carbs.
I also wanted to share my lipid markers on 3/22/2017 – 6 months post CABG. At this point, I was following the DASH diet along with extreme low sodium. Fortunately, at my 6 month visit, my cardiologist started talking about pre-diabetes/insulin resistance. He wanted me to drop sugar and refined carbs plus add some fat (olive oil) to my diet. He mentioned the paleo/Mediterranean diets. After this, I quickly found Dietdoctor.com and the low carb community. I am definitely on a better path with LCHF. Notice my LDL was at 70 (80mg statin)but my AIP and Remnant ratios are in the toilet. The only good ratio at this point was TC/HDL. I was doomed to be back in the OR or worse.
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 131 mg/dL 3.39 mmol/L
LDL Cholesterol: 70 mg/dL 1.81 mmol/L
HDL Cholesterol: 29 mg/dL 0.75 mmol/L
Triglycerides: 159 mg/dL 1.8 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 32 mg/dL 0.83 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 1.1 >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.38 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 70 | Iranian LDL-C: 129
Total/HDL Ratio: 4.52
TG/HDL Ratio in mg/dL: 5.48 | in mmol/L: 2.4
Wow! I rarely see remnants in the 30s! Thanks for the added data.
Thyroid may have something to do with it also.
When mine went high (don’t have the actual numbers to hand right now) my LDL dropped by exactly the same amount as the statin I no longer take. When overtreated (ie. low) the LDL shot up again.
Anecdotally elderly/retired doctors from back in the days before metabolic syndrome (and statins) would suspect thyroid as the cause when they saw high cholesterol/LDL.
Hi Dave, no cholesterol question as i am not a LMHR. My wife appears to be, however. Your work has been helpful in easing our worries.
My question is regarding fasting blood glucose. Mine is consistently higher than I would prefer based on the “normal” numbers floating around. It’s funny because my wife’s cholesterol is high and sugar low and my cholesterol is “normal” and sugar “high”.
Are you gathering FBG data from folks as well? My wife and I have been strict keto for a year and myself low carb for 20years at least. My FBG is usually above 100. It does not really decrease much during the day as well. My fasting insulin is around 2.2 to 2.6 though. This is a puzzler to me. My A1C is 5.2 which I think is consistent with the FBG. Once you and Siobahn get the cholesterol bogeyman destroyed, this would probably be the next big thing to understand.
Thanks for your work
Vernon
Hi Vernon — my first question is — are you athletic? Like, *really* athletic?
I don’t think anyone would ever use that term to describe me. That said I do lift weights 4x per week as heavy as I can go and continuing to increase the weight. This is to support my habit of 30 mile backpacks in the Grand Canyon a couple times a year. My DEXA scan had me at ~17% fat mass when I had it done late last year. Thanks, Vernon
Um… I guess *I* would use that term to describe you. You seriously do all this and *don’t* consider yourself athletic?
So yes, the reason I asked is that I find with those on keto there can be a higher fasting glucose that clearly appears to be adaptive glucose sparing given the very low insulin.
An extreme example would be Shawn Baker. Check out this post from a little while ago: http://cholesterolcode.com/thoughts-on-shawn-bakers-labs/
Thanks for pointing me to that link. I agree with you it’s an energy requirement the body is signaling for. My ketones are typically in 0.5 range. My guess is that is not enough to support the brain’s energy needs and it somehow signals to create more energy and that has to be glucose, because my muscles have gobbled up all the fat before it gets to the liver and can use it to make ketones. I am going to test that by increasing my caloric input from 1800 to 2300 or so per day, Delta from fat. Will let you know.
That’s what I keep seeing. Athletic low carbers with higher fasting glucose, lower BHB, yet very low insulin. So yes, it makes a lot of sense to me that there’s a lot of adaptive glucose sparing.
Hi,
If you have FH its important to look at the level of HDL and TG, but even so, CVD cases are observed in people with optimal levels. What biomarkers do you think you also have to check periodically if you suspect a possible FH?
I also wanted to ask you if you know any scientific evidence of the impact of Lchf on FH?
Many thanks for your work. Greetings from Barcelona
My recent numbers:
I’m a male, 39 years, thin and I do intermittent fasting every day
-==== CholesterolCode.com/Report v0.9.2 ====–
…7 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 275 mg/dL 7.11 mmol/L
LDL Cholesterol: 200 mg/dL 5.17 mmol/L
HDL Cholesterol: 60 mg/dL 1.55 mmol/L
Triglycerides: 77 mg/dL 0.87 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 15 mg/dL 0.39 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.25 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.251 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 200 | Iranian LDL-C: 179
Total/HDL Ratio: 4.58
TG/HDL Ratio in mg/dL: 1.28 | in mmol/L: 0.56
Hi Francesc–
– You said, “If you have FH its important to look at the level of HDL and TG, but even so, CVD cases are observed in people with optimal levels.” and I think this can be true as an outlier. But I’ve actually had a lot of trouble finding studies that stratified for this where HDL is high (such as above 50) and TG is low (such as below 100) where there were high levels of CVD. Do you know of a study that does this with FH?
– No, I don’t yet know the impact of LCHF on FH. And I’m not sure a lot of that data will pour in given FHers with an early diagnosis would likely avoid LCHF like the plague in the first place.
Hi,
look at this paper, it seems that some patients with fh could have a defective HDL:
“(…)measurement of HDL-C alone cannot determine the complex relationship between HDL function and ASCVD in FH patients [124]. Therefore, assessment of HDL function might provide more information about HDL-mediated atheroprotection in patients with FH. HDL particles in FH patients display qualitative anomalies, including TG and SM enrichment, reduced capacity to promote cholesterol efflux from macrophages, and impaired anti-inflammatory and antioxidant activities [3]. These findings suggest a potential role of impaired HDL functionality in the increased CV risk of FH patients. However, it remains to be investigated whether therapies targeting quality of HDL could be effective in preventing progression of atherosclerosis and onset of ASCVD in patients with FH.”
https://doi.org/10.1016/j.drudis.2017.09.014
Thanks, I’ll see if I can check it out.
