Should I quit keto?

#1

I’ve been doing keto for three months now and am so confused by what’s happening to me that I’m not sure I should continue. Sorry this is such a long post but I seem to be having a lot of strange reactions.

The biggest concern I have is with my cholesterol. I know there is a subset of keto eaters who “hyper respond” and I fit the criteria for Feldman’s LMHR’s, but, even among that group, my cholesterol shot up way more than most. My total is 542 and my LDL is 440. I was tested twice just to be sure it wasn’t a lab error. I also know that a lot of people think LDL is not concerning when trigs and HDL are good, but mine is just so high that it makes me uncomfortable.

Because of this I decided to try to cut back on the saturated fat and eat more monounsaturated fat, but this is pretty limiting on keto. I’m eating lean meat, avocados, vegetables, eggs, and small amounts of nuts and seeds. I feel hungry a lot and eat more calories now than before I went keto, but this was my experience with keto even before I started shying away from saturated fat. Everyone else talks about how they are always full and satiated and have no appetite, but I sometimes even binge on keto foods like nuts or (previously) cream or cheese. Before keto I would binge on carbs and now they don’t seem appealing which is wonderful and is the biggest benefit I’ve noticed from keto.

I don’t really have much weight to lose. I’m 5’5" and weigh 132. I would like to lose five pounds but don’t care a whole lot about it. I did drop four pounds the first week but it’s all come back since. I work out about five times a week and my strength and endurance have both suffered since I went keto.

Another strange thing is my ketone levels; I have a blood meter and have tested every morning since day one. I am usually around 0.2-0.5 even though I stay under 20 net grams of carbs pretty much every day. I read that this is more common for LMHR’s, but it makes me wonder why I’m bothering to count carbs and stick to that limit if I never seem to be in ketosis anyway.

Can anyone relate to any of these results? Anyone have any advice? I don’t want to give up keto entirely because it has helped me so much with my horrible sugar cravings, but it really doesn’t seem to be the magic bullet for me that it is for most.

Sad day
CAD (Coronary Artery Disease)
(Michael - When reality fails to meet expectations, the problem is not reality.) #2

As always, we need more detailed info about what you’re eating, how much, when etc. to provide any useful advice. There are many folks on this forum knowledgeable enough to do so and will. I mean actual names and numbers. How many grams of what meat, how many grams of avocado, what specific veggies and how many grams of each? What fats are you eating specifically, how much of each? Again, actual names and numbers.

You mention some scary numbers about total and LDL cholesterol. What are the other relevant numbers you didn’t mention, like LDL-p, HDL, trigs? What is your age, general health, any history of heart issues you/family? If you are worried enough about it, ask for a CAC scan. Having a relatively high total cholesterol and/or LDL will take time to cause any real problems and may just eventually go down to the healthy range, as many on this forum have reported in their own cases. Also, keep in mind that cholesterol is the Fedex of fat metabolism, delivering the energy goods to all the cells and organs. Having a lot of it may simply mean your metabolism is synthesizing a lot of fat energy much of which is just being discarded because you’re still not efficient at using it.

As for your β-hydroxybutyrate samples, read this:

Buy a box of Ketostix and test your urine once in a while. If there is ANY ketones in urine, it means you’re synthesizing more ketones than utilizing. The excess is being dumped. Literally ‘down the toilet’.

PS: don’t expect miracles and you won’t be disappointed :slightly_smiling_face:

#3

Have you tried Dave Feldman’sLMHR group on FB? They have a lot of experience in things from that perspective.

#4

I have joined that group and discuss these things with them as well, but I was hoping to get more opinions. There aren’t many people who actively participate in the discussions there.

#5

Thanks for the response. I’ll try to answer as much as I can.

My typical meals since I started cutting sat fat about a week ago are as follows:

Breakfast: 2 or 3 boiled eggs, 140 calorie pack of sunflower seeds
Lunch: 2 cups non-starchy veg like broccolini, zucchini, asparagus or yu choy, 1 large avocado, 1/2 pound of lean meat like skinless chicken breast, sirloin, or fish
Dinner: Another 1/2 pound of the same lean meats, same sorts of veg, maybe some lettuce or some zero-carb yam noodles, all cooked in about 2 tbsp olive or avocado oil
Snacks: Sugar-free jerky, macadamia nuts or pecans
I drink a lot of coffee and use Splenda. I also drink Crystal Light.

Before I was paying attention to fats I was eating the fattiest meat I could find since I love it: rib-eyes, pork belly, bacon… I also ate cheese and cream and have since cut out the dairy.

Here are all my lab results:

TC: 542
HDL: 90
Trig: 80
LDL: 440
HDL LARGE: 6880
LDL MEDIUM: 264
LDL PARTICLE NUMBER: 2481
LDL PATTERN: A
LDL PEAK SIZE: 229.9
LDL SMALL: 170

I’m 37, in good health, no medical conditions, no medications. My dad had a heart attack young but he drank, smoked, and did drugs like a madman. I would love a CAC as well as a bunch of other tests but I am a Kaiser patient and my doctor won’t do anything for me so I have to pay for them all myself at an independent lab.

(Michael - When reality fails to meet expectations, the problem is not reality.) #6

I should also mention that β-hydroxybutyrate is simply the stored form of acetoacetate, which is the actual energy molecule. Having relatively low concentrations of β-hydroxybutyrate means only that either acetoacetate is not being converted into β-hydroxybutyrate at a high rate and/or β-hydroxybutyrate is being utilized more or less as it’s formed, ie converted back to acetoacetate for use by cells/organs or used directly by the brain. Finally, 3 months in you are not fat adapted yet and it’s very possible that your liver is synthesizing only small amounts of acetoacetate and/or your metabolism is starting to burn fatty acids directly.

