Lowering LDL and Tris, Raising HDL


(Jason Stevens) #1

Hi Guys,

I have been Keto 12 months and just received some alarming lipid panel results.

Total Chl 10.88mmol or 420
LDL 7.9mmol or 305
HDL 1.74mmol or 67
TRI 2.1mmol or 81
Small LDL 1.21 and suppose to be under 0.15.

Should I be Alarmed?

I started at 87kg and i am now 73kg and 15% body fat. I train weights 4 times per week and run an average of 15km.

I mainly eat saturated fat, rarely eat mono. currently 75g of protein and 160g of fat. Carbs always under 5g. You could call my diet carnivore keto.

Does anybody have any suggestions of how I can lower LDL and improve my HDL/Tris ratio?

Is this WOE not for me? I absolutley love this diet and WOL.



Victoria, Australia

(KetoCowboy) #2

I have no medical background, which makes me lucky enough not to be alarmed by cholesterol numbers because they’ve always been meaningless to me.

Sorry I can’t offer any encouragement specific to your case, but it might soothe you to review the latest “Cholesterol OMG” presentation from Dr. Jeffrey Gerber:

Blood work is back! (UPDATED with fractionation results)
(Khara) #3

If you haven’t already found him you might want to read up on @DaveKeto 's work. http://cholesterolcode.com
I sympathize as my numbers got even “worse”. However, as you said as well, I love this way of life, I feel better than ever, and my other health markers improved. So, based on personal experience, I just don’t believe this is bad for me. I’m keeping on Keto-ing on and will continue to learn about the lipid system as I go. I’ve found a way of eating that has greatly improved my quality of life and I’m not going to make the decision to stop based on what is looking to be outdated and inaccurate beliefs about what our cholesterol numbers “should be”.

(Jason Stevens) #4

Thanks for that @KetoCowboy.

(Jason Stevens) #5

Wow @KBG your test results were worse than mine? or your number keep going up each test?


What were they before you started? And have you had any done during the 12 months?

(Always take time to stop and eat the bacon) #7

You might try using a bit more olive oil (which has a lot of monounsaturated fat, and a pretty decent ratio of omega-3 to omega-6) to see if it affects your lipid profile.

Also, do you think you might need to scale back on the protein a bit? The range is around 1g / kg of lean body mass, and you’re eating more than a gram per kilo of full weight.

But looking at your numbers, however, your triglycerides/HDL ratio is very good, so the LDL number is probably nothing to worry about. Total cholesterol is nothing to be concerned with, and the trig/HDL ratio is more important than the actual numbers of either, as far as I’ve read. I’m no doctor, but I’d say if you are feeling good, keep on with what works.

(Khara) #8

Ya. They kept going up. Past tense because I took a break from Keto and so now I feel I’m on a new experiment.

First time Keto, I got labs 7 weeks in and again at 9 months. No pre tests but I have several years of history so can presume pretty confidently where they were which was always hovering within the normal ranges with the total number slowly creeping higher each year and only once going as high as 218.

At 7 weeks Total and LDL were elevated as was my particle count. I chocked this up to the fact that I was overweight and had been eating poorly prior to Keto and was also losing weight rapidly. (I’ve read that rapid loss will result in high numbers.) So, my plan was to test again once the loss slowed down and when I tested at 9 months in, my weight loss was averaging about 1 pound per month. I was at a very comfortable ideal weight. Still plenty of fat to come off slowly over time but, probably at the “last 10 pounds” point. My numbers were even worse:

Total: 491-515
HDL: 60-70
LDL: 400-435
Tri: 99-106
Tot/HDL Ratio: 7.01-8.58
Tri/HDL Ratio: 1.51-1.65
LDL-P: >3500
HDL-P: 23.3
Small LDL-P: <91
Small LDL-P % of Total: 2.60%
LDL Size: 22.7 (Pattern A - Large)
HbA1c: 4.8%
Glucose Random: 81
(There is a range because I got tests both through my regular doctor and an NMR on the same day.)