Here are my results after 6 months for a very fit 55 year old white male 17% BF, very high TC, Should I be concern?
–==== CholesterolCode.com/Report v0.9.2 ====–
…6 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 547 mg/dL 14.15 mmol/L
LDL Cholesterol: 451 mg/dL 11.66 mmol/L
HDL Cholesterol: 75 mg/dL 1.94 mmol/L
Triglycerides: 104 mg/dL 1.17 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 21 mg/dL 0.54 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.28 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.22 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 451 | Iranian LDL-C: 408
Total/HDL Ratio: 7.29
TG/HDL Ratio in mg/dL: 1.39 | in mmol/L: 0.6
Your LDL is higher than most who come here, but not the highest. But as always, I go straight to triglycerides (TG) as a measure of successful energy delivery. You’re coming very close to the profile of a LMHR. If you haven’t already, check out my presentation from a couple weeks ago: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/ or our new LMHR facebook group: https://www.facebook.com/groups/LeanMassHyperResponder/ You’ll find many who l
Hi Dave: First, great work here!! Questions:
(1) Have you done any more looking at ferritin? I wondered if you have noticed any patterns. Mine was “higher” (156) while on Day 4 of a fasting mimicking diet then at 75 a few weeks later, while “normal” LCHF.
(2) Have you listened to Peter Attia’s podcast with Ron Krauss? Any thoughts? Overall a great discussion, but they glossed over the situation with High LDL, High HDL, low trigs, just a very oblique reference that in some instances LDL did not need to be lowered. I understand they are treating patients with bad markers or active disease, but how can one understand heart disease risk if one does not understand the various permutations of the healthy human?
(3) Re LMHR, from my understanding of your theory (and I am in the LMHR group) this is a subtype, and there are some lean folks where the TC and LDL do not get that high but stay more at about 200 or less? Have you looked for/noticed any common genetic component? (i.e. APOE4?) Is there a downside to be LMHR? For example, in the Attia/Krauss discussion one of them might simply argue that being exposed to more LDL over decades will not be as good as a person who is not so exposed.
1 – My ferritin has always been high (typically 500s) up until just recently where it dropped into the 200s. But as it happens, it went as high as the 900s on that multi-day fast.
2 – Heard it and have thoughts, but can’t share them yet. You’ll know why later. 😉
3 – The most common reason that I see, anecdotally, is they tend to be the keto*gainers* who are resistance/weight training. And this makes perfect sense as they are likely removing more LDLp from the bloodstream for endocytosis to meet demands for muscle repair and growth.
Re #2, I hope that means you will be on an upcoming episode!! 🙂
Watch for Monday’s post.
Hi Dave,
Was thinking about your protocol and the concept of lower LDL production during high fat intake as less energy to be delivered to cells…….raised the question in my mind as to whether a greater cholesterol drop would be achieved with a deliberately high meal frequency as well as high fat for the 3 days……my idea being that with a food fat bolus say every hour, the blood would be permanently full of chylomicron fat energy and so even less VLDL would be produced to traffic fat to tissues? Wondering if you have experimented with this and what your thoughts are?
Thanks for all your great work!
Actually, to do the protocol, you pretty much have to eat all day long. Not really much of a choice to reach that level of calories from fat. So really, the challenge would be testing the opposite.
Hi Dave,
I dropped my total cholesterol from 269 to 185. I upped my fat intake and stopped drinking coffee three weeks before my second test. I thought I heard you mention there might be a link between coffee and higher numbers. Did I hear this from you or Robb Wolf? Im interested in your thoughts. I’ve switched to decaf coffee this month to see if the results are similar next test.
I wondered the same about decaf. enjoyed my coffee. Post up when u get results
Nice drop! Yes, in some people it appears as though coffee may be a confounder when attempting the protocol, in addition to possibly raising triglycerides in some.
Hi, do you ever work with people on their health? I just don’t know where to turn. Thanks
Hi Mary — we’re more scientists than medical professionals here — if you’re looking for a low carb doctor, you might find this page a valuable resource: https://www.dietdoctor.com/low-carb/doctors
Here is test still drinking coffee
==== CholesterolCode.com/Report v0.9.2 ====–
…3 months on Carnivore/Zero Carb/Meat Only ::: 12 hours water fasted…
Total Cholesterol:368 mg/dL9.52 mmol/LLDL Cholesterol:NaN mg/dLNaN mmol/LHDL Cholesterol:35 mg/dL0.91 mmol/LTriglycerides:696 mg/dL7.86 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol:NaN mg/dLNaN mmol/L >>> High Risk QuintileRemnant Chol to HDL:NaN >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.936 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 194 | Iranian LDL-C: 606
Total/HDL Ratio: 10.51
TG/HDL Ratio in mg/dL: 19.89 | in mmol/L: 8.64
Here is 10 days later no coffee
CholesterolCode.com/Report v0.9.2 ====–
…3 months on Carnivore/Zero Carb/Meat Only ::: 12 hours water fasted…
Total Cholesterol:403 mg/dL10.42 mmol/LLDL Cholesterol:300 mg/dL7.76 mmol/LHDL Cholesterol:45 mg/dL1.16 mmol/LTriglycerides:292 mg/dL3.3 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol:58 mg/dL1.5 mmol/L >>> High Risk QuintileRemnant Chol to HDL:1.29 >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.454 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 300 | Iranian LDL-C: 413
Total/HDL Ratio: 8.96
TG/HDL Ratio in mg/dL: 6.49 | in mmol/L: 2.
Still a long way to go. But haven’t had a triglyceride that low in years.
54 yo. 6’3″ heaviest. Was 249lb
Now 215. On my way to 205 goal.
Wow! Still high, as you said, but what a big drop from just taking out coffee! You may want to check out the other items on this list and see if there’s anything else on there that could be impacting, just in case – if you haven’t already.
