With this vital survey (5-8m of your time), we’re looking to gather a very large number of entries for our anonymised data pool. We’ll post graphs of the data in future articles and it will allow for strong information on some important decisions ahead.
Thank you in advance for your contribution to the data!
Hi, i have submitted the information for the survey. Have a particular interest in knowing that if my data is as follows: Total Ch.: 374, LDL: 231, HDL: 83.4 , Triyglycerides: 83 but Remnant Cholesterol is 60, should I be worried? thank you for answering.
You are fine. Your TRG:HDL ratio is very low. Your risk of CVD very low. LDL alone is not a consistent measure of CVD. Your TRG:HDL ratio is only 1. Below 2 is considered very good. You are super good. Clean arteries for sure. Skeet skeet boom boom.
Watch this short video if you want to know more.
https://youtu.be/UFlQbU9a7Tw
Hi, sometimes this can happen if the LDL isn’t calculated with the friedewald equation. Friedewald LDL is listed at the bottom if you run your numbers through the report tool. You can then pop that in and you can RC of 17, which is about what I’d expect from the other numbers. Hope that helps! 🙂
I started a LCHF diet in August, 2018. My most recent blood work at that time was in May, 2018: Total chol.- 194; HDL-36; LDL-136; Tg- 112. By June, 2019 the comparable numbers were: 293,51,224,71. However in Oct, 2019 my results were; 356,50,283,98. The increase in my Tg concerned me. Had a test done on 2/5/20 and results were: 287,55,207,125 (full disclosure-I started a statin in late December to placate my Dr.) However, the Tg trend has become a big concern. I would appreciate any comments. My research indicates possible kidney issues.
Higher TG can be present during ongoing weight loss.. Is this a possibility for you?
Hi Bill – I’m not a doctor and thus can’t give medical advice, but the increase from 71 mg/dL to 98 mg/dL, in my experience, could have just been normal fluctuation. However, I agree that the last result would lead me to want to investigate further if it were me. There are many things that can cause an increase in triglycerides. The number one is if you are not 12-14 hours water only fasted (e.g. fast too long, or not long enough). Do you know if you were fully water fasted (no coffee, no tea, etc) for all of these tests?
If you were, you may also want to check into this post and see if anything sounds familiar – and if you have further questions please feel free to follow up and I’ll help to the best of my ability. 🙂
–===== Cholesterol..Code.com/Report v0.9.5.15
Actually started a low carb high fat WOE May 2017 gradually got into KETOf.. and have even done some Carnisvorish…. I am on T4 only Thyroid Medication…labs do not show Hashimotos… however, my C Peptide is LOW as is my Fasting Insulin…. A1C: 5.2
**********************************Previous numbers/Nov 23, 2019 = Total: 361, LDL:243, HDL: 109, Trigs: 43******************** Latest labs from 2/3/2020:
• Female • 59.75 • Coffee: 0 cups/day •
• 12 on months on Keto (less than 20g carbs) •
• 13+h water fasted • Cholesterol Rx: false •
Total Cholesterol: 294 mg/dL 7.6 mmol/L
LDL Cholesterol: 192 mg/dL 4.97mmol/L
HDL Cholesterol: 88 mg/dL 2.28mmol/L
TG Cholesterol: 46 mg/dL 0.52mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.642 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 14 mg/dL >>> 0.1 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 197 | Iranian LDL-C: 153
TC/HDL Ratio in mg/dL: 3.34
TG/HDL Ratio in mg/dL: 0.52 | TG/HDL Ratio in mmol/L: 0.23
Hi – could you clarify what you mean by a low C-peptide and insulin? Sometimes Lean Mass Hyper-responders can have “low” going by lab reference ranges but “sufficient” going by glucose homeostatic control. Thanks for submitting your numbers as well!
