![]() When I wrote a blog post entitled Lipid Changes on a Very-Low-Carbohydrate Ketogenic Diet about 10 months ago, I knew it would be controversial. Although some people in the low-carb community agreed with my position and conclusions, others thought I shouldn't have revealed my lab results because it would give critics ammunition to use against carb restriction. I think the jury is still out on the significance of high levels of LDL-C and LDL-P in people following a low-carbohydrate, high-fat diet. My intent is never to offend anyone, and I'm certainly not an expert in this area by any means. But I did want to be 100% honest with people about my own experience and why I wasn't comfortable with those dramatic increases in lipid values. Since writing that post, many ketogenic dieters have contacted me to report similar results and ask how concerned they should be and what they can do to get their numbers moving in the opposite direction. I'm happy to try to help in any way I can, and although I provide information about what has worked for me, I realize that people respond differently to various dietary changes. Also, there are other causes of hyperlipidemia, including major weight loss (1), as well as non-diet-related reasons, such as hypothyroidism. My follow-up NMR last June revealed improvement two months after making changes to my diet, but I didn't know if my numbers would continue to decline, stabilize, or increase over time. I've been eating a high-fiber, low-carb. lower-saturated-fat diet for about a year, and I recently decided to have another NMR (Nuclear Magnetic Resonance) spectroscopy LipoProfile done to see how things were progressing. April 2015 NMR results I'm really pleased with these results. My total LDL-P has dropped by 250 mmol/L and is now borderline-high, as is my LDL-C, which has further declined from 177 mg/dL last June. My small LDL-P has always been low, but it's now less than 90 mmol/L. Elevated LDL-C, LDL-P, Insulin, and Cardiovascular Disease Risk How important are LDL-C and LDL-P in terms of cardiovascular disease (CVD) risk? It depends who you talk to. I respect the opinions and expertise of the professionals below and believe they all provide valid arguments. I asked Dr. Thomas Dayspring to review my most recent NMR report. He feels that although my LDL-P has improved, it still places me at greater than average risk for a cardiac event. He said that given my age and the fact that I'm in the latter stages of perimenopause, I should definitely monitor this and other values and make appropriate lifestyle adjustments as needed. Also, there's no arguing that I carry a lot of cholesterol in my HDL particles as well as LDL particles, and this cholesterol is transferred back and forth between all the particles within the bloodstream. He questioned whether the excess cholesterol is due to hyperabsorption, hypersynthesis, increased lipoprotein production and lipidation, or decreased clearance. Without further testing, there's no way to know for certain. Dr. Dayspring is a very progressive lipidologist, and I highly recommend his LecturePad presentations (sign up for free, and you'll be able to access all content). In Part 1 of Have Cholesterol Measures Outlived Their Usefulness, he explains the reason oatmeal and other whole grain cereals aren't a good choice to increase fiber intake for most people, why triglyceride levels should optimally be less than 100 mg/dL, and the dangers of relying on LDL-cholesterol measurements to evaluate degree of cardiovascular risk. In Part 2, he discusses the importance of controlling insulin resistance (IR); the interplay between hyperinsulinemia, hyperleptinemia, and appetite; and the benefits of carbohydrate restriction for those with metabolic syndrome: "Dr. Atkins was right." Although in my other blog post I referred to an article where he recommended statin therapy for anyone with an LDL-C level greater than 190 mg/dL, more recently, he said: "That was written some time ago. I'd now amend that everyone with moderate to high lifetime risk for CVD events as determined by lipid/lipoproteins, family history, examination (BP, xanthomata) and smoking history - not simply LDL-C by itself." Dr. Dayspring also provides interesting information in the Cellular Regulation of Sterols lecture series, including the fact that vegans (who consume no animal products and therefore no cholesterol) absorb the same amount of cholesterol from the gut as do meat eaters and lacto-ovo vegetarians (about 55%, on average), but in their case, it's entirely biliary in nature as a result of the gallbladder releasing hepatic cholesterol into the intestine. Even in non-vegans, most of the cholesterol in the gut comes from the bile rather than the food we eat, which is why limiting egg consumption doesn't make sense