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- If you know little to nothing about cholesterol->
- You can check out my Simple Guide to Cholesterol series. It’s full of illustrations and is written for laypeople. Enjoy!
- You can enter your cholesterol numbers into our popular Report tool to check them against many risk calculations at the same time
- If you’re wanting to learn more about why cholesterol could be higher, particularly on a low carb diet->
- You can watch Dave’s recent presentation for Stanford University on the Lipid Energy Model.
- You can also check out the Lipid Energy Model poster here
- You can also check out or Frequently Asked Questions (FAQ) here
- If you’re looking to better understand the risk associated with high cholesterol on a low carb diet->
- Watch Dave’s Deep Dive on Cholesterol and Risk presentation for a more optimistic outlook
- Or you can read The Case for Lower LDL on Low Carb by Spencer Nadolsky for the more pessimistic counterpoint
- If you’d like to understand possible benefits of cholesterol and the immune system, you can read Siobhan’s overview article on the topic here or watch her presentation here
- If you’d like to learn more about lipoprotein(a), you can watch Siobhan’s presentation on it here
- Lastly — you can always just ask us anything our Questions Page. (Just be aware our site does not constitute medical advice and we always recommend consulting with your doctor.)
Hello! I would love to share your presentation with my father, but he is deaf. Do you have a transcript we can access or is it possible to add CC to the you tube video? Thank you!
I don’t… but I may be doing a reprisal of that presentation for the coming Ketofest. If I do, I’ll see if I can work up a text for it as well.
great
sad
Hi Dave, thanks for your work. I’ve enjoyed your twitter feed and will be perusing your site here. I tweeted you about a patient of mine who has familial hypergyceridemia with Trg in the thousands. Currently Crestor and Tricor for this. he is motivated and now has a recent dx of DMT2 with a hgb A1C of 6.7. He is seeking dietary intervention. I’ve been a proponent of low carb high fat diets for many of my DMT2 patients and am having success coaching this, but had some pause in this gentleman given his Trg. He is reticent to start metformin and anxious to intervene w diet. I already started talking to him about LCHF. I am new to LCHF and as a intervention. While high Trg has not been implicated in mortality, non-alcoholic pancreatitis can be a serious complication and high saturated fat diet can be concerning for this. I’ve seen anecdotes about LCHF lowering Trg but would like to see some data on this. Thanks. Chris PA-C
Hi Chris–
– I’m not as familiar with hypergyceridemia — do you mean hyper*tri*glyceridemia? (I’m assuming this due to your mention of the TG in the 1000s) Also, you prefixed with “familial” — if genetic, what is the family history with this disease?
– Certainly, I’d be very concerned about high TG, and yes, low carb is extremely effective in most cases of bringing it down. I’ve likewise seen many labs (some within my own family) where there were high TGs while using statins, even if having lower LDL.
– The higher TG in combination with higher glucose is even more troublesome as my guess is there is a very high abundance of energy parked in his system. Does the patient have a lot of visceral fat? There’s a decent chance he already has fatty liver and may be hyperinsulinemic.
– It’s extremely encouraging he is seeking dietary intervention as I definitely think this should be the first choice.
I have two sets of test results. I did the protocol backwards (5000 calories first, then 500 calories). They weren’t NMR. They do contain some other numbers I found interesting. The high-day test did come back with elevated BUN. Is this common (i.e. because of the high amount of protein)? Either way, I’ll ask my doctor to rerun the test after a week of fasting.
Hi Kaiden-
That’s interesting. But it’s hard to speculate without seeing the labs. Can you post the numbers?
Hi Dave,
I was recently turned-on to your Biohackers podcast interview & on one hand, am excited to tap into a LCHF / Keto community however am now slightly in panic mode after my first NMR, which is the second cholesterol test since going LCHF. Your thoughts would be wonderful. Below are my NMR results from Monday, June 5 2017:
– Total Cholesterol: 233, down from 254 on 10/6/16 (first test on LCHF) up from 202 from my last test before going LCHF
– HDL-C: 67, down from 71 on 10/6/16 (first test on LCHF) up from 55 from my last test before going LCHF
– LDL-C: 154, down from 166 on 10/6/16 (first test on LCHF) up from 130 from my last test before going LCHF
– Triglycerides: 60, down from 86 on 10/6/16 (first test on LCHF) & even with my last test before going LCHF
– LDL-P: 1,724 (no previous record)
– HDL-P: 28.9 (no previous record)
– Small LDL-P: 634 (no previous record)
– LDL Size 20.9
– LP-IR Score: <25
A little background: The Saturday & Sunday leading up to Monday, June 5 2017 were very active where I burned probably close to 1,000 calories each day mountain biking in fairly warm weather. I'm wondering (hoping) the high LDL-P is my liver releasing cholesterol for repair / maintenance? Also, this weekend was a little more carby than usual. Finally, high blood pressure is prevalent on my Mom's side of the family with her dad suffering from both stroke & heart attack. I think both parents are taking cholesterol lowering medications. In terms of next steps, I think another NMR is in order, perhaps not after exerting as much energy in the days leading up? At least to rule it out. What are your thoughts?
Okay, a few things…
1) You are possibly a “Lean Mass Hyper-responder” as I’m calling it now. (I’ll be doing a post on this soon, but for now you can reference my comment here: https://www.reddit.com/r/ketogains/comments/6jjpby/deranged_lfts_on_keto_xposted_to_keto_subs/djisdpp/)
2) Actually, given your intensive exercise, I would speculate that your non-exercise test scores would likely be higher in LDL-C, and marginally higher in LDL-P if my theory/research is consistent on this. (See my blog post on distance running and its impact on my numbers here: http://cholesterolcode.com/impact-of-endurance-running-on-cholesterol/) I tell you this in advance because I want you to be ready for this possibilty if this turns out to be true.
Moreover, the carbs you had may have actually lowered your LDL-C/-P further given my more recent experments with carb swapping in the attempt to test glycogen store influence on lipids. (See here: http://cholesterolcode.com/cholesterol-research-breakthrough/)
3) If you’ve read the links above and even a tiny fraction of my research/data, you’ll have noticed I’m exposing how agile the lipid system is. It is far more regulated than current medical literature believes it to be — at least, I can say this confidentally in the context of low carb given others’ reproduction of my protocol as well.
So with regard to risk, that’s an individual choice. As I often say, when I first learned about my high cholesterol numbers, I was a 9 on a 10 scale of concern. Now I’m more like a 5, but I’m not a 0. I understand why it functions this way with regard to fat-based energy management and how cholesterol is along for the ride. (And on that note, please consider reading my Simple Guide series for laypeople on low carb http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/)
I hope this was helpful. 🙂
Very helpful & thoughtful, thank you. I have read everything you posted & then some. A couple follow up questions. 1. do you have your weekly menu posted somewhere or are you following some other regiment or cookbook? Finally, aside from the normal lipid panel & NMR, do you have your list of recommended blood tests posted somewhere? BTW I submitted an interest form to be in your Ketofest cholesterol study 😀
Glad to be of help!
– I don’t have a weekly menu posted, per se. My primary source of tracking is photographic as I literally take pictures of everything I ingest. However, I get behind on my text-based food logging (currently MyFitnessPal) and mainly have it maintained for all periods just before blood tests. The key is the photos and all the context as I can always catch my text logs up perfectly. (But more importantly, I need all my work to be independently auditable)
It’s worth noting that my diet is better than most, but not ideal, and I try to point that out. Many assume because I’m so disciplined in recording data that I must likewise be disciplined in quality food selection and strongly Paleo. But my diet is probably around 20-25% “fast food” keto, such as lettuce-wrapped burgers from Carl’s Jr. Probably 40-50% I cook myself, such as cage-free scrambled eggs or my keto pizza. The remainder is restaurant or keto snack-ish such as individually wrapped colby jack from a convenience store (sure it’s cheese, but more processed/preserved, of course).
– As blood tests go, I won’t bother doing a single one that doesn’t include an NMR, fasting insulin, and high sensitivity C Reactive Protein (hsCRP). Those are the minimums for me.
But usually, I get the above three and a Comprehensive Metabolic Panel (CMP), a Complete Blood Count (CBC), Cortisol, hbA1C, ApoA1, ApoB, Uric Acid.
I occasionally add Ferritin, Iron Panel, Homocyst(E)Ine, Vitamin B12 And Folate, Vitamin D, and GGT.
Dave, I am going to schedule my next blood test, I find the calorie intake for your protocol challenging :). I am T2D, off meds, but am keeping my carbs below 10g a day – any hint/ suggestion on how to beef it all up while keeping the carbs at that level (if it “has” to be 3%) ?
thanks for your time.
\Lars; Ireland
Hi Lars-
The total amount of calories is individual — you just want to find an upper limit. It’s something you find yourself.
Keeping under 10g of carbs a day while upping total calories would probably be unrealistic. You’d have to use a lot of factory-based oils as the primary fat-sourced, which I wouldn’t recommend. 🙂
True, I did a test run, and managed around 1780 cals… natural carbs, even the mascarpone was made from farm made double cream which raw milk was used for – where I actually know the cow it came from… I was truly sick munching away – Let’s see how I will manage that huge amount :), and if the blood sugar is a wee higher (didn’t rise over 5 today) so be it. Factory based oils don’t usually hit my table (The blessings of living in rural Ireland and knowing the farmers, I guess).- Thanks Dave, good words.
\Lars
Yes — please don’t do anything that is making you sick or feel nauseous. I really want to stress that!
And yes, I’d expect the blood sugar to be higher relative to when you are on a lower caloric load (even fat has small amounts of glycerol backbone that likewise get processed to glucose, so there’s no avoiding some small spike).
In relating your calling ‘Lean-Mass-Hyper responders’ and exercise part, I am bit confused and want to ask some questions. Let say I am a lean person and have lower glycogen stores. I regularly do exercises after low carb high fat dinner (about 2 hours after dinner). Also during day I am quite active physically doing kitchen, garden, shopping works etc. (or playing with kids). in this case my body uses fat or glucose? How long takes my body to use glucose or glycogen? If I have lower glycogen stores and think my body uses it during HIIT exercise and after about 12-14 hours fast isn’t it possible my body mobilising energy from triglycerides that increases my LDL? What is the reason my LDL or cholesterol decrease after exercises?
Thanks in advance!
Hi Latife–
That’s a lot to unpack!
– First, we are already using some amount of glycogen and some amount of fat at all times — but the ratios change, of course, depending on availability and demand.
– I’m not an expert on the exact amounts (I refer you to the *real* experts, Volek and Phinney), but I believe it is extremely rare to completely deplete your glycogen stores. That’s usually done at times like marathons where one “hits the wall” at around the 17th mile, for example.
– The more fat-adapted you are, the more your body appear to have a higher ketone/trig usage relative to a glucose preference when not needed for immediate HIIT or sprint-like activity.
Hi Dave
Thanks you for your blog and the video of your latest research.
Just a question about the lipid response to fat intake. In your studies (fasting, 5000 calories, etc) were you able to test the ldl subfractions (1 to 6)? Reason for asking is – maybe the LDL overall drops on high fat intake but the profile becomes more atherogenic (or vice versa). Hope that makes some kind of sense.
regards
IanA
Hi Ian-
Sorry for the late reply — this one slipped past me.