Hi Dave and Siobhan, here are my numbers from November 2018 to November 2019. In may I was in the hospital, which they later suspect as Hypertrophic cardiomyopathy. Cardiologist insists I take a statin, but he just sees the LDL levels, and not my Trigs or HDL. what are your thoughts? Ive been on a Keto diet since march 2019, I went from 233 lbs to currently 175 lbs…
NOVEMBER 1 2018
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 53 • Coffee: 2 cups/day •
• 20 on years on Standard American •
• 0h water fasted • Cholesterol Rx: false •
Total Cholesterol: 186 mg/dL 4.80 mmol/L
LDL Cholesterol: 126 mg/dL 3.27mmol/L
HDL Cholesterol: 36 mg/dL .92mmol/L
TG Cholesterol: 119 mg/dL 1.34mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: 0.163 mg/dL >>> Medium Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 1.6 Odds Ratio >>> Very High Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Medium Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 24 mg/dL >>> 0.27 mmol/L >>> Very High Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 126 | Iranian LDL-C: 148
TC/HDL Ratio in mg/dL: 5.17
TG/HDL Ratio in mg/dL: 3.31 | TG/HDL Ratio in mmol/L: 1.46
JUNE 21 2019
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 54 • Coffee: 2 cups/day •
• 3 on months on Keto (less than 20g carbs) •
• 11h water fasted • Cholesterol Rx: false •
Total Cholesterol: 227 mg/dL 5.87 mmol/L
LDL Cholesterol: 169 mg/dL 4.36mmol/L
HDL Cholesterol: 37 mg/dL .96mmol/L
TG Cholesterol: 106 mg/dL 1.20mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: 0.097 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 1.6 Odds Ratio >>> Very High Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Medium Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 21 mg/dL >>> 0.24 mmol/L >>> Very High Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 169 | Iranian LDL-C: 175
TC/HDL Ratio in mg/dL: 6.14
TG/HDL Ratio in mg/dL: 2.86 | TG/HDL Ratio in mmol/L: 1.25
SEPT 9 2019
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 54 • Coffee: 2 cups/day •
• 6 on months on Keto (less than 20g carbs) •
• 6h water fasted • Cholesterol Rx: false •
Total Cholesterol: 193 mg/dL 5 mmol/L
LDL Cholesterol: 134 mg/dL 3.47mmol/L
HDL Cholesterol: 34 mg/dL .89mmol/L
TG Cholesterol: 125 mg/dL 1.41mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: 0.2 mg/dL >>> Medium Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 1.6 Odds Ratio >>> Very High Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Medium Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 25 mg/dL >>> 0.28 mmol/L >>> Very High Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 134 | Iranian LDL-C: 159
TC/HDL Ratio in mg/dL: 5.68
TG/HDL Ratio in mg/dL: 3.68 | TG/HDL Ratio in mmol/L: 1.58
NOVEMBER 21 2019
===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 54 • Coffee: 2 cups/day •
• 8 on months on Keto (less than 20g carbs) •
• .5h water fasted • Cholesterol Rx: false •
Total Cholesterol: 221 mg/dL 5.72 mmol/L
LDL Cholesterol: 160 mg/dL 4.14mmol/L
HDL Cholesterol: 49 mg/dL 1.26mmol/L
TG Cholesterol: 63 mg/dL .71mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.249 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Medium Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 12 mg/dL >>> 0.14 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 159 | Iranian LDL-C: 136
TC/HDL Ratio in mg/dL: 4.51
TG/HDL Ratio in mg/dL: 1.29 | TG/HDL Ratio in mmol/L: 0.56
Hi, sorry to hear that you had to be in the hospital for a bit! It must have been very difficult.
We can’t say whether you should take any sort of medication or not, because we’re not doctors and can’t give medical advice.
However, we can provide some additional resources for you to consider for yourself, such as this presentation by Dave looking at LDL from a cautiously optimistic perspective, and this post from Dr. Nadolsky from a cautiously pessimistic perspective. Hopefully by considering two different perspectives you can use that to start looking at info and decide what you feel comfortable with.
One small thing to note is that some of these tests aren’t 12-14 hours water only fasted – this can sometimes skew the results from what they would be normally, so if it were me I’d want to re-test properly fasted 12-14 hours with nothing but water to get a bit more representative data that I could use to make additional decisions regarding lifestyle, etc
Hi Siobhan,
Just thought I’d share my numbers from last week in case there’s anything there that’s of interest to anyone here.
I had one three hour episode of ‘atrial flutter’ back in Jan 2018 and no trouble since then. The cardiologist I was assigned is not keen on low carb/keto. She did admit her opinion of it may be skewed by seeing nothing but patients with some sort of heart issue which was something at least … Unfortunately, since I don’t know of any keto friendly cardiologists (or even GPs) in my area (south of Dallas, TX) I am somewhat stuck with this situation, and at least she’s very pleasant and willing to listen and discuss things. Of course having seen my cholesterol test results she thinks I should really start taking statins and, needless to say, I’m not keen on that idea (particularly now I’ve seen the risk report below).