as a strategy for lowering cholesterol levels. Even people who absorb more cholesterol than average ("hyper-responders") experience only mild elevations in serum cholesterol concentrations when dietary cholesterol is increased (2). Ivor Cummins is a chemical engineer known on social media sites as The Fat Emperor and is a prolific blogger on his website of the same name. He's spent a great deal of time studying and writing about the role insulin and a high-carbohydrate diet play in CVD risk. While he agrees with Dr. Dayspring that LDL-P count is important, he feels that the combination of small, dense LDL particles and high insulin levels are the root cause of coronary artery disease (CAD) (3). He also believes maintaining adequate vitamin D3 levels is crucial to cardiovascular health, and I've recently seen him advise people with genetic defects (such as ApoE4) and very elevated LDL-P to replace a portion of saturated fat with monounsaturated fat and long-chain omega-3 fats. In addition to blog posts, he has several great videotaped lectures on his website, including "The Cholesterol Cunundrum." Dr. Peter Attia is a very-low-carbohydrate, ketogenic diet proponent who believes that elevated LDL-P values warrant dietary modification, including reduction in saturated fatty acid (SFA) intake. In a recent blog post, he describes a patient whose LDL-P dropped from 3500 to 1300 as a result of cutting saturated fat intake down to 25 grams per day while remaining on a ketogenic diet. He goes on to say: "While I believe the population-based guidelines for SFA are not supported by a standard of science I consider acceptable, it does not imply I believe SFA is uniformly safe at all levels for all individuals." A few years back he wrote a 9-part series of blog posts entitled The Straight Dope on Cholesterol, which received a lot of attention and great feedback. Unfortunately, I've only read the first 2 parts at this point, but I'm hoping to read the entire series soon. Dr. Spencer Nadolskey is a family physician who promotes a whole foods diet and healthy lifestyle. He's recently done some experimenting with different diets (low-carb and vegan) and reported the changes in his biomarkers with each. He has a very balanced and moderate approach to health and wellness, recognizing the importance of taking people's preferences and individual responses into account when making dietary recommendations. As I said in my original blog post, most people who follow a low-carbohydrate, high-fat diet don't experience significant elevations in lipids as I did, although it's estimated that at least 25% do. In fact, Dr. Attia states in the blog post I linked to above that even when he was consuming 40% of his calories as saturated fat while following a very-high-calorie ketogenic diet, his biomarkers actually improved. Increased vs. Decreased Risk for Cardiovascular Disease ApoE genotype Apolipoprotein (Apo) E is a regulator of plasma lipid levels. I have two copies of the ApoE3 gene (3,3), which carries a low risk for atherosclerosis and cognitive disorders including Alzheimer's disease (4). Those with the ApoE4 genoptye, who often have elevated cholesterol levels and are at increased risk for developing CAD, dementia, and other diseases, may find the ApoE4 Forums Heart Disease Discussion helpful for information and support. Family history Regardless of genetic markers, a strong family history of heart disease is another risk factor for a cardiac event. Allthough I don't have the ApoE4 genotype or familial hypercholesterolemia (FH), several of my family members have had CAD. My mom, who has stable atherosclerosis, has been on a low-dose statin for over 10 years. She is thin, active, and has never had any markers of insulin resistance (her lipid profile is remarkably similar to my own), although she was a long-term smoker before quitting eight years ago. BMI and waist-to-hip ratio (WHR) My BMI is 19 (under 23 is optimal), and my WHR is 0.7 (less than 0.8 is optimal for women in terms of cardiac risk). LDL-P Larger particles are generally considered less atherogenic than small, dense particles. I have very low small LDL-P and borderline-high LDL-P. While some would argue that my large LDL-P poses no concern, it's still higher than what's considered optimal. Also, in a study published after my initial blog post, large numbers of small and large LDL particles were both associated with increased CVD risk when compared with medium LDL particles (5). In addition, the MESA study researchers, who investigated CAD risk in more than 5000 people, reported this finding regarding carotid intima thickness (CIMT or IMT), a measure of subclinical atherosclerosis in the walls of the artery: "Without accounting for LDL subclass correlation, small LDL and smaller LDL size were associated with IMT