Yes, I have always gotten NMRs for subfractions. Your question is probably better answered in my Breck presentation – http://cholesterolcode.com/about/
Hi Dave. I want to report my results. I ate 4000 calories on Monday, 400 grams of fat. 5000 calories on Tuesday, 500 grams of fat. 5000 calories on Wednesday 500 grams of fat. 5000 calories on Thursday, 500 grams of fat. Tested blood glucose and ketones every night around 8PM. Blood sugar in 70-80’s. Ketones from 4-7.8.
Last meal around 4pm on Thursday. Blood test 8:15 am Friday.
LDL-P >3500 High.
LDL-C >429 High.
HDL-C 74
Triglycerides 147
Cholesterol, Total 532 High.
HDL-P (Total) 34.3.
Small LDL-P 219
LDL Size 22.3
LP-IR Score: 51 High.
Do these numbers look good, or very bad? I am getting very mixed messages.
Hi b—
Your numbers are unusual for the protocol. Can you post your food logs here?
(I should warn I’m deep in the Ketofest experiment now, so might be spotty on reply…)
First, thank you for the blog and all of the information you have been providing to us. I am also a hyper responder. When I started a ketogenic diet, my total cholesterol steadily rose to the 500+ range. After three years of being on the diet and improving all of my health markers, including a 100+ weight loss, my total cholesterol has slowly been going down and it’s currently at 345. I am not concerned over my cholesterol as I don’t believe in the lipid hypothesis but I am very interested in lipids, especially how LDL works.
Excuse my ignorance but since this subject really is fascinating to me, I want to make sure that I am not missing anything important. I am just not understanding what this protocol is for or what it is showing about cholesterol that we didn’t already know and why the results are meaninful. I have read through the blog and I also have a basic understanding of how lipids work. I am just not understanding what your research is showing.
If you eat a whole lot of calories, a few days before your blood test and it makes your cholesterol go down, what does that mean? Why would that be of any importance? You normally wouldn’t eat 5000 calories or more a day, so the fact that doing that causes your cholesterol to drop, is almost a fluke result. In other words, it’s not a true, everyday, result that you would get otherwise. I don’t see why anyone would do that unless they are trying to manipulate results for insurance purposes or to get their doctors off their back.
Most importantly though, I want to know what it means and why it’s meaningful? “Cholesterol” is so dynamic that basically anything can change it. I think that lipidologists know this and it hasn’t changed the country’s obsession on cholesterol so showing this effect on multiple people wouldn’t cause them to think cholesterol is any more harmful.
Gina,
Unfortunately, most doctors aren’t as informed about TC/LDL as they should be regarding both it’s predictive power as a risk factor and its dynamic variability. Instead of educating them, it’s often easiest just to give them a ‘good’ number and move on. If you have a LCHF-friendly doctor who is more interested in measuring insulin resistance, inflammation, and atherosclerosis, you don’t need the protocol.
The research so far has shown that the lipid system is highly dynamic, and more is going on than the conventional wisdom suggests. There is still a lot more to figure out, and we don’t know for sure if having high LDL-p is causal for disease in-and-of itself. So if you’re interested in learning more, you’re in the right place. 🙂
Craig.
Thank you Craig.
Hi Dave,
Your research is really fascinating- I as well had higher LDL numbers when I started the low-carb/Keto diet. The only thing is when my doctor tests my cholesterol he absolutely insists that I take the test non-fasting. When I look at the numbers with a layman’s eye, the numbers are always outside of the normal reference ranges- I.e: Either the ldl to high or the hdl is too low or both. He never seems concerned an always tells me everything is OK
Do you take your tests on a full or empty stomach? Do you think there is any clinical value to doing the test on a full stomach?
Thanks,
Joe
I always take my labs at around 14 hours fasted. I make sure that span of time exists between the meal I ate on the night before and the blood draw the morning of.
The reason is that one group of the LDL particles that originate from food, called Chylomicrons, will be almost entirely cleared by that point. Thus, I can count my scores to be consistent with the other half of LDL particles that come from storage and originate as VLDLs.
I’m puzzled… I’ve read online that LDL goes up after 12 hours. When my LDL was high and my Dr. wanted to put me on a statin, I looked online and found that 12hr factoid, then asked for a retest. Sure enough, my LDL dropped into a range where I wasn’t eligible for the statin. All that was in 2016. Recently (2020) I finally got around to seeing a primary care doctor in my new town and got my blood work again. This time LDL was 309 (higher than in 2016 by a lot), but I’ve been on Keto & Carnivore since Jan. 2017… I expected a big jump. Thing was, my blood draw was at 11am, 14.5 hours after last meal. I’m guessing I’d have much lower LDL if the window had been the 8 to 10 hours recommended (I’ve heard Paul Mason reference that range, and Healthline.com says that’s the standard range). Have you documented your LDL on the shorter window? I assume you’ve done about everything. lol!
Hi, from what we’ve seen fasting less than 12 hours, particularly with low carbers who do this, can result in confounded results. Triglycerides can be higher than they would be 12-14 hours water only fasted, and as triglycerides are used to calculate LDL this would skew the LDL result as well. Personally, though I’m not a doctor, I prefer to fast 12-14 hours to be sure to get representative results that aren’t inaccurate due to a shorter fasting time.
Hi Dave,
I just met you at San Diego LCHF. My name is, Jan an empath, the retired professional athlete, massage therapist and you read my NMR. I loved your presentation and your passion for getting the true data out about what cholesterol numbers really mean. Thank you very much.
Please let me know the dates in advanced so I can plan. As I said to you yesterday I am now single with no children which gives me the freedom to travel.
Looking forward to hearing from you.
Jan
Yes, Jan — it was awesome meeting you!
I may have some studies coming up. Keep an eye out on this blog in case I post something on it in the near future. 🙂
Hi Dave:
Not sure if this is the right place to ask this question…but here goes.
I’ve been on a keto program for the last five years. Virtually no carbs other than leafy greens, cauliflower etc.. Yet fasting glucose is 96. However, fasting insulin is 2 which gives a very favorable HOMA_IR of .47.
I am curious as to why the glucose remains in the 90s. I would think that with no carbs I could get it lower.
Does the low carb, high fat, moderate protein diet produce such low insulin that consequently glucose cannot be driven down below 90 without long periods of fasting?
Thank you.
Check out Dave’s comment from today at 11:32 in The Game of Glucose. Your muscles learn to ignore the glucose so that its only used by tissues that require it.
Hi Dave.
Matt here (twitter @exceleratorbi). I would love to work with you to help visualise your data. I am a professional data consultant and made keto guy.
Glad we were able to connect, Matt. 🙂
Former Reliability Engineer here.
This stuff is fascinating.
Would love to see someone decompose dietary “risk factors” and associations into a ranked list of 1st order, 2nd order, 3rd order effects. Does anyone think that’s possible?
After the 1st order effects, genetics, microbes, frank poisons, (known and unknown exposures), accidents, available calories ( non starvation), exercise levels, even background radiation, a lot of medical science “risks analysis” especially from nutrition, looks pretty specious to me. Presumably the goals are to not die sooner or more painfully than needful and to function well. The first goal is more clear than the last goal
Many biological deaths are marked by (could be modeled as) cascading failures from the disruption of homeostatic processes ( don’t screw around with electrolytes and oxygen uptake). A. Be careful with your experiments B. We don’t know squat about proteomics, or the microbiome for that matter , and C., the whole science of endocrinology appears to be a bit thin on the subject of nutrition.
There are differences in phenotypes that affect metabolic efficiency for some compounds. (12 phenotypes for alcohol metabolism) Homeostasis will mask a good bit of variation. Everyone has some organ reserve. You might not realize damage until you’ve lost a good bit of cellular machinery. Then your numbers are going to go seriously south without a good way back. So be careful.
Thanks for the thoughts, Mary.
Indeed, I share some of your concerns and will try to be careful with the experiments as you suggest.
Hi Dave,
Glad to have found your blog. I had suffered for well over 15 years with horrendous digestive problems. After much trial and error, I tried a no starch diet and the results were incredible. It was the first thing that actually helped me. I eventually discovered that eating as close to zero carb as possible has given me the best symptom control to date. I am probably not in ketosis because I eat a fair amount of protein. I do what works for me.
I read that the body handles saturated fat differently on low carb or keto diets, so I didn’t worry about it, although I have had high cholesterol in the past. But at my physical in June, I got these results:
Total Cholesterol: 561 mg/dl
Trigycleride: 97 mg/dl
HDL: 109 mg/dl
I retooled my diet to lean meat, 2 eggs per day on average, fish,a little cheese, and monounsaturated fat and fish oil. And that is seriously about it, diet-wise, plus a piece or two of dark chocolate. I can tolerate beer because no fiber. No fruit, no vegetables of any kind, because I can’t digest them and any supposed health gains are canceled out by poor quality of life. I might be one of your lean mass hyper responders because I am 5’5″ and 107 pounds or so. Pretty physically active–lift weights and lots of walking. (15,000-20,000 steps/day)
Anyway, I don’t really know if it pays to be tested again. I will not take statins under any circumstances, and I simply can’t eat carbs. I figure I am doing the best that I can under the circumstances, but you seem to have studied this way more, so if you have any thoughts, I would be interested in hearing them.
Thanks,
Kathy
Hi Kathy!
My gosh — your comment somehow slipped through the cracks! I’m likewise emailing you with a heads up about this reply. Sorry about that!
Naturally, when I saw your numbers, I thought Lean Mass Hyper-responder (http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/). You didn’t list your LDL-C, but I presume it is over 300 or 400+. This, along with your activity level definitely suggests a good setup for a LMHR.
While it is possible LMHRs are at greater risk due to higher LDLp/c, I’m extremely skeptical for a lot of reasons that I’ll be posting on (and doing videos on) at a later point. But the core reason is that it makes perfect mechanistic sense and results in some of the lowest inflammatory markers I’ve seen.
I try to be a good scientist and not comment on risk I can’t be sure of, but if I were making an even money bet with all my savings given everything I know to this point — I’d be betting that LMHR isn’t just low risk, but that it is probably the opposite. It might be a superior health profile and with lower all-cause mortality.
Thank you!
Just FYI, total cholesterol last May was 561
Triglycerides 94
HDL: 109
LDL Calculated: 433
Chol/HDL ratio: 5
I no longer do much of any plant foods and feel so much better for it. I have heard Triglyceride/HDL ratio is important, and that’s pretty good…
Very interesting data, Kathy — thank you for adding.
I’m curious if you have considered Dr. Thomas Cowan’s theory on the causes of heart attack. His explanation, while not an explanation of how dietary cholesterol or blood lipids work, it shows that the root cause of heart attacks is not blocked arteries, it’s capillary dysfunction, stress and poor para sympathetic response.
https://cdn.shopify.com/s/files/1/1021/7291/files/What-Causes-Heart-Attacks-Cowan-reprint.pdf?10079655763935097707
While I’ll have to come back around to this paper given available time at the moment — I certainly feel in general agreement with your summary of this as stated. Certainly endothelial damage/dysfunction is an extraordinarily relevant component.
Hi Dave.
