Hey all
Been doing Keto full time since Nov 21 - Very happy with results as I am down over 45 lbs
My question to the group is on Cholesterol. Recent blood work completed was awesome on all fronts except for Cholesterol total (251 mg/dl vs targeted <200 mg/dl)
LDL is 169 and target <100 & Non HDL Cholesterol is 189 vs target <103 mg/dl
Anything to worry about here? I know the fat intake is higher than most being on this diet
Cholesterol Elevated
Sivart1966
#1
SomeGuy
(Joey)
#2
Howdie. I was hoping to hear the most important aspects of your lipid panel…
How’s your HDL and your Trigylcerides? Frankly, much of what you’ve shared for someone not eating carbs - and losing significant weight - is pretty much irrelevant. 
PaulL
(Bacon is a many-splendoured thing)
#5
The search function on this site works quite well, so you might want to do a search on “cholesterol” and browse through the innumerable threads that will turn up. But here’s a quick recap:
Before the discovery of statins, total cholesterol under 300 was considered perfectly fine. Likewise, with LDL. Anything 150 or under was okay, and 169 would have been considered slightly elevated, but not much of a concern.
What is your ratio of triglycerides to HDL? If it is 2.0 or less, your cardiovascular risk is minimal. Even the doctors and researchers who obsess over cholesterol have to admit that. (The ratio should be 0.9 or less, in the units used outside the U.S., by the way.) ETA: I see from a later post of yours that your ratio is 1.55. That is fantastic, and you have little to no risk of cardiovascular disease.
For a real measure of the damage to your arteries, if any, get a CIMT (carotid intima media thickness) test and a CAC (coronary arterial calcium) scan.
For a list of studies and statistics showing that cholesterol cannot possibly be the cause of cardiovascular disease (at best, it might be a marker of disease), see one of my many rants in many threads on this site.
SomeGuy
(Joey)
#6
[EDIT: POSTED THIS BEFORE SEEING @PaulL’s REPLY ABOVE.]
Look, this may run counter to what some (many?) old school doctors are saying, but I simply would not worry about those other metrics besides your HDL and Trigs.
If you had an NMR Lipid panel you’d learn even more, but with simply the 1:5 ratio of Trig/HDL and the loss of 45 lbs (which disrupts a more stable reading of lipids for some time until things settle down), it looks like you’re doing great!
A Trig/HDL ratio of under 2 (US metrics) is considered excellent for heart health.
Congrats on your weight loss. Onward! 
ctviggen
(Bob M)
#8
With many on keto, there’s a period where your LDL and TC will go up, because these are used (in part) as energy trafficking systems, and you’re trafficking a lot of energy via fat. Will yours come down? Probably, but maybe not. It’d be wise to wait another 6 months or so and test again.
That’s a great HDL. Are you a man or woman? (That’s a really good value for men, not bad for women.)
lfod14
#9
If your fat is higher than normal even for keto… there ya go! The claim for a while now has been that our dietary cholesterol has little effect on our serum levels, I’ve found that to not even be remotely true with myself. I dropped my fat down to a sane level and my cholesterol levels droped with it, that easy. I always had real low trigs, usually <50 but total was high when I intentionally was eating higher fat. I also learned it was easier to lose with it lower, most likely just caloric but either way it fixed what was wrong.
PaulL
(Bacon is a many-splendoured thing)
#10
Even Ancel Keys understood that much. What he refused to admit was that it was dietary carbohydrate that raised serum fat levels.
The association between sugar intake and serum cholesterol that appeared in Keys’s Seven-Country Study, and which he rejected out of hand, still remains when the data for all 22 countries are analysed. Whereas the association between saturated fat intake and cholesterol levels disappears; it is present only in the data for the seven countries that Keys published. The existence of a causal link from serum cholesterol to coronary heart disease appears to be an artefact of Keys’s cherry-picked data.
