Low carb and lipids

[bmcgonig]

Great. Thanks for that!

The distinction is that eating cholesterol itself does not raise cholesterol as your body makes all the cholesterol it needs. That doesn’t mean that diet in general doesn’t raise or lower your cholesterol.

A higher fat diet, particularly increased saturated fat, can raise both HDL and LDL cholesterol together. In the case of lower triglycerides, the increased LDL will normally be of the large fluffy type not associated with heart disease risk.

So understanding your situation requires a more detailed look at your LDL composition which more advanced tests can reveal. Alternatively, it can be reasonably estimated from the Trig:HDL ratio (for results in mg/dL). https://www.cooperinstitute.org/201...or-determining-risk-of-coronary-heart-disease

I calculate your ratio as 0.9 (down from 1.9) which is quite low indicating you now have more large fluffy LDL particles rather than small dense particles. That looks like a great ratio:

https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

Another discussion of ratios and risks and lipid numbers in general versus diet gives these ranges:

https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/

 

[RAE]

Yes, exactly!
If fasting insulin were part of the standard blood tests, then insulin resistance would be detected far sooner, as long as the appropriate range was used.
But that is not “standard of care”, so not looked at.

+1. At my next physical/blood test, I am going to request that a fasting insulin test be done. I already have an HbAIC test done each year, but I want the fasting insulin test to see where I stand. It's absurd that this test is not routinely included in a standard blood test package, but it's not. If my doc declines to order the test, I'll just go have it tested on my own, at one of the labs. I think the cost is about $30, so not expensive at all.

 

[EastWest Gal]

So I've been on a low carb diet since around Christmas and just got my blood tests back. I'm not trying keto or anything like that and I'm not counting carbs. I'm just avoiding breads, pastas, rice etc. I'm eating vegetables, actually more than I had before since I was really lax before. Now I try for once a day...before it wasn't a priority.
...
My bloods changed as follows:

Total Cholesterol went from 170 to 220

LDLc went from 100 to 148. Yikes!

Triglycerides went from 97 to 60

HDL went up from 50 to 65 ( that could be low carb or lot more exercise...or both)

Hbaic went from 5.4 to 5.3

So the HDL Trig ratios have improved etc. But the LDLc etc skyrocketed! Probably expected since I'm eating a lot more meat, cheese and bacon etc.

Don't know what my doc will say.

I know lots of people do keto and low carb here so have you also had jumps in cholesterol like this? And does it worry you?

I have the same thing occuring. Your profile looks a lot like mine did last month, including the changes. In my 30s, my cholesterol was 130. Two years ago it was 170 (after 2 months of keto). Last month is was 209. Other than low triglycerides, my profile, including LDL particle size, stunk. But until May (when I retired), I was sleep deprived, stressed, and had a bad diet. Re-started keto diet for weight loss in June. Weight loss and reducing diabetes risk is my biggest goal-have lost 17 lbs so far. I'm looking forward to retesting in a few months. I'm losing weight, doing keto, choosing my fats pretty carefully (olive oil, avocado oil, no seed oils or soybean oil, and naturally occuring saturated fats in the meats and small amounts of dairy), fish, and stepped up my exercise after my labs came back.

Three thoughts come into mind:

1. As others have said, the number of LDL particles is probably of greater importance than the total LDL-C. You can ask your doctor to order this test or you can go find a lab and have it done on your own. It might be called NMR LipoProfile Test or cholesterol particle test. I just had mine done and it was not expensive at all. Some doctors don't know about this test. As a hospital pediatrician, lipid profiles did not register with me, as we usually don't test kids in the hospital for this.

Large LDL particles will mean a lower particle number. My PCP said aim for less than 800. Large LDL particles are rapidly taken up into the fat cells, thus the cholesterol doesn't get deposited in the arterial walls. Smaller LDL particles have been circulating longer and are the ones that deposit cholesterol into the blood vessel walls, leading to atherosclerosis.

This was discussed in Diet Doctor podcast #9 on December 18, 2018, if you like podcasts.

2. Sometimes excessive protein intake leads to protein being metabolized in the carbohydrate pathways, which drives up insulin and LDL cholesterol. Your protein intake might be slightly high for your ideal body weight. Maybe increase the fat and lower the protein a bit?

If you are eating a lot of vegetables, reduce root vegetable intake (carrots, for example), which are high in carbs.