I’ve been on lchf keto for around 18 months, I’m 55 and recently passed menopause (still getting hot flashes, so not settled and my weight hasn’t really budged (bmi 28.5)) but feeling good and fit and healthy. However, got cholesterol reults today – first since being keto and they are:
TRIGLYCERIDES 1.4 mmol/L
CHOLESTEROL 10.8 mmol/L
HDL CHOLESTEROL 2.6 mmol/L
LDL CHOLESTEROL 7.6 mmol/L
Non-HDL Cholesterol 8.2 mmol/l
HLD as % of total – 24
My hsCRP was nice and low at 0.5 mg/l
So, trigs and inflammation not bad, but rest much higher than expected (and comparable to last reading prior to lchf when total cholesterol was about 5.)
I had fasted for 11 hrs prior to test.
I guess I’m a hyperresponder. Would backing off from keto be likely to lower the total and non-HDL?
Although not too worried about being out of “normal” range, I would like to be lower than this and any suggestions from your experience would be welcome.
Thanks
Ann
For a long-term drop, I generally suggest “swapping” in carbs, preferably from healthy sources. Some people mistakenly ADD carbs into their diet and this will likely increase their lipids even more (and I’ve had a few readers do this and confirm this happened to them).
The catch is that the exact amount to hit the threshold of change isn’t easily known. You can read more about this on my experiment here: http://cholesterolcode.com/cholesterol-research-breakthrough/
Dear Dave,
First of all I want to thank you for dedicating your time to research and for sharing it openly, it has been really helpful and a big insight for me in my current situation.
My name is Antonia Montoya and I am from Colombia, South America. I am a women, 32-years old, 5’6” and my current weight is 147 lbs. I have been on a low carb diet for the past 5 months and I have lost around 19 lbs.
Last week I had my blood work done and I was really shocked with my cholesterol levels. I have always had an elevated LDL (maximum 162), but never to these levels.
I would mean a lot to me if you could take a look at my charts and give me your insight. (Please take a look at the reference values used here, they might be different from the USA ones). By all means understand that you are not a medical doctor, but your insight is very valuable to me.
FREE T3:
Now: 2.3
Jan/17: 3.23
Ref Values: 1.71-3.71 pg/ml
Technique: CMIA
FREE T4:
Now: 1.02
Jan/17: 0.94
Ref Values: 0.70-1.48 ng/dl
Technique: CMIA
TSH:
Now: 2.9827
Jan/17: 3.5859
Ref Values: 0.3500-4.9400
Technique: CMIA
TRIGLYCERIDES:
Now: 65
Jan/17: 143
Ref Values: Accepable under 200 mg/dl
TOTAL COLESTEROL:
Now: 377
Jan/17: 252
Ref Values: Accepable under 200 mg/dl
HDL:
Now: 103.2
Jan/17: 77.7
Ref Values: Accepable over 40 mg/dl
LDL:
Now: 269.8
Jan/17: 145.7
Ref Values: Accepable under 130 mg/dl
FASTING GLUCOSE:
Now: 80
Jan/17: 77
Ref Values: 70-110 mg/dl
CREATININA:
Now: 0.84
Jan/17: 0.82
Ref Values: 0.51-0.95 mg/dl
RATIO HDL/T Ch:
Now: 0.27
Jan/17: 0.31
RATIO TRIG/HDL:
Now: 0.63
Jan/17: 1.84
On behalf of the Low Carb-High LDL community, thank you again! I’ve donated a small amount in sign of my appreciation.
Best wishes,
Antonia
Hi Antonia–
Your scores actually are pretty common for a hyper-responder. Your HDL, which was already really good at 78, improved to 103. TG dropping to 65 likewise shows much higher utilization, so I’d expect you’re actually being very good about keeping your carb count low and maintaining energy balance and/or deficit.
Your LDL is actually identical to mine on keto at 270. While I try to be a good scientist and not claim certainty about risk without having empirical evidence, I *can* say that I got to where I am with my research by understanding how this system works, allowing me to alter the numbers easily. And if my understanding is indeed correct, then there’s a perfectly sensible reason we see higher cholesterol on low carb given we are trafficking more fatty acids for energy which “ride share” with cholesterol in low density lipoproteins (LDL). Be sure to check out my Simple Guide series for more info on this: http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb-part-i/
Moreover, there’s actually a counter case to be made that women *in particular* should be celebrating higher cholesterol given they have an “X” of higher cholesterol = lower all cause mortality. I’ll be turning this into a post soon, but there’s some copy/paste from a recent comment I made that includes recent, large scale studies to this effect….
—-
Japan Health Study (91,219) Norwegian HUNT study (52,087).
Key lines from the Japan study:
“Overall, an inverse trend is found between all-cause mortality and total (or low density lipoprotein [LDL]) cholesterol levels: mortality is highest in the lowest cholesterol group without exception. If limited to elderly people, this trend is universal. As discussed in Section 2, elderly people with the highest cholesterol levels have the highest survival rates irrespective of where they live in the world.”
https://www.karger.com/Article/Pdf/381654
Key lines from Norwegian study:
“Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95%”
https://www.ncbi.nlm.nih.gov/pubmed/21951982
Hi Dave,
I’ve been diving into your research and trying to fully understand it. I am a 49 yr old male who has been diagnosed with high cholesterol most of my adult life. I have been on 10 mg of statin for years. I am also on LCHF and continue to get high cholesterol numbers.
I feel silly asking this, but I seem to be missing a simple point of your research. The event that led you to this was being on LCHF and getting high cholesterol numbers. However, your inversion experiment shows that the more fat you eat, the lower your cholesterol number are. If that is the case, then why is cholesterol rising on the LCHF?
Thanks.
-Dean
Hi Dean— Short version: I’m powered by fat (triglycerides), which ride shares with cholesterol in low density lipoproteins. Generally, the leaner and more athletic you are, the higher your LDL because you need even more energy mobilized by fat for availability to tissues. This is why the leanest and the most athletic low carbers can have the highest LDL (http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/).
Thank you Dave – I appreciate your response. Since my initial question, I spent a bit of time on Ivor’s site as well as Peter Attia’s site – I think it’s all starting to come together.
Thanks for sharing your research, it is certainly insightful.
-Dean
Hi Dave,
One of the factors that’s mentioned as a possible cause of elevated cholesterol numbers is weight loss. Is there any information available on how long after weight stabilization that persists?
Since Jan. 18, 2017, I have been on a ketogenic LCHF diet, and have lost 20kg, which was close to 30% of my body weight when I started (No, I’m not anorexic, just short & small-boned!). Currently I’m within two kilo of my target weight and am beginning to work on stabilizing my weight.
I had blood work done on Nov. 4. Below, I’ve compared the results from my last previous test, which was on Jan 5, 2016 to those of Nov 4, 2017:
Total cholesterol 6.76 / 9.49 mmol
Triglyceride 1.15/1.14 mmol
HDL cholesterol 2.14/2.26 mmol
LDL cholesterol Calc 4.09/6.71 mmol
Non-HDL cholesterol Calc 4.6/7.23 mmol
Total cholesterol HDL-C ratio 3.2/4.2
Hb A1c 0.058/0.052
The dramatic rise in my cholesterol numbers freaked me out slightly, and I’ve been researching what I can find on the web. There’s a huge amount of info, and it ranges all over the place. Predictably, it’s left me confused! As well as the question of elevated cholesterol due to dieting, there’s also the apparent protective effect of high cholesterol for old women – I’m 73.
But before I make any decision on diet & lifestyle, I’d like to have a reasonably accurate picture of my cholesterol status. An NMR would be a good next step, but it’s expensive, so I’d like to wait until it’s likely that the post-diet cholesterol spike has settled down.
Thanks for your great work on this vexatious question!
Helena
My personal opinion, given what I’ve learned to this point, is that weight loss must be very active and rapid to have a significant impact on LDL-C. In other words, if you were losing, say 1kg or less a week, I doubt it would have much impact on your LDL-C.
Odds are, your NMR will likewise show higher LDL-P with low small LDL-P given your TG/HDL appears very strong (Pattern A).
Hi Dave,
Thanks for getting back to me – I’ll hold off getting an NMR done until my weight has stabilized, and won’t worry too much about weight loss affecting it, since I’ve been throttling down the rate for the past couple of months.
Another question: most of the numbers on your site are in mg/dl rather than mmol/L, and I’ve tried to convert mine so that I can get a clearer idea of where I’m at. The process has left me rather confused – I’ve used three different methods:
Working from total cholesterol of 9,49 mmol/L, HDL of 2.26 and triglycerides of 1.14mmol/L
– multiply by 18, which gives me 170.82. 40.68 & 20.52
– the table at http://www.joslin.org/info/conversion_table_for_blood_glucose_monitoring.html, which gives me ~ 170, 40 & 27
– the online converter at http://www.onlineconversion.com/cholesterol.htm, which gives me 366.97, 87.39 & 100.97
I can see why the “multiply by 18” & the Joslin one are different – they’re both convenient, but probably not super-accurate. It’s the third one that puzzles me.
Also, what is a “good” TG/HDL ratio range, and what is the formula for calculating the TG/HDL ratios? I’m guessing it’s simply divide TG by HDL, which gives me the TG/HDL ratios of 0.50 (rounded) in mmol/L, and the following from the converted values:
– 20.52/40.68 = 0.50 (rounded)
– 27/40 = 0.68 (rounded)
– 100.97/87.39 = 1.156 (rounded)
I suspect that, once I figure I’ve got a reasonable amount of information (it seems to be a real rabbit hole!), I’m going to see if there’s a study out there looking at these issues that I can join.
Seeing that the baby boomers are approaching old age, it would be interesting to see how cholesterol behaves in the elderly & old – and whether anybody is actually bothering to research this! (My physician if a firm believer in the evils of cholesterol & referred me to a cardiologist who tried to put me on statins well before I went keto & my cholesterol numbers were “good” – presumably because of my age. Sigh.)
These are the conversions I get:
– TC: 9.49 mmol/l = 366.97602 mg/dl
– HDL: 2.26 mmol/l = 87.39366 mg/dl
– TG: 1.14 mmol/l = 100.97431 mg/dl
And yes, this is actually a very common profile for hyper-responders (very similar to mine).
TG/HDL of 2 or less is commonly considered optimum.
I know conventional doctors continue think of cholesterol as evil, and they will likewise see a lot of us LCHFers coming in with very low inflammation levels, lost weight, lower blood pressure, low a1c, etc, but will point to higher LDL as the concerning marker — to which I recommend they visit http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/
Hi Dave
I just came across your blog and it has been very helpful. This is very informative and thank you for all the knowledge you are sharing. I need your help and some advice on my cholesterol situation if you dont mind. I am 40 yr old male and mostly been diagnosed to border level cholesterol from past 5 years. I have been working very hard at the gym and lifestyle to improve my cholesterol levels. But unfortunately this does not help me much and I bumped into the Keto diet.
I have been on Vegetarian Keto Diet (eat eggs) from 60 days now.
My macros has been like 75-25-5 and around 1800-2000 calories per day. My Ketones are at avg of 1.5 and Blood sugar avg at 92.
Before 60 days non-keto : HDL – 35, LDL-153, Tri-112, Total-210
After 60 days of keto: HDL – 35, LDL-196, Tri-140, Total-259
Some of my concerns are:
– My HDL never increased? (this was my main reason to start keto)
– Should I increase my ketones?
– I am also pre-diabetic before Keto and getting my blood sugar normal is my other goal.
– Cholesterol numbers are concerning and What changes would you suggest me to do on the above data I provided?