How are all of the cholesterols actually measured? Do they seperatre the ldl from the Hal and then measured the cholesterol they contain. Same question for trigs. Is it trigs in Iipoprotein only. Do they include free fatty acids in albumin. I hope my question is clear
1) It’s complicated, and depends on the method (see Mr Google about that)
2) HDL is measured, LDL is typically calculated through an equation
3) Trigs are directly measured, and yes — trigs are almost never outside a lipoprotein “boat” inside the bloodstream (instead, they are free fatty acids, AKA NEFAs)
4) If you want a blood measurement of NEFAs, you have to get that separately. It’s its own test.
To a degree I suspect it depends on the lab and the equipment they have. In the past my LDL was always calculated. Originally my current doctor used a lab that actually measured LDL – the result came out about halfway between the standard Friedwald and newer Iranian equation, which was interesting.
Now she has to use a different lab and the LDL is again calculated rather than measured. Our nurses, and an increasing number of doctors elsewhere, now only provide total cholesterol and a “ratio”. Obviously trigs must be measured to do this but the result is unavailable. I suspect someone brought out a cut price analyser which only provides the result the doctor/nurse needs to determine your statin dose.
Here (UK) useful things like NMR are generally unavailable.
I am a 61 year old woman.5’9″ 145lbs –CONVENTIONAL MARKERS AND RATIOS—-==== CholesterolCode.com/Report v0.9.2 ====–
…2 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 337 mg/dL 8.71 mmol/L
LDL Cholesterol: 261 mg/dL 6.75 mmol/L
HDL Cholesterol: 65 mg/dL 1.68 mmol/L
Triglycerides: 55 mg/dL 0.62 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.17 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.433 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 261 | Iranian LDL-C: 215
Total/HDL Ratio: 5.18
TG/HDL Ratio in mg/dL: 0.85 | in mmol/L: 0.37
My Dr. freaked insisting on statins. I procrastinated for 4 months until she refused to refill my thyroid meds until I had another test.(I don’t have a thyroid). I panicked and with only 2 days before blood test I went off keto hoping to lower LDL. BTW I will never do that again Ive struggle all week to feel well and get back to where I was. Just got my results and I lowered LDL by 78. I also had a A1-C of 5.60 without metformin for the last 4 months. She only saw the TC of 260. LDL183 HDL 63 Trigs 69. I have a statin prescription in front of me that I don’t intend to take. WTF I have an appt on the 9th of August so she can make sure I’m complying!! Seriously thats not going to happen!
Hi Mary–
Sorry to hear about your struggles. Yes, I imagine that change in your diet within the three day window meets my carb-swap experiments and likely lowered your LDL (but as you pointed out, it also shifted your metabolic pathway back to glucose again as well).
I’m a fan of working with your doctor, but if your doctor doesn’t want to work with your goals, you might want to consider finding another doctor instead. This is a good page of links to find a LC doctor if you’re interested: https://www.dietdoctor.com/low-carb/doctors
=== CholesterolCode.com/Report v0.9.2 ====–
…6 months on Standard American ::: 11 hours water fasted…
WARNING: fasting for less than 12 hours can risk confounded lipid numbers. See https://www.youtube.com/watch?v=ZQHztlN1Yls
Total Cholesterol: 252 mg/dL 6.52 mmol/L
LDL Cholesterol: 177 mg/dL 4.57 mmol/L
HDL Cholesterol: 79 mg/dL 2.04 mmol/L
Triglycerides: 68 mg/dL 0.77 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: -4 >> High Risk Quintile
Remnant Chol to HDL: NaN >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.423 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 159 | Iranian LDL-C: 138
Total/HDL Ratio: 3.19
TG/HDL Ratio in mg/dL: 0.86 | in mmol/L: 0.38
Hi Dave, these are my latest blood check results.
I’ m man, 59y old, BMI=26,7, I follow IF ( 16:8) for the last 6 months with an adherence of ~80%. Hypertension, regulated with medication.
My doctor wants me to start taking statines. Note that eight months ago the baseline was: TC: 6.11, TG: 0.82, HDL: 1.85, LDL: 4.02
I want to start an LCHF diet in // with IF.
Could you comment p’ease on my lipid profile as I don’t want to start statines?
Thanks a lot for the superbe job on the blog.
Mike
Whether you go on statins is not for me to say — it’s between you and your doctor.
I think your lipid panel looks good, IMO. It’s actually very close to Lean Mass Hyper-responder cutpoints (see http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/ and/or my recent presentation here for more: http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/ )
Thanks a lot Dave for your prompt answer!
Thanks for the remnant cholesterol calculator! These are my results. I’m a bit concerned that it’s coming up medium-high risk. Any thoughts on this or what my plan of action would be to improve my numbers? Note: my LDL was a calculated LDL if that makes a difference. Thanks!
–==== CholesterolCode.com/Report v0.9.2 ====–
…15 months on Keto (less than 20g carbs) ::: 12 hours water fasted…
Total Cholesterol: 291 mg/dL 7.53 mmol/L
LDL Cholesterol: 150 mg/dL 3.88 mmol/L
HDL Cholesterol: 114 mg/dL 2.95 mmol/L
Triglycerides: 136 mg/dL 1.54 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 27 mg/dL 0.7 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.24 >>> Medium-Low Risk Quintile
It’s coming up higher risk due to your triglycerides. Now the oddity is that your HDL is as high as it is — normally high TGs mean low HDL.
Thus, my first two questions are:
1) Were you 12-14 hours WATER ONLY fasted for your blood draw?
2) Are you a big coffee drinker?
For more on these, check out this article: http://cholesterolcode.com/high-triglycerides-on-low-carb-and-what-to-do-about-it/
I was 12 hours water fasted. I drink generally 1 or 2 cups of coffee every day. I’m not sure if that qualifies me as a big coffee drinker. Also – for some additional information: I’m 32 years old. I lost 60 pounds on a Keto diet and am at 21% body fat. I’m not sure if any of those things would affect the triglycerides. Thanks for the link! I’ll check it out.
It’s not that your TGs are super high, just oddly high given your profile. It’s possible it is the coffee that is having an impact, but it could be other things on the list as well. http://cholesterolcode.com/high-triglycerides-on-low-carb-and-what-to-do-about-it/
I just remembered that I did take Natural Calm magnesium drink the night before, less than 12 hours before my blood draw. It has Stevia in it. Could that affect the test?