but large LDL was not. However, after accounting for their inverse correlation, both LDL subclasses showed highly significant and independent associations with IMT, with a greater difference in IMT per large LDL particle compared with small LDL. Smaller LDL size was no longer significant after taking into account the particle concentrations of the two LDL subclasses and risk factors. Thus, small LDL was a strong confounder of the association of large LDL with subclinical atherosclerosis, which may explain the widely-held view that larger LDL size is less atherogenic (6)." Triglycerides, HDL-C, and HDL-P Low fasting triglycerides, high HDL cholesterol, and a large number of HDL particles are considered cardioprotective. Fortunately, I meet the criteria for all three. However, per Dr.Dayspring, my HDL-C/HDL-P ratio of 67 suggests potential dysfunction: "In a recent study, individuals with the highest HDL-C/HDL-P ratios (>53) had a significant 1.5-fold increase risk for atherosclerosis progression compared with individuals with the lowest HDL-C/HDL-P ratio (<41) (7)." However, at this point we don't really know whether my risk is increased, and I'm comfortable with these values but will continue to monitor them. Interestingly, 4 years ago, when I was following a low-fat diet with at least 50% of calories from carbohydrate, my triglycerides were 55 mg/dL, and my HDL was already quite high at 79 mg/dL. I think it's safe to say that I'm not inherently insulin resistant. Insulin levels I've had fasting insulin tested three times within the past three years, and each time my level was between 1 and 2 mIU/mL, which is considered very low ("Normal" ranges from 1 to 10 mIU/mL). Researchers have known about the connection between elevated insulin levels and heart disease risk for decades (8), and Ivor Cummins has discussed this extensively on his blog and in his lectures. Fasting blood glucose, postprandial blood glucose, and A1c Elevated blood glucose, even at prediabetes levels, causes damage to endothelial cells that greatly increases CVD risk (9). My fasting blood glucose levels are consistently in the 80s, and 1-2 hours after eating, I am always under 130 mg/dL. I have an A1c every 6 months, and it has been 5.1-5.2% for the past 3 years. Prior to going low carb, my A1c was 5.6%, and my postprandial blood glucose values were routinely higher than 160 mg/dL. Age I'll be 49 this year, and as stated above, I'm transitioning into menopause, when changes in hormones, lipids, and body fat distribution increase CVD risk (10). Low-carbohydrate diets are clearly beneficial for reducing CVD risk in people with metabolic syndrome and type 2 diabetes (11). But what about people with type 1 diabetes or those like me, who don't have IR but follow a carbohydrate-restricted lifestyle for blood glucose issues, weight control, or simply because they feel better when they eat this way? My Diet I track what I eat in My Fitness Pal most days and have been doing this for over a year. While the nutritional information for the food database isn't completely accurate (as I'm sure anyone who uses it would agree), it does give a good general idea of caloric and macronutrient intake. Carbohydrates: I eat 30-45 grams of net carbohydrate per day consistently. Carb sources include nonstarchy vegetables, berries, Greek yogurt, cottage cheese, nuts, and dark chocolate. Fiber: My fiber intake is very high, roughly equal to my net carb intake. A typical day includes half a large avocado, 1 cup of blackberries or raspberries, 2-3 oz unsweetened chocolate or cocoa (more than half the carbs come from fiber), 2 Tbsp flaxseed and/or chia seeds, 3-4 oz nuts, and 4-6 cups of nonstarchy vegetables. Fiber helps lower cholesterol levels yet doesn't appear to compromise absorption of fat-soluble vitamins and other nutrients (12). Total Fat: According to My Fitness Pal data, my fat intake ranges from 80-100 grams, which is around 50-60% of my caloric intake (I'm usually between 80-90 grams). Monounsaturated fat accounts for the largest percentage, and primary sources are avocado, olives, nuts, and meat. Eating fatty fish like sardines or salmon 3-4 times a week ensures that I get plenty of long-chain omega-3 polyunsaturated fats, including docosahexaenoic acid (DHA), which is anti-inflammatory and believed to be cardioprotective (13). Saturated Fat: I don't deliberately set a limit, but I generally end up consuming 20-30 grams of saturated fat daily. Although I'm usually on the lower end of that range, this still allows for modest amounts of cheese, half-and-half, coconut oil, butter, and fatty meat. Protein: I've discovered that I feel best and most energetic with a relatively high protein intake of around 100 grams per day, which is just over 1.75 grams per kilogram body weight. Am I in ketosis? I