She agreed we could review the situation in six months. I’d like to try adding more exercise to my routine (I’m mostly sedentary right now) to see if that improves my numbers. She did suggest a calcium artery scan and I agreed to get that done. I suspect it’s not going to be good news – after all, I’ve spent 50+ years eating tons of carbs and sugar, though I have at least been doing IF then OMAD since Sept 2012 … Once I get those test results I’ll return to complete your survey in full.
While I’m getting tested for things I’m tempted to get an NMR LipoProfile test done, if only to satisfy my own curiosity since it appears particle numbers and sizes may be relevant/significant.
Any thoughts on any of this?
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Female • 58 • Coffee: 0 cups/day •
• 11 on months on Keto/Low Carb (Less than 50g carbs) •
• Approx 14h water fasted • Cholesterol Rx: Never (if I can avoid it) •
Total Cholesterol: 258 mg/dL (6.67 mmol/L)
LDL Cholesterol: 158 mg/dL (4.09mmol/L)
HDL Cholesterol: 89 mg/dL (2.3mmol/L)
TG Cholesterol: 54 mg/dL (0.61mmol/L)
———RISK REPORT———
Atherogenic Index of Plasma: -0.576 mg/dL >>> Lowest Risk Third
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
Jeppesen: —X—|——|—— >>> Lowest Risk Third
Cholesterol Remnants: 11 mg/dL ( 0.12 mmol/L) >>> Low Risk
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 158 | Iranian LDL-C: 126
TC/HDL Ratio in mg/dL: 2.9
TG/HDL Ratio in mg/dL: 0.61 | TG/HDL Ratio in mmol/L: 0.27
Hi, looks like you are a hyper-responder, if not a borderline a hyper-responder (for someone sedentary the LDL is a bit below the cutoff), in other words a profile I commonly see with low carbers. We can’t say whether you should or shouldn’t take a certain medication, as we’re not doctors. But there are resources on the site if you’re looking further to get a better grasp of the general research.
If you are in Texas and are looking for a cardiologist, have you considered Nadir Ali? He’s in Houston and I believe can also do remote consults if you were looking for a second opinion.
Looking forward to your updated data, and thanks for sharing the initial info as well. 🙂
can anyone input on how APOB genetic component combines with carnivore and being lean/fit ? LDL 390 , HDL 50, trigs 108, carnivore 6 months 150 LB 15% BF est; but haven’t worked out in some time, 36 y/o low c-peptide 0.5, low fasting insulin 1.6, low HS-crp 0.7
Hi – sounds like you fit the profile of a standard hyper-responder if your LDL and total cholesterol has gone up from a low carb/carnivorous diet. If you were asking how people with the mutation you mention do with carnivore, you may want to ask in the Cholesterol Code facebook group, as you’re more likely to get a response from people with the mutation. If you were asking us a specific question if you could just clarify what you were wondering about, we may be able to answer (though can’t give medical advice as we’re not doctors, of course). 🙂
Hi guys, I’m on keto and then LCHF diet for 2.5 years now. I just did a report on the site with the numbers below but from my lab test, my Apo B was at 123 mg/dL which put me at high risk. Should I be worry about it? Should I change my diet because of this?
Total Cholesterol: 281 mg/dL 7.27 mmol/L
LDL Cholesterol: 175 mg/dL 4.53mmol/L
HDL Cholesterol: 89 mg/dL 2.3mmol/L
TG Cholesterol: 72 mg/dL 0.81mmol/L
Cholesterol Remnants: 17 mg/dL
Hi Jen,
We can’t say whether you should worry or not because we’re not doctors and can’t give medical advice. However, you may be interested in this post from Dave that goes over this exact topic that may help provide a little context to apoB measurements to go along with your overall numbers. 🙂
I want to point to this article that has nice info on apoe alleles and lipid metabolism: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297981/ (even though the title mentions brain aging and alzheimer’s)
Thanks! I’ll give it a read, if I haven’t already.