Big Thank you for everything you are doing and looking forward to your reply! Appreciate your response!Thanks!
Hi Vik
This is indeed an unusual change — or rather, lack of change.
As you mentioned you are vegetarian keto, you may actually not have a lot of saturated fat in your diet, instead having more M/PUFA. Saturated fat typically results in increased HDL (and often LDL as well).
Your trigs increasing by 28 may be noise (first test might have pulled low, the second pulling high), but I’d still be curious if that continued to be slightly higher in your next test.
Regarding increasing ketones, I’m actually not a big fan of targetting high ketone (BHB) measurements as I think it’s less relevant than most people do. Blood tests of any substrate are capturing what is in transit in the bloodstream and not yet used. Thus keto athletes can often have lower ketones test markers than sedentary because their cells are consuming them faster, leaving less in the blood for the test to pick up.
If you aren’t already, be sure to track your food closely and I’d recommend taking your sample logs to the forums bringing them your concerns. HDL being persistently low at 35 is something I’d want to look into as it could be some other factors (such as thyroid), but I’d want to rule out diet relation first.
How can you be sure that cholesterol drops due to a huge amount of calories and not due to the fact that excessive protein and part of the fat you consume on the days before the test? It seems that the protein you eat on usual days is largely sufficient for the body and all the extra will be converted to glucose?
The fact that only 95g of glucose is needed to drop cholesterol also seems to support this hypothesis.
My more recent energy status experiments appear to knock this hypothesis down as when I have higher carbs but lower overall calories, my LDL goes up relative to the upper baseline. Moreover, I had an experiment last year where I ramped up the proportion of fat relative to both protein and carbs where it continued to follow the Inversion Pattern.
That sounds interesting. Do you think the type of fat matters?
By the way does a common cold can affect the results of the blood test? I don’t know if I have to put off the test until I feel really well.
The type of fat appears to matter for some with regard to saturated vs M/PUFA, but doesn’t appear to affect my Inversion Pattern as much. I plan to do another experiment on this next year.
A cold might impact lipids, yes. LDL can be unregulated to fight an infection. How much and for how long isn’t as well known.
Finally, my cholesterol is absolutely normal (I’m so happy!) although I’m very thin (my bmi is 20 and it overestimates my weight because I’m very tall).
Maybe because I eat much more than I’m supposed to? I think my caloric intake might be about 2500 Cal which is quite much for a woman who does no sport.
But in fact I feel I need 3000 to feel comfortable after having a meal.
I wonder what my cholesterol levels were before this diet and how much I used to eat. I think quite less than now, and still I am losing weight…
LCHF is really unusual and its effect is so independant of calories. It’s great that you are trying to develop some scientific base for it.
Yes, I find a lot of people ultimately find a caloric load higher than they thought they would — I certainly have. I used to average 2200-2500 calories/day when before keto, but pull closer to 3000 now. The punchline? I weighed 35lb more before!
And of course, thank you for the kind words.
Hi Dave,
Thanks for clearing up my conversion confusion – if I’ve calculated correctly, my TG/HDL ratio is 1.15539, which is a number to be pleased about!
Last January, I expected that, if I lost the extra weight I was carrying, my doctor would be happy with the results. Now, even though I have, talking with her is probably going to get “interesting”.
Though I wasn’t pre-diabetic, and not suffering from insulin resistance, I was worried about my weight and blood pressure. After ten years of battling a slow but inexorable weight gain, and developing borderline hypertension, I went on an LCHF diet. With great success. I won’t bore you with the details – if you’re interested, there’s an entry on my blog:
http://redefininglittleoldlady.com/little-old-lady-on-ketones-or-seven-months-on-an-upside-down-diet/
So far, I haven’t found a physician who’s willing to work with me on LCHF, so, when I was close to my target weight of 50 kilos, I made an appointment with a nurse practitioner at a local clinic. She was willing to prescribe a bunch of blood tests for me. When the result came in, she was very much alarmed and phoned me immediately, with the advice to go see my doctor as soon as possible
I wasn’t best pleased myself. I had been merrily expecting wonderful results – and most of them were excellent! Blood pressure down from ~ 130/90 to 100/80, Hemoglobin A1c of 0.052, all the other values bright & shiny.
But, as you said is typical for hyper-responders, the cholesterol figures were in what is routinely perceived as the prescribe-a-statin-immediately zone. For many reasons, I’m unwilling to even try statins.
Aside from the physical improvements, I’ve never felt better. My energy is way up, and for the first time, I’ve managed to keep up a regular exercise program (two vigorous one-hour aquafit sessions a week, plus an average of half an hour’s walk daily the other five days) for more than a month or two.
But the biggest improvement is that the low-grade depression that’s been dragging me down for years is finally lifting. So, even if I weren’t deeply concerned about the side effects of statins, it would take an awful lot of solid evidence to persuade me to change my diet significantly.
Which is going to make for a lively conversation when I finally do go see my family practitioner! I’ll give her the link and see what happens…
Thank you again!
Fantastic story, Helena!
In so many ways, I’m happy to be living in this time where we can crowdsource our respective data. Like so many others, I daily get stories of (1) fantastic markers, (2) feeling better than ever, (3) having incredible, lasting energy, yet (4) having high cholesterol. But as I keep pointing out, all of these make perfect mechanistic sense in the context of being powered by fat.
Hi Dave
I am a UK based zero energy architect/renewable energy engineer who has been LCHF for about 14 years and have been time limited feeding (usually 16:8) and also occasional intermittent fasting.
As I had a blood test recently I fasted for about 2.5 days prior to the blood test as my focus was on keeping blood glucose levels low. I was somewhat surprised to find that my cholesterol came back high as did my trigs.
I was perplexed for a while then I remembered your presentation at Low Carb Breckinridge and I think that you mentioned that when you fasted your cholesterol shot up – was that also true of your Trigs?
I am due to see my doctor this evening so I am trying to pull some thoughts together.
I was very impressed with your research into the topic and it does seem as if you have nailed it and the thinking about LDL being an energy transporter – especially if one is LCHF/keto – seems to make sense.
Good luck with your experiments and research.
Regards
DT
Yes Dr D, you probably *maximized* your potential cholesterol numbers by fasting 2.5 days. Note these are the highest LDL numbers I’ve gotten with my own 2.5 day fasting experiment earlier this year: http://cholesterolcode.com/the-fasting-disaster/
Thank you for the kind words. Certainly the sooner everyone can know and understand this information, the better. 🙂
Dave,
I just tried your protocol twice after being prescribed cholesterol lowering medication. After the second try my Lipid panel came back within normal levels.
Total Cholesterol:
11/11 – 395
11/17 – 242
11/22 – 186
I would be honored to share more my blood test and food journal if it would be of benefit.
Thank you for sharing this information.
Awesome, Corey. We are certainly interested in gathering citizen scientist data!
First, what were the TC/TG/HDL-C/LDL-C numbers? That would let us plot you on the Blood Pool visualizations.
So 11/11 was a low-calorie phase and 11/17 and 11/22 both high calorie phases?
Yes, what Craig asks! Thanks in advance for adding your additional data for us! 🙂
Wow! You managed to drop total cholesterol over 200 points in 10 days. Can I ask what dietary changes you made on the second try?
Hello Dave,
I hope you can give me some advice on my Lipid numbers. I have been keeping my blood work numbers from my late 30s. I didn’t have blood work done any more often than what was required by an insurance company or as part of a normal checkup. My family history seems to show that we have higher Triglycerides than most people, and I tried to lower them by staying in good shape and eating healthy. My game plan had been to eat low fat and if I did eat fat, it would be the “healthier” fats (EVO, etc.). The most I have ever weighed is 200 lbs and I am 6 feet tall. In an effort to improve my Triglycerides, I worked to lose fat and get leaner. I would eat small portions of healthy meals and finally got my weight down to about 175. I wasn’t counting calories, and I didn’t track carbs, but I did target an approximate amount of protein. Occasionally i would get close to breaking the 170 mark, but it was like a wall. I started reading a lot about nutritional Ketosis in August/2017 and got a game plan ready and started eating a Keto diet. So I have been in nutritional Ketosis a little over 3 months. The amazing thing is how fast I have dropped pure fat from my body. I have tracked everything I eat and rarely went over 20 net carbs on any day. I have been eating 70-80% fats, 15-20% protein, 3-5% carbs. I currently weight 153 and I feel great. I had blood work done about 2 weeks after starting Ketosis, it just happened to be my annual checkup and I have to check my TSH numbers for my Hypothyroidism (that was diagnosed about 5 years ago and I take Levothyroxine 75mcg each day). I will give you some results from a few of my past blood draws going back long before I started Ketosis and hopefully you might have some thoughts about what I should be doing.
2/9/2013
Total Cholesterol 254
Triglycerides 538
HDL 35
6/29/2013
Total Cholesterol 276
Triglycerides 1380
HDL 32
12/2/2013
Total Cholesterol 194
Triglycerides 312
HDL 34
VLDL 62
LDL calc. 98
8/18/2014
Total Cholesterol 167
Triglycerides 222
HDL 36
VLDL 44
LDL calc. 87
(These numbers are after I started eating very small healthy meals as I described above and dropped my weight down in the mid 170s. This is also the lowest Triglycerides I have ever seen with my blood draws)
2/1/2016
Total Cholesterol 224
Triglycerides 662
HDL 28
VLDL 132
LDL calc. unable to be calculated
(Because I was in a routine of eating basically the same things and working out the same, these numbers surprised me and my Doctor. As I tried to figure out what I did to make these numbers change, I knew that the only material change in my diet, was that I had cut back almost entirely from eating Tuna (after reading an article in Consumer Reports about Mercury poisoning) and had stopped using fish oil supplements, thinking that I was getting plenty of fat from the EVOs and Flax. So I told the Doctor to give me a few weeks to put fish (Salmon, not the same risk of Mercury poisoning) and fish oil back in my diet and lets see if everything goes back to the 8/2014 numbers. They did, surprising myself and the Doctor (see the 5/16/2016 results below).
5/16/2016
Total Cholesterol 165
Triglycerides 222
HDL 34
VLDL 44.4
LDL 87
9/13/2017
Total Cholesterol 468
Triglycerides 1251
(These numbers are after I have been in Ketosis for approx. two weeks, and I have never seen my Cholesterol numbers ever go this high).
12/06/2017
Total Cholesterol 487
Triglycerides 1115
HDL 35
(The only thing I changed between the 9/13 test and the 12/06 test, was that I stopped using butter cooking my eggs and I reduced my cheese intake to one slice in the morning with my eggs. In that first two weeks of Ketosis, I had been eating lots of cheese all through the day.)
I am curious about your thoughts looking at my history and how it might relate to my short experience with being in Ketosis. Do you think that having Hypothyroidism (even though control with Hormones) having any effect on my results in Ketosis?
Thanks
Hi Ron,
– Of course, hypothyroidism can impact lipid numbers. I’m curious, what markers led to your being diagnosed with it?
– In doing a quick google, it appears Levothyroxine is associated with higher cholesterol. (Such as here: https://www.rxlist.com/consumer_levothyroxine/drugs-condition.htm)
Thus, one or both of these may be impacting your results.
– Your high triglycerides would certainly concern me. If the above two confounders weren’t truly in play here, I would wan to do a 23andMe in your shoes and learn of any genetic markers I may have that could explain this high level. This seems especially appropriate given you mentioned this appears to run in your family. Often your SNP data from this research gives valuable clues on both diet and medication allergies/reactions.