So HDL, triglycerides, and particle size were good, but the rest looks pretty bad. I couldn’t believe it. This was the best I’d felt in my adult life, even compared to when I was skinny because to stay skinny I had had to watch everything that went in to my mouth and feel deprived and hungry all the time. Being carb dependent and staying thin is almost like feeling like an addict, trying to hold out as long as possible but always thinking about that next fix and promising it’ll be just a little. Anyway, at 9 months in, the extreme opposite of how I felt and what my lipids showed brought about almost a teenager like defiance. While concerned and bothered by not having the perfect numbers that I had expected to go along with my healthy weight, I immediately just rejected the tests. All of a sudden I wasn’t able to just trust the recommended guidelines because I had first hand personal experience that I was indeed healthier. This is when I found Dave Feldman and Cholesterol Code and I began a small amount of researching. If nothing else, I was just relieved to know other people were experiencing this too and it allowed me to give myself permission to listen to my body and not make any rash decisions based on guidelines that now felt so contrary. Basically I decided to just give it time and learn and reassess as I go.

Fast forward some amount of time and I did end up going off Keto. This was not an intentional decision, it was more of a slide and crash due to extreme stress. I spent more than half a year back on the SAD diet and worse than that really just eating crap. Gained back all the weight. Realizing that was just about the dumbest thing I’d ever done, I decide to go back to low carb/Keto for good.

That was August 1st and this time I did get starting blood work. All of my numbers had reversed back into the recommended ranges except total and particle count which were both just slightly elevated. All others including ratios were good. So, again, my weight was too high, my overall feeling of health was at its lowest, if looking at a me in person, one would’ve said eeek, she’s not doing so well, yet if looking at my lipids only, one would’ve said I was in perfect health. Upon seeing my labs, I actually felt like I’d gotten away with something, like I’d cheated the system, because the way I’d been eating, I really did not deserve good cholesterol numbers. Then, I’d take a look in the mirror and oh ya, I didn’t get away with anything. So, once again, a complete disconnect between how I looked and felt and what the numbers said. I should also note that at this point, my HbA1c was starting to creep up again. Not out of range yet but at the high end of good.

So, I’m at the beginning of a new personal experiment. I completely expect to see my numbers go up and out of recommended ranges again. The only change I have made is I consciously drink less heavy cream (and no BP coffee) and I’m incorporating intermittent fasting more and am working towards extended fasting. I haven’t decide yet how often I’ll test. Wanted to do monthly but wasn’t able to get away from work around September 1st and so missed that opportunity. Maybe I’ll do every other month or quarterly instead. Dave Feldman has demonstrated just how dynamic and reactive blood cholesterol tests are within just a few days and so in my opinion a test on any one given day will be only partially informative. Wish I could see it daily!

Sorry such a ramble! I will try and remember to update when I do get my next test. And, I hope to hear what you learn and do along the way.

(Jason Stevens) #9

The week before i Started Keto my total was 5.0.
HDL 1.6.
LDL 3.1.
TRI 0.6

So triglycerides have gone up 3.5X and LDL doubled.

(Jason Stevens) #10

Thanks Paul. I agree, i will be adding a good amount of olive oil and macadamia nuts back into my diet before I retest.

With the protein, from what I have researched it’s 1g to 1.5g of protein per kg of lean mass. My lean mass is around 62kg at the moment and I’m having 1.2g per kilo of lean mass. Considering I’m lifting heavy in the gym 4 times per week I think i’m pretty close. I have been down to 65g a day but didn’t feel great.

How do I workout the ratio of trig/HDL? I was of the understanding HDL was meant to be higher than Trigs?

(Siobhan) #11

So - am I getting this right?
HDL and LDL have gone up and trigs are now below <100?
Have triglycerides gone up on keto or gone down?
EDIT: reread your post. They went up. Interesting! They can fluctuate, and tend to go higher when fasting longer term…

It sounds like you are beginning to look like a lean mass hyper responder. You put out more LDL particles to traffic more energy from fat (higher LDL/particle count) but you are using a whole lot of that energy because you are active (lower particle size/TG <100)
This fits with Dave Feldmans observation that LDL tracks with dietary fat intake. The more fat you have leading up to three days following the test, the lower the LDL and vice versa. I would suggest you watch his talk from Ketofest to see this explained in detail - it is on YouTube.

If TG went up - did you fast longer than normal before the test? This can increase TG

Based on the research I have done I have good reason to not be concerned unless you have seen an unexpected drop in HDL.
As you said all your other markers look good - is it just the particle size and LDL you are worried about? LDL particles have many uses - transporting energy from fat, repairing cells (such as after exercise for example?), fighting infection… so you need to look at other markers too like Lp(a) and CRP, fasting insulin, and hba1c. Have you gotten those tested?

If it is just a case of LDL going up, and size changes - you may want to watch Dave’s talk as I said.
Hope I interpreted your concern correctly!

(Jason Stevens) #12

@siobhan thanks for the reply.

I have been reading through @DaveKeto blog with keen interest. He raises some very good points.

