Concerned... My first blood panel after eating Keto for almost a year

(Alan) #1

This is a long post (my first on this forum) and I’m NOT looking for medical advice but I’m hoping to get some information from someone who may have had a similar experience about high total cholesterol and LDL numbers on results on my first post-keto blood work. I had the blood work done for an upcoming physical this week.

I’ve been eating Keto for almost a year. I haven’t methodically tracked what I’ve been eating, but can say that for the most part I’ve been very conscientious what I’ve eaten. I’ve experienced many positive results including better mental focus and acuity and less anxiety and depression. About 3-months ago, I was feeling better than I had emotionally in a long time, and weaned myself (very slowly) off anti-depressants which I’d been taking for decades.

Although I wasn’t particularly overweight when I started the Keto diet (I’m 6’ 2" and weighed 180-lbs or so), but after I hit an all time high on the scale at 185 and was starting to carry some new belly fat, I wanted the trajectory for my weight to improve.

After almost a year of Keto, while weight loss wasn’t really a primary goal of the diet, I’m back down to around 170 pounds which I consider to be a much better weight for me. Before I started doing a sedentary job 20+ years ago, I weighed around 165 which I’m guessing is where my body may reset if I continue on this Keto journey which I very much want to do.

I have a history of cardiovascular disease in my family with both my dad and his Dad dying from heart attacks, although both were overweight and smokers so I’ve always tried to maintain a healthy diet, but the definition of healthy has shifted for me over the past year.

My total cholesterol for the recent blood work was 341 mg/dL where it’s almost always been under 200 in my past results. The calculated LDL result was 249 which was 100 mg/dL higher that it’s ever been. So, I was rattled and upset when I saw those unexpected numbers.

Before he ordered the tests, I thought about asking my doctor to order a more detailed lipid panel for particle counts and for Lipoprotein(a) and Lipoprotein(b) which from what I’ve read would be good to know, as well as the particle counts, but I wasn’t expecting my LDL’s to be so out of whack. In retrospect, I wish I had done that and will discuss this with him next week as an option.

Interestingly, other markers look good. My triglycerides were 63 mg/dL, and HDL was 79 mg/dL which is almost 30 points higher than what I’ve averaged over the years. And finally, while this isn’t a lipid panel result, my C-reactive protein result was under 3 mg/L which is significantly lower than what had been in previous blood work.

I’m trying to stay calm, but I started the diet without consulting with my doctor (in retrospect probably not a great idea) whom I like very much , but I’m concerned that rather than partnering with me to try to figure out what’s going on, he may push me to drop the diet, or worse still, push statins or other drugs.

I think it’s far more likely that I’ll figure this out with the support of my doc once we get to talk, but I’m hoping to find some information here to help point me in the right direction. And to be honest, I’m hoping someone can help talk me off the ledge a bit and deal with the anxiety surrounding the results.

This isn’t a question that can be answered definitively on a forum, but I’m wondering if I might be one of the small percentage (1-2%?) of people who don’t do well with a high fat / low carb diet. I hope that’s not the case because there have been so many great benefits that I’ve experienced, but it’s a little scary right now…

Any similar experiences out there? And if so, what did you do and what were the results?

Thanks all!

(Cheryl Meyers) #2

Just a quick response to ask if you have read @DaveKeto’s blog about cholesterol? It explains how the tests are affected by your fat intake in the three days prior to testing. He was on the 2KD podcast too: Episode #63 - Cholesterol Code Update with Dave Feldman