3. Consider time restricted eating ( eating only in an 8 hour window in the day) or intermittent fasting. Some people find it easy to skip breakfast and delay lunch, for example. This has been shown to drive down LDL cholesterol. Also, you are above your recommended ideal body weight, and time restricted eating can rapidly correct that, which could improve the LDL cholesterol profile.

There are a lot of great resources about this. I really like Diet Doctor website and podcasts as there is specific information, available without paying for a membership.

I'll be curious what your doc says and how this plays out for you. I'll be rechecking in November and seeing where I stand. It's weird how my numbers are almost identical to yours.

 

[audreyh1]

I also like dietdoctor.com. I didn’t link their extensive pages on cholesterol and LDL because much of that is member only, requiring subscription, although the first month is free.

The Dietdoctor podcasts are free.

 

[bmcgonig]

I have the same thing occuring. Your profile looks a lot like mine did last month, including the changes. In my 30s, my cholesterol was 130. Two years ago it was 170 (after 2 months of keto). Last month is was 209. Other than low triglycerides, my profile, including LDL particle size, stunk. But until May (when I retired), I was sleep deprived, stressed, and had a bad diet. Re-started keto diet for weight loss in June. Weight loss and reducing diabetes risk is my biggest goal-have lost 17 lbs so far. I'm looking forward to retesting in a few months. I'm losing weight, doing keto, choosing my fats pretty carefully (olive oil, avocado oil, no seed oils or soybean oil, and naturally occuring saturated fats in the meats and small amounts of dairy), fish, and stepped up my exercise after my labs came back.

Three thoughts come into mind:

1. As others have said, the number of LDL particles is probably of greater importance than the total LDL-C. You can ask your doctor to order this test or you can go find a lab and have it done on your own. It might be called NMR LipoProfile Test or cholesterol particle test. I just had mine done and it was not expensive at all. Some doctors don't know about this test. As a hospital pediatrician, lipid profiles did not register with me, as we usually don't test kids in the hospital for this.

Large LDL particles will mean a lower particle number. My PCP said aim for less than 800. Large LDL particles are rapidly taken up into the fat cells, thus the cholesterol doesn't get deposited in the arterial walls. Smaller LDL particles have been circulating longer and are the ones that deposit cholesterol into the blood vessel walls, leading to atherosclerosis.

This was discussed in Diet Doctor podcast #9 on December 18, 2018, if you like podcasts.

2. Sometimes excessive protein intake leads to protein being metabolized in the carbohydrate pathways, which drives up insulin and LDL cholesterol. Your protein intake might be slightly high for your ideal body weight. Maybe increase the fat and lower the protein a bit?

If you are eating a lot of vegetables, reduce root vegetable intake (carrots, for example), which are high in carbs.

3. Consider time restricted eating ( eating only in an 8 hour window in the day) or intermittent fasting. Some people find it easy to skip breakfast and delay lunch, for example. This has been shown to drive down LDL cholesterol. Also, you are above your recommended ideal body weight, and time restricted eating can rapidly correct that, which could improve the LDL cholesterol profile.

There are a lot of great resources about this. I really like Diet Doctor website and podcasts as there is specific information, available without paying for a membership.

I'll be curious what your doc says and how this plays out for you. I'll be rechecking in November and seeing where I stand. It's weird how my numbers are almost identical to yours.

Thank you for that. I'll let you know if anything changes. You may have read my weight wrong, my BMI is under 22. I'm out of the US at the moment and don't think I can get those LDL size tests done here. Hopefully though that the low ratio really means that I have the large LDL cholesterol type.

 

[EastWest Gal]

I must have read it wrong. Thanks for the correction.

 

[JAGOTI]

That Mayo clinic article is still telling you to

The US Dietary Guidelines dropped that recommendation in 2015, announcing that "dietary cholesterol is no longer a nutrient of concern."

This article was published in April, 2018 - several years after the 2015 Dietary Guideline revisions explicitly dropping all dietary cholesterol limits. Yet Mayo Clinic staff persist in publishing old recommendations that have since had significant changes.

It's simple - Statins are big $$$$$ for the Pharmaceutical Industry.

https://www.michaelwest.com.au/statin-wars-secrecy-and-the-worlds-most-lucrative-drugs/

 

[audreyh1]

This was discussed in Diet Doctor podcast #9 on December 18, 2018, if you like podcasts.

