Hi all,
I have my annual physical with my GP in a week, and I’ve been fully keto for 6 weeks. Beyond the typical medical tests which doctors order, do you all recommend any other tests?
For example, I’ve heard in the podcasts (but haven’t completely followed) that my cholesterol could go up but that the breakdown and ratio would be better – BUT I would need a specific test to track that breakdown. Or something like that.
(Is this post in the right category?)
Thanks
this is a good place to sart and its complete with understanding why.
Be aware that in early days your cholesterol numbers might be alarmingly high. Don’t worry until you’ve been keto six months. Even then, a certain segment of the population is what Dave Feldman calls “hyper-responders,” whose cholesterol counts act counter to what you might expect. If your numbers are still wonky at six months, check out www.cholesterolcode.com for more information.
Thanks. I’ll be sure to do that. I may have listened to that episode, but it’ll be good for a review – and I’ll take notes this time.
If, for whatever reason, this doesn’t work for me, is it possible I could be doing permanent damage or putting myself at risk? Or, does real risk come after years & years of improper nutrition. (Sorry, I may be looking at this in the traditional perspective toward fat & heart health.)
Keto is not improper nutrition and healthy fats are just that. HEALTHY. There are many who will tell you this WoE is dangerous, but it is not. You are probably eating better nutritionally than you have in years. Arm yourself with info from the “Show Me the Science” category. And if you hear the word “statin” coming from the doctor’s mouth, the answer is “NO.”
PS - make certain your Cholesterol panel is pulled after at least 12 hours of fasting (like overnight). If it’s not, it’s invalid.
Thank you. I have a lot of reading (and podcast listening) to do. I’ll note the 12-hour (min) fast.
Is there a specific or special type of panel I should request (as opposed to the standard)? I’m sure that’s in the other category. I just haven’t gotten there yet.
Not at this point; you’re too early into this to worry about cholesterol at all.
Cholesterol is an essential precursor to many essential hormones, and it is the main building-block of cell walls. The original study linking cholesterol to cardiovascular disease was performed on rabbits that were force-fed meat products, despite the fact that they are obligate herbivores. (No wonder they developed health problems!) Cholesterol is so important to the body that the body manufactures all it needs, whether we eat any at all.
Most of the randomized controlled studies done since Ancel Keys’ day have shown that the amount of dietary cholesterol is completely irrelevant to the risk of heart disease—even Keys understood that. As our ability to measure cholesterol has improved, it has become clear that it’s not the cholesterol itself that is the problem, it is the lipoproteins in which the cholesterol is transported through the bloodstream. Small, dense lipoproteins are vulnerable to oxidation and when oxidized are sometimes damaged beyond the body’s ability to recognize and scavenge them. They can then sometimes lodge themselves in arterial walls and cause inflammation. The cholesterol in arterial plaques is not actually the cause of the problem, but rather part of the body’s attempts to repair the damage, just as fire trucks are not the cause of fires, but part of the attempt to put them out. You may have a high lipoprotein count, but if the proteins are all the large, fluffy kind, your risk of developing problems is much lower. Some studies have even shown that a higher level of cholesterol might actually have a protective effect, especially in post-menopausal women. It appears we still have a great deal to learn.
There is a condition called familial hypercholesterolemia, in which members of certain families all have extraordinarily high serum cholesterol levels. As Dr. Phinney points out, fully half of people with this condition live perfectly normal lives, never develop heart disease, and die at perfectly normal ages of other conditions. He argues that this fact demonstrates that it is not the cholesterol level itself that is the problem, but that the ones who do develop heart disease and who do die of heart attacks actually have some other underlying problem that we haven’t yet discovered. This is also borne out by the fact that although study after study has shown that statins lower serum cholesterol, there is no evidence that they thereby reduce cardiac mortality or even the risk of heart disease.
Dr. Gerber, Dr. Berg, Dr. Westman, Dave Feldman, and Ivor Cummins all have excellent lectures available (mostly on YouTube, the ones I know of) on the state of our current scientific understanding of cholesterol. The ones I’ve watched have all been very interesting, even though it is somewhat frustrating that the experts don’t always agree on what the risk factors really are. Again, it appears that we still have much to learn.
Hi! For anyone interested, I just got my results back. Here’s a subset of what was done (let me know if there’s something else you want to see). To my untrained eye, they look good, but feel free to comment.
The 3 days prior to the test, I fat-fasted for 2 days, then ate LCHF the last day, then dry-fasted 12 hours until the test.
I’m 5’8", ~168 pounds, 39yo.
Insulin 2.5
Ferritin 294 (I’ve had mildly elevated ferritin for a couple years for unknown reasons, maybe due to lots of kale)
HbA1C 4.8
Glucose 89
Sodium 141
Potassium 4.1
Calcium 9.2
Cholesterol, Total 163
HDL 55
HDL Ration 3.0
LDL, calculated 94
Triglycerides 46
"The Great Cholesterol Myth by Dr. Stephen Sinatra and Jonny Bowden is also a great, easy to read source for understanding the cholesterol truth.
Yes wow! I started Keto a month ago just to get my triglycerides down. I hope I have your success.
Specific to cholesterol, there is a slightly advanced test called an ApoB. It can give you an idea of particle size breakdown.
When you do get to a point where you want to have your cholesterol checked, and if it comes back high (as hyper-responders do), you should ask to get an NMR lipid panel run. It gives a more detailed breakdown of the different particle types which gives a clearer picture of any potential cardiovascular risk.
@stajove & @PaulL
Thanks for your kind words! If I may, what exactly is outstanding about these scores? Is it the super-low triglycerides? Or some other score or combination?
@DiMo & @Kaiden I’ll note those tests down for sure.
@Regina I failed to clarify in my original post that I have been LCHF for about 18 months now with regular binges on carbs on weekends. I was strict keto for the past 6 weeks, with no carbs. I also run somewhat regularly, have small fasts frequently and occasional long fasts. So, I imagine all that my scores weren’t the results of just 6 weeks.
Thanks, everyone!
Fasting insulin < 5 is excellent. This is the marker people in this community are most interested in.
Biggest takeaway for me was HbA1C < 5 and your HDL to triglyceride ratio is < 1:1. Once I hit those numbers it’s maintenance mode for me!
Your HbA1C will not be believed by many doctors. Nobody has one that low anymore (at least, it sure feels that way!). An excellent triglyceride/HDL ratio is anything under 2.0 when measured in mg/dL, or 0.9 (if I recall correctly) when measured in millimoles.
Just don’t forget, as I am sure your doctors will remind you, that the keto way of eating is unsustainable and will kill you. (Personally, I hope to go at age 107, while sky-diving.) 