rarely check urine ketones anymore, but when I do they're usually trace or negative. Ketosis has never been my goal (aside from the 3-month experiment I discussed in the prior blog post); keeping blood glucose levels and other biomarkers under control, looking and feeling my best, and eating a healthy, well-balanced diet are what's important to me. However, I realize that for some people, ketosis can be beneficial and desirable. Further Testing What about having Coronary Artery Calcium (CAC) scoring, a CIMT, or other tests to rule out subclinical atherosclerosis? According to Dr. Dayspring, CAC testing isn't advisable for women younger than 60, who usually get a zero score even if trouble is brewing. He believes that a CIMT can be useful if done correctly. Here are his recommendations for further testing in my case, some of which I've already had done. I plan to do the rest within the next year or so. Sterol synthesis and absorption markers Omega 3 index Inflammation markers: MPO, Lp-PLA2, hs-CRP Once per lifetime tests: ApoE, MTHFR genotypes and Lp(a) level (I'm negative for ApoE and MTHFR genotypes but haven't had Lp(a) done yet) Homocysteine (I received a score of 8 on a scale of 4-15 umol/L when last done 2 years ago) Vitamin D (50 ng/ml as of February 2015, which is considered within the optimal range) On Not Taking Sides I'm a very moderate person. I don't like confrontation and dislike the "us vs. them" mentality. It probably won't come as any surprise that I'm a registered independent and vote Democratic as often as I do Republican (and increasingly frequently for another party altogether). In addition to the experts listed above, I like and respect the diversity of opinions on this subject that have been voiced by many other knowledgeable people, whether or not they're advocates of carbohydrate restriction. It's generally agreed within the low-carb community that people have different levels of carbohydrate tolerance. So why is it considered heresy to propose that the same might be true with respect to optimal saturated fat intake? As I said earlier, I think we still don't know enough about what kind of risk elevated LDL-P and very high LDL-C carry in the setting of a very-low-carb diet where other markers improve. Because of this, I choose to eat in a way that allows me to enjoy all the benefits of carbohydrate restriction yet keeps my LDL particle number at a level I feel comfortable with. Some may think I've gone too far in making changes to my diet in order to improve my numbers; on the other hand, I'm sure there will be others who feel I haven't gone far enough, since my levels still aren't considered "optimal." I understand both points, but I have to go with my gut on this one. Ultimately, it's up to you to decide what feels right for you given what we currently know and don't know. References 1. Phinney SD, et al. The transient hypercholesterolemia of major weight loss. Am J Clin Nutr. 1991 Jun;53(6):1404-10. 2. Fernandez ML. Effects of eggs on plasma lipoproteins in healthy populations. Food Funct 2010 Nov;1(2):156-60 3. Phillips MC. Apolipoprotein E isoforms and lipoprotein metabolism. IUBMB Life. 2014 Sep;66(9):616-23 4. Lamarche B, et al. Fasting insulin and apolipoprotein B levels and low-density lipoprotein particle size as risk factors for ischemic heart disease. JAMA. 1998 Jun 24;279(24):1955-61. 5. Grammer TB, et al. Low-density lipoprotein particle diameter and mortality: the Ludwigshafen Risk and Cardiovascular Health Study. Eur Heart J. 2015 Jan 1;36(1):31-8. 6. Mora S, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007 May;192(1):211-7. 7. Qi Y, et al. Cholesterol-overloaded HDL particles are independently associated with progression of carotid atherosclerosis in a cardiovascular disease-free population: a community-based cohort study. J Am Coll Cardiol. 2015 Feb 3;65(4):355-63. 8. Després JP, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996 Apr 11;334(15);952-7. 9.Maschirow L, et al. Inflammation, coagulation, endothelial dysfunction and oxidative stress in prediabetes - Biomarkers as a possible tool for early disease detection for rural screening.2015 Mar 6. pii: S0009-9120(15)00071-5. 10. El Khoudary SR, et al. Progression Rates of Carotid Intima-media Thickness and Adventitial Diameter during the Menopausal Transition. Menopause (New York, NY). 2013;20(1):8-14. 11. Volek JS, Feinman RD.Carbohydrate restriction improves features of the Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab(Lond) 2005 ;2:31. 12. Ramprasath VR, et al. Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds. Nutrition Journal. 2014;13:101. 13. Richard D, et al. Infusion of docosahexaenoic acid protects against myocardial infarction.ProstaglandinsLeukot Essent Fatty Acids.2014 Apr;90(4):139-43.
62 Comments
Dwight Lundell M.D.