An interesting quote from that podcast #9 from Dr. Krauss. Dr. Krauss had been tasked by the AHA to work on updating their dietary guidelines, and he tried to bring them in line with science, but no dice:

But what I found was to my surprise that the standard low-fat high carbohydrate diet actually worsened the lipid profile in a substantial subset of this population very strongly related to heart disease risk outcomes, higher levels of LD particles and higher levels of triglycerides which is another risk factor for heart disease. And it wasn’t a complete surprise because looking back over the years others have shown that high carb diets can induce a high triglyceride level and the effect on the LDL was really what was quite surprising.

And as a result of that and further research that I engaged in to explore that mechanism further, I changed my views on what the proper diet should be for heart disease prevention. One issue was individualizing the approaches to people based on their metabolic profile. So there’s an issue of not everybody needs the same diet. But for the overall recommendations I tried to move the Heart Association a little bit further away from the low-fat approach and I wrote another set of dietary guidelines five years later that reflected that.

But that was like trying to move a mountain, because the amount of investment in that old message was so strong that there was resistance to doing that. Overtime I think with further research if we can talk about, that approach I think has been challenged by many others.

And that change I think is now in play, although organizations like the Heart Association and even the US dietary guidelines that are charged with making public recommendations still up put a great deal of emphasis on the facts out of the equation, beginning to be more concerned about the carbohydrate trade-off. But I think it could be taken even further.

On LDL and large versus small particles: Here is a recent presentation by Dr. Krauss discussing the two main patterns of LDL particle size and how they represent metabolic health. It’s pretty technical. But their experiments have shown that if you have more small LDL particles, it’s actually harder to lose fat, even with the same caloric intake! Losing weight, and eating low carb, each independently reduce the number of small LDL particles = improved health. Saturated fat has no effect on this process, and simply results in more large LDL.

It’s less than 30 minutes - worth wading through, IMO

 

[Tekward]

+The best predictor of cardiovascular health is your triglyceride/HDL ratio - if you are below 2.0, you're doing well; if you are below 1.0, you're doing great. QUOTE]

Thanks for this. Digging into our numbers, it sounds like delaying SS would be a good move.

Some interesting background:
https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

 

[donheff]

+The best predictor of cardiovascular health is your triglyceride/HDL ratio - if you are below 2.0, you're doing well; if you are below 1.0, you're doing great. QUOTE]

Thanks for this. Digging into our numbers, it sounds like delaying SS would be a good move.

Some interesting background:
https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

Interesting. With my weight staying low even with chocolate I am at 1:1. When I was on LCHF without chocolate I was down around .6. Probably worth manning up and dropping the chocolate.

 

[braumeister]

It's simple - Statins are big $$$$$ for the Pharmaceutical Industry.

Since so many statins have gone off patent protection, I don't think it's as much of a profit motive as it used to be. But confirmation bias is still a huge issue. Nobody likes to admit they were wrong, and to admit they were wrong for so many years is just too much to swallow. Things are changing, but as in most scientific fields we won't see real change until most of the major proponents of the SAD are dead.

 

[audreyh1]

Interesting. With my weight staying low even with chocolate I am at 1:1. When I was on LCHF without chocolate I was down around .6. Probably worth manning up and dropping the chocolate.

Could chocolate really make that much of a difference? Are we talking large daily amounts? Milk chocolate?

 

[RAE]

Could chocolate really make that much of a difference? Are we talking large amounts? Milk chocolate?

It's possible. Milk chocolate contains a lot of sugar. One Hershey's chocolate bar (43g) contains 4.87 teaspoons of sugar. If you eat a couple per day, you are consuming almost 10 teaspoons of sugar! For comparison, one 12 oz. can of coca-cola contains 7.27g of sugar. All of that sugar would undoubtedly have an effect on triglycerides.

Dark chocolate (70% or higher cocoa content) would be a much better choice, but I recall that Donheff does not like dark chocolate.

 

[RAE]

Since so many statins have gone off patent protection, I don't think it's as much of a profit motive as it used to be.

Yes, this is true, but statins are still a HUGE money-maker for Big Pharma, so there is still plenty of incentive to market them. I just read this online:

"Statins are the most widely prescribed cholesterol-lowering drugs in the world.
Since their introduction in the late 1980s, statins have been a particularly lucrative class of drugs, primarily for pharmaceutical giants Pfizer, Merck Sharp & Dohme and AstraZeneca.
Pfizer’s Lipitor is the most profitable drug in the history of medicine. At its peak in 2006, yearly revenue for Lipitor exceeded $US12 billion.
Despite their patents recently expiring, revenue for statins is still expected to rise, with total sales on track to reach an estimated $US1 trillion by 2020. Statins are very big business."

