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

[Stephen]

I got my blood test results yesterday and my Triglicerides were high at 3.6.
My cholesterol is high (hyperresponder)

Not fussed about my cholesterol, but Triglicerides… my doctor is a lady I had not seen before and she actually knew about Keto. She looked at my bloods and told me I am not doing keto right!! She suggested I was perhaps eating too much protein and not enough fat.
I am sure everyone would agree, this doctor is a keeper!

So I started tracking my food again and was surprised my carbs where 40g and i did not hit my goal of 75% fat. Would this explain my high triglicerides do you think? It also highlights how easy it is to go over if you are not brutal and track everything.

–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 50 • Coffee: 0 cups/day •
• 30 on months on Keto (less than 20g carbs) •
• • Cholesterol Rx: false •

Total Cholesterol: 379 mg/dL 9.8 mmol/L
LDL Cholesterol: 267 mg/dL 6.9mmol/L
HDL Cholesterol: 54 mg/dL 1.4mmol/L
TG Cholesterol: 283 mg/dL 3.2mmol/L

---------RISK REPORT---------
Atherogenic Index of Plasma: 0.359 mg/dL >>> Highest Risk Third
----> Go to https://tinyurl.com/ycccmmnx for more on AIP

Framingham Offspring: 0.9 Odds Ratio >>> Medium-Low Risk
----> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study

Jeppesen: >>> Medium Risk Third
----> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study

Cholesterol Remnants: 58 mg/dL >>> 0.64 mmol/L >>> Medium-Low Risk
----> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants

------CONVENTIONAL MARKERS AND RATIOS------
Friedewald LDL-C: 268 | Iranian LDL-C: 380
TC/HDL Ratio in mg/dL: 7.02
TG/HDL Ratio in mg/dL: 5.24 | TG/HDL Ratio in mmol/L: 2.29

[anon54735292]

How long were you fasted? Even for 40 gm carbs those trigs look very high & I’ve never noticed higher protein impact mine to any large degree.

[Stephen]

I hadn’t eaten that day and blood test was just before midday.
Unless I had eaten something and forgotten, but I don’t think so… I rarely have breakfast and when I do it’s usually bacon and eggs so I’d remember it hehe.

[anon54735292]

Well you’re clearly familiar with Dave Feldman’s site but I’m not sure if you’ve seen this.
https://cholesterolcode.com/high-triglycerides-on-low-carb-and-what-to-do-about-it/ It is possible that you went a bit too long without food.

[Stephen]

Thanks for the link, had not read that one.

I suspect it was carb leaks for me. Started tracking my food again and discovering my low carbs foods in a day were totalling up a bit high. 3 here and 4 there is fine but, but it adds up fast if too many.

Have also quit alcohol (not a big drinker anyways) and coffee (will see how that goes…)

Got results of my liver ultrasound and I have slight fatty liver. Looking at my liver blood test they were lower than a year ago so think i’m doing the right thing. more fasting, more exercise and more keto is in order.
I disagreed with this doctor (different one this time) who said I need to do a low fat keto. I was like ummm… where will I get my energy? I don’t eat carbs. He said from protein. So um isn’t that bad, I said. If you run out of carbs when doing exercise your body turns to protein which he agreed with ( and named the process) so I think he actually contradicted himself there.

I can see how easy it is to get discouraged by these doctors who say this stuff. He said you can lose weight sure but you can’t do it long term. I said show me the science. I think he may have then said there are studies to support everything…
Sigh…

[PaulL]

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.

Whoops! A zombie thread—when will I learn to check the dates first? But I’m going to leave the summary below, in the hope that it will be useful to folks. (BTW, zombie threads are fine around here, so getting in the habit of checking dates is a good idea.)

These are the markers to focus on. The better indicator for heart disease risk, if you believe in the lipid hypothesis in the first place (which, more and more, I am finding problematical), is the ratio of trigylicerides to HDL, which in your case is awesome. Anything under 2.0 in your measurments (and under 0.9 when measured in mmol) is consdiered good; your ratio is closer to 1.0, which is superb. If you had had an NMR analysis of your LDL, it would have shown the “good” Pattern A distribution of particle sizes. You don’t mention your HbA_1C percentage, but anything at 5.5 or below would be a sign of decent metabolic health and low risk for cardiovascular disease. But there are a lot of reasons to mistrust cholesterol levels as an indicator of cardiovascular risk, including a number of large epidemiological studies that actually show greater risk from lower cholesterol. (There are plenty of threads on these forums about this, if you’d like to learn more.)

The most reliable indicator of the extent of heart disease is a CAC (coronary arterial calcification) scan, which shows the actual extent of any damage to your coronary arteries. (Which, of course, is why most doctors won’t order it, and why a lot of insurance plans won’t pay for it.) Your CAC score provides a good estimate of your risk of myocardial infarction over the next 5-10 years. And you’ll be glad to know that a well-formulated ketogenic diet can help to stabilize and even reverse arterial plaque. Also, getting enough Vitamin D and enough Vitamin K₂ can help get that calcium out of your arteries and into your bones, where it belongs.

Lastly, it is possible that you are what Dave Feldman calls a “lean-mass hyper-responder,” in which case you can probably manipulate your cholesterol readings to quite an extent, by eating the correct way during the week before the test. Dave is a software engineer turned cholesterol researcher, who is producing original research into the human lipid system. Check out his site: www.cholesterolcode.com.

Another software engineer turned cholesterol researcher is Ivor Cummins, who is more of a synthesist. His site, www.thefatemperor.com, has pulled together an enormous amount of research on cholesterol in the human body. As you might guess from the name of the site, Ivor’s thesis is that the idea of using cholesterol as a marker for cardiovascular disease has about as much substance as the emperor’s new clothes.