4/15/2015 10:56:40 am
Nice post and congrats for sharing your numbers. They are for the most part insignificant in terms of heart and artery health. The key is inflammation of the endothelium, the most common cause is hyperglycemia. So the most important number for heart health is Hb A1c reflecting your average blood sugar. The particle size and number is just an attempt to extend the whole cholesterol theory, which is surely being discredited. The only way cholesterol ever gets deposited in the artery wall is when it is consumed by a white cell, activated by injury to the endothelial cell layer. Ignore the lipid numbers an keep your sugar and insulin low with your current diet.
Reply
4/15/2015 11:33:47 am
Thanks very much for your comments and insight, Dr. Lundell. Appreciated!
Reply
Rakesh Patel MD
4/16/2015 12:33:31 am
I would disagree that A1C is the most important marker of heart health as we know that in non diabetics it can miss dysglycemia in over 90% of patients when compared to OGTT. 4/16/2015 12:45:16 am
Hi Rocky, 4/15/2015 01:25:26 pm
Bravo Franziska, and thank you for sharing these results.
Reply
4/15/2015 09:30:16 pm
Thanks so much for your comments and for sharing your own ideas on this subject, George. I find them both intriguing and plausible. You're one of the "knowledgeable people" I was referring to above, and I appreciate everything you bring to such discussions.
Reply
Hi Franziska,
Reply
4/15/2015 09:36:01 pm
Thank you so much for your kind words and insightful comments, as well as sharing your own experience. You're another of the "knowledgeable" ones whom I respect and learn from.
Reply
I just noticed Dwight Lundell M.D.'s comment and want to second it. He makes a fair point about "particle size and number is just an attempt to extend the whole cholesterol theory, which is surely being discredited"...look at it this way; even if LDL-p in & of itself exerts a substantial negative effect, we already know enough to say that dietary SFAs, cholesterol or CHOs can't possibly explain much of it. It brings us back at square 1 to explain (hypothetically) why LDL-p has this (supposed) effect - we'd still want to look at endothelial status, mitochondrial processing, membrane composition, gaseous exchange effects (like NO) etc.,
Reply
4/15/2015 09:38:00 pm
Thanks for the additional interesting comments -- much food for thought there! :)
Reply
4/15/2015 08:25:37 pm
Thanks Franziska for this great summary. Your approach is balanced and informative as always.
Reply
4/15/2015 09:40:54 pm
Thank you very much, Axel! I believe you were the first one I contacted one year ago to help me interpret my results. I appreciate your continued support and enjoy your writings.
Reply
Vicky
4/15/2015 09:44:10 pm
Excellent post! I am a nurse and follow the research very closely. I agree, you have to be objective and not take sides on these issues.
Reply
Thank you for your kind words Franziska, it means a lot coming from you.
Reply
4/15/2015 10:13:53 pm
Appreciate you raising these points, Raphi. Very intriguing!
Reply
4/15/2015 11:21:19 pm
Hi Franziska as always an interesting and thought provoking post.
Reply
4/16/2015 12:01:08 am
Thanks for your comments, Eddie. Appreciate you sharing your point of view.
Reply
4/16/2015 02:08:21 am
I forgot to address the last quote about abandoning LDL targets. It's because the new guidelines call for statin treatment for all people age 40 and over who have diabetes, regardless of LDL levels:
Reply
4/16/2015 02:39:29 am
Thanks for clarifying that point Franziska.
Reply
Charles Grashow
4/16/2015 08:58:37 am
"I think the jury is still out on the significance of high levels of LDL-C and LDL-P in people following a low-carbohydrate, high-fat diet."
Reply
4/16/2015 09:28:42 am
Hi Charles,
Reply
4/16/2015 11:25:28 am
This is true. There is simply no epidemiology of cardiovascular risk in populations with very low triglycerides. If you look at this study, the lowest TG measurement is over 88.5 mg/dL, or 1 mmol/L. 4/16/2015 11:49:37 am
Thanks so much for your comments and all the links, George. I wasn't aware of several of these associations. Very much appreciated. I feel even better about my numbers now.
