Keto diet: expected lipid test results?

[Bongleur]

Told the MD I have been doing Keto since the fall & wanted a lipid test. Called & says its over 300 and should be under 200 so they want me to take drugs to reduce it.

Don't have the hardcopy blood test yet so don't know what test they did.

Need to learn about what levels are "normal" when on Keto, for which tests, and I know I need to agitate for a more detailed test - fractionation test ?

There is a thread on "denied LTC insurance" and I wonder if this sort of thing will "look bad" because there is no official recognition for Keto diets and what levels are normal.

 

[bloom2708]

You could try "not keto".

https://nutritionfacts.org/

https://nutritionstudies.org/whole-food-plant-based-diet-guide/

LDL between 50-75. Even under 100 can be plaque forming.

It's tough out there.

 

[retire to nature]

I am 42yo female RN. When I had drunk some fat from meat, it came to 400. haha. Blood work could be what you ate recently. I didn't worry about at all. But I have quit keto now because I have been sick because of stress. As I know an asian RN, patients are fed rice porridge when they get sick, I started to eat carbs back. Also, I had to take CT scan for other reason, my biliary duct was distented. I am not sure if it was from keto, but possibly keto plus extreme stress with my stuff. My benefit from keto was learning my bad habit not eat enough fat due to low fat movement. I have a check up blood recently, it was back to my normal level. I don't recommend to put you on medication.

Also, what matter is HDL, if your HDL is high, it is good sign, but it is low, I would cut down how much you consume fat.

 

[Bongleur]

Got results back & an old to compare:

WHEN...Chol...Trig...HDL.....LDL....Chol/LDL
2011___193___60___61__120____3.2
2020___346__111___59__262____5.9 ; non HDL Chol: 287 (what's that?)

Don't know if 2011 was fasting; 2020 was not fasting & on a keto diet.

The MD suggests I have familial hyperlipidemia (FH), but do the 2011 results indicate that at all?

They didn't do any size fraction test, which I wanted to know. Would that data be useful? Or LDL-P particle number test.

This from 2014 seems to talk about what it means if keto causes higher Chol, and high LDL-P:

Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience - Low Carb Dietitian

"LDL-P is a measurement of the number of LDL (low-density lipoprotein) particles in your blood which carry cholesterol, triglycerides, and another type of fat called phospholipids. According to lipidologists (experts in the field of cholesterol and other lipids), LDL-P is the strongest predictor of risk for cardiovascular disease (CVD) and future cardiac events.

this type of dramatic elevation in LDL-C and LDL-P doesn't occur in most people who adopt a very-low-carb, high-fat diet.

I've seen estimates that somewhere between one quarter and one third of low-carbers experience this. I've met and read about several who have.

Most people who eat VLCKDs see their cholesterol rise only slightly, not at all, or even decrease, remaining within or near the normal range. I've met plenty of folks like this as well.

 

[braumeister]

Don't know if 2011 was fasting; 2020 was not fasting & on a keto diet.

Those tests are meaningless if not fasting.

 

[euro]

Braumeister is correct. Doing lipid labs non-fasting is pointless.
Also, lipid numbers will be irrelevant during weight loss (fat is shed into the blood during that state), so wait until your weight has stabilized for 2-4 weeks.
The really important parts are triglyceride (will be less than 100 if you are truly keto), LDL particle number (especially small LDLp - should be less than 1000 for total particles and less than 400 for small particles). HDL should be >50. Everything else is either calculated (and thus inaccurate), or irrelevant.

Peter Attia has been mentioned here before. He has a highly scientific approach and thus may be difficult to follow for most non-scientists, but he has a lot of really relevant information and a really well reasoned point of view on this topic. See peterattiamd.com for his website. His podcast is called “the drive”. I highly recommend it.

 

[audreyh1]

Time2 had linked to a 5 parts series of podcasts (#20-24) with Dr. Tom Dayspring Oct 2018.

I’ve downloaded these podcasts for our very long drive.

 

[euro]

Time2 had linked to a 5 parts series of podcasts (#20-24) with Dr. Tom Dayspring Oct 2018.

I’ve downloaded these podcasts for our very long drive.

Yes, that series is excellent. For even more of the fundamentals, check out his 9 part series called “Straight dope on cholesterol” - also found on his website.

 

[audreyh1]

Oh thanks!

 

[Time2]

Got results back & an old to compare:

WHEN...Chol...Trig...HDL.....LDL....Chol/LDL
2011___193___60___61__120____3.2
2020___346__111___59__262____5.9 ; non HDL Chol: 287 (what's that?)

RE, Non-HDL:

Chol = 346, HDL = 59 and 346 - 59 = 287=Non-HDL
How they didn't charge you much for that!

 

[Bongleur]

RE, Non-HDL:

Chol = 346, HDL = 59 and 346 - 59 = 287=Non-HDL
How they didn't charge you much for that!

So "non-HDL" includes what categories? LDL and something else?
I don't know lipid terminology at all.

Not doing keto for losing fat, but to not get hungry 2 hours after I eat (post prandial hypoglycemia, I presume). My % bodyfat before starting was about 20%, its dropped to about 17%.