Maybe — but I don’t know for sure.
Hi Dave, Thanks for all of your great work. Wondering if you have any thoughts about my numbers… I have always had great lipid panels, but also have been an outlier with low triglycerides. When I was eating SAD my trigs were around 70. Since going LCHF with bouts of keto and zero-carb, they’ve been down around 30. Also my fasting glucose has always tended high, around 100, which did not change with diet. My A1C was around 5.4 on SAD and has been around 4.6 recently.
Most of what I’ve found about low trigs involves chronic inflamation, thyroid issues, starvation, malnourishment, fat malabsorbtion. But none of those seem to apply to me.
Any thought s on whether it’s anything to worry about?
Thanks!
–==== CholesterolCode.com/Report v0.9.2 ====–
…5 years on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 165 mg/dL 4.27 mmol/L
LDL Cholesterol: 87 mg/dL 2.25 mmol/L
HDL Cholesterol: 69 mg/dL 1.78 mmol/L
Triglycerides: 30 mg/dL 0.34 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 9 mg/dL 0.23 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.13 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.719 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 90 | Iranian LDL-C: 54
Total/HDL Ratio: 2.39
TG/HDL Ratio in mg/dL: 0.43 | in mmol/L: 0.19
I know many LMHRs with TG in the 20s and 30s. I’m not terribly concerned it is too low given they (and you) are literally powered by fat and thus the *usage* is higher. Likewise, LMHRs tend to have higher fasting glucose, which makes sense as I suspect high adaptive glucose sparing given their fasting insulin is so low.
–==== CholesterolCode.com/Report v0.9.2 ====–
…6 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 260 mg/dL 6.72 mmol/L
LDL Cholesterol: 153 mg/dL 3.96 mmol/L
HDL Cholesterol: 92 mg/dL 2.38 mmol/L
Triglycerides: 62 mg/dL 0.7 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 15 mg/dL 0.39 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.16 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.531 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 156 | Iranian LDL-C: 129
Total/HDL Ratio: 2.83
TG/HDL Ratio in mg/dL: 0.67 | in mmol/L: 0.29
Should I be concerned with these numbers…. I had my DNA tested and it said that I am genetically prone to high LDL but I have never had it this high before. I had my blood taken after 3 months of strict LCHF and lost 15 pounds in the 3 months.
I don’t answer the “should I be concerned” questions — but I will say I like that lipid profile. High HDL and low TG and low Remnant Cholesterol.
Hi Dave,
I’m writing because I got a bit worried with my last blood test. My previous one was in nov-2015. I’ve been most of the time in a low carb diet since 2013. I was probably around 80kg, and I’m 5’10”, regularly weight training. The results were:
–==== CholesterolCode.com/Report v0.9.2 ====–
…2 years on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 194 mg/dL 5.02 mmol/L
LDL Cholesterol: 128 mg/dL 3.31 mmol/L
HDL Cholesterol: 55 mg/dL 1.42 mmol/L
Triglycerides: 56 mg/dL 0.63 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.2 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.353 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 128 | Iranian LDL-C: 104
Total/HDL Ratio: 3.53
TG/HDL Ratio in mg/dL: 1.02 | in mmol/L: 0.44
After gaining a bit of weight I’ve been following a strict LCHF for two months (maybe even keto, but I don’t track exactly the amount of carbs, they are mainly from leafs and vegetables, some eventual lower carb fruit), and increased the amount of fats. I also restrict my feeding window between 12-20pm. My weight dropped from 83kg to 79kg and I’m feelin great. The last results were:
–==== CholesterolCode.com/Report v0.9.2 ====–
…2 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 273 mg/dL 7.06 mmol/L
LDL Cholesterol: 203 mg/dL 5.25 mmol/L
HDL Cholesterol: 51 mg/dL 1.32 mmol/L
Triglycerides: 86 mg/dL 0.97 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 19 mg/dL 0.49 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.37 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.134 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 205 | Iranian LDL-C: 190
Total/HDL Ratio: 5.35
TG/HDL Ratio in mg/dL: 1.69 | in mmol/L: 0.73
I was worried about the increase in LDL, with hello staying the same. What’s your opinion? I appreciate your help.
This is pretty standard for a hyper-responder, actually. Your HDL is moderately high and your TG is low. You appear to be getting closer to a LMHR profile. If you haven’t already, check out the Simple Guide series here: http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/
Hi Dave,
these are my lab results:
…15 months on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 247 mg/dL 6.4 mmol/L
LDL Cholesterol: 166 mg/dL 4.3 mmol/L
HDL Cholesterol: 70 mg/dL 1.8 mmol/L
Triglycerides: 44 mg/dL 0.5 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.16 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.556 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
On my lab results TG were marked as too low… are there any possible consequences to low TG, or is it just a lab range i should ignore?
Thanks in advance…
IMO, triglycerides of 44 aren’t too low for low carb. I know many LMHRs who have TG in the 20s and 30s.
I am 33 year old Women 5’4″ 110lbs. My doctor wants me to take drugs to lower my LDL through natural means like B3 and others foods because I told them I wont take drugs. What do you think? My small LDL-P 326 but the large VLDL-p couldn’t be determined not sure why.
HDL-P: 40.4 nmol/L
Large HDL-p: 11.4
LDL size : 21.7
HDL size: 9.6
VLDL size: 44.2
HA1C : 4.9
Before going on the diet the LDLC was only 100 the triglycrides were 52.
Have a family of history of heart diseases. In my mind I thought it was due to the type of diet they consumed.
