I did read the FAQs, but didn’t see this question there, so:
I started on keto in April of this year (2017).
In June, I had a coronary calcium score done, and at the age if 40, I scored a 139 (I had it done because of enormous family history of CVD).
My cardiologist sent me for tests. Because of the results, he want me to ditch keto and is considering recommending medication for me.
I have been watching Ivor Cummins videos like CRAZY to see if I can find guidelines to better understand my results. I also know the Dudes have floated a ratio as a good indicator, but I can’t find the podcast it was in.
Can someone help me find keto/fat friendly ways to understand and process my test results?
One ratio that is a reliable indicator of heart disease risk is Triglycerides/HDL, which ideally you would like to be under 2, lower is even better. So for example, if your Trigs are 100 and your HDL is 50, then 100/50 is a ratio of 2 — which is pretty good.
I agree with this, assuming that your doc understands keto and cholesterol values and is not just promoting the standard dogma about total cholesterol, statins, etc.
As soon as my doc heard that I began eating ketogenically, he told me he wanted me to stop. He doesn’t seem particularly open-minded to keto.
My results are screwy. My TG and HDL numbers are BEAUTIFUL, but my LDL numbers are all scary.
So, just really interested in where I can find research-based ways to interpret my results instead of the standard “fatisthedevilwhatiswrongwithyou” perspective. I’m also interested in research-based explanations for wonky results.
Thank you for the reminder of the TG/HDL ratio. I have a 1.2!!
I wonder if the LDL concerns might be unfounded. Check for posts here by @DaveKeto as he is doing some very interesting work on cholesterol. Also check his website, cholesterolcode.com.
Personally I think that if a doc is not familiar with keto and the current nutritional science, then they have no business advising for or against, just like I have no business advising on quantum mechanics.
Personally, I’d be looking for a new doc. There’s just way too much evidence that keto works for the vast majority of people to ignore. And the reasons that it works are pretty easy to understand. The saturated fat hypothesis is done. Medical professionals who continue to insist patients eat low-fat are doing them a disservice.
I don’t see that your blood tests are bad, per se. If your trigs and HDL look good, and you’ve only had the one cardiac calcium done, then you have some good news, and clearly some work to do in fixing the cardiac calcium situation. Give more time and have another cardiac calcium scan done. And as @gardengirlkp suggests, consider at least getting a second opinion, even if you don’t replace your doc entirely.
I have really high remnant lipoprotein count, and my small dense LDL III and IV are really high. Even Ivor Cummins and Cate Shanahan have stated that there’s a strong correlation between those counts and heart disease.
The thing you want to care about with your CAC score is progression. When you do your next follow up CAC, you’ll have a sense of this. I’d rather have a CAC of 500 with a 2% progression than a CAC of 50 with a 40% progression.
Also, can you post your lipid scores? I can’t opine on their pattern without knowing the values.
I JUST finished watching your talk for Low Carb DOwn Under! It made me laugh and gave me some hope! I have been obsessively watching videos by Phinney, Volek, Cummins, Naiman, and Shanahan for HOURS. I got my results today and haven’t been able to focus on anything else since. I am SO grateful to Cathy for telling me about you!
The results are below. I have put my pre-keto results from last year in parentheses. It is pertinent to note that I have recently been lowering my daily fat intake in an effort to lose weight. I’ve also been intermittently fasting and was fasted for 22 hours when I took the test.
That’s very kind. I try to help out fellow hyper-responders in general, but don’t always get the bandwidth. Hopefully, I can be of help here.
Of course, if you’ve seen my talk, you know what I’m going to say here. Your lower fat intake and long fast are almost certainly spiking your numbers somewhat. I just recently fasted for 2.5 days and got the highest numbers I’ve ever had. http://cholesterolcode.com/the-fasting-disaster/
Clearly, you are a hyper-responder and your LDL-C is higher than the average, but so too is your HDL-C, which is a stellar 84! And with VLDL down at 21 I think this looks pretty good.
I say this often, but to say one more time – HDL-C is the number I most care about. I’d like everyone above 50, but optimally above 60. You usually don’t get above 80 unless you are very lean and/or athletic.
Your LDLp at 1394 is surprisingly low for your LDL-C, showing you are very positively discordant (it’s a good thing). You’re also Pattern A, of course, and you have a low Lp(a), which is likewise good.
If your AST is measured in IU/L, then it is well within reference range at 33.
Your hsCRP of 5.2 is the one thing I’d pay attention to. But here’s the thing – it’s a very sensitive needle. Mine is usually <1.0, but has been elevated when taken during marathon training season and following half marathons, once going as high as 52.96(!). It was likewise elevated to 4.55 when I was sick. But in all cases, it snapped back during the vast majority of my other non-event tests to under 1.0.
In general, hsCRP is a good “something might be going on” gauge – but only if it is consistently high. That said, there are a few people I know with consistently high hsCRP that don’t appear to have anything wrong that we know of.
I try to answer here. But I’m a bit more reliable from comments on my blog, generally.
Yes – you can just do 23andMe to find that out pretty easily.
Yeah, I can’t help you there. If they buy into the LDL=bad paradigm, there isn’t much to persuade them. That said, try to see if your doc get you a CAC (calcium scan) and CIMT (carotid intima-media thickness) test. Note with both of these you’ll want to care about their progression over time more so than the score itself. In fact, if they are your first tests of this kind, you won’t be able to know how much of your life pre-keto impacted those numbers, that’s why you’ll care about progression when comparing them to future tests.
I’m glad you’re looking at Ivor’s information, he also talks about it in this 2KD podcast. Basically, it’s the change in existing calcium score that is the biggest predictor of future events.
On a related subject, if you also have soft plaque, there is hope that keto can help with that.
I was following a keto diet since March of 2017 fairly strict until mid Sept of 2017.
My bloodwork was taken a week after starting Keto and it was as follows
TC 224
Tri 81
HDL 44
VLDL 16
LDL 164
All other tests were normal
My next bloodwork was taken on 10/30/2017
Mind you the month prior I wasn’t as strict keto and was also,coming off antibiotics and also not sure if Sam-E could have had any effect on the bloodwork but was also taking that for 2 weeks that month.
I also demanded an LP(a) test and CRP test
Results
TC 231
TRI 99
HDL 54
VLDL 20
LDL 157
LPA - 266 NMOL°°°°° good is <75NMOL
CRP 0.6 MG
I am quite aware of the whopping L.p.(a) … I am happy my LDL went down a little and my HDL went up a little…I think the CRP is good. Not happy my VLDL went up a little.
The LP(a) though has me very concerned on staying on a keto path. I am considering going full vegan/low oil diet to decrease my LDL as they carry the LP(A) … I’m not sure what to do
Do you think having an L.p. a that high should draw my attention to controlling my cholesterol even though the whole cholesterol concept has been debunked? Or does that go out the window for people with a genetic predisposition like this ? Obviously this has me extremely concerned about which lifestyle/diet to adhere to…Keto or the completely other side of the spectrum…being something like Dr.Furhman or Caldwell type vegan/low fat/no sugar diets.
I also take 1000mg of high quality fish oil and 400mg of Coq10
Just started taking 500mg of pure Niacin too for the LDL and LP(a)
Take a multivitamin /magnesium/L-Arginine and Carnitine/inisotol
I am a 37 year old male , weighing 176 and 5 '9. Btw.