I am not keto. I do consume olive oil and coconut oil. I eat nothing with “ingredients”, besides the aforementioned oils, and on occasion dark chocolate. I eat fruits, veggies, beans and meat – including beef, and no more than 5 gram of sugar a day in that piece of dark chocolate . My numbers have gone up considerably since I have added more fat to my diet. Here are my numbers.
total: 274 March 2020 216
trig 44 March 2020 68
HDL 89 ” ” 74
LDL 172 ” ” 126
bp 105/68 consistent
pulse 65 at rest consistent
exercise regularly, at least – cardio and weights, for over 5 years
weight 105lbs consistent, my whole life
height 5’4.5
age 59
female
Does anyone think I have moved in the wrong direction? I was fasted at my last test, however I did not exercise the day before my test.
Hello Becky, • • • Cholesterol Rx: false •
We’re not doctors and can’t give medical advice, so we can’t say if the new profile is of concern or not. However, we can link resources and share our thoughts if it would be of interest.
If you’re looking to get an idea of some different thoughts regarding high LDL with high HDL and low triglycerides, Dave has a presentation from a cautiously optimistic perspective here, and we have a guest post from Dr. Nadolsky from a cautiously pessimistic perspective here.
You may also be interested in the Cholesterol Code facebook group, as there are people there with similar profiles who can share their perspective, what they’re doing about it (e.g. some stick with it, but opt for closer monitoring via bloodwork and additional tests, others opt to make changes to lower LDL, etc). They also discuss the latest science/resources/etc there as well.
I’ve also run your numbers through our report tool, which looks at risk calculations from a couple different studies.
Here is before:
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Female • 59 • Coffee:
•
•
Total Cholesterol: 216 mg/dL 5.59 mmol/L
LDL Cholesterol: 126 mg/dL 3.26mmol/L
HDL Cholesterol: 74 mg/dL 1.91mmol/L
TG Cholesterol: 68 mg/dL 0.77mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.395 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 16 mg/dL >>> 0.15 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 128 | Iranian LDL-C: 112
TC/HDL Ratio in mg/dL: 2.92
TG/HDL Ratio in mg/dL: 0.92 | TG/HDL Ratio in mmol/L: 0.4
and after: • • • Cholesterol Rx: false •
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Female • 59 • Coffee:
•
•
Total Cholesterol: 274 mg/dL 7.09 mmol/L
LDL Cholesterol: 172 mg/dL 4.45mmol/L
HDL Cholesterol: 89 mg/dL 2.3mmol/L
TG Cholesterol: 44 mg/dL 0.5mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.663 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 13 mg/dL >>> 0.1 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 176 | Iranian LDL-C: 135
TC/HDL Ratio in mg/dL: 3.08
TG/HDL Ratio in mg/dL: 0.49 | TG/HDL Ratio in mmol/L: 0.22
Male, age 63, 5’9”, 155 pounds. Lost 17 pounds in five weeks when I started keto seven months ago. 25 grams of net carbs or less per day. Very active, workout six to seven days a week, primary workout plan is high intensity interval training with lots of variety. I stopped taking Atorvastatin about two months ago after taking it for decades. First blood test since stopping statin- Blood sugar 76. Total cholesterol 400, Triglycerides 107, HDL 73, LDL (reported as non-HDL chol) 327, VLDL 21. My doctor sent me an urgent email and I thought he was going to have a heart attack. His exact words are, “You are at high risk for a cardiovascular event”. I feel like I fit the profile for a lean mass hyper-responder but admit to being taken aback by the LDL. I thought I had a good reason for going off the statin but now am wondering whether I should go back on at the half rate. Doctor awaiting my response… Thank you very much for reviewing this case study.
Hi Rick,
We can’t say whether you should take any medication or not as we’re not doctors and can’t give medical advice. Likely what I’d do in the same position is look into a couple of different perspectives and see which makes most sense for me and my personal goals/situation and discuss what you find with your healthcare team to help decide what you’re comfortable with over the long term.
For example, we have this presentation from Dave on the question of high LDL when paired with low triglycerides and high HDL here that approaches from a cautiously optimistic perspective, and we also have this post from Dr. Nadolsky from a cautiously pessimistic perspective.
As for your lipid panel, the numbers you posted would leave you with an LDL of 304, not 327. It’s a minor point, but to clarify non-HDL cholesterol also includes remnants (VLDL, IDL) as well as LDL.