–==== CholesterolCode.com/Report v0.9.2 ====–
…6 months on LCHF (20g to 120g carbs) ::: 16 hours water fasted…
Total Cholesterol:
275 mg/dL
7.11 mmol/L
LDL Cholesterol:
185 mg/dL
4.78 mmol/L
HDL Cholesterol:
79 mg/dL
2.04 mmol/L
Triglycerides:
57 mg/dL
0.64 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol:
11 mg/dL
0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL:
0.14 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.503 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 185 | Iranian LDL-C: 151
Total/HDL Ratio: 3.48
TG/HDL Ratio in mg/dL: 0.72 | in mmol/L: 0.31
Hi Amy — are you lean and/or athletic? Your markers are near that of a LMHR http://cholesterolcode.com/ketocon-2018-initial-lmhr-presentation-rough-cut/
I am surprised they didn’t get a measurement back on your LDL-P. But Id’ guess given your LMHR profile and LDL-C that your LDL-P will likely be 1850 plus or minus 300
It’s not for me to say whether you should take steps to lower your LDL, that’s between you and your doctor. But I will say I like that lipid profile overall given you have very high HDL and very low TG. For more on why I like those risk factors, see: http://cholesterolcode.com/cholesterol-endgame/
Hi Dave,
I am pretty lean. I run around with 2 kids under 8 everyday so I might be athletic too lol.. From all the things that I have read online I shouldn’t be surprised that LDL went up since my body is suppose to be running on fat now. They told me the total LDL-p was 1700 they just couldn’t tell me the Large LDL-p number. I would assume that would be 1700 – 326 right?
Correct. So yes, my prediction was right regarding the LDLp. And yes, being powered by fat can result in a profile like this when lean and/or fit (LMHR).
Loved the podcast with Bret Scher
–==== CholesterolCode.com/Report v0.9.2 ====–
…10 months on LCHF (20g to 120g carbs) ::: 16 hours water fasted…
Total Cholesterol: 328 mg/dL 8.48 mmol/L
LDL Cholesterol: 239 mg/dL 6.19 mmol/L
HDL Cholesterol: 74 mg/dL 1.92 mmol/L
Triglycerides: 70 mg/dL 0.79 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 15 mg/dL 0.39 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.2 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.386 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 240 | Iranian LDL-C: 207
Total/HDL Ratio: 4.43
TG/HDL Ratio in mg/dL: 0.95 | in mmol/L: 0.41
Thanks — and hello LMHR! 🙂
Hello Dave, me and my boyfriend are doing keto since October. For me everything was great lab work great lost 57 pounds and no longer insulin resistance. But my boyfriend had a blood test today and everything was perfect but this.. Fasting for 11-12 hours
Triglycerides: 308.
Total cholesterol: 420.
HDL:45.
LDL:313.
VLDL:61
Tg/hdl: 6.8
All higher risk I use you calculator.
He has been eating a lot of heavy whipping cream and coffee. He’s also taking omega 3 supplements. He’s really lean now. Her weight is 62kg not a lot of muscle but he was obese and lost 58 pounds. I’m really concerned before keto he had high cholesterol and triglycerides but nos as high as now. He feel really well on keto and don’t want to stop it. What we can do? (sorry for my english). Thanks!
This is definitely where I’d recommend starting: http://cholesterolcode.com/high-triglycerides-on-low-carb-and-what-to-do-about-it/
Either the coffee, the heavy whipping cream, or both might be a big part of the problem.
For how many days you think we need to do it? (eliminate coffee and hwp, and also put more monounsaturated fats, like walnuts and olives) . One, two weeks to test again? Thanks for the answer!
I think 10 days is a fairly solid time period to then retest.
Hey Dave,
In addition to this report, see below:
–==== CholesterolCode.com/Report v0.9.2 ====–
…5 years on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 387 mg/dL 10.01 mmol/L
LDL Cholesterol: 307 mg/dL 7.94 mmol/L
HDL Cholesterol: 64 mg/dL 1.66 mmol/L
Triglycerides: 81 mg/dL 0.91 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 16 mg/dL 0.41 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.25 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.261 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 307 | Iranian LDL-C: 272
Total/HDL Ratio: 6.05
TG/HDL Ratio in mg/dL: 1.27 | in mmol/L: 0.55
Doc is still concerned about high oxLDL-p because of:
HDL-p (29)
LDL-p (2869)
hsCRP (2.43)
ApoB (200) .
CAC has gone from 15 to 41 over a 2 year perilod (I’m 65YO male)
My argument was that small LDL-P was 222, ApoA1 was 178, LDL-particle size was 22.3, large HDL-p number was 11.9, large vLDL-p was <0.8. I had the ClevelandHeartLab test 3 years ago and oxLDL was 95 so was "high" at that time. Lp-PLA2 was 197 and MPO was 164, both supposedly "low risk". Thoughts?
I think your profile looks pretty standard for a hyper-responder.
As an aside, I’m not a huge fan of the existing oxLDL-P tests, but it would take a long time to explain why. Generally speaking, there’s not really an oxLDL test that I like yet because they all don’t have very compelling outcome comparison data.
Hi Dave,
Thank you big time for all your work on lipids on keto.
Question: From your experience, does excercise (esp. resistance training) have any effect on the results of the Cholesterol Drop Protocol?
Would it be advisable to pause excercising during these few days? – It should be hard on the low calorie days anyway.
Ove
Hi Ove – in my experience it can, in fact, interfere. I’ve seen a few people who’ve tried the protocol and didn’t experience a drop, and retried without exercise during that week and the protocol worked as expected. This would make some sense as LDL is taken up by cells to be used for repair, so it may limit how much change you can see. I would say go ahead and limit intensive exercise during the protocol period – walks are okay, but nothing intensive just to make sure it doesn’t confound results.
Hi Siobhan, thanks for the advice.
–==== CholesterolCode.com/Report v0.9.2 ====–
…18 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 295 mg/dL 7.63 mmol/L
LDL Cholesterol: 214 mg/dL 5.53 mmol/L
HDL Cholesterol: 64 mg/dL 1.66 mmol/L
Triglycerides: 60 mg/dL 0.68 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 17 mg/dL 0.44 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.27 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.388 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 219 | Iranian LDL-C: 183
Total/HDL Ratio: 4.61
TG/HDL Ratio in mg/dL: 0.94 | in mmol/L: 0.41
Dave – These are my lab test done on June 23rd 2018. I would like your help to lower my ldl for next test to shut my doctor up. Please let me know how I can proceed for my next lab test. I love being on Keto diet I had similar journey to yours going to HFLC and I am also a software engineer so I do understand your methods.
