My Journey/Help with Lipid Profile


(Danny) #1

Hey all,

Brand new here so, first of all, hello!

A little about me:
Age - 42
Height - 5’11"
Weight - 160
Lifestyle - Physically active, work out 4-5 days per week

I’ve been doing something of a “pseudo keto” diet since mid September 2022. By that, I mean I haven’t been 100% keto but, have greatly reduced my carb intake overall and eating keto roughly 4 days per week. I’ve had other poor habits given a highly social lifestyle and living in a town chock full of microbreweries… I’ve definitely been drinking more than I should be during this time. Plus, I’ve allowed myself some cheat meals on weekends, though not excessively so. And, finally, my fat intake has been a bit lighter than the traditional keto regimen. Again, hence the “pseudo keto” label.

I’m also not an overweight person. When I started, I was roughly 170-172 and now weigh about 160. I’m 5’11” and physically fit with a 4-5 day per week HIIT workout regimen.

The reason I started keto is because I have a lot of mysterious reactions to food (difficult to pinpoint) which has led to a lot of gas, bloating, discomfort and even GERD. Upon starting, the results were nearly instantaneous… My usual indigestion/gas subsided significantly and I generally felt better. All positives, no perceivable negatives.

However, about 4-6 weeks in, early November, I got a lipid panel to see if this would be a sustainable way of life and the results were less than desirable, at least according to my GP.

Total Cholesterol = 275
HDL = 71
Triglycerides = 106
LDL = 183
Glucose = 76
A1C = 5.3

I figured this was due to the increased fat intake that my body definitely wasn’t used to as I’d been eating a lower fat diet for a very long time. So, we decided to give it a couple months and retest.

In that time, I kept up a very similar lifestyle doing my “pseudo keto” with some weekend cheat meals and drinking a few days a week (including a decent amount of beer). I know that probably makes me sound like an idiot and I realize that so please be gentle with your feedback - I’m making changes and cutting back now.

I then did an NMR and ApoB test (at my request) about two weeks ago to see how I was tracking. Here were the results:

Total Cholesterol = 262
HDL = 70
Triglycerides = 102
LDL = 172

LDL-P = 1594
Small LDL = 446
Large VLDL = <1.5
HDL Particle Number = >41
Large HDL = 8.5
LDL Particle Size = 21.4
VLDL Particle Size = 44.4
HDL Particle Size = 9.1

ApoB = 117

Everything aside from my Total Cholesterol, LDL-C and LDL-P show to be in good standing, according to the tolerances referenced on the test results. Further, my Trig/HDL = 1.46 (<2.0) and my LDL-P/LDL-C shows as discordant but in a good way according to studies I’ve read/watched.

This time around, I took these results to a local cardiologist that is a known fan of the ketogenic diet and his response to the numbers was a bit on the fence. According to him…

  1. I shouldn’t see an increase in LDL as a result of doing keto and he’d like to see that LDL number come down. So, he’s going to have me do an ApoE test to see if I’m a hyper responder.
  2. He felt my ApoB was a little high and said he’d like to see it below 100, though the tolerances noted on the test results showed 50-150 putting me right in the middle at 117.

So, his instructions were to a) stop taking my daily fish oil supplements and b) cut back the drinking, which came as no surprise, then retest in 6-8 weeks. Plus, he’s having me do a Calcium CT just to see how that looks given my age.

In any case, I’m now starting to get a little concerned about these numbers given the reaction of my cardiologist. It’s unclear if he’s concerned or just trying to truly optimize everything for me and he’s a little cryptic so I wasn’t able to gain clarity on that in speaking with him.

For some additional context - I look and feel better than I have in years… So that’s a major plus. ALSO, with some of the information I’ve gathered in my recent research, I went back and looked at my two previous lipid test results from April 2022 and August of 2020. LDL was lower but, overall, it didn’t look great!

4/2022
Total Cholesterol = 214
HDL = 57
Triglycerides = 134
LDL = 130
Glucose = 93

8/2020
Total Cholesterol = 217
HDL = 60
Triglycerides = 148
LDL = 127
Glucose = 83

My diet during both of the above tests was what most would consider relatively healthy. Low fat, moderate/higher carb intake, mostly home cooked meals during the week with more frequent cheat meals on the weekends. And, yes, a decent amount of alcohol intake (15-20 drinks per week).

I was a bit flabbergasted by my triglyceride results and the Trig/HDL ratios… Not great. But, at the time of each of these, my GP (different than the one I have now) gave me a :+1: on the results.