My HDL has stayed fairly consistent. I have good CRP but haven’t done the other tests.

@KBG Very interesting reading, thanks. Good luck with your new experiment I will be keen to see your results. I’m a terribly slow at typing so don’t be offended by my short reply’s.

(Always take time to stop and eat the bacon) #13

Just the reverse; triglycerides are generally higher than HDL. The trig/HDL ratio is supposed to be under 2.0; in other words, your HDL level is supposed to be at least half the level of your triglycerides. So at a ratio of 1.2, you are in good shape.

You’re right about the protein. It seemed large at first glance, but 1.2 times your lean mass is great, and you don’t want to be on the low side if you’re lifting.

(Jason Stevens) #14

My HDL is 1.7mmol and Trigs are 2.1mmol,

(Always take time to stop and eat the bacon) #15

So 2.1 / 1.74 = 1.206 something. That’s a very good ratio.

(Jason Stevens) #16

I’d like to thank everybody who has commented and @richard for recommending I join this fantastic forum. I am feeling a lot more relaxed about my test results. I am going to keto on!!!

(Always take time to stop and eat the bacon) #17

:+1: :bacon::bacon:

(Jason Stevens) #18

Just had a conversation with my doc. He had previously only emailed results. He is very concerned about my high small LDL. It is nearly 10x the expected level. @richard he had an extended conversation with Prof Ken Sikaris from Melbourne Pathology about my test results. The out come, Prof Sikaris recommends I take the mildest dose of a statin drug. Prof Sikaris is probably the leading specialist in this field. I certainly am not going to take the drug, or go back to a carb diet. Apart from adding more monounsaturated fat into my diet is there any other ways of reducing the small LDL?

(Richard Morris) #19

I highly respect professor Sikaris, and am looking forward to meeting him for the first time at Low Carb Gold Coast. His lectures on Youtube are still some of the best on the subject of lipid levels on a ketogenic diet. If professor Sikaris told me to go on a low dose statin I would, but I would want to have a conversation with him about it to see if he thought there was a specific advantage in reducing all cholesterol production to lower the number of this one category of lipoprotein, or is the recommendation out of an abundance of caution. It might be worth trying the statin and seeing if it does lower small LDL (if you do make sure you supplement with CoQ10 which is an essential co-factor that we make using the same pathway as Cholesterol).

But there might be something else to try. I had a sub-fraction analysis in April of 2016 and had an LDL 3 of 0.39 mmol/l which is not a lot but it is above the 0-0.15 mmol/l which is the ideal range. I had a second sub-fraction analysis in November of 2016 and had an LDL 0.06 mmol/l.

At the same time I went from HDL of 1.0 to 1.2, LDL from 4.7 to 4.6, Triglycerides from 1.45 to 0.91.

Massive difference right? What did I do? That second test was the one where I tried out @DaveKeto’s protocol, where for 3 days before the test I actively ate a lot of fat - which for me was an extra cup of macadamias every day.

What does that mean? It seems that No-one really knows. But it does change the test. And it shows that these numbers we think of as stable benchmarks of our health are really only just reflecting what we ate the last 3 days.

(Dave) #20

IMO this is a very common lab for a hyper-responder. In fact, your numbers are close to mine when I was first testing (about 7.5 months in). I qualify it that way because (I haven’t blogged about this yet) my baseline numbers may have dropped in the last several months. My original averages were TC: 380, LDL: 270, HDL: 65, TG: 80.

  • Note that TG is the “noisiest” of markers I track and you shouldn’t read too much into it in small margins.
  • HDL of 67 is fantastic!
  • Given you’re keto, LDL tracking upward with the HDL is actually very common, particularly if you’re approaching a Lean Mass Hyper-responder. http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/

I don’t know what a Small LDL of 1.21 means. I’m guessing it is LDL-C from small LDL particles? Is that right?

Maybe because I’m tired and I can’t do my usual lengthy qualifying shpeal, but frankly, I’m going to be annoyed if all this anguish over LDL proves silly in the long run when given a LCHF context. I’m not saying I’m sure this is the case, but I can say that I feel more confident of it with each passing experiment. As Richard mentions above, these huge shifts in cholesterol we’re doing showcase how dynamic cholesterol is given it is a passenger (not a driver) on the larger energy metabolism.

I’m excited to meet Sikaris in a few weeks at Gold Coast. I’ll definitely be talking lipids with him and I’d like to get his opinion on my research and the larger question of fat-based energy distribution and its impact on cholesterol.