Help needed please

(Liam) #1

Hi first post…
Been on low carb four ish weeks, gradually moved towards keto, carnivore at times, now decided on 2 meals a day.
I’m a confused about all the different opinions about cholesterol levels and plaque. I’m a 55 yo male. Do I definitely need a test or tests for something to be safe?
Have any of you not tested and had strokes, heart attacks, or heart problems?
Many thanks

(Bob M) #2

I wouldn’t get tested for a while, because LDL (the so-called “bad” “cholesterol”) can go up initially.

There are plenty of markers you can get: HS-CRP; ferritin; GGT; fasting insulin and glucose; sedimentation rate; trigs/HDL; etc. Many of those are looking for inflammation, though some are markers for “insulin resistance”.

The cheapest real test you can get is a coronary arterial calcification scan.

(B Creighton) #3

Your confusion reflects the sad state of our knowledge concerning cholesterol and heart disease. IMHO suffice it to say that all the general advice we have been getting in the last 50 years has been mostly wrong or far off the mark. Around 50% of the people who end up on the operating table have cholesterol levels within “normal” limits. Again IMHO, the main tests I would be concerned with are the LDL/HDL ratio, omega 6 - omega 3 ratio and oxLDL(which can be had at Ulta labs), which you want below 80 - Also your fasted blood sugar and insulin. Focus on optimizing these numbers, and I think you will do fine.

(Liam) #4

I appreciate your replies. Does everyone get tests and how many get heart disease though not testing. So it seems you can’t just change your diet safely you need money to be able to afford tests? Not for a lot of money and my wife wouldn’t be happy spending money on tests as she already thinks I’m doing something silly.

(KM) #5

I have never been tested for anything in the 12 years I’ve been eating a keto diet. I mean that literally, other than a recent abdominal surgery, I haven’t been to a doctor in 13 years. IMO there is nothing I’ve seen that precludes a ketogenic diet (especially one that reduces processed foods) being helpful to nearly anyone. Edit: that’s fancy talk for “keto is a good idea”.

Of course this doesn’t mean I’m not wrecking myself, but if so it’s taking a godawfully long time to show itself, I’m 63 and after losing 25% of body weight in the first 3 years have maintained a healthy weight and basic good health since.

If you respect modern medicine or just have a fascination with your numbers, or you have a specific health issue you want to see progress with, testing is useful. Otherwise I personally see no reason for it, especially not for a change in diet, which most doctors have no idea about anyway.That’s my non- medical opinion.

My experience through my husband’s doctor, you go to them and ask permission, with tests, they say “oooh, booga booga, fad diet, don’t do it”. You go do it anyway. You come back fixed or better, at least, they say “huh, one off concidence, nothing to do with that voodoo diet”. IMO, why bother unless you enjoy arguing.

(Liam) #6

Thanks for your reply. It’s obviously what I want to hear. I just hope your right. If I had the money for tests I might do them but we all have to live within our means.
I’ll probably post another post asking it in a different way to try and get some kind of consensus.
I’m really glad you’ve done well on keto. Are you keto, carnivore, or something else? Thanks

(KM) #7

I cycle between low carb, keto and occasional 100% carnivore. My idea is seasonal eating (doesn’t always happen). Definitely try to stay as close to meals home made from single low-un processed ingredients as I can.

(Liam) #8

Great thanks. I’m much the same. Thanks

#9

Since you’ve already started, your cholesterol numbers will be useless for a few months. Past that, you can do an NMR to see what kind of shape you’re in. While you’re adapting, and especially if you’re losing a lot of fat, your cholesterol will spike up for a while.

Standard panels are useless either way, but even more so for a keto’r. The bad guess equation they use doesn’t scale when you’re low carb / keto. So you need direct measurements.

With the exception of sdLDL (which a standard panel doesn’t give you) not much on a cholesterol panel tells you anything as far as heart attack / stroke risk. There are other markers you can check that have a much larger impact, but those aren’t on most cholesterol panels.

(KM) #10

There are some new guidelines out there.

(B Creighton) #11

Heart disease is the most common cause of death in the U.S., so lots of people die from it whether testing or not. Testing just allows you to get a better idea of what you may want to try to optimize.

I believe the diet I follow is quite safe, and I got my carotid arteries sonogrammed last Oct, and no plaque was found vs the 90% of people my age who have at least some plaque in their carotid arteries. Did testing help me? I believe so - it helped me to realize I could do better by optimizing certain things, but I believe the main things were supplementing with vitamin K2 daily and vitamin D in the winter, and changing my diet… that was huge. I do not eliminate all carbs, but concentrate on cruciferous veggies, asparagus, and foods high in soluble fiber.