So, although my Total Cholesterol and LDL are up at this time, my Triglycerides, HDL and Glucose numbers are looking much better.

**Bottom line, I’m not sure what to make of where my numbers currently are at 4 months into eating this way. So, I’m looking for feedback from this community on my numbers as they stand today. Any thoughts, insights, etc. would be greatly appreciated.

Again, please be kind in your responses and remember I’m aware of my misgivings with the drinking and even the cheat meals. I’m modifying those parts of my life/diet for the better.**

Thank you all, in advance, and I look forward to gaining even more knowledge about this lifestyle by way of this community!


New Blood Panel Results
(Bacon is a many-splendoured thing) #2

First, welcome to the forums!

There’s a lot to unpack here. First, the point of a ketogenic diet is to lower insulin. The high-carbohydrate diet recommended by most governments raises serum glucose, which provokes a large insulin response. Hyperglycaemia is damaging, hence the insulin response, and hyperinsulinaemia is also damaging and appears to be the root cause of all the chronic diseases currently plaguing our society. So that’s the reason to keep carbohydrate low. That way insulin stays as low as possible, too. We need some insulin in order to live, but the point is to avoid having too much.

Overweight and metabolic dysfunction are not 100% correlated. It is possible to be thin and sick, just as it is possible to be overweight and otherwise healthy. I’m glad that cutting the carbohydrate has helped your food issues.

Now, as to your lipid numbers. First of all, your ratio of triglycerides to HDL is wonderful, 106/71 = 1.49, and anything under 2.0 (0.9 or less in the units used outside the U.S.) means a minimal cardiovascular risk, as is borne out by your NMR results. Total cholesterol and LDL level are relatively meaningless as cardiovascular risk markers. Triglycerides over HDL and the Pattern A of the NMR analysis associate strongly with each other and with minimal cardiovascular risk. You are doing great.

It is possible that your total cholesterol and your LDL will come down a bit in a couple more months, but you are already in fine shape. At best, lipid numbers may be a marker for cardiovascular risk, but they are certainly not causal. The CAC your cardiologist wants to do will tell you a lot more about the condition of your arteries. You might also ask for a CIMT (coronary intima media thickness) test, as well.

Some people find that their LDL goes up on keto. These people tend to meet certain criteria, which you can read about at www.cholesterolcode.com.

Worrying about cholesterol is the standard of care, and doctors are under enormous pressure to prescribe statins. Your CAC scan will be the main diagnostic. If your Agatston score is less than 100, a statin is contra-indicated.

Other things to consider are your HbA1C (which is fine) and your inflammatory markers. If they are all normal, then you are in fine shape and have nothing to worry about.

In reality, there is not much actual evidence to support the idea that our lipid levels cause cardiovascular disease. There is a lot more evidence to suggest that the actual problem could well be hypercoagulability of the blood, and a high-carbohydrate diet certainly contributes directly to that problem by glycating haemoglobin, and indirectly by the effects of chronic hyperinsulinaemia.

In short, you are doing fine, despite your cardiologist’s lingering worries. Keep calm, and keto on.


(Danny) #3

Yes, sorry for the novel of an initial post! I can be a bit verbose… But I also wanted to provide full context as the story wouldn’t be complete without it.

In any case, I truly appreciate your feedback and it’s nice to hear someone say my numbers look good. I’ve been considering reintroducing some healthy/complex carbs into my diet (more vegetables, beans and some light whole grains) to increase my fiber intake but still keeping it 50-100g per day, and going to more lean protein options. However, maybe it’s good for me to stay the course while reducing our bad habits and seeing how that trends.

I’ve cut beer out of my diet and reduced my weekly alcoholic beverage intake (wine and spirits only) from a terrible roughly 20 to about 10-12, and there are no more cheat meals. So, it would be interesting to see how just those changes impact my numbers in 6-8 weeks.


(Bacon is a many-splendoured thing) #4

First, fibre is one of those things that some people swear by and other have to avoid completely, with most of us not needing to worry about it. If you search for posts about fibre on these forums, you will find plenty of people with leaky gut, irritable bowel, and Crohn’s disease who claim that fibre exacerbates their problems. There are also quite a few people who can’t seem to move their bowel without fibre. And for most of us, fibre is neutral. You’ll have to experiment to see which category you fall into. I find that I only get constipated if I don’t get enough salt, otherwise I’m fine.

