I got back my latest lab results, these were taken while eating ZC/carnivore and having been keto prior to that. My total cholesterol is 388, LDL (listed as LDL Cholesterol calc) is 260, HDL 121 and Trigs are a super low 37. I have very high total cholesterol historically on keto with about 320 being the highest I’ve had. I know I also have higher cholesterol numbers in my family (for whatever that’s worth!) but these numbers, the total and LDL seem very high. I’ve listened to the keto geek podcast with Dave Feldman and @siobhan and understand that since I am fairly lean and active and am utilizing FFAs as fuel, I have lots of cholesterol “boats” circulating in my blood to transport energy. But is this cause for worry? My fasting glucose is 102, which is fairly normal on keto I know. I’d had coffee that morning too. Not sure what to make of these numbers, other than I know my inflammation is low as reflected by my triglycerides.
VERY high total and LDL cholesterol
Yes this is to be expected based on the Feldman theory of cholesterol - lean+active=high LDL. Whether or not you worry about these numbers is up to you. Given that there is zero rigorous scientific evidence linking high LDL independently to CVD I personally wouldn’t care. If you stopped exercising I bet your LDL would drop somewhat. Might be a good experiment to do if you are nervous, to verify that the LDL correlates with energy demands.
These results sound typical of a hyper-responder as detailed in @DaveKeto 's protocol. I’m also active and lean and have had similar results having previously had “normal” readings when on a standard diet.
Your Trig:HDL ratio is great. This would suggest that if you were to have a full lipid profile test (LDL-P), you would most likely have protective non-atherosclerotic pattern A cholesterol “boats”.
@siobhan has been instrumental in helping me interpret my lab results over the last few years, based on Dave Feldman’s research. She sent me to his calculator on the Cholesterol Code website, and indeed I am in the lowest risk category. I was just a bit shocked at that total number, but as she pointed out this, along with the low trigs and high HDL, indicates my body is utilizing FFAs as energy at a high rate. So I’m in super fat burning mode! Pretty awesome
How long have you been keto?
My Trigs:HDL ratio has improved throughout my time eating this way, it’s currently 0.44 which I am really pleased with - nowhere near as low as yours though!
You are most definitely a Lean Mass Hyper-responder. http://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/
It’s not for me to say whether you should be worried or not. But I will say I’m typically on the cusp of a LMHR, and were it not for my experiments, I’d remain as one everyday unless/until the data led me in a different direction. I often say I was “a 9 on a 10 scale of concern, but now I’m more like a 5 and dropping given I’ll ive learned and discovered with my research on the lipid system. But I’m not a 0.”
Thank you @DaveKeto!! You’re the expert here so your interpretation is really valuable to me. I have given @siobhan my info from the past few years, all taken on keto, and it shows the same pattern.
Ironically, I have lots of reasons to believe a LMHR is actually a superior metabolic profile. In fact, I speculate LMHRs enjoy more active autophagy compared to everyone else because they are in a greater “blended fasted state” overall. (This is why I think it’s much harder for LMHRs to do muti-day fasting)
Thus, it will be pretty frustrating for me if we ultimately learn my speculation is correct and our natural aversion to high LDL drives a lot of LMHRs out of the profile that turned out to serve them well. Again, not saying I know this for sure, just that it fits with my existing theory from a mechanistic perspective and thus far all the LMHRs who I keep tabs on continue to show excellent blood markers (so far).
Only a worry if your doc gets triggered (see what I did there) by your trigs, and other lipid panel markers. And then makes a snap judgement to prescribe statins.
May want to do that Feldman protocol before the next blood draw if so, that’s what I’m planning on doing in April before my next checkup. Seeing a constant hbA1C of 5.0 and hs-CRP of 1.7 put my doc’s mind at ease about my keto.
Have you done a CAC CT and/or CIMT ultrasound before, at least to check those boxes? There’s also hs-CRP to put both your doc’s and your mind at ease regarding inflammation.
@daveketo Actually, curious, do the LMHR respond as well as you or any other normal responders to the protocol?
Dave, if someone is LMHR and stops exercising but continues to eat keto intuitively, would you expect their LDL to drop?
In terms of magnitude, yes. However, to use my own first experiment as an example: a drop of 256 to 183 mg/dL in 3 days is clearly massive and clearly demonstrates dynamism, it won’t stop someone from still being single-minded on that metric itself. “183 is still way too high!”
This is why us engineers have little patience with this field sometimes. If your original ranges come from studies that don’t take into account a new, foundational mechanism that is clearly in play – why do you stick to them?
@DaveKeto I cannot fast longer than 24 hours. I can’t “push through” a “wave” of hunger like lots of people do when they fast. Mine is a long story but a couple of years ago when I was very underweight and very, very active (due to me having undiagnosed anorexia) I was on keto and would not fast longer than about 18 hours and I saw clearly the results of autophagy. My skin tone improved greatly which I know is a side effect. So I think you’re on to something there, LMHR might experience autophagy sooner than those who don’t fit this profile. There’s no way I could fast for three days to try and get the benefits of autophagy.
Hah, indeed. My last hobby was autocross and having an intervention like a driving school or tire pressure scheme that would improve performance to hundredths or thousandths of a second were common and encouraged. Your drop is astronomical.
Right! And again, all of this fits the mechanistic energy model I was working through in the first place. I didn’t know just how common LMHRs were until I openly declared it in that posting. I was more curious if there would be a whole lotta other people coming out of the woodwork to shoot it down. I.e. “No, I’m 30% body fat and I have these same cut points.” But it’s so predictive I don’t even need to see anything else about the person to know their lipids say they are lean and/or athletic (and usually both). There are a tiny few exceptions, but it’s easily a 90%+ predictive rate (no hyperbole).
My fear is that I believe this same principle in energy economy will apply to children of keto parents who are on the same diet. I believe if we took cholesterol tests of these kids (which doesn’t often happen normally, of course), we’d find a lot of LMHR profiles — and they’d likely get misdiagnosed as having familial hypercholesterolemia. 
I fear the same with kids. I’m a member of TypeOneGrit on Facebook & see postings every now and again with doctors checking type 1 diabetic children’s blood lipid levels (since switching to a low carb presumably HIGH FAT diet) & get very upset about it, advising statins, declaring premature CVD, etc.
It’s usually the same story… Dr. says: I don’t care that your blood glucose/A1c is better. I don’t care that you feel better (stable blood sugar;no blood sugar rollercoaster) on a low carb diet because all that cholesterol is going to lead heart disease & premature death!
It’s Atkin’s on trial reincarnate.
Why is everyone throwing Feldman’s theory as certainty? It is purely a hypothesis, which may or may not be wrong.
Good question. Even Dave is careful not to frame it in such a way as he comes off as certain.