Marc Rouleau
4/24/2015 03:48:32 pm
George, thanks for sharing the study linking elevated triglyceride levels to heart disease and death risk levels. For those who may not have clicked through to review the study directly, I want to highlight two points: 4/28/2015 08:53:59 am
Thanks for spotting that Marc. I'll revisit that paper. So that's the lowest cut-off (not measure, d'oh!) and they're non-fasting. 4/16/2015 03:59:20 pm
Interesting post. I see a lot of lipid panels with the athletes I work with and the elevated total cholesterol is common and not unhealthy because the more critical markers like triglycerides, HbA1c, ratios, VLDL etc. are better than ideal. I also make sure their Vitamin D status is where it should be and they are actively supplementing with Magnesium. Stephen Phinney, Jeff Volek and Bev Teter are some of the researchers whom I communicate with on a regular basis. Bev can tell you that a female who is practicing carbohydrate restriction and has high total cholesterol is probably healthier...you can see her here: http://www.cbn.com/cbnnews/healthscience/2013/february/forget-cholesterol-inflammations-the-real-enemy/
Reply
Hi, Franziska - I run a very low-key blog on the Science of Nutrition, Obesity and Diabetes and I want to commend you for being brave enough to post your test results online. I would also like to give you some food for thought. :)
Reply
4/17/2015 09:10:01 am
Thank you so much for commenting here and for sharing your own story as well. Congratulations on losing over 100 pounds and learning to manage your symptoms!. I'd not heard of this variant of metabolic syndrome before, and it's very interesting.
Reply
Gerri
4/19/2015 12:01:17 pm
Please provide references for further research on MSXX. Thanks.
Reply
Gerri
4/18/2015 06:06:54 pm
Though way out of my league with the knowledgeable comments above, I want to thank you for taking on another tough topic & presenting thoroughly researched & fair-handed info. I'm going to take a Rip Van Winkle nap & awaken when the jury has reached a conclusion.
Reply
4/19/2015 12:18:22 am
Thanks so much for the nice feedback, Gerri. Appreciate your continued support.
Reply
Marc Rouleau
4/21/2015 09:42:03 am
Thanks for the update of your results as well as the analysis and commentary - very helpful.
Reply
4/22/2015 10:28:36 pm
Thanks so much for taking the time to read and comment, Marc.
Reply
kelly
4/22/2015 03:05:17 am
Can you explain the math behind the HDL-C/HDL-P ratio? I'm having a hard time with that... 96/36 = 2.66? Sorry, I'm missing something..
Reply
4/22/2015 10:37:02 pm
You have to convert from mg/dL to mmol/L. I apologize for not doing that. HDL-C = 96 mg/dL = 2.5 mmol/L . HDL-P = 36.8 umol/L. The ratio is 67.
Reply
kelly
4/23/2015 01:56:55 am
Ahhh, nice thank you for the explanation on how to get that ratio.. 4/23/2015 10:36:57 pm
Thank you so much for all of your insightful comments. Agree strongly with all of your points. It's so hard to keep saying, "We're not sure" and "I don't know." People often want definitive answers and tend to place trust in those who argue their positions most vociferously without acknowledging that they may be wrong.
Reply
Wenchypoo
4/25/2015 04:46:55 am
I'm not a scientist or anything--just a practicing LCHFer with a question. My own LDL numbers have been rising from NMR to NMR, and I wonder if I (or you, or both) could have some sort of saturated fat intolerance? IS there such a thing as a saturated fat intolerance?
Reply
4/27/2015 11:19:14 pm
I wouldn't call it a saturated fat intolerance, as that would indicate you're unable to eat any amount (i.e., lactose intolerance, celiac intolerance). I'd say it's just a response to increased saturated fat intake that occurs in a sizable minority of the population who eat LCHF.
Reply
4/28/2015 09:12:08 am
My LDL is usually high on any diet, 5-6, but with all other risk factors minimal (BP, ECG, BMI, HDL, TG, CRP, HbA1c, FPG) I'm fine with that usually. 4/28/2015 10:48:27 pm
Thanks so much for reporting back on the results of your experiment, George. Sorry to hear that your LDL-C increased rather than declined, as you'd hoped. Agree that HDL-C and TG improve almost across the board with LCHF, while the LDL-C response is anyone's guess.