(Sheri Knauer) #3

The same thing happened to me. I had always been an exerciser and healthy eater (well, what I believed to be healthy eating but like you, that has shifted in the last year). I was always proud of my low total cholesterol(average was under 180) and low ldl(well below 100) numbers. I started keto Aug of 2016. In Nov of 16, I had to get blood work done for insurance purposes. My total cholesterol was 318 and my ldl was 215. My doctor, who was new (my husband insisted I get a primary care doctor since I didn’t have one that I liked very much so never went to) immediately freaked out when he saw that number and wanted me to start taking a hefty dose of statins. I refused. From everything I had read about keto and cholesterol and cholesterol in general in regards to heart disease, I was absolutely confident in my decision to refuse to take statins. He had his office assistant call me and try to push them on me, no come in so we can discuss anything. He had no interest in having a discussion about any reason why my cholesterol levels increased so dramatically from previous years (we’ve had to get a cholesterol panel done every year for insurance so he had data from the last few years).
I told my husband I was not going back to this doctor but my husband convinced me to give him another try. He had to get some blood work done 4 months later and convinced me to get mine done again since cholesterol levels are know to be wonky in the first 6 months of keto (my first blood draw was when I was only 3 months keto) so I agreed. Went to Dr in March 17, husband got blood draw and had convinced the dr to have blood drawn on me so a VAP test could be run so we could determine particle size, not just general numbers. So the doctor seemed open to that, his assistant came back in the room 10 minutes later and said they can’t find a lab that does the VAP test so if I want it done, Im on my own. Alrighty then. Strike 2 on this doctor.
So, on my own, I find a lab that will run and NMR test and that test still came up with high total cholesterol (353) and high ld (229) but it determined the particle size was primarily type A, my HDL was 113 and my triglycerides were 54. I felt those numbers were awesome.
Then I get the call from the doctors office (his assistant again). Apparently the doctor had never seen results from an NMR test and in the hours of research he put in to try to interpret the results, his conclusion was that my total cholesterol and ldl were still high and since I refused to take statins, he wants me to go see an endocrinologist.
Strike 3 and he is definitely out!
So I would re listen to the podcasts from the 2 keto dudes regarding cholesterol, check out the links they provide on their website. There are also podcasts that discuss cholesterol (Ketovangelist and Keto Talk). Listen to those. There are a lot of videos out there on You Tube regarding understanding what the cholesterol numbers mean presented by doctors and researchers who understand and are familiar with cholesterol and the keto diet. Then I would go back to your doctor to discuss armed and ready with the studies, knowledge and data that you can discuss and share with him. Who knows, maybe your doctor will take a renewed interest in learning updated research regarding cholesterol.
Both of my maternal grandparents died of heart attacks and my paternal grandfather died of a stroke, paternal grandmother died in her 90’s but she had dementia due to atherosclerosis.
Good luck and don’t let those numbers freak you out because its really not cut and dry, your numbers say this so it equals this. Request the VAP or NMR test to get particle size. You can request also a heart calcium scan which will tell you if there is any kind of plaque buildup on the coronary arteries.

(Sheri Knauer) #4

I would also read up on what statins do to you and how they are pretty much ineffective in preventing heart attacks and really don’t do anything but produce a lower number on the cholesterol tests. It was interesting when I read the percentage of people with “optimal” cholesterol numbers due to statins still suffered from heart disease and heart attacks and how it was found that healthier, longer living people actually had higher cholesterol numbers. Statins are just bad news all around. My husband is non keto and had been taking a statin for about 10 years. His cholesterol numbers were good according to the “normal” standards so his doctor took him off the statins. When he got tested again, he was freaking out because the numbers went up and wanted to start taking statins again and fortunately I convinced him to not take them and I am slowly trying to educate him on cholesterol numbers (he is not very good at understanding anything that involves any kind of medical jargon so its been challenging to help him understand but baby steps. At least I convinced him to not start taking statins again).

(Alan) #5

Thanks very much for your supportive post(s) about your similar experience with your blood work. I don’t get the sense from reading about the experiences of others who have moved to high fat low carb diets that seeing total cholesterol go up 150 mg/dL or LDL’s go up well over 100 mg/dL is common experience. But after reading your posts about someone who did have a similar experience, I’ve come in off the ledge a bit.

I very much need to do more reading about this phenomenon. I’ll check out the the podcasts you’ve mentioned, dig a bit deeper on YouTube and also check @DaveKeto’s website that Cheryl mentioned.

