I am 67 years old, thin and in shape. A month ago I added doing a 16 hr fast daily. Am on half-keto diet (I recognize this is not ketosis) meaning eating a small amt of carbs. I eat mostly organic. I eat just enough meat for my body. Lots of organic fresh and steamed veggies. The only oil I have is grass fed organic butter and organic MCT oil. I consume almost zero PUFA’s (seed oils). Have a strength training and aerobic program 4-5 days a week. I drink 1/2 - 1 alcoholic drink a day. No smoking.
I just went to my primary doctor. My vitals and bloodwork were excellent except for one thing, my LDL was high, at 147. Should be lower than 100, 160 is quite troublesome. The doctor tells me to eat (even!) more fiber, exercise more and to take Red Yeast Rice supplement. I read about Red Yeast Rice and am doing a partial dose, there are some mild concerns for some people I read about. I increased my exercise. I cannot increase my fiber intake, it’s already very high.
Question, it must be that the butter and MCT oils are jacking up my LDL level right? Or something else? Any insight or advice on what to do?
Advice or insights please, my LDL is rather high, 147
Four years ago, LDL below 150 was considered fine. The limit used to be even higher, years ago. It is the statin manufacturers who changed the recommendation for keeping LDL under 100, because it made millions more people candidates for their products. Gotta earn that eighty-million-dollar bonus at the end of the year!
I could give you lots of reasons not to worry about your LDL, but they all boil down to our mantra, “Keep calm, and keto on.”
There are a some considerations to bear in mind.
Firstly, it is far too soon in your process to worry about your lipid results. Once you have been eating a ketogenic diet for six months, the numbers will have settled.
Second, the evidence that LDL is the cause of cardiovascular disease is actually very skimpy, and there are respected researchers trying to turn around our thinking about this. At best, cholesterol levels might be a marker for the real problem, but they are not the cause of the problem. It may well be, as many researchers have posited, that cholesterol is present in arterial plaque to repair damage, not cause it. (Much as fire trucks are there to deal with fires, not start them.)
Third, even diehard cholesterol-fearers have to admit that the LDL number bears very little relationship to cardiovascular risk. In particular, the ratio of triglycerides to HDL is far more predictive. If you are in the U.S., you want your ratio to be 2.0 or less, in the rest of the world, 0.9 or less.
Lastly, if you are really worried about your cardiovascular risk, ask your doctor for two tests: a CAC (coronary arterial calcium) scan and a CIMT (coronary intima media thickness) scan. Your doctor might baulk, and the insurance company might not pay, but if you can find a good deal on the price, they will probably be worth it. The CAC measures the calcification (if any) of arterial plaque (if any). The CIMT measures how occluded your coronary arteries might be.
So the first thing to do is to look at your lab numbers and figure out what your ratio of triglycerides to HDL is. That will probably set your mind at rest. Also, if your inflammatory markers are all good, your heart rate is low, your blood pressure is normal, your HbA1C is good, and your fasting glucose and insulin are normal and it’s only your LDL that is raised, then I’d say you’re in pretty good shape. And remember—saturated fat raises HDL, not LDL, and dietary carbohydrate raises triglycerides. So a low-carb, high-fat diet is actually going to prevent cardiovascular disease, not cause it.
PaulL and ctviggen,
The readings are:
Triglycerides 97
HDL 57
97/57 = 1.7
Yeah heart rate low, blood pressure on the low side of normal (what was it 120/70…?). Glucose normal. Cannot find HbA1C, or insulin on the lab report.
Got your point that the saturated fat I eat butter and MCT oil raises the HDL, not LDL. And how the statin medicine lobby influenced interpreting the readings in their favor.
I’m close to a year on eating this greatly reduced carb and some butter and increased MCT oil, and lots of organic veggies and a modicum of meat diet.
Much thanks!
Dave
Dave
Your numbers are just perfect. Nothing to see here. Your LDL level is just fine. Keep doing what you’re doing! 
Cheers
Alec
I was reading yesterday - here somewhere, I think - about the PUFA content of animals who are fed PUFAs. Animals can’t produce PUFAs on their own but flesh can contain PUFAs if the animal is fed a PUFA rich diet.
Do your research on red yeast rice. It once had similar properties to statins / was a pre-statin. When this was discovered, it became illegal to sell (in the US at least) unless the active ingredient was removed. 
God bless capitalism. I’m not a big fan of statins, but I am not sure RYR with its cholesterol reducing properties intact is available even if you want it. (This may have changed again … Anyone?)
That certainly indicates low cardiovascular risk. If you were to have an NMR analysis of your LDL done (particle counts by size), the distribution would show the healthy Pattern A, which correlates with minimal cardiovascular risk.
Contrary to what we’re told a lot, Keto does typically raise our cholesterol, whether that’s bad or not depends on the breakdown of which LDL you have. If your doc’s not doing NMR’s, he has no clue.
When your carbs are low, but not keto low you do have to pay more attention to your fat intake. My cholesterol was around 280’s at it’s highest when I did standard keto, I do a hybrid TKD/CKD now so my carbs are higher, and my cholesterol now sometimes is too low. My last check it was at 120 and my doc (she’s actually smart) told me get it up a little.
Are you in the US? Because if you are Red Yeast rice won’t work. Only works outside the US sadly. I’ve used it, but had to import the real thing since we can’t buy it here.
Don’t shy from fat, but don’t look for reasons to add it in where it wouldn’t be.
How many carbs are you eating daily? and what’s your typical fat intake?
Yeah, as others have replied above, you’re doing fine. No LDL issues whatsoever given your HDL/Trigs and eating habits/exercise.
“Half-keto” is like being half an alcoholic. You can’t mix fats + carbs and hope for the best. Pick a side and stick with it for your own sake.
(ps - we’re about the same age… my LDL-C is well over 200 and my heart risk is near zippo … my doctor has no concerns as he understands genuine low-carb lipid profiles)
The only suggestion I’d offer is to stop screwing around with yeasty rice. Your body doesn’t need that silliness - your LDL is perfectly fine and natural. Keep the carbs down and you’ll outlive your doctor.
PUFA’s. Yeah from what I have been reading the more grains the animal eats the more their Fat contains PUFAs, and we ingest PUFAs by eating those animals that way as well. And have been reading in a few places that once one stops eating PUFA’s our bodies slowly dispose of the PUFAs it ingested previously over the course of a few years.
Red Yeast rice. What I have here is they state there is no Citricin poison in it. Ok that is a good thing. It is supposed to contain monacolin K as the active ingredient which is supposed to be a good thing to reduce LDL. Yet that could possibly cause serious problems. OK I am stopping Red Yeast Rice.
Yes I live in the US. My total fat intake per day is 2 - 3 tablespoons of MCT oil and 1.5 tablespoons of grass fed butter.