And, as much as they’re denigrated as useless, Ketostix are actually the only direct way to measure how much acetoacetate is being dumped unused from your system. That is very relevant information.

#7

I’m a bit confused by this. Most people tell me that levels will be higher at first and decrease as you become fat-adapted and more efficient at using the ketones. I also always hear the the urine sticks are useless and the blood test is the only accurate measure, which is why I forked over so much dough for the blood tester.

(Bob M) #8

I’ve been low carb/keto 5.5 years and am never above 0.5 in the morning unless I fast a long time. Test later in the day. My blood sugar goes up from midnight to noon then down all day until midnight, and my ketones are the reverse of that.

You really to need to get a CAC scan done. It’s the only thing that tells you actual risk.

(Bob M) #9

Oh yeah, and look around. I found one place for $100 and another for $300.

#10

I’ve tried testing at other times of day and have never seen anything higher than .9. It seems to be .2 - .5 no matter what time of day it is.
Since I’m pretty young and have only been doing keto for a few months I worry that a CAC scan wouldn’t be useful yet since I could be just beginning the damage.

(Bob M) #11

You know, ketones to me are useless values. Like other markers, they only tell you “something” about your body. You are also eating relatively low fat (as I also do). If you want to increase your ketones, increase your fat intake. But that just increases ketones for what I don’t think is a good reason.

If you are concerned that keto is harming you, get a CAC scan done now. Check again in 6 months or a year. If no progression, then keto is not harming you.

(Bob M) #12

You might also get a test for FH (familial hypercholesterolemia). There are two different types, homozygous and heterozygous. Depending on type, there are different treatment paths.

#13

I’m a bit fuzzy on all the cholesterol measurements, but I believe the current theory is that the small (dense) LDL’s are the ones that convey the highest risk, regardless of total particle number. Also small HDL, but I don’t see a measurement for that.

Pattern A = mostly large, so good. Pattern B = bad.

Anyone have a reference range for good, bad, really bad on these numbers?

(Edith) #14

I’m not a hyper responder, but i always have lowish ketones as well. My morning reading is usually 0.2-0.3. The only time that goes up is if I eat low protein or I do intermittent fasting for several days in a row. Even then my morning ketones will be 0.4 to 0.9.

I recently started what I call a keto carnivore trial: meat only, with some seasoning and allowing olive or avocado oil. My morning ketones have been higher, ranging anywhere from 0.4 to 1.1. Those are high numbers for me. And those numbers are without measuring my macros. I’m also finding keto carnivore way more satiating.

(Michael - When reality fails to meet expectations, the problem is not reality.) #15

Read Amy Berger’s article. That will help. Keep in mind the basic premise that YMMV. We are all individuals with many varying factors that determine exactly how we metabolically respond to nutrient inputs. There is always a wide range of results. Hardly anything is cut and dried exactly this for everyone. So ‘most people’ aren’t necessarily going to include YOU.

I’ll go out on the limb here. No, blood test for β-hydroxybutyrate is not the only accurate measure of ketosis. It may not even be the best test for determining the quality/efficiency of ketosis. And it does NOT register efficiency of fat burn. But until recently it has been pretty much the only test available for home use. Breath testing for acetone, especially done along with plain old glucose blood testing, may turn out to be much more indicative of the general state of ketosis and efficiency of fat burn. As well as general state of overall health. But the jury is still out, since home-use acetone breathalyzers that are usefully accurate are relatively new and lots more testing/investigation is needed.

The bottom line is: don’t get discouraged because you have low β-hydroxybutyrate readings on your blood test. The concentration changes minute by minute all during the day. If you want to demonstrate this fact to yourself measure it hourly for a day. It’s a dynamic system and very noisy.

(Cancer Fighting Ketovore :)) #16

You said you’ve only been doing keto for 3 months.

  1. Do you have any lab work from before keto? If so, how does it compare to your recent lab work?
  2. How long ago was this lab work? I assume because of your concerns it was fairly recent.

I’ve read on the forum here that it can take up to 6m for things to stabalize more. Perhaps you can keep going for another 3 months and then run the lab work again. The more data points you have over time the better you can see trends.

#17

I know from 23 And Me that I don’t have FH, but that’s a good idea bout the CAC. I’ll start shopping around to get a baseline number. Thank you!

#18

Sorry, I should have at least included the standard ranges from the tests.

TC: 542 <=199 mg/dL
HDL: 90 >=40 mg/dL
Trig: 80 <=149 mg/dL
LDL: 440 <=99 mg/dL
HDL LARGE: 6880 Range: 3966-11938
LDL MEDIUM: 264 Range: 122-498
LDL PARTICLE NUMBER: 2481 Range: 732-2035
LDL PATTERN: A
LDL PEAK SIZE: 229.9 >= 217.4 Risk: Optimal >222.9; Moderate 222.9-217.4; High <217.4
LDL SMALL: 170 Range: 75-452

#19

I’m definitely leaning more on protein than most people on keto since I can’t just guzzle olive oil. I think my macros are usually around 5C, 30P, 65F. I can’t imagine eating nothing but meat though since I really love veggies and am already having trouble limiting them so much.

(Bob M) #20

I think Dave Feldman’s idea that lipoproteins are an energy transport mechanism, particularly for you LMHRs. If that is true, then you could be perfectly fine, especially if you don’t have FH. But no one really knows. And the CAC scan is really the only thing that can tell you that (well, the carotid artery test might, but the CAC scan covers a larger area).

Note that you might need to get a prescription to get a scan. The two testing facilities I called said I did (I’m in Connecticut), but I just found a third that says (online – haven’t called) I don’t need a prescription. (Of course, it’ll turn out to be the most expensive, I bet!)