– When you dropped off your tuna, it might have dropped down your ratio of fat vs carbs. This would make sense for lowering *both* your LDL and HDL, but your VLDL increased. This suggests you were still in an energy surplus, but on the carb side of the fence. I rarely see VLDL that high, and it can be a bad sign as it is highly associated with CVD. (VLDLs aren’t remodeling to LDLs because they aren’t properly dropping off their energy, which is common when cells are already too topped off and aren’t uptaking any).
– Right now, I’m inclined to think you’re in an energy surplus of some kind — and it might be from a commonly consumed, probably refined source such as alcohol, sports/protein shakes, oils, etc. This, in combination with a systemic issue (such as genetic) might be a big dysregulation. Unfortunately, that dysregulation could be the hypothyroidism, medication for it, or both.
Again, I’m not a medical professional, just an engineer obsessed with lipids and the patterns they expose in this area. So as always, nothing I say constitutes medical advice.
Dave,
It is interesting that you suggested the DNA test, I had just received my test kit from Family Tree DNA. My Sister is working on our genealogy and said this specific test would be helpful to collect info about our family tree. The test I ordered is the Y-67 (Examines 67 short tandem repeats (STRs) on the Y chromosome). I don’t know if this will give me any of the info that I could get from 23andMe or if it would be similar. Let me know if you think this test will shed any light on any of these lipid numbers. If you want to see the results, let me know.
Thanks
I’m not familiar with Family Tree DNA, myself. Mainly, I just like 23andMe for the robustness of the data and accompanying reports (not to mention tools like prometheus that work with it).
Hello Dave,
I don’t think there was any specific markers that led my Doctor to suggest the Thyroid test. He is a really good guy that is more open to correcting health issues naturally if possible and he suggested we should do a Thyroid test since I had never had one before. After looking at potential causes of Hypothyroidism, one cause can be lack of Iodine, and I actually supplemented that for six months without positive results before going on the hormone.
As far as your thoughts that I could be in a “energy surplus”, I will tell you that i do consume a few protein drinks (but not everyday), specifically Muscle Milk and Advant EDGE. I only drink one of these if I want to add some protein to my numbers for the day, and I chose these because of the low carbs they have. I do consume one tablespoon of MCT oil (three teaspoons throughout the day). Sometimes I eat a snack/protein bar and I have a few different brands, all with low carbs, but I do notice that they show a high carb count and then after subtracting the fiber and then the “sugar alcohols” that brings the total down to 1 to 3 net carbs. Could those “sugar alcohols” be creating this energy surplus? I have read if you consume alcohol and you are in Ketosis, your liver will burn the alcohol first and basically put your fat burning state on hold, until the alcohol is burned. If that is true, that shouldn’t be a very long time, because the total calorie count in these protein/snack bars is approx. 150 to 250 calories. I do occasionally have an alcoholic drink and when I do, I mix one ounce of Rum with diet Pepsi and hardly ever have more than two (which is just a little more than “one shot”). As I think about these sugar alcohols and or alcohol consumed, I didn’t think there would be much impact, because I burn approximately 450 to 650 calories at the gym everyday (according to my Apple watch), depending on if I’m just weight lifting or doing cardio. Like I said earlier, I was weighting in the mid 170s three months ago and now I’m 153 after being in Ketosis. I’m sure I have a small amount of fat stores on my body, but most have been burned off.
I guess what is confusing me, I can go back to eating the way I was prior to being in Ketosis and get my Lipid numbers back down, to at least where they were (Cholesterol 165, Triglycerides 222), but how can being in Ketosis not be good for me after losing so much fat, not to mention feeling very good. After reading on your web site that I can order my own blood work and they have a location about 10 miles from me, I am wanting to experiment tweaking different things in my diet to see how much it will affect lipid numbers, so your suggestions will be appreciated. Do you have any thoughts of what I should try first and for how many days, before I schedule another blood draw?
Thanks Dave.
Hi Ron —
I generally avoid individual medical advice. From a diet perspective, if I had the same numbers, I’d start from a whole foods diet for a couple weeks and get tested to determine if this had an impact. And if favorable, I’d likely take it longer and retest again. If not favorable, you have a better sense of whether it is genetic and/or related to the newer diet you have.
Hi Dave. Thanks for your resources and research. I’ve been traditionally high in cholesterol all my life. I went LCHF about 2 yrs ago. I am fat adapted and typically in mild ketosis. Just got my numbers again and I’m confused. I think I’m a hyper responder. Will get tested for FH. In general my TG to HDL ration is less than 2 which I think means good. But the other numbers worry me. I am active and in shape but not exactly lean. I would like to lose another 20-25 lbs. What are your thoughts? Total: 353 HDL: 67 LDCL:261 TG: 112.
I had the quest diagnostics lipo profile earlier this year and it turned up with pattern size A. My holistic doc has not been worried. But these LDL numbers are trending up. I see him again in a month.
Thanks,
Chris
Your profile looks pretty standard for a hyper-responder.
If/when you get leaner, you may see your LDL and HDL go up, and TG go down further. But again, this would make mechanistic sense.
Hi Dave.
Haven’t looked at the site for awhile, but I see you have been busy.
You may be aware of the following paper by, among others Volek and Phinney, apologies if so.
It looks analytically at stepwise increments of carbs and decrements of fat in a controlled feeding experiment.
Although the emphasis is on the disconnect between dietary and plasma fat, there is an interesting sidebar on plasma cholesterol versus dietary fat that supports your main thesis.
Enjoy.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113605#pone.0113605-Aarsland1
I think I read it early on in my learning about lipids, so it’s worth coming back around to it given what I know now. Thanks for the tip. 🙂
Hello. I’m not a Keto dieter and my carb ingestion is probably a bit more than a true low carb diet, maybe more in the daily 80-150 grams or fewer range. My weight is on the low side for my height/age (BMI just touch over 20). My cholesterol numbers have been trending upward the last decade or so, even when I ate true low carb for a while. Lately they’ve gone up quite a bit, with LDL going up enough to get my primary doctor’s attention, from 177 to 219. She retested it 5 weeks later and it went up an additional 15 points, to 234.
I’ve been on a couple different statins years ago, both of which eventually caused muscle soreness, so can’t and won’t go on a statin again. I’ve read Cholesterol Myth, Good Calories/Bad Calories, and other books, so don’t buy into the “cholesterol causes heart disease” camp anyway. But I have started monitoring my particle counts, etc. even though my doctor is only focused on the traditional numbers (LDL, HDL, trigs).
Anyway, I stumbled onto your inversion-pattern video a couple months ago so decided to try the 3-day protocol before my next test. I ate my usual diet but tried to really increase the fat. Each day I ate two avocados, a lot more nuts, more EVOO, etc. I just got my test results and thought that you’d be interested. The protocol definitely worked in my case:
My results (from 11/2017 test to 1/2018 test):
LDL: from 200 to 167
HDL: from 68 to 63 (minor decrease likely from less exercise)
Total Cholesterol: from 281 to 238
Triglycerides: from 63 to 39
I’m pretty pleased with the results–I’m pretty sure that the doctor will get off my back now, even though she thinks the LDL is still way too high (but it’s been around that number for at least 5 years). I thought I’d share with you though the dramatic results. I’ve never had a trig number so low either.
Hi Diane-
Thank you so much for sharing!
I’ve been wanting more non-Low Carbers to do this protocol for this very reason — to show if the Inversion Pattern indeed works outside a low carb diet (as I’ve always suspected it would if one is metabolically healthy).
So glad to have you adding your numbers to our data pool! 🙂
Glad to share! FWIW, I’m planning to run an NMR test next week to see how the numbers differ from the latest above ones, without my doing the 3-day protocol or making other changes. I want to get a handle on how much the 3-day protocol affected the numbers, even though I think cholesterol numbers are a moving target within a range specific to each of us, so I expect there will be some differences based on whatever I just ate and other (unknown) variables anyway.
Hey Dave, so I redid my cholesterol test (NMR, different lab from the one my doctor uses), exactly 2 weeks from the above test earlier this month. The above test used the 3-day high-fat protocol, whereas the one just done 2 weeks later did not. My cholesterol numbers did go up, as shown below:
Comparison of 3-day protocol numbers to later 2-week numbers (no 3-day protocol):
Total Cholesterol: from 238 to 266 (+28)
LDL-C: from 167 to 188 (+21)
HDL-C: from 63 to 67 (+4); not sure why this one changed
Triglycerides: from 39 to 55 (+16)
Interesting! Okay, so I’m working at isolating impacts for those who saw results that didn’t show and common confounders. A few questions:
1) You water-only fasted for 12-14 hours before the blood draw, yes? (No coffee, tea, etc)
2) Do you drink coffee? If so, about how much did you drink on average during the days before the blood draw?
3) Did you have any MCT or coconut oil?
4) Any medication? And if so, were there any changes between the last test and this current one?
Thanks! The added information will be helpful for our research if you can let me know! 🙂
Hi Dave! Here’s some more info:
1. Yes, I fasted for 12-14 hours before the test, just drinking water.
2. Yes I drank coffee on the days before the test — just a cup a day (50% decaf, 50% caf, or 75% decaf, 25% caf). This is the same amount I drink every day no matter what.
3. No, I didn’t have any MCT or coconut oil on the days before.
4. Yes, I take medication: 75 mcg synthyroid, which I took even the morning of the test each time, per doctor’s orders. I also take supplements (but not during the fast and not at any different frequency/dosage in the days preceding the tests). The only supplement that may be noteworthy is what I’ve been taking since 8/2017 to reduce cholesterol: 1000 mg citrus bergamot (the NOW Pro Cholesterol brand). For the 11/2017 test, I had been taking the Pro Cholesterol for about 3 months; for the 1/2018 test, it was almost 6 months. To isolate the changes that were from the Pro Cholesterol vs. the 3-day protocol, I then got my cholesterol redone two weeks later in the latest test results.
Ah, very interesting. Of course, I’m gravitating toward the Synthroid. The thyroid can certainly impact lipid numbers and early on in my research, I read a lot about that with hypothyroidism (which I suspected at the time I might have as a hyper-responder). I would later find that T3 being a little bit lower is actually pretty common for low carbers.
Your NOW supplement is also interesting and could certainly be a confounder given it is targeting it directly.
Outside of that, I’m doubtful your one cup of coffee was that relevant, particularly if you didn’t have any the morning of the blood draw.
Are you saying that you think the Synthroid made my 3-day test results as you expected or different than if I weren’t on Synthroid?
FWIW, I think one reason my cholesterol numbers started trending so much higher earlier last year was from being on too low of a dose of Synthroid — I had recently switched from desiccated pig thyroid med Nature Throid to Synthroid and my doctor had started me too low since my last Nature Throid dose was too low. My Synthroid dose had just been stabilized right before I started the NOW supplement, although I still believe that hypothyroidism impacts cholesterol levels even if treated with medication.
I don’t know for sure if it was the Synthroid, just that it is the first I’d wonder about among the suspected possibilities. It could also be the hypothyroidism which can certainly impact lipid numbers all its own.
Suspected possibilities in what respect? I’m trying to understand why it seems my results are confounding? Did you not expect the 3-day protocol to work for someone who isn’t super low carb? Or did you think the results would be more dramatic in testing two weeks later w/o the 3-day protocol? What was it about my results that are confounding?
