LDL Cholesterol advice

(Deborah Meghnagi Bailey) #1

Let me start by saying that I myself have been on lchf for over sixteen years, and I’ve read a ton, so I know that cholesterol is much more complicated than it’s been made out to be and is not the culprit for many things. That said…

My husband, 42 year old, is tall and slim - he’s just under 6’2" and around 160lbs. He has an incredibly fast metabolism - one of those people who even when he sits down is jiggling his legs unconsciously because his body needs to keep burning fuel. He is a teacher, also, so he’s basically on his feet and walking most of the day, throughout the week. Also does a half hour fast walk each work day. He is almost never ill. Sleeps like a baby and can fall asleep easily.

Before we met, he ate the SAD - he even tried to eat low fat, even though he was slim, because both grandfathers died of heart disease. Since we got married, eleven years ago, he has eaten a much lower carb diet, although not completely low carb, as he is slim and healthy and has high energy needs.

Nowadays I’d say he is on a lowish carb diet. He eats sugary desserts only on the weekend, and not a lot of it. He’ll have starch a few times a week, but not every day.

Here’s the thing…His blood test results always show extremely high ldl. His hdl and triglycerides are normal - not as good as those typically on a low carb diet, but then he’s not on a complete low carb diet. He had another test today, first in a few years:

glucose 85
trigs 93
hdl 52
ldl 318

I am quite sure the doctor is going to be pushing a statin on him, and there is no way I want him on a statin. And even with everything I know about cholesterol and how it’s not the demon it’s made out to be, I can’t help but worry at such ‘abnormal’ results because my husband is wonderful and I don’t want to lose him and I don’t want him to be one of those ‘healthy’ men who drop dead suddenly in their forties. I don’t see it happening; like I said, he’s never ill, he’s active, he gets plenty of sleep, he doesn’t get overly stressed, and he eats a lowish carb diet, even if it’s not fully low carb. But… should I be worried? Should there be other tests he should take? Are there resources I can look at that will deal with something like this?

Thank you in advance for any advice offered.

Deborah

(Deborah Meghnagi Bailey) #2

@DaveKeto could you advise on this? My thought is that my husband could be a LMHR but that he is not fully keto so his trigs/hdl aren’t as they would be if he were fully keto. Unfortunately we don’t have all his labs available; we changed HMO a few years ago but we’re pretty sure that at one point - and it might have been when he was more lchf than he is now - his LDL went up to 600. But should he be going more keto? Or is he simply a healthy, active, slim man with a crazy fast metabolism and I shouldn’t worry?

(Cathy) #3

I think LDL is misunderstood. If you consider the fact that as many people who die of heart attack with ‘elevated’ LDL as those that have low LDL, it seems like a red herring. The more relevant indicators are triglycerides and HDL.

Given that we know that sugar and starches are the major contributors to coronary disease, I would think full keto would be a good idea. Many of us come to keto for weight loss but we all discover that it is actually more important to metabolic health and much more - so being thin is great but does not spell ‘good health’, necessarily.

(Bacon is a many-splendoured thing) #4

His trig/HDL ratio is less than 2.0, which is great, so it is highly likely that an NMR analysis of his LDL particle sizes would indicate pattern A, which is associated with low risk for heart disease. The biggest risk is that his doctor might insist on a statin, which is much more likely to harm him than his LDL. Fortunately, he is a grownup and doesn’t have to take it if he doesn’t want to.

If you can, check out Dave’s www.cholesterolcode.com site and see if following the protocol before the next blood test bring his LDL down.

(Adam Kirby) #5

LDL is basically a marker of fat energy trafficking. As you say, he has always been thin and with a fast metabolism. So put a guy like that on even a mildly low carb diet and he’s going to burn a ton of fat very easily, hence the high LDL. Assuming he has low fasting insulin which seems likely, I see no biomarkers of concern.

(karen) #6

There is also the issue of particle size. “big fluffy” LDL hasn’t been shown any correlation to arterial damage, it’s the “small dense” particles that are the issue. Before he rushes onto a statin, he might want to get a particle size test like NMR LipoProfile done. I have heard that for those on LCHF, LDL often goes up, but it’s the fluffy kind that’s rising, the number of dense little particles may actually be falling.

(Deborah Meghnagi Bailey) #7

Thanks everyone. I guess my one area of concern is that he doesn’t show the typical low carb pattern - although as you saw, his hdl/trigs ratio is good, his hdl isn’t actually that high and his trigs aren’t that low - so with that being the case, i was more ‘worried’ about the ldl than i would have been if he showed the typical insanely high ldl that also went with super high hdl and super low trigs.

at one point a few years ago we remember his ldl being as high as 600, but we don’t have access to those records anymore because he switched hmo, and i can’t remember if he also had higher hdl and lower trigs then.

i definitely don’t think he’s insulin resistant at all. he’s so slim, he’s so active, and for the last 11 years he’s had a lowish carb diet, and his glucose is always low. i don’t think there’s any hidden insulin resistance there.

(Karen) #8

Also a CAC test can be helpful, I hear.

K

(Adam Kirby) #9

His lipid numbers are almost identical to mine. If his LDL shot up to 600 on proper low carb, then he is definitely an extreme hyper-responder. I haven’t seen a single cogent argument made how someone like your husband is at elevated risk of anything.

(Cathy) #10

You may be right but I have been keto (99.9% consistant) for the better part of 9 yrs. and am still insulin resistant. It is something that is not always easy to reverse and detect aside from blood testing.

Lots of thin, active people are extremely insulin resistant. For instance, I have a relative who is a professional athlete and is slim and very active and now is pre diabetic. This person will be insulin resistant. Admittedly, there has been no evidence of a low carb diet but insulin resistance is not something that happens in the short term.

(Deborah Meghnagi Bailey) #11

Thanks, Adam!