 

[donheff]

Could chocolate really make that much of a difference? Are we talking large daily amounts? Milk chocolate?

I buy 17 oz Pound Plus bars from Trader Joe’s. They last about two days. I’m addicted.

 

[audreyh1]

Since so many statins have gone off patent protection, I don't think it's as much of a profit motive as it used to be. But confirmation bias is still a huge issue. Nobody likes to admit they were wrong, and to admit they were wrong for so many years is just too much to swallow. Things are changing, but as in most scientific fields we won't see real change until most of the major proponents of the SAD are dead.

I think that after years of being pushed, doctors are used to focusing on the LDL number, because it is easy to measure, they can lower it with a drug, and they’ve probably been taught lower is better. So you’ve have a couple of decades of indoctrination (get it) and it’s going to take a long time to change.

 

[audreyh1]

I buy 17 oz Pound Plus bars from Trader Joe’s. They last about two days. I’m addicted.

OK, yes, 8.5 ounces per day of milk chocolate seems like a problem.

My calcs say about 150g of sugar in 1/2 Trader Joe’s Pound Plus milk chocolate bar!

 

[audreyh1]

Well. I'm joining you in the boat bmcgonig! I got my lipids back today.

I had my lipids done a couple of weeks before I started on the ketogenic diet, and then again after 90 days on the ketogenic diet.

• Dramatic drop in triglycerides as expected. It dropped 40% - down to 85. Still a little above the 80 target my doc wants.
• HDL stayed the same - a bit of a surprise. Although last time it was up 10 compared to last September and the highest I had ever seen.
• LDL up 30 points! Surprise - oops.

So - LDL and thus total look worse. However, the triglycerides/HDL ratio is much improved. It dropped from 2.25 to 1.37. I'm very happy with that.

So overall a big improvement. And if the proxy for particle size is to be believed, this indicates more of the LDL is the large fluffy harmless kind.

I have also read that if you are losing weight, your blood lipids can be elevated temporarily. I have also seen some low-carb studies that show an increase in LDL during the first 3 months, but after a year had dropped below initial value.

And I am still losing at a rate of a little more than 3 pounds per month. I know it's fat loss, because I have been weight training 3 times a week and increasing the weights.

Anyway - we shall see in a few months I suppose.

 

[bmcgonig]

Well. I'm joining you in the boat bmcgonig! I got my lipids back today.

I had my lipids done a couple of weeks before I started on the ketogenic diet, and then again after 90 days on the ketogenic diet.

• Dramatic drop in triglycerides as expected. It dropped 40% - down to 85. Still a little above the 80 target my doc wants.
• HDL stayed the same - a bit of a surprise. Although last time it was up 10 compared to last September and the highest I had ever seen.
• LDL up 30 points! Surprise - oops.

So - LDL and thus total look worse. However, the triglycerides/HDL ratio is much improved. It dropped from 2.25 to 1.37. I'm very happy with that.

So overall a big improvement. And if the proxy for particle size is to be believed, this indicates more of the LDL is the large fluffy harmless kind.

I have also read that if you are losing weight, your blood lipids can be elevated temporarily. I have also seen some low-carb studies that show an increase in LDL during the first 3 months, but after a year had dropped below initial value.

And I am still losing at a rate of a little more than 3 pounds per month. I know it's fat loss, because I have been weight training 3 times a week and increasing the weights.

Anyway - we shall see in a few months I suppose.

Congratulations! I beat you on LDL...mine went up 49 points..[emoji16][emoji16]

 

[audreyh1]

Congratulations! I beat you on LDL...mine went up 49 points..[emoji16][emoji16]

I beat you on LDL, my absolute number is higher than yours! LOL!

 

[donheff]

Well. I'm joining you in the boat bmcgonig! I got my lipids back today.

I had my lipids done a couple of weeks before I started on the ketogenic diet, and then again after 90 days on the ketogenic diet.

• Dramatic drop in triglycerides as expected. It dropped 40% - down to 85. Still a little above the 80 target my doc wants.
• HDL stayed the same - a bit of a surprise. Although last time it was up 10 compared to last September and the highest I had ever seen.
• LDL up 30 points! Surprise - oops.

So - LDL and thus total look worse. However, the triglycerides/HDL ratio is much improved. It dropped from 2.25 to 1.37. I'm very happy with that.

So overall a big improvement. And if the proxy for particle size is to be believed, this indicates more of the LDL is the large fluffy harmless kind.