It looks like you’re close to the profile of a Lean Mass Hyper-responder – with HDL and TG being slightly off of the cutpoints. Were you 12-14 hours water-only fasted for the test? If not, that may have influenced the results.
Regardless, you may be interested in the Lean Mass Hyper-responder facebook group, as there are plenty of people there with similar profiles who can share their experience, if they’ve decided to move away from the profile and why, if not what they’re doing instead (e.g. what they’re looking at to keep an eye on things), etc which may be of interest as you navigate what you’d like to do moving forward. Hope that helps. 🙂
Rick, I am a scientist not a physician: so none of the following constitutes medical advice. You are in a very interesting group. Jeff Volek, one of the pioneering researchers in LCKD (professor at Ohio State), found quite a bit of this in highly trained athletes. High LDL but also high HDL and low TAG. In addition to the others’ comments, there may be a training- intensity component to your profile. Volek has published several papers that you might be interested in plus several conference presentations on YouTube.
Have you experimented with your food options? Low carb can be composed a lot of different ways in terms of protein and fat types and proportions. Wide room for variation. Protein can be a real wildcard *possibly* bumping up fasting TAG in some people. Fat/protein ratio is worth at least playing with, especially since people have shown a tendency to cut carbs and then ramp up protein instead of boosting fat. Carnivore is another option that a lot of individuals have reportedly had success with, but we don’t have much in the way of systematic evidence to judge one way or the other.
Have you asked your physician to test your inflammatory markers, at a minimum your hs-CRP? If inflammation is low and all of your other metabolic markers are good (liver, kidney, HbA1c, electrolytes, etc), you might be in a better position to make an informed decision about whether or not to take additional time to continue experimenting and researching. Another observational study came out this year examining TAG/HDL as a predictor of CVD (https://doi.org/10.1016/j.numecd.2020.05.009). It is encouraging, but not definitive since it was not a controlled clinical trial. Check it out.
One more thing to consider is to search for a physician who is immersed in the low carb research. You can jump on the internet and search “low carb physician near me” or “keto physician near me.” If that doesn’t turn up much, search out some local DO’s (doctor of osteopathic medicine), who tend to have a little more wellness training than MD’s. You can call their offices and ask whether the doc is open to patients practicing low carb or keto. Don’t be afraid to go to an out-of-town physician: ideally you only need to see him/her once a year anyway, so the drive could be very much worthwhile. Good luck!
Hi Frank – thanks for commenting. 🙂
Just wanted to bring up that Diet Doctor has a “low carb doctor” map/list – you can also filter by doctors who do remote consults, in case there’s not one nearby. Just thought you’d want to know about it, so you can share it with others who are looking for low carb/carnivore friendly docs! 🙂
Hello
Do you think that figures could be quoted in SI units, i.e. nmol/l, mmol/l? As I understand it few outside the USA use mg/dl or similar units. I know that my TC is 5.1, HDL is 2.0 and fasting TGs are 0.7 but I haven’t a clue what they are in US units.
Hi David! In this situation, our report tool can be pretty handy. If you flip it over to mmol/L display, and input your numbers it will also tell you what it would be in mg/dL.
For example, your numbers would be:
TC – 197 mg/dL (5.1 mmol/L)
HDL – 77 mg/dL (2 mmol/L)
Triglycerides – 62 mg/dL (.7 mmol/L)
Hey there. I love what you all are doing. I’ve been following a very low carb diet for nearly three years now. I do a poor job of tracking specifics, so I was unable to fill out that survey with any degree of confidence. I recently had bloodwork ordered and my results are as follows:
Total Cholesterol: 693 mg/dL
HDL: 43 mg/dL
Triglycerides: 166 mg/dL
LDL >350 mg/dL
Chol/HDLC Ratio: 16.1
Non-HDL Cholesterol: 650
Crazy right? Yes that was water only fasting, no coffee for the three days prior.
I keep getting mixed information around whether I should be concerned or not. About 5-7 years ago, my Cholesterol was high, but not that high, and my Calcium Heart Scan came back a 0(none found) back then. I was then put on a statin and I stopped taking the statin on my own about two or three years ago. My doctor back then wanted me to stop the low carb diet and increase my statins, but something didn’t feel right about that. I can’t find a doctor that even considers thinking out side the box. BTW, I’m barely over 40, generally around 170-175 lbs, 6 ft 2 in, thin with average muscle, and do hardly any intentional exercise, pretty sedentary other than up and down the stairs to my offices 3-5 times a day. I only recently started a nightly routine of a 10-15 minutes light workout, mostly abs. Any guidance on where to go from here? Thank you all again.