I do listen to and enjoy the 2 Keto Dudes podcast and that’s been a good info source… And maybe I wasn’t paying attention because I hadn’t seen my cholesterol numbers, but I don’t recall hearing a story quite like this until you shared your experience. It seems to be a FAR more common outcome to have HDL’s go up some and for the LDL (and total) to go up a bit, stay the same or even go down rather than sky rocket.

And while my long time GP has never recommended a Keto diet or anything similar to me, he has always kept very up-to-date on new research and I"m hoping on new interpretations of research that’s been around for a while. I have read and heard quite a bit about the lack of efficacy and side effects of statins, and I think at this point, that would be a deal breaker for me if my doc took a hard line and insisted that I take the statins and wasn’t willing to work with me to try to sort this out… I really don’t want to look for another doc (again, he’s been great over the years) and I don’t think I’ll need to but it adds additional stress about the possibility of having to “fire” my doc and look for someone new to see when I’m already feeling some stress from the numbers.

I am determined (and stubborn :slight_smile: ) and one way or the other, I’ll work this out. Getting the additional tests to show more about the cholesterol profile and the profile of the “high” LDL’s seems like a good place to start and I hope that my results look like yours. That would ease my mind further.

I guess my concern here as I mentioned in my original post was that I’ve read that there appears to be a very small percentage of people who don’t respond well to low carb high fat diets, but as in your case, I’m hoping that the good results in the other blood test results (higher HDL,'s, lowest ever triglycerides, along with good glucose numbers and no markers for inflamation) means that this does turn out to be something that I don’t need to freak out about and that I can continue down the Keto path which has already been a rousing success in many other ways.

Finally, if I’m able, I think I’m going to try to move this post and thread to the “cholesterol” section of the forum which I didn’t see last night when I joined the forum.

Thank you again for sharing your similar experience here!

(Jeremy Storie) #6

From what I’ve heard the higher your hdl the lower your small particle ldl (which is what sticks to your artery walls). Your total ldl may have gone up but your hdl probably did as well.

(Roxanne) #7

Hi @Alan. You are not alone, I had a similar concern just a few weeks ago. See my thread referenced below:

After doing some more research, I’ve decided I’m not concerned about the higher LDL at this time and will KCKO. If my doctor gives me a hard time (these tests were done through my naturopath so my GP hasn’t seen them), I’ll push for particle size testing.

I second the recommendation of reading/watching the stuff posted by DaveKeto.

(Jacquie) #8

@Alan I’m what @DaveKeto calls a hyper-responder, too. :slight_smile: I also have a family history (both sides of my family) of CVD. Here’s my post and Dave’s response that was posted on another thread.

@DaveKeto Thanks so much for posting your presentation! I’ve followed your work for some time and find it very interesting and exciting. I think I may be a hyper-responder. :slight_smile: I’ve been lc since the mid 90’s, paleo, primal and Whole30 before becoming keto over 2.5 years ago. My last lipid panel in 2015 was - Cholesterol 9.17 mmol/L, HDL 3.49 mmol/L, LDL 5.22 mmol/L, Trigs 1.02mmol/L. . My 23andMe results show I’m ApoE 3/3. I can’t get particle testing where I live in Canada.

I hope to use your protocol in a month or so before my next blood work. I’m already practicing with macadamia nuts. :smile:

Dave’s response -

Wow, Jacquie - I rarely see such a killer Trig/HDL ratio! Your HDL is through the roof - congrats!

As it happens, I find HDL is the single most relevant marker I watch for now.

There’s a lesser known tidbit in that hospital study low carbers quote all the time. You know the one that shows the majority of admitted having “optimal” LDL cholesterol? The kicker is less than 10% had HDL cholesterol of above 60. Or to put it another way, over 90% had an HDL under 60. Kinda makes you wanna have a nice and high HDL, yes? :wink:

I was offered statins by my Dr. years ago, which I refused after doing lots of research. Now, my family Dr. tells me I have excellent ratios and never mentions statins. :wink:

@Sheri_Knauer we have similar family histories re CVD.