Thanks,
–==== CholesterolCode.com/Report v0.9.2 ====–
…18 months on LCHF (20g to 120g carbs) ::: 16 hours water fasted…
Total Cholesterol: 295 mg/dL 7.63 mmol/L
LDL Cholesterol: 214 mg/dL 5.53 mmol/L
HDL Cholesterol: 64 mg/dL 1.66 mmol/L
Triglycerides: 60 mg/dL 0.68 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 17 mg/dL 0.44 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.27 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.388 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 219 | Iranian LDL-C: 183
Total/HDL Ratio: 4.61
TG/HDL Ratio in mg/dL: 0.94 | in mmol/L: 0.41
So you can try the protocol here: http://cholesterolcode.com/extreme-cholesterol-drop-experiment/ — but note it is not a guarantee, use at your own risk, etc.
And of course, as always, please share back the data however it goes.
Hi Dave,
I was’t able to increase my calorie intake to 5k/day. I tried one day and I gave up. So I decided to increase it by somewhere between 500 to 1K per day taking it to around 3k per day -“Doing my own experiment”. After 3 days I took the blood test. it wasn’t great, but it is the best panel I have had in years – see below results . as you might guess from the results below my first blood test after going Keto was done on 2/28/17
Date Total Cholesterol HDL LDL Triglycerides
8/4/18 227 69 139 61
6/23/18 295 64 214 60
9/20/17 268 61 191 59
2/28/17 297 70 216 56
10/3/16 234 58 163 66
7/29/14 222 55 148 95
I still would love to try again in a month to increase my calorie intake by somewhere around 1.5k per day and try to take a test again.
Thanks,
Eating a lot can be much more difficult than most people expect 🙂
I will be interested to see if you experience an even bigger drop if you can manage the higher caloric load later on. Otherwise, nice!
Hello, I just listened to your podcast with Chris Kresser. I have the profile you talked about. I have high LDL-180, HDL-74 and triglycerides-74. I have been exercising, paleo and gluten free. The dr. wants me to take a statin but I also have two copies of APO4 gene. I am concerned because my Father had two heart attacks but he smoked but I don’t want to take the statin. I weigh 118. Thanks for any advice.
Hi Debbie–
– I haven’t actually been on Chris Kresser’s podcast yet (but I have been on plenty of others)
– For what it’s worth, I find the ApoE4 allele has really only a small dispensation toward higher LDL. In actuality, my research is exposing *nothing* has a greater association than leanness and energy demand (fit/athletic) while on LCHF. In fact, it’s not even close. Please check out these links on LMHRs here: http://cholesterolcode.com/category/lean-mass-hyper-responder/
And consider joining our LMHR Facebook group where you’ll find a lot of people who have this same profile: https://www.facebook.com/groups/leanmasshyperresponder
Have you ever checked your cholesterol numbers after eating salmon every day?
Many years ago I ate salmon twice daily for a month (sometimes with egg whites) with either mustard or sugar free ketchup. Occasionally I ate a vegetable. At that time my cholesterol numbers decreased significantly. I’m currently on keto and IF and have lost over 30 lbs in 3.5 months (190 to 157 lbs., 5’4”, 67 yo- healthy). I quit Zetia 3 months ago and my cholesterol was 242 (LDL 170) two weeks ago. Because I Need Low cholesterol numbers for a job overseas, I started Zetia and quit coconut oil at that time. . I will have my cholesterol checked in 2 weeks and then again in August. Any advice/comments?
Tried a modified Feldman Protocol for my latest blood draw: keto diet (>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.25 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.268 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 224 | Iranian LDL-C: 200
Total/HDL Ratio: 4.81
TG/HDL Ratio in mg/dL: 1.24 | in mmol/L: 0.54
Don’t know why my comment above got messed up – pasting the full report
–==== CholesterolCode.com/Report v0.9.2 ====–
…3 years on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 303 mg/dL 7.84 mmol/L
LDL Cholesterol: 224 mg/dL 5.79 mmol/L
HDL Cholesterol: 63 mg/dL 1.63 mmol/L
Triglycerides: 78 mg/dL 0.88 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 16 mg/dL 0.41 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.25 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.268 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 224 | Iranian LDL-C: 200
Total/HDL Ratio: 4.81
TG/HDL Ratio in mg/dL: 1.24 | in mmol/L: 0.54
I am not a lean mass hyper responder but tried a modified Feldman Protocol for three days prior to my latest blood draw: ate a keto diet (< 20g carbs/day), upped my caloric intake 40-50%, and avoided all caffeinated drinks.
Results show my total cholesterol is slightly lower (303 here, 312 & 315 last two tests) so no appreciable drop. What pleasantly surprised me was my HDL hit a high (63 here, 56 and 53 last two tests) and triglycerides hit a low (78 here, 127 and 111 prior two tests).
Not sure if it was the keto or no caffeine or both that affected HDL and Triglycerides.
Interesting. You mentioned your total, but not your LDL cholesterol. Can I assume it didn’t drop appreciably as well?
Correct – my LDL did not drop appreciably. On latest test LDL was 224, prior two were 230 an 236.
Good to know. There’s rarely a lack of significant change overall with the protocol. Most it goes down with a few going up (85%-ish vs 15%-ish).