I was speaking in the hypothetical of the Protocol working if one were not low carb. Again, I don’t have a lot of examples, so I don’t know for sure if it would. But if it turned out to work for higher carbers as well, then I’d consider my above possibilities as potential reasons why it might not have worked in your case. I was just thinking out loud, that’s all. 🙂
It did work for me… at least I think it did. 🙂 When I didn’t do it, my cholesterol shot back up. Doing it, total Cholesterol was reduced 28, LDL-C was reduced 21 and Trig was reduced 16. I myself consider the 3-day protocol to have worked.
Maybe I didn’t word the above test results better–the increase in the numbers reflected two weeks later, not doing the 3-day protocol, meaning the 3-day protocol had reduced my numbers by that same amount. Does that make sense?
Ah! Gotcha!
Hi Dave
I appreciate all of your information and hard work behind the scenes you bring to we lay people. I’m due for a lipid panel in 2 weeks. I’d like to know if for the 3 days prior to the blood draw if I eat mainly copious amounts of raw macadamia nuts ,avocados and bacon trying for around 5000 calories each day should I see favorable lipid panel results compared to my last one I did 3 months ago while eating a low carb diet ( but not the very high fat like I plan on doing this go around) I certainly appreciate your comments on my question
Sincerely
Scott Belanger
Newcastle Maine
Given our current data thus far, I think it’s likely. Right now the success rate seems to be about 85% for those people who try the protocol. But as always, I caveat that it isn’t medical advice, use at your own risk, etc.
http://cholesterolcode.com/extreme-cholesterol-drop-experiment/
Hi Dave, I’m just wondering if you have done any cholesterol testing with regards to eating keto and being dehydrated vs not being dehydrated? I recently had blood work done and my numbers are as follows (I have been pretty strict keto for nearly 2 years):
Tryg: 94 (up from 83 six months prior)
HDL: 56 (down from 64)
LDL: 196 (down from 240)
I’m a tad confused as to why my tryglycerides would have gone up and HDL gone down, but given the ratio I’m not highly concerned (although my doctor is slightly panicked and wants to put me on statins).
BUT, my tests always show that I am dehydrated. I have a very hard time getting in adequate water and am horrible at adding extra salt. Oddly enough I still feel terrific.
I did a quick online search and discovered, “Drinking water can actually thin the blood, making in a natural way to help the blood pump more smoothly. When the body is dehydrated, the blood becomes acidic which can lead to a build-up in LDL levels of cholesterol. Drinking plenty of water will keep your blood ways clean and eliminate excess buildup of cholesterol waste from the body.”
I’ll be going in for more blood work soon. I’m curious to see if I do a simple change like drinking over 2 litres of water a day and getting 3 to 5 grams of salt, if my ldl levels would drop considerably. Perhaps chronic mild dehydration can be another reason so many people on keto may have higher levels of ldl?
I’ve struggled with getting enough water and salt throughout my time with keto. I find I need around 4g of sodium or more on average (*sodium* — not salt. That’s about 10g of salt!) or my body will start developing electrolyte issues. But I may be an unusual case on that.
I haven’t done much direct testing on hydrated vs dehydrated just yet. I’m not sure LDL levels would be substantially affected unless one was severely dehydrated given the amount of blood volume overall.
Thank you for taking the time to respond. I’m quite curious with regards to this subject. I’d be interested in knowing further information on the following study: “Dehydration during fasting increases serum lipids and lipoproteins”.
https://www.ncbi.nlm.nih.gov/pubmed/7895421
Maia, interesting point. Thank you for adding the references to the study. I will try to be more conscious about sufficient hydration during 12 hour fast prior to the blood draw. Normally I do not drink enough water anyway and especially before the blood tests I try to be even stricter with my intake. All this proves further how volatile the numbers can be.
I found an old Soviet book about nutrition of pregnant women (written in the 80s) and it says that a typical requirement of salt for a non-pregnant person is 12-15g but it advises to reduce the ammount salt to 5 g by the time of giving birth because it reduces pain and makes the delivery faster. The book seems to have a good theoretical basis although it recommends a high carb diet.
Even for as much as I already salt my food, I find I need to supplement some with Sports Salts as well to hit the right electrolytes lately. This may change at some point, but right now if I don’t maintain at this level I get typical symptoms like leg twitches/cramps.
LI’m so confused. I’m trying to understand all this info and it’s frustrating. I am on 40mg a day of Atorvastatin and I hate this medicine. I’m using keto and love it. I have managed to lower my blood pressure enough to come off 1 of my meds. My goal is to be medicine free and I’m using keto to do this. Can you please help me better understand my LDL/HDL numbers and what I can do to improve them? I was told to focus on “cleaning” my arteries and that would help improve cholesterol. But I’ve also been told cholesterol isn’t the issue it is the triglycerides. I weight train 6 days a week. Do cardio at least 4 days a week and eat HFLC diet (keto). Thank you.
Total:213
LDL: 136
HDL: 26.6
TRIGLYCERIDES: 252
Hi Matthew,
Indeed, these numbers look challenging. On LCHF you should be seeing your triglycerides going down and your HDL going up. Both of these are in a tough range.
I’d want to encourage you to track your food very closely and start sharing these logs and your lifestyle for advice on the forums. It’s possible that you’ll want to confirm everything you’re eating is keeping you keto to help meet these targets. A good forum I’d recommend is KetogenicForums.com.
You could also find a good keto coach as well who could work with you one-on-one or in group sessions.
Greeting! I have been strictly keto for 5-months. My most recent cholesterol test show a rise across the board including my triglycerides (before keto 102; 30-days keto 133; 5-mos keto 150). Not sure what to make of this, any info you can point me to?
Hi Linda — it’s hard to get a clear picture without your other blood markers. See if you can run them through our report tool here and repost: http://cholesterolcode.com/report/
Hi Dave, i got to know about from the 2 Keto dudes and went over yours interviews and presentations. You make a very compelling case for the correlation of lipoproteins and TG/Cholesterol transport in the blood with keto diets and fasting states.
As a biologist, I think your model seems very good and you data clearly support it well. What I am missing is the role of HDL in this model. If the LDL (U and V variantes specially) are the long range transport vesicles, and the local distribution from the fat tissue to the local TG consumers is done by NEFA, what is HDL doing and why is it associated with better healthier outcomes? Any insights? or maybe could someone point me to a reference where this is discussed?
Many thanks and keep up the great work!
So I believe there are two components overall…
1. HDL, like emergency vehicles, are often in lower circulation when they are “in use” as it were. This is a bit of an oversimplification because this encompasses a few different things at the same time. Moreover, it can be confounded by other things that raise HDL for bad reasons, such as alcoholism or genetic problems with CETP. But overall, I believe higher HDL generally means “bored cops patrolling the neighborhood” — you are thankful that they don’t seem to have much to do.
2. I believe HDL may have an energy delivery pathway, particularly in one who is fat-adapted. They exchange the Apolipoprotein C-II, which is involved in fatty acid transport (typically from VLDLs via hydrolysis), but it is speculated (though not very well studied) that HDL may likewise drop off TGs in the same way if they have many to spare. And they WOULD have many to spare in a high TG delivery environment as there may be more CETP bloating them up with it. This likewise explains why Lean Mass Hyper-responders would have substantially higher HDL on average.
Thanks. So as far as I see their role is less clear, and their label as “good” is mostly based on correlation. I look forward to more of your ideas and experiments. Cheer!
Hi Dave,
Here are my numbers, this really freaks out all the wellness workers every time. The one time they checked it twice thinking something was wrong with their equipment. They see the other good numbers for blood pressure and blood sugar and are beside themselves.
I am 51 and have been low carb many years, after I lost weight my cholesterol shot up. I feel great. Thanks for all your info, I feel at times I am a lone duck with this, but after following this site I realize I am not alone.
Tc 359
LDL 273
Hdl 76
Tg 50
Yep — looks just like a Lean Mass Hyper-responder. Please read this article http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/ (and check out comments below). I’m gonna guess you are lean and/or athletic.
And Remnant Cholesterol of just 10 mg/dL! That’s a great risk score.
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 359 mg/dL 9.28 mmol/L
LDL Cholesterol: 273 mg/dL 7.06 mmol/L
HDL Cholesterol: 76 mg/dL 1.97 mmol/L
Triglycerides: 50 mg/dL 0.56 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 10 mg/dL 0.26 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: -0.546 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 273 | Iranian LDL-C: 221
Total/HDL Ratio: 4.72
TG/HDL Ratio in mg/dL: 0.66 | in mmol/L: 0.28
–==== CholesterolCode.com/Report v0.9.2 ====–
…4 years on LCHF (20g to 120g carbs) ::: 14 hours water fasted…
Total Cholesterol: 291 mg/dL 7.53 mmol/L
LDL Cholesterol: 199 mg/dL 5.15 mmol/L
HDL Cholesterol: 80 mg/dL 2.07 mmol/L
Triglycerides: 61 mg/dL 0.69 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 12 mg/dL 0.31 mmol/L >>> Lowest 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: 199 | Iranian LDL-C: 166
Ha HA I did the candy thing, this helped me get top placement on my life insurance, even though it is a little high by there books all the numbers were amazing. As you can see from my top post it dropped it about 70 points.
That’s great, Ruth — I’m glad it worked out for you. 🙂
What candy thing?
Im lean-mass hyper responder and trying to figure out how to drop total cholesterol to 220 for life insurance. I was at 330 eating carnivore, then introduced carbs and dropped to 265. Pretty sure I only ate around 2,000 to 2,500 calories per day the 3 days leading up to exam. Will up that to 5,000 and try again.
Hi Dave.
I have recently found your experiments and it has been really interesting and helpful in helping make sense of my own numbers. I am a researcher by trade so i was wondering if a) I can help in any way with your experiments or analysis, b) whether adding my data to the pool would be useful
For context i have always had high cholesterol as does my whole family. Genetic testing shows that i have increased ldl, decreased hdl and high trigs due to CELSR2, APOC1, PSRC1, APOE, CR1L mutations. I have been keto since 2014 and this has been great, my BF is about 14% and my cholesterol numbers are super fun. See my reports below. I don’t have my tests from pre-keto but they were similar. Particle size shows high levels of small and large particles and an average mean size because of this.
Are you going to be rolling the cheap blood tests out to Australia at all? Would love to do the Feldman protocol.
Total Cholesterol: 406 mg/dL 10.5 mmol/L
LDL Cholesterol: 340 mg/dL 8.8 mmol/L
HDL Cholesterol: 50 mg/dL 1.3 mmol/L
Triglycerides: 89 mg/dL 1 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 16 mg/dL 0.41 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.32 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.114 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 338 | Iranian LDL-C: 305
Total/HDL Ratio: 8.12
TG/HDL Ratio in mg/dL: 1.78 | in mmol/L: 0.77
Given your run up before seeing your report, I was expecting you might have something much worse in Remnant Cholesterol. But you’re actually right next to the 15mg/dL lowest risk quintile anyway.
Yes, thanks for adding your data! I may have something coming soon with regard to research (wink wink), so please stay tuned to the site on that. 😉
Yeah the numbers are probably better than they would be without keto, especially with 4 more years of high carb food.
Awesome, I will keep an eye out for it!