Hi CJ,
Although we’re not doctors and can’t give medical advice, we can comment with our thoughts in case they may be of interest.
If I were in a similar situation, I’d personally want to investigate the cause of the higher than expected triglycerides here to see if I could identify the cause. It’s also possible that doing so, may lend additional context to the LDL as well as sometimes things that confound triglycerides can also impact LDL levels, although it’s not a guarantee of course.
Have you gone through this list to see if anything stands out as likely for you?
You mentioned being water only fasted – how long was this fast? Was it 12-14 hours (being sure to be at least 12 hours, not even a little under)? Did you have any other caffeine sources beyond coffee, such as tea?
If those don’t sound likely, then did you get any additional blood markers that may provide additional context like inflammatory markers or fasting insulin? These may help narrow things down, and if you do get additional testing it may help to track for the week or so prior to the bloodwork while eating normally as this can provide additional information in terms of calorie amounts, composition, etc.
I have been on a keto diet for about two months. My cholesterol came back high and after watching your videos I decided to have a NMR LipoProfile done. My numbers are very confusing and frightening. My LDL-C is 212, HDL-C is 81 and Triglycerides are 92 for a total of 308. My LDL-P is 2570. My HDL-P is 36.8. Small LDL-P 833 and LDL Size is 21.4. My Insulin Resistance Score is less than 25 showing I am insulin sensitive. Based on the high LDL-P score I am very worried. That number seems to be off the charts. I have never had high cholesterol but my LDL has been steadily increasing over the past 5 years even though I eat a healthy diet and I have refused to take a statin even though my doctor has been pushing it. Was on plant based prior to keto so I don’t understand why this is happening. I really need help in reading this report. My doctor ordered it for me against her better judgment. She didn’t think I needed it. HELP!
Hi Jeri,
We’re not doctors and can’t give medical advice, so we can only comment with our thoughts in case they may be of interest.
It sounds like you may be close to the profile of a Lean Mass Hyper-responder e.g. someone who is typically lean, active, and powered by fat (e.g. on a low carb/ketogenic diet). You may be interested in the Lean Mass Hyper-responder facebook group as there are many there with similar profiles who explore the latest research regarding it, their experience, their perspective, and how they’ve approached having the profile (e.g. taking steps to move away from the profile and how they did so, sticking with it but getting additional testing to keep an eye on things, etc).
For those who decide they are not comfortable with it for the longterm, or would just like to confirm it is dietarily induced, the most consistently effective method (presuming it is dietarily induced) that we’ve seen demonstrated by people thus far is to decrease fat and proportionally increase carbs (e.g. isocaloric carb swapping). Amount needed to achieve this varies per person, but most people report between 75g-150g carbs per day (e.g. still low carb just not keto). You can read more about this here.
We can’t say whether this profile is of concern or not (as, again, we’re not doctors and can’t give medical advice), but we can offer some resources to explore different perspectives on the topic. For example there’s this presentation from Dave looking at high LDL in the context of high HDL and low triglycerides from a cautiously optimistic perspective, plus this post from Dr. Nadolsky looking at the same topic from a cautiously pessimistic perspective.
Regarding the LDL-P, From what we’ve seen in ourselves and others, generally LDL-P is LDL-C x10 +/- 15% or so in generally metabolically healthy people, so for an LDL-C of around 212 I’d expect LDL-P to be roughly between 1800 nmol/L and 2440 nmol/L – yours appears to be just outside of this range. But it’s worth noting that other things can impact this “concordance” – for example, in accordance with the inversion pattern, LDL-C tends to follow a 3 day pattern, and LDL-P tends to follow a 3 day pattern with a 2 day gap (5 days total) so if there’s a change in food intake or composition between these two periods then the concordance can be slightly off. We’ve also sometimes seen fasting time (particularly as it gets above 20 hours) prior to the blood draw, and exercise may also influence these numbers, although of course I can’t say whether this is the case here and likely the only way to confirm it would be to re-test while tracking/controlling for these factors.
Hopefully some of that is of interest and helps provide a bit of context so you can explore this further with your healthcare team and decide what you feel is best for you.