Been doing it since fall, so weight should be stable by now.

Any of these podcasts have transcripts? I'm not a listener, I read & highlight & cut & paste bits into my own notes.

So the essential tests are HDL, LDL-P (which I guess I need to demand) and Triglyceride?

 

[euro]

Any of these podcasts have transcripts? I'm not a listener, I read & highlight & cut & paste bits into my own notes.

So the essential tests are HDL, LDL-P (which I guess I need to demand) and Triglyceride?

Yes, as far as I recall, Peter Attia makes it a point to publish transcripts of all of his podcasts.
Yes, IN=MHO, those three lipid parameters (4, if you get small LDL particle number and total LDL particle number) are all you need

 

[Time2]

I have Great results in my blood test while on a Keto diet.
I have been on a Keto Diet for 7 weeks before the blood tests.
I tried for 20 Carbs, but in reality I was between 20 and 30 grams.
I'm weighing and tracking all my food in Cronometer.
I also take 5 mile walk almost every day, I also added some other exercises, since I started Keto.
I lost 11 lbs while on keto. Also, my doc changed my cholesterol med since my last test. (Lovastatin to Rosuvastatin)
So, the improvements include, Keto, exercise, weight loss and a change of cholesterol med.
I wish doc had not changed my med, so I had a clearer picture.

 

[Time2]

Told the MD I have been doing Keto since the fall & wanted a lipid test. Called & says its over 300 and should be under 200 so they want me to take drugs to reduce it.

Don't have the hardcopy blood test yet so don't know what test they did.

Need to learn about what levels are "normal" when on Keto, for which tests, and I know I need to agitate for a more detailed test - fractionation test ?

There is a thread on "denied LTC insurance" and I wonder if this sort of thing will "look bad" because there is no official recognition for Keto diets and what levels are normal.

I'm not sure how you did keto. There is know way I could have done it without Chronometer, a scale, and my ketone blood test machine.
I weighed all my food and logged it into Chronometer. I did daily Ketone blood tests. I have been in ketosis the whole time. 0.4 to 5.6, but maybe averaged 1.2.
I had plenty of Olive oil, I used Quest MCT oil powder, I may go with C8
(Medium chain triglycerides) next time I read it's better. Once or twice a day I would use a bouillon cube in cup of water and mix 2 tbls Olive oil and a scoop of the MCT powder. Partly because I was always low on fat and because you need more salt on Keto. btw, Knoor tastes better than Tone's,
but you need to cut them in half or make a double cup.

My results were in the previous post, I have lost another 7lbs since then.
Everyone's body is different, but I would not know how to eat keto and be able to stay in ketosis if I did not have the accessories. I suggest you try it. You need a scale Chronometer is free and I bought a Keto-Mojo on Amazon for $50, and while you are buying get another container of test strips. If you start feeling icky when you first go into Ketosis, have something with salt, thus the bouillon broth.

 

[Bongleur]

I just don't eat much carb. I have a "ketoscan" breath meter that measures acetone.

I don't understand how people get enough fat. Meat and hard cheese are about 50:50, and at best 60% fat. Its so easy to eat too much protein -- and the excess turns into glucose.

I started with avocado smoothies with coconut milk, but wasted too much $$ on over-ripe avocados. So now I drink whipping cream. I can add seltzer for a "soda" and monk fruit if I want sweet, and fruit flavorings or use flavored seltzer.

Enough roughage is also a problem - salad & celery. All the premade keto stuff has horrible "soluble" fiber, which is absolutely counter productive. Manufacturers presume the whole world is constipated all the time.

 

[yakers]

To get fat I add oils & butter. Olive oil , MCT other oils, butter on everything that can take it, veges, various bread substitutes fat bombs for snacks.

 

[ER Eddie]

Total chol and LDL can rise under keto. That's a common occurrence and a common concern. You can find lots of info out there about it.

The real question for me is, is that actually a problem, or is the whole cholesterol thing a big nothing burger, propped up by bad science, financial interests, and medical professionals too busy to question the received dogma? You can probably tell from my tone what my beliefs are.

I think it's very important to self-educate on this subject and not just go with what your doctor tells you. From what I've read, there is no good evidence that cholesterol is a cause of health problems. And although there is some data to suggest that LDL may sometimes play a small role, what seems more important than overall LDL level is type of LDL (e.g., glycated or not, size) and the environment that the LDL is in (i.e., metabolic health or sickness).

I personally don't pay much attention to Total chol. or global LDL. I don't think they're good markers for anything.

 

[Bongleur]

To get fat I add oils & butter. Olive oil , MCT other oils, butter on everything that can take it, veges, various bread substitutes fat bombs for snacks.

Oil requires LOTS more "roughage" to avoid exit issues.

The bread substitutes are all high protein and significant carbs.

SOLA bread:
3.5g fat......... x9 = 31.5
5g protein.......x4 = 20
3g net carbs....x4 = 12
...........Total kCal = 63.5 & label rounded down to 60
Percent fat = 49.6

1 TBS butter 12g fat x9 = 108 kCal label rounded down to 100

bread & 1 TBS = 171.5 kCal
% fat = 139.5 / 171.5 = 81.3% so not a way to "catch up."

