My husband had been doing keto for a 2-3 years. He’s recently had a post blood test telephone gp check up and his cholesterol is very high. We were expecting that with the keto, but when he asked for more In depth information ie size and density, they refused. She said his bmi was high and he needed to lose weight,. He told them why his bmi always looks high (short but very muscular) and could he be seen in person to prove this. The gp refused and said she just needed the numbers she had to give this diagnosis. We’ve ordered a private test to try and drill down. If his test comes back and confirms small high density ldl what are the changes he could make? I’m doing keto as well but I’ve reduced my dairy and animal fats. I’m sorry to gibber on but I’m just so angry at the distress this doc has caused and who had clearly not checked his history.
Cholesterol high
Start here.
Why so?
I’m sorry your GP is being so shirty; she’s not being helpful by refusing to allow your husband to come in person. But keep calm and keto on, as we say.
The link Michael posted to Dave Feldman’s site has a lot of useful information that you might want to check out. It sounds as though your husband might be one of Dave’s “lean-mass hyper-responders.” If he is, he could fudge the next test results by eating a certain way during the week before the blood draw. Dave doesn’t recommend deceiving one’s physician, but . . . .
Before you assume the worst, you should be able to check the ratio of your husband’s triglycerides to his HDL from his current bloodwork. In British units, you want a ratio of 0.9 or less, in American units, 2.0 or less. That virtually guarantees that an NMR will find healthy Pattern A for his LDL particle sizes. I don’t know if you can get a CAC scan done in your jurisdiction without a doctor’s prescription, but if you can, it’s not a bad idea. It measures coronary arterial calcium deposits and is probably the best indicator of arterial damage and cardiac risk over the long term.
I found myself getting a bit sick of and with it so switched it around a bit. My husband was very heavy handed with the dairy (butter and cream on top of the coconut oil) in my bullet coffee and sauces. My stomach improved with the cut back and the addition of apple cider vinegar.
Not sure how helpful I can be with the OP but I’ll share a little n=1 perspective…
Yes, CAC scan is well worth the trouble and cost. My wife and I have had three in 2 years. But the results can be puzzling and there is some question out there about exactly how to interpret results (viz., volume vs density, soft plaque vs hardened). I feel they’re best seen as part of an overall picture.
Lean Mass Hyper-Responder is a real thing - but more folks are not, than are. I happen to be one of those LMHR types and my data (and personal contribution) are part of Feldman’s data set. The link provided by @amwassil is great reading.
An NMR panel will certainly provide greater insight into what’s going on in terms of “good” vs “bad” lipid activity. A simple basic lipid panel is almost useless on its own when doing keto given the effects on HDL, Trigs, differences in LDL particle size and remnants that come into play.
While there’s nothing wrong with lowering fat, make sure you’re getting enough healthy fat to burn - since you’re cutting out carbs, you can only handle so much protein, and you need to get sufficient calories from somewhere. Don’t go into caloric deficit mode to the point where your metabolism begins to shut down. That’s entirely counterproductive to everything you’re trying to achieve (weight loss, improved health, etc.)
Best wishes and keep us posted on developments.
Badge of honor! I’m around 11% BF right now and I’m “morbidly obese”. When docs are stupid enough to bring up BMI when I’m in there… I make them regret it 
Once you get back your test you’ll have a better idea. I can’t eat super high fat and maintain good numbers. I eat enough fat to keep everything running but I don’t look for reasons to add it in either. There’s also ways to drop it really fast if you wanna fake a test (after you get your real one back obviously) but what’s the point? Who cares what your GP says, just deal with the private ones and do your own labs when you want to know stuff.
So the results are in
Total cholesterol : 7.77 mmol/
LDL 1 : 1.58 mmol/l LDL 5 : 0.00 mmol/l
LDL 2 : 1.66 mmol/l LDL 6 : 0.00 mmol/
l LDL 3 : 0.78 mmol/l LDL 7 : 0.00 mmol/l
LDL 4 : 0.05 mmol/l Comment: Currently significantly increased total and LDL-cholesterol levels. Elevated levels of small dense LDL-particles were detected in LDL-subfractions 3 and 4. Hence there is evidence on type B. -
There is a strong correlation between type B and atherogenic risk. Screening for additional risk factors like insulin resistance or diabetes and further components of a metabolic syndrome is essential. For improvement of this LDL subfraction profile correction of lifestyle including sufficient physical exercise, weight loss, a carbohydrate restricted diet and in particular reduction of saturated fats is recommended. Therapeutic treatment should be niacin or fibrate based and also contain omega-3-fatty acids. Quarterly testing may be suitable for assessment of therapeatic measures. Please see coloured report attached. Result from Referral Laboratory ID [900].
Currently trying to get a cac scan booked.
I should add, his sugars are always normal and his ketone is always normal for our diet.
If you are near London try Rivers Hospital in Hertfordshire… It’s where I had mine done a few years ago. It was also the cheapest in the UK at the time (although our American cousins would wince at the price). I think it’s somewhere around £350 now.
We’re in the Highlands and husband a teacher, so access would be curtailed by work, but we can try for the school holidays. We tried the Nuffield in Glasgow but have had no response from a request made 2 weeks ago.
I got a quote from a nearby Nuffield (Brighton I think) it was almost £800…
That’s a lot more than I was expecting, but if it confirms one way or the other it will be worth it. We’ll shop around and see how it goes.
I’m afraid it’s not cheap in the UK I did a lot of research and Rivers was the cheapest I found… if you do find anywhere less than £350 please let me know… A trip could be arranged as I’m kind of due for my next one!
The cheapest we’ve found close to us is Glasgow for £400, but it requires a gp referral. My husband is off to pester the gp for an email referral now.
That is really expensive. Mine was $100 in the US, without a referral. I did have to shop around, though, and drive over an hour one way to the place, for a 5 minute scan.
If the pattern is B, this should change over time. My pattern changed from B to A, but it took a while. Probably a few years.
Also, don’t do much real fasting for at least 4 days before the blood test, as fasting messes everything up.
Had the UK mot been on the red list we worked out it would have been cheaper for him to go abroad.