I have also read that if you are losing weight, your blood lipids can be elevated temporarily. I have also seen some low-carb studies that show an increase in LDL during the first 3 months, but after a year had dropped below initial value.

And I am still losing at a rate of a little more than 3 pounds per month. I know it's fat loss, because I have been weight training 3 times a week and increasing the weights.

Anyway - we shall see in a few months I suppose.

Congratulations, That sounds great. Once you get to your target weight, and stay there for a while, you may be able to drop off keto and stay good - both in terms of weight and lipids. I was able to add rice, potatoes, and pasta back into the mix with virtually no problem. But you need to be careful, daily weighing,alert for return of cravings. My only problem is the chocolate - I can't go half way. I do cut it out if I get two pounds over target which, even with chocolate, is unusual for me. Between the LCHF weight loss and aging I think my appetite has simply dropped. But I eat plenty of protein and lift weights so I am not overly concerned. I think all of this is easier for men than women, particularly men who were skinny throughout their youth.

 

[bmcgonig]

Congratulations, That sounds great. Once you get to your target weight, and stay there for a while, you may be able to drop off keto and stay good - both in terms of weight and lipids. I was able to add rice, potatoes, and pasta back into the mix with virtually no problem. But you need to be careful, daily weighing,alert for return of cravings. My only problem is the chocolate - I can't go half way. I do cut it out if I get two pounds over target which, even with chocolate, is unusual for me. Between the LCHF weight loss and aging I think my appetite has simply dropped. But I eat plenty of protein and lift weights so I am not overly concerned. I think all of this is easier for men than women, particularly men who were skinny throughout their youth.

I read somewhere that when you eat chocolate it takes 30 seconds for the craving for more chocolate to cease after the last bite. So the secret is to put the chocolate down after a bite(s) and walk well away. As they say ymmv [emoji16]

 

[audreyh1]

Congratulations, That sounds great. Once you get to your target weight, and stay there for a while, you may be able to drop off keto and stay good - both in terms of weight and lipids. I was able to add rice, potatoes, and pasta back into the mix with virtually no problem. But you need to be careful, daily weighing,alert for return of cravings. My only problem is the chocolate - I can't go half way. I do cut it out if I get two pounds over target which, even with chocolate, is unusual for me. Between the LCHF weight loss and aging I think my appetite has simply dropped. But I eat plenty of protein and lift weights so I am not overly concerned. I think all of this is easier for men than women, particularly men who were skinny throughout their youth.

I’m not in too much of a hurry to add back in starchy carbs and grains. First I need to get my triglycerides down a little more if I can. It also might be best to have my fasting insulin below 5, but I don’t know if that’s possible.

So I think I’ll still stay in ketosis a bit longer. Then maybe gradually transition to 50g of carbs. Given my rather high blood ketones readings which are usually above 3, I suspect I would remain in ketosis even at 50g net carbs. Maybe just the lighter nutritional ketosis.

I’m getting down to just about 5 pounds from my target weight - although weight loss hasn’t been a priority. I still have excess abdominal fat, so I guess that takes a while to “rearrange”. I may have set my target weight a little high, around BMI 24, but if you get too skinny as an older lady, it may be harder to maintain bone health.

The weight has come off much faster than I expected, as I didn’t have that much to lose. I also started doing weights about halfway through.

I am a bit nervous about transition to maintenance. Far less is written about that.

 

[audreyh1]

I read somewhere that when you eat chocolate it takes 30 seconds for the craving for more to cease after the last bite. So the secret is to put the chocolate down after a bite(s) and walk well away. As they say ymmv [emoji16]

I’ve been enjoying 85% chocolate. It goes well with coffee - that’s when I usually want some, with an after lunch espresso. I eat a tiny amount - usually just 4g. Just take the small piece and put away the bar. I don’t seem to need to go get more.

I am also a chocoholic. But I like dark, can’t stand milk chocolate - way too sweet and mild.

Cocoa has so many great nutrients that eating it is beneficial, but it’s a serious trade off in chocolate candy with added sugar. Of course one can always use cocoa powder to flavor things....

 

[footenote]

Fun LCHF maintenance treat:

1 serving 5% Greek yoghurt
1 tsp liquid sugar sub (ex: liquid Splenda)
1/2 tsp vanilla

Add unsweetened berries, other flavor extracts and 1/2 square chopped 85% chocolate
(I like raspberries, DH's fave is peppermint extract)