Frightening cholesterol numbers (and ratios)

(Smith) #1

After two months on keto, my current numbers are 377 total, 308 LDL, 44 HDL, 126 triglycerides. Prior to keto, my cholesterol had hovered around 220 total for years (LDL around 150, HDL around 40, triglycerides between 100 and 150).

I’ve browsed a number of the threads here about high cholesterol, and of course read a great deal of material elsewhere, and I realize that high cholesterol in and of itself isn’t necessarily a bad thing. However, my numbers haven’t just shot up; the ratios appear to be all wrong, too.

What could be causing this response? What can I do to address it?

Should I be worried? Should I consider reverting to a standard diet?

Thanks!

#2

Are you losing weight? Lipid numbers will be wonky during weight loss.

(Adam Kirby) #3

How long did you fast before getting the blood test?

(Smith) #4

I’ve lost 5-10 pounds since starting the diet, primarily in the first month. To be honest I haven’t tracked my weight, because weight-loss wasn’t my objective. I seem to have stabilized in the last few weeks though.

(Smith) #5

13 hours.

(Smith) #6

Thanks for the replies, guys. A bit more background information would obviously be helpful.

First of all, I started keto not to lose weight but to attain the myriad other health benefits associated with it. Ironically, I first read about it when searching for a solution to my chronically “high” cholesterol, which has hovered around 220 total for the last 10 years (40 HDL, 150 LDL, triglycerides between 120 and 160).

I used to be quite athletic but in recent months I’ve become quite sedentary due to work commitments, although I do typically clock over 10,000 steps per day according to my fitbit.

I’ve lost a significant amount of weight since starting keto, but I haven’t tracked it since weight-loss wasn’t my goal. Most of my pants are far too big now, and I’d guess I’ve lost a good 3-4 inches of waistline. I hadn’t even realized the excess fat was there…

Weight-loss was most pronounced during the first month of the diet but has stabilized in recent weeks.

I tracked my consumption meticulously during the first month using Cronometer, but haven’t done so for the past month as I felt I’d developed a good sense of what I could and couldn’t eat.

My target macros (based on the Perfect Keto calculator) 2,300 total calories, with 128 grams of protein, 193 grams of fat, and 30 grams of net carbs. I would say in the last month my fat consumption has probably dropped while protein has increased, but I check my glucose and ketones regularly and both remain at healthy levels (glucose ranges between 80 and 100, ketones usually between 1 and 3).

As far as foods, my typical day goes like this:

Breakfast: 4 boiled eggs, an avocado, and 1 tablespoon of coconut oil in my coffee.
Lunch: 100 gram portion of beef or chicken, bowl of broth, salad with olives, walnuts, and olive oil. Another cup of coffee with coconut oil.
Dinner: Usually the same as lunch, minus the coffee.
Snacks: Walnuts, pecans, olives as needed. Small quantities of cheese from time to time, but I suspect I may have a dairy intolerance.

Two immediate tweaks I think I can make are to add more salmon, mackerel and sardines to my diet, and eliminate the coconut oil from the coffee.

Fortunately, I had a number of blood tests done in addition to cholesterol. Everything appears to be normal apart from Alkaline Phosphatase, which may be down as a result of the vitamin D supplement I take. Just a guess.

Bilirubin 0.9 mg/dl
Alk Phosphatase 39 IU/l
AST (SGOT) 21 IU/l
ALT (SGPT) 31 IU/l

Sodium 138 mEq/L
Potassium 4.8 mEq
Chloride 102 mEq
Carbon Dioxide 26 mEq
Magnesium 1.9 mg/dl

Iron 98 ug/dl
Total Iron Binding Capacity 269 ug/dl
Iron saturation 36%

BUN 16 mg/dl
Creatinine 1 mg/dl

Ferritin 171 ng/ml

TSH 2.12 uIU/ml

That’s probably too much information, but any additional insight would be greatly appreciated.

Thanks again!

#7

The information is great! I can’t comment on your other levels but other folks might be able to.

While you’re burning off excess fat, your lipid levels will (generally) be higher: those extra inches off your waist have been mobilized for use by your cells for energy. That in itself might account for your numbers and you might see different levels in a few months.