Hi Marian — I’m only seeing a partial report. Can you copy/paste the whole thing? (Should include total cholesterol, LDL, etc)
–==== CholesterolCode.com/Report v0.9.2 ====–
…3 months on Carnivore/Zero Carb/Meat Only ::: 16 hours water fasted…
Total Cholesterol: 286 mg/dL 7.4 mmol/L
LDL Cholesterol: 217 mg/dL 5.61 mmol/L
HDL Cholesterol: 58 mg/dL 1.5 mmol/L
Triglycerides: 57 mg/dL 0.64 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.19 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.37 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 217 | Iranian LDL-C: 180
Total/HDL Ratio: 4.93
TG/HDL Ratio in mg/dL: 0.98 | in mmol/L: 0.43
Hi Dave et al, I’m happy with what I received above, but am curious about the fairly significant drop in HDL from my last panel taken in January (when I was between a dirty low carb and a low-quality SAD). The January results were TC:212 LDL:122 HDL:76 TG:94. I expected my HDL to remain stable or increase from Jan, but today’s HDL:58 is the lowest I remember. 62/M/5’10/185, have lost 15 lbs on carnivore, maybe 20 to go. Any thoughts on the drop in HDL? Thanks much..
Hi Donald,
In my experience, that drop could very well be normal fluctuation.
HDL does tend to be a bit slower to move but in my own results I’ve seen it fluctuate back and forth by about 15 points, and Dave has likewise seen his HDL fluctuate quite a bit as well in response to fat intake, and exercise.
One thing is that I’d want to make sure is that it is not continuing to drop and just to keep an eye on it. But other than that, it still looks to be in a pretty normal range, and adjusting to a diet may have just tweaked it a bit.
Will do, thanks much Siobhan!
Hi Dave,
Hope you’re well. Just ran my latest numbers through your report and got a negative score on Cholesterol Remnants – what do you make of that?
Cheers, Lee
–==== CholesterolCode.com/Report v0.9.2 ====–
…36 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 327 mg/dL 8.46 mmol/L
LDL Cholesterol: 262 mg/dL 6.78 mmol/L
HDL Cholesterol: 74 mg/dL 1.91 mmol/L
Triglycerides: 59 mg/dL 0.67 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: -9 >> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 241 | Iranian LDL-C: 201
Total/HDL Ratio: 4.42
TG/HDL Ratio in mg/dL: 0.8 | in mmol/L: 0.35
This can be due to calculating the LDL improperly or via a different way than the calculator is expecting.
If you use the LDL from the friedewald LDL-c at the bottom of the report instead you get RC of 12 – which is pretty low, but not below 0 low 😉
The negative result can also happen when they *do* use friedewald, but the triglycerides (used in the calculation) are so low it messes with the equation (generally like <30).
Ok great, thanks for taking the time to respond 🙂
Just curious, will the calculator be adjusted to account for the new Martin-Hopkins method? Quest Labs uses this method exclusively now. Thanks!
I’d assume not, as the research on remnant cholesterol uses friedewald so it wouldn’t be equivalent as far as calculating risk. If you input your numbers into the calculator it says friedewald calculated LDL at the bottom that you can put in though. 🙂
Hey Dave, My lipid results:
Total Cholesterol 336
HDL 92
LDL 228
Triglycerides 78
I think I may be a Lean Mass Hyper Responder. Doc mentioned the word statin because of LDL. I want to lower my trigs. I think they’re a bit high because I’ve been overindulging on summertime fruits which are in season. Would like to lower my LDL too. I don’t eat any dairy so I can’t fatten up on heavy whipping cream prior to a retest. What do you think? Am I a LMHR? Also, genetic testing from twenty three and me revealed I’m a APOE3/4 carrier. I think the APOE4 half means I’m more prone to heart disease and Alzheimer’s. I don’t want a sudden unexpected heart attack like that Bob Barker commercial. Nor do I want Alzheimer’s. If I eat lots of veggies, that tends to destroy my gut – I don’t want to do that. It took me years to get my gut functioning well. What should I eat? What say you? Thanks for exposing the potential non-harm from high LDLers who might be LMHR. Cheers.
I certainly wouldn’t consider those triglycerides high! Under 80 mg/dL is pretty typical, and I’d be happy with those results!
Also, yes you do seem to be a hyper-responder. If you want to try the Feldman Protocol sans dairy to temporarily lower LDL that should be doable, just opt for very fatty meats for the protocol, like pork belly, pork shoulder, lamb breast, and so on.
APOE4 carriers do seem to be at a higher risk of alzheimers/heart disease, but as far as I’ve seen it addressed this still seems to relate to insulin resistance, as mentioned by Ivor Cummins and Amy Berger. “More vulnerable to modern disease” is how I’ve heard it discussed, meaning making sure to avoid modern risk factors (insulin resistance, dietary factors, etc) *may* be key. Amy discusses this in her book “The Alzheimer’s Antidote”.
As far as I’m aware eating lots of vegetables doesn’t lower risk of alzheimers or heart disease in and of themselves, so if they hurt your stomach perhaps it is best to limit them to match your tolerance? That is certainly not my area of expertise though.
Siobhan, thank you! I may have a few clarification questions but want to review the protocol again – my answers might be there. BTW, great presentation.
Any questions and let us know of course! And thank you! 🙂
Ok, I reviewed the protocol, a few questions. I’ll do 3 days (or 5 days if I’m measuring LDL-P too). Gonna quit coffee for two weeks prior, quit MCT and coconut oil, fast for 12-14 hrs before the test.
1) Is a shorter 12 hour fast better than a longer 14?
2) Should I also avoid exercise during the 3 days leading up to the test? (Seems like exercise might increase LDLs)
3) If my normal baseline calories are ~2000, should I increase them ~50% to 3000 during the protocol or should I eat more? (I’m afraid I’ll have a hard time eating so much especially if I aim for 80% fat 15% protein)
4) If in addition to a standard lipid panel I want to test Lp(a), should I wait and have that test done when I’m back on my “normal” baseline diet?
1) Anywhere within the 12-14 hour range is fine, I’ve not really noticed a huge difference going more towards 12 hours or more towards 14. I usually try to hit 13 just for consistency.
2) Avoid strenuous exercise, yes some walking is ok if it’s a part of your normal routine
3) Just eat as much as you can comfortably without making yourself feel unwell with as much of the extra calories coming from fat as possible. High fat cheese, heavy cream, bacon, etc. Try to keep ketogenic ratios. The higher the fat, the bigger the drop will be.
4) I would wait for a normal baseline, I’m not sure what the feldman protocol does to it, so it’s better to make sure you don’t confound it on accident.
