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.
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?
This is a really good link: https://www.cooperinstitute.org/2015/12/10/the-blood-triglyceridehdl-ratio-and-ldl-particle-size-critical-issues-for-determining-risk-of-coronary-heart-disease
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:
http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i
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.
http://www.marksdailyapple.com/the-straight-dope-on-cholesterol-10-things-you-need-to-know-part-1/
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.
http://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/
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 (https://en.wikipedia.org/wiki/Carnitine_palmitoyltransferase_II_deficiency). 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.
http://circ.ahajournals.org/content/circulationaha/82/2/495.full.pdf
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.
Richard,
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.
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!
'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!
Deb
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
Here is a list of low carb doctors that is on Jimmy Moores site. From what I understand, he is working on making it better and more comprehensive. Also, PAs tend to be more open with dietary lifestyles that are not the SAD diet, however, not that all are but more so than traditionally trained MDs, especially the older generation of MDs. http://lowcarbdoctors.blogspot.com
Scroll down the page some and you will see a list of doctors by state, not just the ones in the middle with the included pictures. Hopefully there will be one on there that is somewhat local for you.
Alan-
Do you use coconut oil? I ask because of my experience (which I’ve since seen happening to others).
I am hypothyroid, and when I was initially diagnosed, my LDL was high, and so my endo has monitored it to see if it adjusted as I began taking Rx supplemental thyroid hormones. I get labs every 4 months. My LDL was going down nicely UNTIL I began using coconut oil. By coincidence, I began right after one check up, and 4 months later, my LDL had gone up 40 points. My endo knew it had been steadily going down (to within normal range), so he asked about any 'dietary changes' I'd made recently, and the only one was the CO. He advised me to stop using it, and I went back to my EVOO and butter for fats. Four months later, my LDL was back down those same 40 points, so it definitely was the CO.
I had a VAP test, and my LDL was 100% Pattern A (the large, fluffy kind), but my cardiologist seconded my endo's advice to avoid CO because he said that Pattern A is 'better,' but elevated LDL isn't good no matter what the particle size.
As others have said, the key is the ratio rather than the pure numbers, but I wanted to mention the CO issue in case you are like me–someone who has a problem with CO.
As I am so stressed about my numbers I have thrown money at the problem now and have just received back a Cardio IQ Lipoprotein Fractionation Test… The results are not good and have me really confused as I am following a Keto diet, dont smoke or drink and do about 3-4 hrs of cardio in the gym every week. My numbers are not going the right way at all, any thoughts, ideas or anything that you can offer to stop me stressing out? My detailed results are attached.
Thanks again for everyone’s help, you are really helping me to try and understand how I move forward…Cardio IQ Lipoprotein Fractionation - Dec 2017.pdf (190.2 KB)
I can’t help with interpreting your numbers on that, but I will say that the documentary film The Cereal Killers offers a ton of helpful encouragement & education - and I highly recommend it.
It accompanies a 40 something atheltic guy (Donal O’Neil, who is also the director) as he transitions to keto and participates in a medical lab that is studying cholesterol and several other factors. Being that his dad had died from heart disease in his 50s despite being a champion athlete, Donal’s early lab results that are “not good” worry him - and confuse him, being combined with his other “good” results on things. He works with specialist observation as he continues his keto journey - and it is confirmed that his high cholesterol is not the bad kind, etc.
The film interweaves interviews with Stephen Phinney MD in California and Tim Noakes MD in South Africa - as well as a New Zealand athletic coach and soccer players.
It’s a really well-done film, with great cinematography and interesting locations (including a grassfed beef farm in Ireland) and people.
Richard, thank you so very much for your response. I too fall into the hyper responder category of ketonians. I am a 53 year old female, keto since Feb2016, when I was diagnosed with diabetes (HaA1C of 6.2 and Hashimoto’s). This way of eating has changed my life and I lost 40lb. To put my mind at ease I had a coronary calcium score test - it came back at zero, HbA1C is now 5.6, LP-IR is 25< and CRP test came back at 0.6 and …YAY! However, my lipid panel has gone up significantly and as of this week looks like this:
Total cholesterol is 313
LDL - 207
LDL-P is 1916
small LDL-P is <90
LDL-C is 207
LDL size is 21.9
HDL is 93
HDL -C is 93
HDL-P is 45
Triglycerides are 63
With so many pieces to this (and two marked as HIGH by the lab on NMR ranges)it was really good to read your response to Alen’s post. If I understand correctly all you said…no worries for me even though some of these numbers are high?
I think those are pretty good.
Your LDL is at least 96% pattern A, benign.
A doctor who didn’t appreciate the nuance of lipoprotein subfractions might likely want you on a statin above 200 mg/dl.
Mine was 208 when my doctor put me on a statin.
And the rest is a long horrible story.
Thank you once more, Richard.
I appreciate you looking at my ### and giving me your feedback. I value it very much!
I did not know how to asses the information I was given and you shed light on the %%% for me.
I have read your story before, and I am not one not to freak out…but it is so nice to hear a reassurance that it looks good in the scope of the Big Picture. All women in my family have high cholesterol ( I was the lone hold out) and so I was not really surprised to see mine creep up there as well. My mom and sister (9 years younger) have been on statins for many years. However, I have no plan on ever going on them after reading through the many studies and side affects! I wish I could convince them too, I keep trying… : )
Keto on!
LDL is not measured, it is a calculation that is total chol-HDL-trig/5.
I am writing this because your post helped me so much. I am 80 and have been taking statins for 10 years. I stopped. I started Keto. I went to my regular doctor to get a blood test after one month. She freaked out. She used every scare tactic she could think of. Namely I was killing myself and it would not be a pretty death. Someone would have to feed me and wipe the drool off my chin. I decided to get my own blood test two months after that office visit. I just received the results and at first I was freaking out.
It was not just a simple type A or type B. My LDL-P was 3000. It said that
was small LDL. My triglycerides were 69 and my HDL was 62. My overall cholesterol was 348. It said the particle size of my LDL was 21.1 and that it should be greater than 20.5 which it is. I had to go searching for LDL size and
this is what I found 21.2 to 23 is large and 18 to 21.2 is small. I also found that you should forget about your LDL… my triglycerides to HDL ratio is 1.3
which is more important. I hope you are still alive as I hope that I am not risking my life as my report really said high risk for heart disease. When
I was 48 my first cholesterol test was just the same as the current one. I
was very healthy and after many tests they concluded that it was my choice
about statins. I choose not to take them but became fearful at age 70. And
now I am not.