The slices are small, maybe hold 2 TBS butter but not 3...
I might as well lick the butter off a spoon.

 

[Bongleur]

I think it's very important to self-educate on this subject and not just go with what your doctor tells you.

I went to a doc because I wanted a blood test. Told him I'm doing Keto. Told him I'm not fasted. They called back and said your lipids are really high, we want to prescribe a cholesterol lowering drug.

Complete idiots.

Trouble is, they pass this crap data to my insurance company, who will "flag" me.

 

[audreyh1]

My LDL went up sharply 30 then 40 points on keto. I think that’s simply a function of a higher fat diet. My HDL went up on keto too. And my triglycerides dropped so much, that it put me at a very low risk with a trig/HDL ratio of 1.

Ironically for DH, he already had great (very very low) triglycerides and very high HDL (like exceeding 100 sometimes) even with a “normal” carbs diet (healthy food cooked at home). So he already had a sub 1 trig/HDL ratio before cutting starchy carbs. He never tried to go keto like me, but probably is usually at mild ketosis. His most recent numbers were actually worse, but still very good and still sub 1 ratio. His LDL went up about 30 points too. He found that increasing fat in the diet helped with his digestion, particularly with the occasional quite serious constipation he would suffer.

 

[Bongleur]

Total chol and LDL can rise under keto. That's a common occurrence and a common concern. You can find lots of info out there about it.

The real question for me is, is that actually a problem, or is the whole cholesterol thing a big nothing burger, propped up by bad science, financial interests, and medical professionals too busy to question the received dogma?

What I have found is quite complicated. To me, the starting data is "what particle size or weight lipid does the liver pump into your blood?" and then "why do we see a different size & weight distribution in systemic blood?"

All the lipids in my blood are either:
1) metabolized

2) excreted

3) sticks to my arteries -- but recent data seems to say that ONLY happens if the arteries are damaged from some cause unrelated to lipids.

4) cannot save as fat if insulin is below a boundary, so probably no fat. And the % bodyfat device on my scale says my fat mass is constant over time.

 

[ER Eddie]

What I have found is quite complicated. To me, the starting data is "what particle size or weight lipid does the liver pump into your blood?"

Yes, it is complicated. I don't pretend to know everything. I do know that LDL-C, which is what most basic lab work measures, cannot answer that question. It's also just an estimate.

I remember reading in Gary Taubes' book (Good Calories, Bad Calories) that there are about half a dozen different types of LDL particles. He has a good chapter on that issue, if you haven't read it yet. The book was written a while ago, so we know more now, but even at the time Taubes was writing, it was clear that simply measuring LDL-C did not tell you a whole lot.

Other physicians and engineers I've listened to over the years have talked about the difference between glycated or oxidized LDL vs. non-glycated or non-oxidized LDL, with the former being the type associated with damage. So the trick is to avoid oxidation or glycation, which generally means avoiding environmental toxins, vegetable oils, and sugar. The message I came away with was that LDL itself was okay, but if you have a toxic soup of sugar and processed food stuff it's swimming around in, it gets nasty. It's the environment the LDL is in, not the LDL itself, that is the problem.

The actual association between LDL and heart disease is a pretty small one, and it's an associative link, not a causal one.

The whole label of "bad cholesterol" is insane. LDL is something our body naturally produces -- it's not something that is going to kill us. It's there for a reason and a purpose. It's the metabolic soup it's swimming around in that is the problem. Dave Feldman, an engineer who's done a lot of work in this area, refers to LDL as like an ambulance at the scene of an accident. It's not the cause of the accident; it's just at the scene, trying to help.


Here are a couple brief, pop-level Youtube videos on the subject. I won't claim these guys are unimpeachable experts -- Berg is a chiropractor and Lauer likes to take his shirt off a lot -- but they may be worth a watch. I saved them when I was a bit anxious myself, a couple years ago, when my LDL increased after going on a low-carb diet.

Here's something a bit more academic:

LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature
https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391

Also, check out Taubes' chapter on the subject of LDL in Good Calories, Bad Calories, if you have the time.

I went to a doc because I wanted a blood test. Told him I'm doing Keto. Told him I'm not fasted. They called back and said your lipids are really high, we want to prescribe a cholesterol lowering drug.

Complete idiots.

Trouble is, they pass this crap data to my insurance company, who will "flag" me.

Hypercholesterolemia! Sinner! Thou shalt take a statin to be cleansed of thy sin. What a racket.

They don't even understand that a lipid test needs to be fasting? Ur...

 

[audreyh1]

You can’t take a lipids test unfasted!

 

[6miths]

You can’t take a lipids test unfasted!

+1

I was wondering why you would not fast or why the lab would do it if you hadn't fasted. There are exceptions but given you are posting on a FIRE forum I wouldn't expect you would be an exception to doing the test fasted.

 

[audreyh1]

Well, I hear of people getting their lipids test unfasted. I know for sure it really messes up the triglycerides number.