Is the elimination of coffee primarily to lower triglycerides or is it also geared towards lowering LDL? I don’t want to give up coffee if I don’t HAVE to.
Sometimes people doing the protocol will not experience a drop if they have coffee during, so it’s definitely a possibility. You don’t necessarily have to, but I’d much rather give it up the first go around rather than not experience a drop and have to redo it (I know from experience the high calorie portion of the protocol is not easy, nor is it particularly fun!). But, of course, the decision is left in your hands 🙂
Thanks for your guidance. My retest was a success. I’d say I’m a LMHR.
–==== CholesterolCode.com/Report v0.9.2 ====–
…2 years on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 249 mg/dL 6.44 mmol/L
LDL Cholesterol: 134 mg/dL 3.47 mmol/L
HDL Cholesterol: 102 mg/dL 2.64 mmol/L
Triglycerides: 42 mg/dL 0.47 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 13 mg/dL 0.34 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.13 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.75 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 139 | Iranian LDL-C: 101
Total/HDL Ratio: 2.44
TG/HDL Ratio in mg/dL: 0.41 | in mmol/L: 0.18
Wow! I think I also saw you mention this on twitter as well – I’ll reiterate it’s definitely a success of the protocol (and your hard work put into it, of course 😉 ) congrats on such a huge drop!
What would be the top 5 or more tests for a LMHR to request from their doctor to put them at ease regarding heart disease risk? Is there a post anywhere? I’m thinking 1) CAC, 2) CIMT, 3) Lp(a), 4) NMR or something that tests for LDL particle size (small dense vs large fluffy), 5) any others?
standard lipid panel (for redundancy), insulin, and hs-CRP
I’d agree with the ones already listed
I just did another lipid test for my doctor. I didn’t change anything about my diet (no hyper calories or hyper fat). I just ate normal. The test came out about the same which is perplexing. It makes me think these lipid tests are worthless. I’m still hoping to have a CAC test or oxidized LDL test so I can stop worrying about this LDL nonsense.
–==== CholesterolCode.com/Report v0.9.3 ====–
…2 years on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 251 mg/dL 6.49 mmol/L
LDL Cholesterol: 143 mg/dL 3.7 mmol/L
HDL Cholesterol: 97 mg/dL 2.51 mmol/L
Triglycerides: 54 mg/dL 0.61 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.11 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.614 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 143 | Iranian LDL-C: 113
Total/HDL Ratio: 2.59
TG/HDL Ratio in mg/dL: 0.56 | in mmol/L: 0.24
Did you happen to be logging your food, and weight, in the days leading up to this test? It’s certainly interesting that LDL didn’t go back up after the protocol.
Which CardioChek at home device do you or Dave use for at home lipid testing? It looks like there’s an expensive one and also a relative cheap one (~$80). Would love your or Dave’s thoughts on which to get and also how accurate it is.
Dave has the CardioChek Plus. I don’t have one yet (trying to work it into my budget for the Plus as well).
As far as I understand, the main difference is that the CardioChek Plus can do simultaneous readings of a full lipid panel (Total, HDL, trigs, and calculated LDL) plus glucose from 2 test strips. The CardioChek home device (the cheaper one) only does separate tests one at a time (HDL, total, trigs, glucose all separate).
As far as I’m aware the Plus is pretty accurate (or else there’d be no point in using it), and he has done cardiochek vs lab readings and they are comparable (although not exactly the same due to rate of error, a few minutes between tests, etc). That’s just off the top of my head so I’ll double check with Dave too. Especially as he has experience using it fairly frequently.
I’ll be doing a broad comparison soon on the CardioChek readings vs my lab tests of minutes earlier. I think I’m getting a pretty solid data set together now to compare with…
Dave/Siobhan,
I’m at my whits end trying to improve my numbers. I’ve lost 50lbs and kept it off over the last 4yrs (low carb). In 2016 I got some blood work done as I was tightening up my diet and losing the last bit of that 50lbs. My ratios came back poor. I researched and read and listened to Ivor and Dave and tightened up my diet even more, added much more exercise. I currently exercise 5 mornings a week in the fasted state (30min jump rope in Zone 2, Pull-ups 13, Push-ups, pistol squats). I eat one meal a day mostly meat with very little veg (sauerkraut, cruciferos veg). No sauces, no liquid dairy, no BPC or other liquid fats or bombs. I do drink a fair bit of coffee and will now have to quit as I understand because for no other apparent reason my Trigs are still stubbornly high. The morning of my last blood work I didn’t exercise as It conflicted with the time I needed to have the blood drawn. Is it possible that the trigs parked in my blood were there in preparation for my usual workout? What else can I do to collapse my risk? I’ve applied each and every one of Ivor’s levers to minimize my risk. Please any insight you could provide would be greatly appreciated.
******************************************************************************
June 2016 (LCHF, actively losing some weight at the time)
-==== CholesterolCode.com/Report v0.9.2 ====–
…5 months on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 381 mg/dL 9.84 mmol/L
LDL Cholesterol: 277 mg/dL 7.16 mmol/L
HDL Cholesterol: 39 mg/dL 1 mmol/L
Triglycerides: 334 mg/dL 3.77 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 65 mg/dL 1.68 mmol/L >>> High Risk Quintile
Remnant Chol to HDL: 1.67 >>> High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.576 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 275 | Iranian LDL-C: 423
Total/HDL Ratio: 9.77
TG/HDL Ratio in mg/dL: 8.56 | in mmol/L: 3.77
*****************************************************************************
July 2018 (One Meal a Day, Nutritional Ketosis full time, previous 3 months Carnivore, did not exercise morning or bloodwork, did not drink coffee morning or bloodwork)
–==== CholesterolCode.com/Report v0.9.2 ====–
…2 years on Keto (less than 20g carbs) ::: 12 hours water fasted…
Total Cholesterol: 662 mg/dL 17.12 mmol/L
LDL Cholesterol: 572 mg/dL 14.78 mmol/L
HDL Cholesterol: 51 mg/dL 1.33 mmol/L