(Todd Allen) #9

From what I’ve read the HDL to triglycerides ratio has been shown to be a MUCH better predictor of developing metabolic syndrome, diabetes and cardio vascular disease than ldl. And a good ratio correlates strongly to having a good mix of LDL particles. And your ratio is good. LDL can change rapidly, for example if you are stressed or have a cold or infection it can rise a lot. So multiple tests should be done before becoming too concerned.

In addition to the previously mentioned hack of manipulating LDL through diet/fat you might consider nicotinic acid, aka niacin or vitamin B3 which is cheaper than statins and has fewer/better side effects. When my doc pushed statins for high LDL I suggested we try niacin first and he consented and my LDL came down and my doc is now happy. Which is good because if he wasn’t I’d have to start looking for a new doc.

Inflammation is an essential ingredient of developing athersclerosis and even if you can’t get you LDL down much if you can continue to lower your markers for inflammation such as C-RP then high LDL should be less of an issue.

(Crow T. Robot) #10

Check out Ivor Cummins’ blog

He’s basically ripped LDL to shreds as far as being a valid marker for atherosclerosis. It’s a red herring, but persists because it’s lucrative for drug companies who just happen to have an expensive pill to lower it.

PS - Congrats on the stellar trig/HDL ratio. That is one marker that correlates very well with real world outcomes unlike LDL.

(Luke Jeffery) #11

I’ve posted my last three lipid panels. The first is pre keto, 2nd is 4 months in and last is 1 year into keto. As you can see my LDL is up considerably when compared to my pre keto days. BUT Triglycerides are down and HDL is up and the HDL:triglyceride ratio suggests that my LDL is mostly pattern B.

(paul ) #12

Awesome subject and close to my heart. (Excuse the pun).Keto 6 months down 50# I never go off diet <5 carbs a day, in solid ketosis all the time.
Decided since I have 2 stents and wanted to get really lean at 61 this was the best way. Starting weight 265, current 216. Waist 44 to 36. Havent had blood drawn yet but still on statins and BP meds. BP has dropped from 145/92 on meds to 112/72. May have to go to Doc to reduce BP meds.
My question is that I am familar LDL/HDL ratio but what is a good ratio for HDL/tri?

(Luke Jeffery) #13

This is a really good link:

I wrote it the wrong way round in my earlier post it’s trigs divided by HDL. The lower the ratio the better.


Some more good reading, from Dr Attia:

(Jo Lo) #15

Be careful about lowering your LDL too much. Vitamin D and testosterone, among other good things, are made from cholesterol. If you lower LDL using statins you might lower these too.
Also, most heart attack victims have low cholesterol, in the 100’s. The whole relationship between cholesterol and heart disease has been presented wrongly for 40 years. Increased suicide is another a nasty side effect of very low cholesterol BTW.

In short, we can’t believe anything in the convention wisdom about cholesterol! Start fresh, read Jimmy Moore’s book, Attia’s blog, and listen to Ivor’s excellent videos. Marksdailyapple is another good resource. In fact, a useful summary of Attia’s material is there, with hundreds of interesting comments.

(Richard Morris) #16

Some people go keto and their LDL goes down, and some it barely changes, and in some people LDL goes up when they go low carb - and they are generally called hyperresponders.

It’s possible, but unlikely as your trigs/HDL are stellar. Less than 2 is ideal, yours after a year of keto is less than 1 - that’s outstanding.

People who really can’t do well on a low carb diet usually have structural problems like a deficiency in the enzyme that transports long chained fats across the wall of their mitochondria to be burned ( These people really can’t live on fat, they pretty much have to be glucose burners.

A lot of hyper-responders have this experience. It’s what led @DaveKeto to begin his experimentation to work out what was going on, and ultimately he found several interesting patterns that no-one else seems to have noticed.