Hi Dave! Love your blog. Love your videos. I just discovered yesterday that I am apparently a hyper responder. He’s my story: I’m 49 years old, not very active. I started Keto a couple years ago and have lost 40 lbs over the two years. Initially I was taking a statin. While on a Statin, my total Cholesterol was about 180. My LDL was about 115. My HDL was about 50. My Triglycerides were about 95. Then about four months ago, I decided to stop taking my statin to see what the effect would be on my lipids. So after four months of not taking statins and also being strict on keto (85%, 20%, 5% macros), I decided to get my lipids tested yesterday. The doctor called me back a few hours later with the results: He informed me that my total cholesterol is 330! My LDL is 255. My HDL is 60. My Triglycerides are 73. I was STUNNED! I really expected my numbers to be excellent. He is insisting I go on Lipitor immediately. I’m resistant. Any thoughts?
This is very common for LCHF, of course. Your Remnant Cholesterol has you at the lowest risk quintile:
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 330 mg/dL 8.53 mmol/L
LDL Cholesterol: 255 mg/dL 6.59 mmol/L
HDL Cholesterol: 60 mg/dL 1.55 mmol/L
Triglycerides: 73 mg/dL 0.82 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: -0.277 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 255 | Iranian LDL-C: 223
Total/HDL Ratio: 5.5
TG/HDL Ratio in mg/dL: 1.22 | in mmol/L: 0.53
I have more on Remnant Cholesterol here: http://cholesterolcode.com/remnant-cholesterol-what-every-low-carber-should-know/
Ironically, your profile is very good compared to what I say for sedentary hyper-responders — you have high HDL and low TG by comparison.
Hi Dave – I thought these figures may be of interest – I am a 62 yr old LADA diabetic on LCHF since 2013 – my LDL score started out in 2014 on 4 mmol/l moved to 9 and the latest test is 8.5 My HDL was 1.8 mmol/l at best and Trigs 1 mmol/l at best, now 2. but was as high as 2.3 mmol/l
My doctor being worried suggested a CAC scan but it came out 0 and showed a strong heartbeat. I am grateful indeed, but as you can see from my lipid profile it indicates a high risk of CVD but for me it is not the case. My Lipo (a) is >> Medium-High Risk Quintile
Remnant Chol to HDL: 0.54 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.187 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 321 | Iranian LDL-C: 351
Total/HDL Ratio: 8.12
TG/HDL Ratio in mg/dL: 3.54 | in mmol/L: 1.54
Hi Norman–
You copied just a portion of the risk profile text, so I can’t see TC and the actual RC number. I recommend copy/pasting where the line starts. 🙂
Of what I can see, your trigs at 2 mmol/L would be of concern to me. Triglycerides (TG) typically track with Remnant Cholesterol, hence the higher risk score. It suggests your VLDL “boats” aren’t successfully dropping off their cargo (TG) as effectively, which could be due to severe insulin resistance for example. ( See here for more: http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb-part-ii/ )
I have been Keto since AUG 2017 (pre-keto numbers were Total: 231/LDL138/HDL 80/Trig-64 taken April 2017) as you can see, after 6 months of Keto…BIG increase. Hard to wrap my head around it. But TG/HDL ratio looks okay….
–==== CholesterolCode.com Report v0.8 ====–
Total Cholesterol: 688 mg/dL 17.79 mmol/L
LDL Cholesterol: 586 mg/dL 15.15 mmol/L
HDL Cholesterol: 72 mg/dL 1.86 mmol/L
Triglycerides: 150 mg/dL 1.69 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 30 mg/dL 0.78 mmol/L >>> Medium-High 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: -0.042 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 586 | Iranian LDL-C: 554
Total/HDL Ratio: 9.56
TG/HDL Ratio in mg/dL: 2.08 | in mmol/L: 0.91
Hi Kim — this pattern is one I see often with those who are in a surplus of fat with a higher proportion of it being liquid fats. Do you have a lot of heavy whipping cream, coconut, MCT and/or oils in general?
Also, what’s your average daily carb intake, roughly?
So I do 1 TBSP of MCT a day and probably a total 4 TBSP HWC (1 per cup of coffee). I had done quite a bit of olive oil for salad dressing, but not daily and not for quite some time before the tests. I guess if butter falls in the category, that could be it. Saute a lot of spinach in butter. My carb intake is generally 20 net or less. My carbs come mostly from Avocado, Spinach, and Broccoli. I don’t do nut flours, Keto baked goods, or anything like that. Pretty much eggs, meat (mostly pork chops/pork belly/Chicken Thighs/and beef on occasion), salad, cheese. I was pretty shocked to see the numbers triple in such a short time. I thought waiting 6 months was enough time. So some other stats: 48 y.o./5’8″/152 lbs/workout 5 days a week. I don’t know my body fat, but it is not extremely low. And have not actually lost weight on Keto, maybe some fat (I would hope) and added a little muscle. Some other things that changed in my blood were my RBC, not sure if thats relevant but seems they got larger, but my B12 and folate are high and normal respectively. This is all very fascinating when you really start to look at it. At the same time a little scary. The Dr. called as soon as they got the tests and called in a prescription, which I have not (nor will I) pick up.
Very interesting, Kim. While I do see TC and LDL at high levels like that from time to time (usually LMHRs), they are almost always accompanied with low TGs.
And just to be sure — you were fully fasted (water only) before taking these tests, yes?
I was fasted. Maybe I should try a 24hr and ask for retest. Do you have any resources for keto-friendly doctors in the Vegas area (I think I saw that you reside here as well)
I wouldn’t recommend a 24hr fast as it will likely spike your numbers. I typically suggest a 12-14hr fast for a cholesterol test.
And yes, I have a doctor here in Vegas (Dr Edwards). Reach out to him via his site: https://docedwardsfitness.com/contact/
Thanks for the information and all of the great info on your site.
Also, I did do the NMR Profile, but I think I understand them, but still the numbers are huge. LDL-P > 3500, HDL-P (Total) 32.2, Small LDL-P <90, LDL size 23, LDL Size Large Pattern A 23.0, Small Pattern B 20.5
Hi Dave – sorry about the gremlins – below is the full picture – My confusion is because of my 0 CAC score and no problem with liver – kidneys – blood pressure – hba1c – 6.3 and test reveal large particle size – Regards
-==== CholesterolCode.com/Report v0.9.2 ====–
…5 years on LCHF (20g to 120g carbs) ::: 12 hours water fasted…
Total Cholesterol: 406 mg/dL 10.5 mmol/L
LDL Cholesterol: 329 mg/dL 8.5 mmol/L
HDL Cholesterol: 50 mg/dL 1.3 mmol/L
Triglycerides: 204 mg/dL 2.3 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 27 mg/dL 0.7 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.54 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.248 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 315 | Iranian LDL-C: 365
Total/HDL Ratio: 8.12
TG/HDL Ratio in mg/dL: 4.08 | in mmol/L: 1.77
Hi Norman — this profile would be of more concern to me given the higher triglycerides (again, this typically tracks with Remnant Cholesterol). You might want to look into further reducing your carbs as a possible solution to better reduce your triglycerides.
Thanks Dave agreed – the trigs do concern me.
Your blog is amazing, thank you for sharing all the information!
I would really, really, really love to read about these variables and how they might impact results:
1. Apoe-4 and, in particular, Apoe 4/4 vs. other genotypes (I’m not sure if you know your genotype but this might be possible if a community of people with different genotypes does similar experiments)
2. Holding total calories, total carbs (let’s say medium), and total fat constant, drill down into effects of MUFA vs SUFA and even better MUFA vs specific types of SUFA, e.g. a week of getting 90% of fat from olive oil (mostly MUFA) vs a week of coconut oil (SUFA, mostly lauric acid) vs a week of dairy/animal fat (SUFA but different fatty acids).
Hi Kevin,
1. I’m an apoe 3/4. You should swing by https://www.apoe4.info as they have a lot of great materials and forum admins that can do a FAR better job of breaking out this info better than I can. 🙂
2. Check out Chris Bair’s recent work on this very subject here: https://www.ketochow.xyz/2018/02/results-conclusions-6-week-fat-experiment-42-days-keto-chow/
(full disclosure: Chris is a Patron and his company provide product for my experiments)
Thank you for the recommendation! I know about the forum 🙂
Though I’m not aware of any n=1 experiments that would be done just as well as yours or Chris’ that looked at differences by genotypes.
Chris seemed to have responded well to coconut oil but I wonder if this might be due to the fact that he’s not APOE-4.
By the way, one more idea. In addition to LDL-P and other markers, it might be worthwhile to look into Apolipoprotein B and Lipoprotein (a) as these two seem to be quite predictive of cardiovascular risk too.
I have a number of tests where I took both NMRs and ApoA1 + AboB. ApoB does indeed track with LDL-P (.84 Pearson). Lp(a) is quite a longer and more complicated story. (see upcoming posts from Siobhan on that)
Hi Dave, I just saw your Youtube Video about high fat diet on Cholesterol. Very impressive. I’m going to start Keto, but i’m also afraid about the high fat intake to my Body, I have a triglyceride-anemia. My highest result was Trigs: 1148, Cholesterol 598, LDL not measurable and HDL 33. I’m on Statines and Ezetimibe which keep my values in order. My Question: Do you see a Chance to start LCHF to get rid of the tablets or do you see the Chance of LCHF is working for me even with the medicine. i’m also having Diabetes 2 (15,2), but brought it down to 10 within a few days on Keto diet. 111 kg on 1,86m (far to much). looking forward to your answer.
I know your are not a doctor, but maybe you have an opinion based on your experience.
Cheers Bernd
Hi Bernd–
Not sure if I can offer much advice here as I think this is better handled by a low carb doctor if you have existing genetic lipid considerations. I do think a low carb diet could help depending on the nature of the root cause for your hypertriglyceridemia, but you’d want to be sure by working with a low carb medical professional.
Thx, for your prompt response. Yes, i will ask my Doctor as well. It is a genetic defekt. I will take the values with medicine as a baseline and see whether is any further positive impact under LCHF. Not sure whether they have enough experience in relationship to Keto here in Singapore.
I know it’s a challenge, but try looking around and networking. You’d be surprised at just how many LCHF medical professionals there are now. 🙂
Hi Dave! Have been fascinated with your presentations thus far and can’t wait for what’s to come especially on remnant cholesterol. The following are my latest lab test but I will be doing your protocol soon hopefully the 10+ day protocol but for now here’s the latest also I’ve been doing LCHF/Keto since August of 2017 but not strict my fault when I travel I tend to go off here and there but not too crazy 🙂
Total CH-202
HDL-67
LDL-118
TRIG-75
Chol/HDLC Ratio-3.0
LDL/HDL Ratio-1.8
Non-HDL Chol-135
Lipoprotein-10
HS CRP-0.7
T3 uptake-31. (Normal)
T4 Total-5.7 (normal)
Free T4 index-1.8 (normal)
TSH-9.90 (High)***
My stats: Female
Age: 41
Height: 5′
Current weight: 154.3lbs (and still losing)
Highest weight: 297lbs
Not bad, Sylvia. I ran your report and your RCs are just 17 (2 shy of the lowest risk quintile).