However, what pops out the most is that you have some assumptions about cholesterol numbers that may not be serving you. I would head over to Dave Feldman’s Cholesterol Code so that you get a better idea of what “high” may or may not mean when it comes to cholesterol. He also has a number of YouTube videos that explain things beautifully.
Teaser: it may be the coffee more than the coconut oil that’s raising your numbers (and that’s not necessarily a problem)

(Brian) #8

That was my first thought.

But I do think at 8 weeks in, your body is still doing a lot of adjusting to your new way of eating. Things like that take time.

(Smith) #9

Thanks, Madeleine. I’m familiar with Dave Feldman’s work and have been spending a lot of time on his site lately. According to his tool, my remnant cholesterol is in the medium risk quintile, and my RC to HDL is medium-high. The only positive is that AIP is in the lowest risk third.

If the ratios were better (i.e., higher HDL, lower RC), I wouldn’t be as concerned about the high numbers for TC and LDL.

I hadn’t realized coffee played a significant role in cholesterol, but I’ll definitely look into it

Thanks again!

(Smith) #10

Thanks, Brian. I’ll definitely look into the role that coffee might be playing, but it’s also good to know that these numbers aren’t cause for alarm so early into the transition to a fat-adapted state.

(Candy Lind) #11

Good plan!

If you look up his extreme drop protocol, you’ll see that he recommends stopping both coffee and coconut oil when preparing for your blood tests. Apparently both things can make your numbers wonky.

Did you put your numbers in his reporting system? They have a help forum, too. @DaveKeto & his assistant @siobhan come here occasionally, but are quicker to analyze, answer questions & make suggestions over there.

(Smith) #12

Hi Candy Lind. I did indeed post my numbers on Dave’s site, and it was siobhan who first suggested that it might be the coconut oil.

Regarding coffee, can I eliminate the effect by using a filter? I’ve read that cafestol is the ingredient that affects cholesterol levels, and it can be reduced to negligible levels by using a paper filter (I typically have espresso).

(Candy Lind) #13

I’m certain that if you wanted to perform an “N=1” test on that, @DaveKeto or @siobhan would be happy to help you set up parameters! I doubt, considering the pervasive use of paper filtering of commercial and “private” coffee, that it would actually make much difference, unfortunately.

(Bob M) #14

It took a while to raise my HDL. I went on a low carb diet 1/1/14, and you can see that even 6 months later, my HDL was <40:

Lipids

You can also see how variable these are. By the way, the ones with yellow highlighting were taken after 4.5 days of fasting. Trigs go up (HDL down, TC and LDL up) when I’m fasting a lot, as occurred before the 10/31/16 fast (though that test was taken after only 12 hours of fasting).

I’ve kept my coffee consumption basically the same throughout this time. I’m on a lower fat, higher protein keto diet now.

(Bob M) #15

Oops, I meant 10/31/16 TEST not fast.

(Smith) #16

An n=1 test may indeed be in order.

(Smith) #17

Those numbers are indeed highly variable. In light of Dave’s work, it certainly makes sense that the results would be “worse” after fasting, but it flies in the face of conventional wisdom. Of course your latest results simply shouldn’t be possible if the lipid hypothesis is true.

I had been consuming an unusually low amount of calories for the few days before the test (unintentionally… was busy), so that may have skewed the results. Perhaps it’s time to try to Feldman Protocol.

(Adam Kirby) #18

This will absolutely raise your LDL as your body starts mobilizing more internal fat. Your lipid numbers still look ok, would be preferable to have trigs <100, and obviously your LDL would give most doctors a heart attack but tbh I find that the metric of least interest. I would do some more tests and see how much your numbers can vary before feeling any panic at all over these particular numbers.

#19

Honestly, to me it seems like the lipid results people get with changes in coffee consumption are indicative mostly of how variable lipid numbers are and how many different factors there are in the short term.

But … we’ve reached the end of my experience with these things, and if you’re already on the CC site, you’re probably on a good track. Best of luck figuring this out!

(Omar) #20

I did not see positive change until after 5 months into keto.

the first result that I saw a significant drop in the triglycerides was after quitting coffee.

but I do not know if coffee made a difference or my body has finally reacted possitivly.