(Walter Hackett) #12

At 55 Id definitely get baseline bloodwork at least. Keto can help some people but others see LDL go crazy high. Better to know your actual numbers.

(Liam) #13

Many thanks all.
I’m willing to get a test or 2 of some sort but completely confused about which ones. Also depending on what the results are it could then open what feels to me as another bag of worms about what to do about it and then more tests.
Has there been a vote of which test(s) people on here feel are the most important?
That would help me certainly. Thanks from the UK

(B Creighton) #14

Well, this is true. Initial testing may find areas of concern that need to be further explored. That doesn’t mean you avoid doing the testing - at least that can inform you that you need to make changes, and wake you up to what areas of your health you can improve. In other words if you do a simple fasted insulin test, and your result comes back at 5, you can feel confident that you are not in immediate danger of insulin resistance, diabetes, etc. However, if it comes back at 11, you may indeed wish to consider further testing such as fasted blood glusose, CAC scan, CT angiogram, carotid sonogram, etc because your risk for heart disease is much higher with insulin resistance. So, IMHO, it is important to get some initial screening tests such as fasted insulin and/or CAC to identify common problem areas. These tests are relatively cheap, and can let you know whether further testing is likely to be relevant. I hope that helps you understand why and how testing can help.

(Liam) #15

Many thanks to all replies.
If I’ve been on keto for a month or 2 do I need a fasted insulin test? Won’t my insulin be low or show i don’t have high blood sugar?

#16

Unless you have a reason to, no, not really. Watching your blood sugar (if that’s even needed) is a lot easier, doesn’t require a lab and shows you a better view of what’s going on. If you’re showing signs of insulin resistance, after a while if you can’t fix it, then check Insulin.

Obsessing about Insulin was a thing for a long time in Keto circles, mainly from demonizing Insulin like it’s bad vs the real world where we require it for life and thinking it’s the “fat storage hormone”, while ignoring that it also drives minerals, nutrients, proteins and everything else we need into our cells.

(Jane) #17

I get an annual physical every year that is paid for by my insurance company, so all the “standard” tests are covered. I see a nurse practioner and find they are not as strongly opinionated about diets.

I switched to a new one and asked for my HbA1C and fasting insulin, knowing I would have to pay for them since I am not diabetic. She just nodded and said “sure, I can order them”. I didn’t throw out the “k” word, but we told her we eat “low carb, low sugar” and she nodded and didn’t ask any further.

In your case, I wouldn’t open that can of worms just yet and hold off for at least 6 months before having any cholesterol tests run. I did a CAC about 3 years into keto and had 0% blockage in all 3 arteries and that was after 3 years of saturated fats and olive oil. It cost me about $100 out of pocket and I ordered my own test. You may not have that option in the UK.

I have been keto/low carb for 8 years now and have so much more energy and feel better. I always say “I came for the weight loss and stayed for the health benefits”.

(Edith) #18

I believe that is true for most of us long timers on the forum.

(Philip H Kern) #19

I’m replying only because you asked. I have been keto for about 10 years, though I don’t stress when I’m away on holiday or going out to eat (which is rare for us). I’m 63 and have recently added resistance training twice a week (and 100 gms of carbs on lifting mornings).

To your question, my journey started after years of low-level chronic fatigue. So I was doing all sorts of tests all the time. None found anything specific enough to address, but when I switched to keto, my overall cholesterol went down while my HDL went up. So my G.P. saw that as good news. I also went (over an extended period) from skinny fat to a better body composition. Other realities for me are low blood pressure and resting heart rate, and good insulin response.

So I haven’t had any tests in a few years, and haven’t even visited the doctor for a while. As far as cholesterol, I’m increasingly convinced that it is a secondary marker of something–but I’m not sure what. If my HDL went up a bit I’d do nothing. And if my LDL went up, I would do the same. Of course, I wouldn’t know if it is happening because I’m not having it tested. Much more meaningful markers of health in my case are reduced belly fat, the energy to get through the day, and improved strength, posture, etc. from the resistance work. Looking younger than my actual age is a bonus.

(Niko Neko) #20

Dave Mac has had a lot of guest on his Youtube channel that discuss their first hand experience with cholesterol including a man who said he had extremely low cholesterol and then had a heart attack. You might find some good stories that resonate with you on his channel.

https://www.youtube.com/@zerocarb/videos

(this is a carnivore video because I’m high fat keto carnivore, Cheers!) :smiley: