Adventures in Ketosis (long)

[braumeister]

At 39, your HDL is still borderline. That's surprising, since exercise will usually raise it.

 

[Time2]

Excellent! What dose of Rosuvastatin are you on? I read (I think it was Jason Fung) that low dose Rosuvastatin (5mg) is really effective at lowering inflammation, while not overdosing you on the statin. With those numbers you might want to talk to your doctor about the lower dose. Of course, if you're one of those that doesn't have statin side effects it may not matter. But it would be nice to get a reading based on the low dose too, just to see how whether it's worthwhile to take it or not. But congrats on an excellent set of numbers.

I'm taking 10mg per day of Rosuvastatin.


My BP didn't act as I have read.

I was happy with my BP, it seemed to go down, and lately I have morning high BP. I've been sporadic with my BP med (only when I see it high). I suspect the half life is longer than a day and so you have some left in your blood if you take it regularly. I'm going go back on 1/2 pill every evening and follow up. I within 3 hours of going on my BP med 1 pill was too much.
So I started 1/2 morning and 1/2 evening, then decided 1/2 pill was enough.
I need to start regular BP checks to get a handle.

 

[audreyh1]

Usually a higher fat diet will also raise your HDL. It certainly did for me. It probably hasn’t been long enough on keto for TIME2 to see those results.

 

[Time2]

Usually a higher fat diet will also raise your HDL. It certainly did for me. It probably hasn’t been long enough on keto for TIME2 to see those results.

I had an 8% increase, I thought that was pretty good, hope it does increase.
My last four tests were 30, 33, 36, and 39, it's going the right direction.

 

[audreyh1]

I had an 8% increase, I thought that was pretty good, hope it does increase.
My last four tests were 30, 33, 36, and 39, it's going the right direction.

It certainly is. Overall that's a very big improvement.

 

[braumeister]

I didn't mean to imply otherwise. It's just that you still have some ways to go before your HDL level gets to what I would call "good." Keep doing what you're doing and you'll get there sooner rather than later.

 

[Time2]

I didn't mean to imply otherwise. It's just that you still have some ways to go before your HDL level gets to what I would call "good." Keep doing what you're doing and you'll get there sooner rather than later.

No problem, I'm wasn't offended or hurt I realize my level is still not in the normal range. My wife's HDL is often above 90!
I'll never get there, but it's nice to see an increase after putting in some effort.

As I understand, exercise will increase HDL, since my gym closed, I'm not lifting weights, I'm looking for a set though.

 

[braumeister]

My wife's HDL is often above 90!
I'll never get there, but it's nice to see an increase after putting in some effort.

Yes, but you can ignore the difference -- men and women have different metabolisms to start with, and individual differences are pretty large as well.

I've followed a LCHF diet for about ten years and my HDL is normally in the 80s, occasionally the 90s.
DW, OTOH, follows no particular regime at all, although she sort of tries not to have as many carbs as she used to. And her HDL is always at least the equal of mine if not higher. So don't compare yourself with anyone else. Your progress in a short time is impressive.

 

[harley]

I didn't mean to imply otherwise. It's just that you still have some ways to go before your HDL level gets to what I would call "good." Keep doing what you're doing and you'll get there sooner rather than later.

Not necessarily. Some of us just are genetically inclined to low HDL. I'm one. Things like keto and exercise and such can improve your HDL by 10-20%. But when your baseline is 35 (mine), 20% only takes you to 42. The only time I had what most would consider a decent HDL (50ish), I was taking niacin. It raises the number, but doesn't improve overall mortality numbers, so I cut it out when I cut out statins. It was nice to get away from the flushes.

 

[audreyh1]

Yes, but you can ignore the difference -- men and women have different metabolisms to start with, and individual differences are pretty large as well.

I've followed a LCHF diet for about ten years and my HDL is normally in the 80s, occasionally the 90s.
DW, OTOH, follows no particular regime at all, although she sort of tries not to have as many carbs as she used to. And her HDL is always at least the equal of mine if not higher. So don't compare yourself with anyone else. Your progress in a short time is impressive.

DH’s HDL is naturally very high, and his triglycerides quite low even before he stopped eating starches/grains. He didn’t go on the strict keto diet, but he did gradually stop eating high carb foods. And his trig/HDL ratio didn’t improve because it was already well below 1! In fact it got a little worse - but still below 1, lol.

So huge differences in our blood chemistry even when generally eating the same food.

 

[EastWest Gal]

Those numbers are amazing. Note how low your triglycerides are! You HDL will probably gradually rise with continued exercise.

I had borderline high blood pressure when ai started and now my BP is normal. I bought a Welch Allyn Bluetooth digital BP cuff on Amazon for $64 last week.

Before I was using the Higi stations in the stores.

 

[Time2]

I bought a BP cuff years ago when my doc wanted to put me on a BP med.
I suggested I get a cuff and make a record, rather than rely on one a once a year BP test at the doctors office. I did that, and he looked over my records and put me on a BP med.
I had a lot of anticipation getting my blood tests, after all I read and listened to about how a Keto Diet can improve blood lipids, I wanted to see what happened for me. It was a pleasant answer.

 

[audreyh1]

Still maintaining ketosis.....

It’s been easy for me because I enjoy eating this way. We really enjoy delicious food. I haven’t counted carbs for a long time, but simply avoiding grains and added sugar, and occasionally eating starchy vegetables like carrots, sweet potatoes or leeks, I have no trouble staying in ketosis. We eat a lot of fish and seafood as well as meat and poultry/eggs, tons of veggies, diary, not much fruit.

So in spite of some impressive blood numbers, including both triglycerides and HDL at 67 and routinely low (below 110) blood pressure, my PCP at my last telemedicine checkup was not happy with my LDL number which went higher with my keto diet and has mostly stayed there. A higher fat diet does that in many folks.

She even mumbled the dreaded statin word and wanted another test in 6 months which will be next month.

In preparation for this, I found several CVD Risk estimators ACA, AHA, etc., put in my numbers, and they all give me the same answer: 2.8% which is just above the 2.6% “optimal” level and well below the 7.5% or 10% 10 year risk threshold that calls for intervention. None of them ask for LDL, although they take total, HDL, blood pressure, etc.

One of the estimators clearly stated - statin not indicated - in my results.

We’ve run into this before with other tests where our PCP seemed very out of date.

Anyway - I thought I was going to have to insist on some additional tests first, but if my risk is low per the current CVD Risk Estimators - pretty much end of story in my book.

Just an update.

 

[RAE]

So in spite of some impressive blood numbers, including both triglycerides and HDL at 67 and routinely low (below 110) blood pressure, my PCP at my last telemedicine checkup was not happy with my LDL number which went higher with my keto diet and has mostly stayed there. A higher fat diet does that in many folks.

She even mumbled the dreaded statin word and wanted another test in 6 months which will be next month.

In preparation for this, I found several CVD Risk estimators ACA, AHA, etc., put in my numbers, and they all give me the same answer: 2.8% which is just above the 2.6% “optimal” level and well below the 7.5% or 10% 10 year risk threshold that calls for intervention. None of them ask for LDL, although they take total, HDL, blood pressure, etc.

One of the estimators clearly stated - statin not indicated - in my results.

We’ve run into this before with other tests where our PCP seemed very out of date.

Yeah, I would agree that your PCP is way out of date on LDL. As I'm sure you know, the LDL in your case is almost certainly mostly the larger, fluffy LDL particles, which do not cause CVD. There is a LDL particle size test that can be done to prove that, if you want to mention that to your PCP and have her order it, but I would bet that this test would confirm that your LDL is composed mostly of the larger particles, not the small LDL particles that can penetrate the artery wall and cause problems.


Another way to get a good idea of what size LDL particles you have is to look at your Triglyceride/HDL ratio. If you are below 2.0 (and with your diet, you may be even lower than 1.0), then LDL should not be a concern at all.



I actually had my PCP order the LDL particle size test when he said my LDL was too high a couple years ago. He had no idea such a test was available, but he looked it up and found it, and was then happy to order it for me (my insurance did cover it). As expected, it showed that my LDL particles were mostly the larger particles. After reviewing the results, he agreed with me that my higher LDL was not a problem.

 

[audreyh1]

My other doctor believes that particle size and ApoB tests just aren’t reliable/consistent yet, and the Triglycerides/HDL ratio gives you a good answer any way. He says calcium score is the way to go if you really want to see what is going on.

As you can see from my above post my ratio is 1.0 which is excellent.

I had already pointed out my great ratio before, but this time the PCP seemed to be focused on LDL.

I’m not going to do a calcium score yet, now that I see the latest CVD Risk Estimators have my risk at low. I will show those results at my next appointment.

 

[RAE]

My other doctor believes that particle size and ApoB tests just aren’t reliable/consistent yet, and the Triglycerides/HDL ratio gives you a good answer any way. He says calcium score is the way to go if you really want to see what is going on.

I’m not going to do a calcium score yet, now that I see the latest CVD Risk Estimators have my risk at low. I will show those results at my next appointment.

Yeah, I've considered getting the calcium score test, but the test does give you a pretty good dose of radiation, which I'm not anxious to have. My trig./HDL ratio was 0.87 the last time I had those things checked, so my CVD risk is also very low according to all the calculators. So I'll pass on the calcium score test unless things change.

 

[audreyh1]

Apparently the radiation dose can be quite low. Depends on the facility. But I won’t take that step with current numbers.

 

[braumeister]

I got the calcium score about ten years ago, and it was a little elevated so my doc had me go for the full CT scan. They didn't find anything really concerning but I might be interested in getting the score again as a comparison. Not in any rush though.

 

[audreyh1]

I got the calcium score about ten years ago, and it was a little elevated so my doc had me go for the full CT scan. They didn't find anything really concerning but I might be interested in getting the score again as a comparison. Not in any rush though.

I’m under the impression that more than once doesn’t provide new info? Certainly taking statins causes more calcium (soft?) to show up, so if you’ve taken such drugs the calcium score doesn’t help. That’s just what I remember from a few podcasts/videos over the past few years.

 

[braumeister]

I’m under the impression that more than once doesn’t provide new info?

I don't know. When I had it done, my doc said that it wasn't possible to tell if the calcium they saw had been deposited recently or in the distant past, so my assumption is that if I get a later one and the number is noticeably higher than the earlier score it would be an indication that I'm doing something wrong.

I don't think I'm doing anything wrong so it would probably be a waste of time but I admit to being slightly curious.

 

[audreyh1]

Well, this is discussed in some podcasts with Peter Attia and maybe the Fat Emperor, so there’s definitely information about it for you to find out more.

 

[braumeister]

Thanks, I'll do some digging.

 

[audreyh1]

Thanks, I'll do some digging.

A brief mention from this :

(Note that if your calcium score is higher than zero, there's no point in getting a repeat exam in the future. The calcified portion of the plaque won't disappear, and your treatment advice wouldn't change.)

https://www.health.harvard.edu/heart-health/do-you-need-a-calcium-scan

 

[braumeister]

Yes, the biggest thing I get from reading is that a calcium score really isn't all that useful. One big study showed that nearly half of the sudden cardiac deaths they looked at were in people with zero scores.

 

[mickj]

Yes, the biggest thing I get from reading is that a calcium score really isn't all that useful. One big study showed that nearly half of the sudden cardiac deaths they looked at were in people with zero scores.

My calcium score was zero, I have had two heart attacks.