One of the benefits of fibre is supposedly that our intestinal bacteria turn it into butyrate, which is good for our intestinal lining. But there are some data to suggest that the ketone body β-hydroxybutyrate is even better for the intestinal lining. As Dr. Jason Fung, the nephrologist and fasting guru, likes to say, “Carbohydrate is poison, and fibre is the antidote. But if you’re not going to eat the poison, why do you need the antidote?”

Lean protein is problematic. If you are not going to eat much carbohydrate, then most of your energy will have to come as fat. There is such a thing as “rabbit starvation,” which is so named from the fact that rabbits are too lean for a human being to survive on for long. Some people need a higher proportion of protein, however, while others need less. The place to start is 1:1 by weight, which is 69% fat : 31% protein by calories. You can adjust from there.


(Robin) #5

Been there, still doing that with my lipids.

As far as the symptoms going away from keto… ABSOLUTELY. I shared all of those and they disappeared. You need to strongly consider fully committing to this in order to maintain the results. Good luck.
You got this!


(Danny) #6

Thanks, Robin! Can I ask what symptoms you’re referring to specifically?

Also, are you saying your lipids are still elevated (mainly LDL)?


(Edith) #7

We usually suggest people wait about 6 months after starting this way of eating before getting blood tests done. It frequently takes about that long for the body to really get adjusted and fat adapted. You can even see that in your own blood test results. Your total cholesterol in November was 275. Two months later it dropped to 262. At the same time, your Triglycerides continued to drop and your HDL increase. It seems you are certainly heading in the right direction.

You mentioned drinking enough that it sounds like it could be an issue. I think it is really good that you are cutting back.


(Bob M) #8

He does not know about what he speaks.

This shows that most people get an LDL rise, though the people with lower body mass have higher LDL rise.

Particularly, the first 6 months or so likely means higher LDL.

But if you’re male with an HDL of 71, that means you tend toward LMHR, which means you’re going to have higher LSL. (And LMHRs can have…stunningly high LDL.)


(Robin) #9

@DannyG No problem… but understand we have differences too… I’m 68, female, started keto at 215 lbs and now weigh 147… 1 year strict keto, then I slid naturally into carnivore 1 1/2 years ago.

To your specific question : “mysterious reactions to food (difficult to pinpoint) which has led to a lot of gas, bloating, discomfort and even GERD’… all of the above and more. Achy joints, fatigue. And diverticulitis, which I discovered was brought on whenever I ate vegetables… especially raw.

My doc learned about keto right along with me. He is very supportive. Everything has improved but my lipids. My total is almost 500 and my ldl is 400. But my trigs and HDL are great. And I have low blood pressure.

Once you find your balance on keto, you will be able to easily identify which foods cause problems. And you can test the theory by eliminating them. You can always try slowly adding things back in too.

BTW… I am a recovered alcoholic. I would not have been able to accomplish this if I were still drinking. But we are all different and react differently. That’s why you will often get conflicting opinions here.

Simply lowering your carb intake is a big win. It’s up to you how far you take it. It’s a win-win.


(Bob M) #10

Wholly crap! Impressive!


#11

Really comes down to what you’re eating specifically. At 4 days keto 3 days off, what does that off time look like? Still a clean low carb diet? Or “normal”? Keto raises our cholesterol more than people say it does, but depending on what you do on those other 3 days could have a huge effect. Keto and high carb eating aren’t compatible. You can eat normal low carb and then eat higher, but to bounce from one extreme to the other will have your cholesterol all over the place.

I do a Hybrid of TKD/CKD, so I’m having carbs pre-workout and I do a carb reload once or twice a week to top off muscle glycogen. But even then, I’m not eating “normal” amounts of carbs. Sometimes it’s hard to find the balance that works for you.

Have you done a food sensitivity test or a stool test? I learned a ton with those.


(Danny) #12

Wow, that really is impressive! Well done!! Also encouraging to hear you have a doc that’s gotten onboard with everything despite your cholesterol numbers - Hard to find open minded medical professionals, it seems. They seem to want to follow the conventional wisdom despite it being outdated in many ways.

Thanks for sharing! Also, you may have misread what I was saying about my food sensitivities. I don’t have any on keto which is great! But I used to have many prior to starting keto. That’s definitely been the biggest benefit of this diet for me.


(Danny) #13

I say 4 days on 3 days off because my wife and I would usually be out with friends over the weekend (including Friday evening) having drinks, etc. A lot of the time, that includes carb heavy microbrews and, often a cheat meal which could be a cheeseburger with the bun or a Thai meal with some rice or, on a couple of shameful occasions, some pizza. It would only be a couple of meals like that per week but, still, not great and when combined with the beer, really not great…

That said, I still do have (for example) a slice of thin sliced Dave’s Killer Goodseed bread with breakfast but it’s only 9g net carbs and, when committing to keto during the week (and now always) I’d stay well under 50g of carbs per day easy.