I’m sorry that you were surprised by this, and anxious about your response. Let’s see if I can talk you off the ledge.

LDL is a particle your liver makes on demand to traffic energy in the form of lipids throughout your body. When we go keto, we are switching our bodies from fueling primarily on glucose to one that is fueling primarily on lipids. So it makes sense for the liver to make more LDL particles to traffic more lipids … so the real question I think is why does everyone else NOT hyper-respond as well.

I suspect some of the variability has to do with how much body fat we have, if we have 100 lbs of body fat then we know that can contribute 3150 kCal/day into our circulation so that’s not a bad days worth of energy right there. Such a person doesn’t need a lot of additional lipid traffic, so the LDL their livers make is just mopping up the leftovers and sending them to fat to be stored. Those people probably need to make less LDL.

People who have a lot less energy available from body fat, and lipid energy coming in via the gut has it’s own giant particles to traffic it about the body called chylomicrons and they last for about 30 mins after a meal and then they are picked up by the liver with their remaining payload of energy. Of course most of us don’t eat for 24 hours a day but we do burn fat all day so the liver has to make LDL to ship all that energy out into circulation.

But the question we have to ask is what does this mean for your cardiovascular disease risk?

Back in the 1970s we used to think that high cholesterol is a bad thing, because people who get cardiovascular disease first observe fatty streaks of cholesterol in their arteries. In the 1980s it became evident that one of the particles that traffics cholesterol HDL was actually protective against CVD - so then we had good cholesterol particles (HDL) and bad cholesterol particles (LDL). In 1990s Ronald Krauss discovered that not all LDL is associated with cardio vascular disease. LDL particles were either pattern “B” small dense LDL particles which were atherogenic, or they were pattern “A” large buoyant LDL particles and were benign to cardio vascular risk.

There are tests that can determine how large your LDL particles are which will confirm whether your LDL is high risk, or benign.

However one interesting markers we can look at in regular lipid panels is your amount of triglycerides being carried in your blood.

Your triglycerides are 63 mg/dl and as you can see from that chart it is highly likely that your LDL particles are likely mostly Pattern “A” and utterly irrelevant to cardiovascular risk, and even though you appear to have a lot of LDL particles, almost none of them are pattern “B”.

Hope that helps. But if you want some real diagnostic evidence, get an NMR test to confirm the size of your LDL.

High cholesterol levels
Keto and cholesterol
(Alan) #17


The response on the site from MANY people to my post has been remarkable and I am very grateful to everyone who jumped in. At this point, I’m going to talk with my GP during my upcoming physical and hope that he’s onboard with my commitment to Keto and doing some additional more specific testing to drill down into what components make up my calculated LDL number which may be high by traditional/past medical standards, but provides zero detail.

The forum is going to help provide my with more information going forward (I already listen to and love the podcast you and Carl do) and give me some additional support. And hopefully I get to the point where I can “graduate” and be one of the people who can help to provide support and information for others.

Many thanks again to you (the other folks) who took to time to respond to my “mini-freakout” and to share some similar personal experiences and point me at some great information resources.

(Deb N.) #18

Sheri, as to your cholesterol levels, they mirror my own. I’m currently attempting to teach my PCP, who also wanted me on statins. I absolutely refused, and am insisting on a more specific test, which apparently was not in the list of labwork that she was reviewing. In my desperation, I also did an online search for some keto-friendly physicians, and found none (so far)… which is very concerning and frustrating. The new paradigm can’t shift quickly enough for us!

(Deb N.) #19

'Love that chart! With a triglyceride count of 57, HDL of 112 and LDL of 196 (total cholesterol of 319), my doc wanted me on statins! No other problems at all to warrant this and so I’ve been pushing back, and will continue to do so! Thanks for sharing!

(Sheri Knauer) #20

Not true. The higher your triglycerides are, the more your ldl particles are the small, dense, pattern B type. You want a high HDL number and triglycerides below 100