Dietary polyunsaturated fatty acids have been shown to reduce LDL cholesterol, but they bring with them certain undesirable effects, among them systemic inflammation. The best way to raise HDL cholesterol is supposed to be with saturated fats, and mono-unsaturated fats are supposed to be the fats that get metabolised for energy. I’m not sure how accurate this view is, however, because I am watching an interview with Benjamin Bikman, who is claiming that the short- and medium-chain fatty acids are what generally get metabolised, whereas the long-chain fatty acids are more readily stored.
Make of this what you will.
ctviggen
(Bob M)
#12
If I’m not mistaken, you eat higher carbs too. That alone can cause lower “cholesterol”:
Personally, I’ve eaten tons of fat, including TONS of that evil saturated fat, with basically no change in my TC or LDL. (The thing that changes my cholesterol the most? Fasting > 24 hours.)
For me to believe what anyone says in this area, I need:
- Cholesterol tests taken at least weekly, preferably daily
- An exact calorie, fat, carb, protein content, including breakdown of PUFA, MUFA, and saturated fat
- If you think “fat” causes “high” cholesterol, I need to see at least a week with low fat, low carb, then a week with high fat, same carb.
- Then see what happens if you add carbs, not to high levels, just more than what you were eating.
I’d prefer to see lean beef for the low fat days, then the same exact lean beef, but with added beef fat or maybe butter. While this is still a tough calculation, as you’re adding mainly MUFA (beef fat) or saturated fat (butter), it’s at least an attempt to keep the number of variables small.
I see ludicrous statements online all the time, where people say they ate more “saturated fat” because they ate more meat. But meat is mainly MUFA, not saturated fat. If you actually want to eat a lot of saturated fat, you have to eat dairy or cacao butter.
And statements like “I ate less fat” are meaningless, without saying what you replaced that fat with. If you replaced with carbs, even “good” carbs like vegetables or squashes, that is much different than if you went from ribeyes and pepperoni to top round and ham.
Ketogran
(Janette Fowler)
#15
Forgive me for probably getting this in the wrong place but I need help understanding the following. Please can anyone help me to understand this. I am 68 and have always had elevated cholesterol and previously had statin treatment which I stopped 5 years ago following going keto/ weightloss/ remission in type 2 diabetes etc.
This year my total chol was 11.9 but was taken after a short fast. These readings were taken in March and my doctor referred me to a lipidologist who wants to trial Rosuvastatin. I do not want to do this BUT did become anxious (even though I’ve read plenty) at the doctors need to refer me and do something about this. These are U.K. tests and if anyone can clarify them for me I’d be very grateful. I did wobble during lockdown and ate more carbs that I would normally and had slightly elevated blood sugars /weight gain compared to previous tests but am more stringent now on keto.
Total chol 7.2 mol/ltr
Triglycerides 0.8
HDL-C. 2.5
LDL-C. 4.3
Non HDL C. 4.7
ALT. 18 U/L
HBA1C. 49 Mmol/mol
TSH 2.5. m U/L
eGFR. 84 mL/min
Thankyou in advance
PaulL
(Bacon is a many-splendoured thing)
#16
Your ratio of triglycerides to HDL is 0.32. That is fantastically good. It means that your LDL particle sizes fall within the healthy Pattern A, and your cardiovascular risk is minimal. In the measures used in your area, you want the ratio to be 0.9 or under.
I can’t comment on the other numbers, because they are in unfamiliar units, but if your laboratory report provided reference ranges along with your values, then you should have some idea of how they compare.
007
#19
Several podcasts address this (e.g., 2ketodudes). Cardiologist William Davis MD has many, many YouTube videos. He also has books (Wheat Belly, Undoctored and Super Gut). They are not hard to read and are chock full of practical information. I am not a salesman for him.
You did not list the triglyceride level. Since cholesterol and LDL levels vary hourly, ignore them. Focus on the ratio of triglyceride to HDL (high density lipoprotein). If the ratio is 1 (ideal) or 2 (less ideal ideal), that’s a great starting point.