As for the food sensitivity and stool tests, yes I have done that and found nothing of note. It was suggested I try a FODMAP diet and that was nonsense. My brother has a gluten sensitivity and certain things containing gluten mess with me but others don’t… For example, beer and small amounts of bread don’t do anything to me.


(Danny) #14

Thanks for all of this! It would make sense if I were a LMHR as, in the past, my wife decided to try Paleo and I attempted it with her (in 2016) but, after a visit to my doc for my annual physical, I found my cholesterol was elevated so I stopped… That was before any of this information you’re sharing, and that can be found in many other places in different formats, was well known. By me at least.

On a similar note, regarding LDL reaction to keto, I just watched this video by Mike Prevost in which he discusses this topic around the 29 minute mark. And if anyone seeing this hasn’t watched this video, do it - Interesting stuff!


(Joey) #15

@DannyG Welcome to the forum!

Okay, I’m going to cut to the chase:

It ain’t the fat … it’s the carbs.

“Pseudo-keto” sounds like a term you made up to describe what you’re not doing … i.e., you’re not cutting out the carbs.

Stay off the carbs and your Trigs will come down as your HDL rises. To hell with the rest of those figures (except that your A1C is not problematic, yet).

If nothing else, as you roam the taverns of your social life, please remember this:

Beer = bread
Cheat meals = more bread

If you had gas bloating, GERD and related discomfort while on carbs and it was abating without carbs, well… it’s highly likely to be the carbs. :roll_eyes:

Trigger alert: I’m going to be blunt…

You can either stop eating all those carbs or you can continue to deal with gas bloating, GERD, and discomfort. It’s your call, my friend.

None of this even speaks to what’s likely happening slowly but surely to the rest of your body you haven’t heard from yet … your arteries, liver, heart, and brain

Simple question: Does your 42 year old rapidly-aging body deserve to be “cheated” on? If so, go for it and check back in with us in about 10-20 years.

Meanwhile, take it from a mid-60s guy who once fit your 40+ yr old description. Wish I’d cut out the carbs 20 years sooner. Am finally feeling like I’m 25 again.

:vulcan_salute:


(Danny) #16

Not sure if you read my entire post but I repeatedly acknowledged that the beer and cheat meals were a terrible decision and I’ve stopped doing that. And, yes, as I mentioned, I referred to it as pseudo keto because of these poor habits. So, no need to harp on it - I got it.

That said, I truly hope cutting these “cheats” out results in improved LDL and even stronger Trigs and HDL, both of which are currently much better than they were before keto.

Appreciate your time and feedback.


(Joey) #17

Sorry if I offended. Was intending to promote and support you in making the best choices for yourself going forward - perhaps punching the point more than was helpful. My bad.


(Danny) #18

No worries - Context is hard to convey via text. Appreciate the support.


(Michael) #19

Welcome Danny. Your numbers are better than mine, except your HDL is lower. My LDL is somewhere around 325 - 400 depending on the day. From my perspective, I am a bit worried about my sd-LDL (around 500) but certainly not my normal LDL. So while you say you want “better” LDL, I doubt your will go down, if anything it will probably go up more as you lose more body fat. The question is, do you believe the old paradigm (LDL bad), or the new paradigm (LDL does not matter on it’s own). There is no definitively correct answer, but I will be going with this paper https://journals.lww.com/co-endocrinology/Fulltext/2022/10000/Statin_therapy_is_not_warranted_for_a_person_with.14.aspx# meaning no statins for me. You should of course decide for yourself, and while reading what is written here, none of us know 100% for sure, so keep that in mind as well.


(Danny) #20

Thanks for the thoughtful and informative response, Michael. Scrolling around this forum has shown me that my LDL-C really isn’t that high. It was just a shock to me, and my doctors weren’t reassuring in any way.

I didn’t think a Small LDL of around 500 was bad - According to the reference range on my test, anything <634 is ok (mine was 446). But, who the heck knows… These reference ranges all seem outdated.

As for my LDL-C increasing as I lose weight, I’m not sure how that can happen. I don’t really have weight to lose as I’ve always been lean and fairly muscular and now there’s really no adipose left. At this point, I weigh about what I did when I graduated high school but with more muscle mass. Almost worried about getting lighter! Not complaining at all, it’s just crazy what this diet can do, even when not followed strictly (as I hadn’t to date).