Reply
George Henderson
8/5/2015 01:18:04 pm
Hi Franziska,
Reply
8/5/2015 10:39:32 pm
Hello George,
Martha
1/20/2016 07:07:09 am
I have been following a ketogenic diet for about four months. ("low carb"/New Atkins before) I wanted to lose about 20 pounds that had crept up over the 5 years of menopause, I am now post-menopausal, and I have mild hypertension. The diet has been wonderful. I feel great, huge amount of energy, sleeping well, etc. I exercise quite a bit; marathoner and Pilates and have been able to run half marathons without carb loading. I had lost 10 pounds and about October decided to do a modified egg fast to lose the last 10. I had my labs checked the second week of January and was a bit dismayed: Total chol: 322, total LDL 168, triglycerides 80 and HDL138. Three years ago, my HDL was 153 and TG only 43 with LDL 133. I'm going to get NMR to differentiate the LDL, but I'm wondering your opinion of the benefit of HDL so high. I mean, is it a case of diminishing returns?
Reply
1/20/2016 09:44:28 am
Hi Martha,
Reply
Nas
3/22/2016 12:44:26 pm
Thank you so much for this update Franziska, it's really helpful :)
Reply
Eliza
6/6/2016 11:10:02 am
Franziska,
Reply
6/6/2016 12:26:30 pm
Thanks so much for your kind words of support and for sharing your story, Eliza. I'm so sorry you've been struggling with weight gain even though you've been following a healthy LC diet. That's extremely common in women during and after the menopausal transition. I hope your new healthcare practitioner can provide helpful guidance.
Reply
Diane Schneider
12/6/2016 04:43:56 pm
Hi Franziska, I am having somewhat the same reaction to a LCHF diet that you did. I have been watching your two blog posts for awhile hoping for another update. Have you checked your particle number again since you wrote this post? I am very curious if the lower saturated fat has worked for you. So far I have checked mine twice with lower sat. fat and it has gone up instead of down but I think I may have had some carb confounders. I am preparing to try again, hopefully without any confounders.
Reply
12/6/2016 05:34:20 pm
Hi Diane,
Reply
8/4/2017 09:36:28 am
I'm 78 and just lost 32 lbs on keto in 4 months (214 to 182). I'm a retired legal federal appeals research specialist, and really appreciate your non biased approach to understanding increased LDL cholesterol levels on keto. I'm responding as there is little info about seniors on keto anywhere, and thus this may offer some insight.
Reply
8/6/2017 06:37:22 am
Hi Mike,
Reply
Mike
1/21/2018 08:52:27 am
Thanks for this post - I have incorporated chia seeds, walnuts, spirulina and turned over to leaner sources of meat to reduce my LDL-p and it worked!
Reply
Thanks so much for your comments and for sharing the strategies that helped you lower your LDL-P, Mike! Sounds like you have a very healthy low-carb lifestyle. I'm eating pretty much the same as outlined in this post, albeit with more walnuts and flaxseed over the past year or two.
Reply
Robert Whigham
3/18/2018 10:40:58 am
After several years low-insulinogenic and time-restricted eating I started having high LDL cholesterol. I suspect the cause is Reverse T3. (rT3). rT3 is considered metabolic inert by nearly all medical professionals with few exceptions like Dr Westin Child. rT3 may not enter cells like T3, but can replace T3 on liver cell LDL receptors disabling those receptors causing LDL-C to soar. Per Dr Child rT3 rises during infection and starvation to fight infection and to conserve energy. Various diets are known to increase rT3 over time. It would be interesting to know the rT3 status of all low-carbers with high LDL-C.
Reply
3/18/2018 12:44:24 pm
Thanks for your comments, Robert. Your premise is interesting, although my own rT3 is actually very low and has been for several years. However, it's possible that other people who follow a low-carb way of eating may have elevated rT3 levels.
Reply
3/18/2018 02:11:18 pm
That is interesting; we have to ask what the purpose of such an adaptation to reduced carbohydrate intake could be.
Sheryl
5/19/2018 02:09:46 pm
Wow, this has been one wonderful post. Your honesty is beyond amazing, and speaks much for your character. Reading this, I thought back to my teenage years in the early 70’s, when I experimented for a short time with the then new Atkins diet, and borrowed his first cookbook from the library. I remember the chapter on him recommending low saturated fats for high cholesterol, because heart disease ran in my family. Maybe he wasn’t too far off base back then.
Reply
Lisa K
6/25/2019 04:50:11 am
Thank you for this wonderful blog! I am in the same boat and following your journey! I love the info and also the references to various thinkers in the field. I will look for updates. Thank you for taking the time to provide this information. It's so valuable!
Reply
Your comment will be posted after it is approved.
Leave a Reply. |
Author
Franziska Spritzler, RD, CDE Categories
All
Archives
July 2019
|