–==== CholesterolCode.com/Report v0.9.2 ====– on – ::: …
…
Total Cholesterol: 202 mg/dL 5.22 mmol/L
LDL Cholesterol: 118 mg/dL 3.05 mmol/L
HDL Cholesterol: 67 mg/dL 1.73 mmol/L
Triglycerides: 75 mg/dL 0.85 mmol/L
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 17 mg/dL 0.44 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: -0.309 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 120 | Iranian LDL-C: 110
Total/HDL Ratio: 3.01
TG/HDL Ratio in mg/dL: 1.12 | in mmol/L: 0.49
Hi Dave!
Thank you for all the work you are doing, this is all very fascinating! I have been carnivore since Jan 1st, and I recently got my blood work done. Last time I had it done was July of 2017. But, I’m just not sure how to read it. Is there anyone you would recommend or any resources to refer to in regards to reading everything? Here are my results:
Total Cholesterol 226 (High) (was 181 in 7/17)
HDL Cholesterol 45 (was 58 in 7/17)
Triglycerides 46 (was 58 in 7/17)
LDL Cholesterol 167 (High)(was 111 in 7/17)
CHOL/HDLC Ratio 5.0 (High)(was 3.1 in 7/17)
Non HDL Cholesterol 181 (High)(was 123 in 7/17)
Glucose is 95 (was 86 in 7/17)
Insulin 5.7 (was 2.9 in 7/17)
Everything else is within their ranges, except for:
BUN 31 (High)(was 26(High) in 7/17)
BUN/Creatinine Ratio 26 (High)(was 21 in 7/17)
ALT 56 (High)(was 28 in 7/17)
Also interesting is that my testosterone levels were all almost cut in half, but I don’t feel any different in that regard. Dr. Baker (his testosterone levels were considered on the low end) mentioned that it could be that his body is just very efficient and processing and absorbing testosterone.
I used your reporting tool, but have no idea what the results mean 🙂
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 14 mg/dL 0.36 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.31 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants
–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.348 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 172 | Iranian LDL-C: 135
Total/HDL Ratio: 5.02
TG/HDL Ratio in mg/dL: 1.02 | in mmol/L: 0.45
Any help, feedback or direction would be greatly appreciated!
Cheers,
Lee
The reporting tool effectively says you are low risk in RC and AIP — mostly likely a good thing. 🙂
I can’t speak to T as much since it isn’t in my wheelhouse. But I’m going to guess you aren’t seeing any signs of low T just as Baker isn’t…? The carnivore diet is still pretty new and these ranges are hard to judge given the context is very different now. So I genuinely have no idea if it is a good or bad thing.
Thanks for the feedback! And, no signs of low T, just the opposite 🙂
Dear Dave,
I came across your videos in youtube and this website only yesterday. Thank you! I am extremely glad to see what you do, which is so relevant to me being (very likely) a hyper-responder myself, who had to quit LCHF (see ‘My LCHF history’ below, after my questions for you listed next)!
Now by seeing all the amazing information that you have been putting forth, I am eager to restart the LCHF diet. To that end, I would like a few clarifications from you on some of the things to have mentioned in your blog:
– When you say ‘the fasting disaster’ makes LDL go over the roof, does that also indicate that a hyper-responder should better avoid intermittent fasting to keep LDL low? (I like to doing intermittent fasting, as it feels good and because the weight loss is faster when I want it).
– Again, when you emphasize, in the Feldman Protocol, on avoiding coconut oil and coffee (two of my favorite things) as they have resulted in discrepancies in the cholestrol lowering experiment, does that also indicate that these are things a hyper-responder should better avoid in daily diet?
– In short, should a hyper-responder be keeping the LDL from shooting-up, on an LCHF diet, by always eating more calories, not fasting, and avoiding coconut oil and and coffee?
My LCHF history:
I had to quit the LCHF diet two years ago, which I blissfully enjoyed for a span of 7 months—seemingly with all its benefits except for the dramatic lipid profile—until the day I got my blood work which returned the following:
TC – 422 mg/dL
HDL – 76 mg/dL
TG – 133 mg/dL
LDL-C (Friedewald) – 319 mg/dL
To contrast, the numbers (from an year before the foregoing test) when I was eating a not-so-healthy high-carb-moderate-fat diet—and thereby was overweight—were:
TC – 279 mg/dL
HDL – 47.4 mg/dL
TG – 176 mg/dL
LDL (Friedewald) – 196.4 mg/dL
(Thanks to your calculation tool, I’ve noted that with LCHF I could improve my remnant cholesterol only to:
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 27 mg/dL 0.7 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.36 >>> Medium Risk Quintile
from the worse situation before:
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 37 mg/dL 0.96 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.8 >>> High Risk Quintile.
I have not been physically active enough, and I have a family history of heat disease.)
Obviously, my general physician and endocrinologist freaked out and asked me to stop the high-fat diet immediately. Moreover, as per the advice from Dr. Andreas Eenfeldt of dietdoctor.com, which he has given in his blog:http://www.dietdoctor.com/low-carb/side-effects#cholesterol, I decided to stop doing LCHF. In addition to cutting down on saturated fats while avoiding sugar and excess carbs, I started doing intermittent fasting by skipping breakfast (which used to be ‘coffee with butter/coconut oil/heavy cream’ during my LCHF days) and in two months, I got the following numbers:
TC – 251 mg/dL
HDL – 59 mg/dL
TG – 100 mg/dL
LDL (Friedewald) – 172 mg/dL
(which put into your tool gives:
–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 20 mg/dL 0.52 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.34 >>> Medium Risk Quintile)
I have been following roughly the same type of diet ever since…
Hi George!
– No, my title “fasting disaster” was more my being fun with the title in that I didn’t have the most pleasant experience. My general advice on fasting is that “if you can fast comfortably, then you probably should” (and I have deeper mechanistic reasons for believing this that I won’t go into here.) So consider fasting away — so long as you can do it comfortably.
– I don’t know that you want to avoid coffee and coconut oils on the daily because their higher activation of lipolysis isn’t the root of the problem as I see it. The root of the problem (per my general theory) is the body’s *inability* to deliver TG to tissues (due to insulin resistance, etc) OR a chronic immune or inflammatory response. In both these general categories, higher LDL is a reflection of a problem, not necessarily the problem in and of itself.
– I certainly don’t believe a hyper-responder should simply up their calories in order to have lower blood markers for LDL. Again, I think LDL being higher while TG is low just demonstrates a higher demand for VLDL delivery of that energy in the first place and the LDL succession as the obvious resulting outcome. When my current Breck talk is out, be sure to watch it as I go through this process through a very simple analogy.
Thank you Dave, for the detailed answers! I really appreciate it.
I will surely watch your Breck talk when it become available. Cheers!
Thank you Dave, for the detailed answers! I really appreciate your effort. I will surely watch your Breck talk when it becomes available. Cheers!
I wanted to get back to you on the Feldman protocol I followed for my blood work. I ate an average over the 3 days of 251 grams of fat daily, 27 grams of carbs daily, 93 grams of protein daily and 2190 calories daily. I am a 72 year old woman with moderate activity level. My CAC score was 200. My previous blood work in Nov. ’17 was TC (288), after the protocol (March 2018) (313); Triglycerides Nov. ’17 (156), after the protocol (155); HDL Nov.’17( 63), after the protocol (66); LDL Nov. ’17 (194), after the protocol 213. My remnant cholesterol Nov.’17 was 31, and after the protocol 31. My only ratio that stayed under the suggested level (3.5) was LDL/HDL = 3.32 (up from Nov. ’17 of 3.08) However, my A1C went from 5.7 in Nov.’17 to 5.2 in March 2018. So my takeaway is I’m a hyper-responder.
That’s interesting, Maryann. It’s unusual for there to be nearly no movement in every marker (save your TC). I’m curious if your baseline may have changed since your last lipid score. By chance, has your weight changed at all since your Nov test?
I am down 7 pounds since November and my next draw is in mid-June! I am in Dr. Fung’s IDM program, coaching from New York. I will say that in Nov I wasn’t as strict with keto, but since Jan. I am very keto adapted, watching my ketones/glucose when I fast.
Awesome! Keep up the great work. 😉
And I went off coffee and MCT for a week before!
I had blood drawn for an NMR test through Requestatest.com baseline on Friday, March 30, after fasting for 13 hours. I ate 4,900-5,000 calories, 80% of them from fat and under 4% from cards, each day staring Monday, April 2 through Wednesday, April 4. I had no coconut oil, MCT or coffee any of those three days. I had blood drawn again for a second NMR test on the morning of Thursday, April 5, after fasting for 13 hours. While I used no coconut oil, it dawned on me the second day of the second run-through that I was drinking unsweetened coconut milk and I switched, half-way through, to unsweetened almond milk. It is unclear to me whether unsweetened coconut milk would contain enough coconut oil to be problematic.
03/30/18 04/05/18
LDL-P 2423 1825
LDL-C 194 144
HDL-C 52 47
Triglycerides 114 116
Cholesterol 269 214
Total
HDL-P 25.3 30.2
Small LDL-P 864 941
LDL Size 20.9 20.4
LP-IR 26 97
I would call these mixed results. If I am reading the lab report correctly, my LDL Size dropping from 20.9 to 20.4 means that I went from from being a smidge into Pattern A to being a smidge into Pattern B. Total cholesterol, LDL-P and LDL-C did drop. HDL-C dropped, although not into a “Low” result.
So long as a doctor runs an “old school” test just for Total Cholesterol, LDL-C, HDL-C and triglycerides, at least my numbers look more borderline. On a personal level, I am most disturbed by the swing in LP-IR. I went from literally off the chart for optimal to being in the highest end of the range for diabetes risk.
I had two previous tests done in a similar scenario except that I drank coffee and the results were actually worse. I will post those separately when I have time, but that was a first-run of the protocol for me, with the baseline test taken by my doctor and processed by Quest Diagnostics.
I apologize. I typed the numbers in as a nicely spaced table, but the [spaces] apparently do not hold up when posted.
Excellent work, Mike! Let’s unpack these one at a time:
>>If I am reading the lab report correctly, my LDL Size dropping from 20.9 to 20.4 means that I went from being a smidge into Pattern A to being a smidge into Pattern B.
For me, this is next to irrelevant. In fact, I’m not even sure if this isn’t within the margin of error. Note that I don’t put a lot of stock into Pattern A and B relative to most because I’m still thinking of it from an energy depletion (TG) on a per-particle basis. But that’s a longer subject.
>>Total cholesterol, LDL-P and LDL-C did drop. HDL-C dropped, although not into a “Low” result.
HDL isn’t as reliable in its outcome as LDL, and its 10%-ish change in your numbers wasn’t that surprising to me. Note this is also common with TG. Even though HDL “usually” goes up and TG “usually” goes down, each is less than the 85%-ish likelihood in doing so as LDL.
>>On a personal level, I am most disturbed by the swing in LP-IR. I went from literally off the chart for optimal to being in the highest end of the range for diabetes risk.
This one I have no worldly idea about! I don’t know that I’ve ever seen the IR score change that much. But to be sure, I don’t trust it to be a good surrogate marker anyway. But FWIW, it is true that in my own protocol experiments, I have never seen it rise out of the “<25" category. Real head-scratcher.
Yes! I'd love if you'd post your previous protocol. I want to do a post on "The Coffee Confounder" soon and include results such as yours showing what changed when dropping coffee for the protocol. It's the single biggest thing throwing off my protocol data right now. >:(