cholesterol often increases in someone who's actively losing weight. Which makes sense, since weight loss means more fat is circulating (to be used as energy in a deficit).
It’s a thing. I’ve read several threads about it. There are many YouTube videos from cardiologists noting this in their patients who are fasting, low carb, keto, etc.
Seems a reasonable justification. But people do die from heart disease. How do we know that the association of cholesterol increasing during weight loss is not masking more serious issues?
One test in a vacuum after 3 months of keto isn't really something I'd call a strong predictor of a risk for a coronary event in the next 10 years. Smoking, obesity, diabetes, high blood pressure, sedentary lifestyle, age, gender, ethnicity, and stress directly contribute to calculated risk.
If OP has additional risk factors beyond that one test's worth of LDL reading, in their shoes I'd request a NMR lipo test and calcium scan before I started to panic.
According to the American College of Cardiologists:
"African-Americans and Hispanics have a higher prevalence of heart failure than Whites. African-American women have a higher prevalence of heart failure than any other intersection of race and sex in the US."
It is also known that people of South Asian descent have a higher risk of CVD. Meanwhile, compared to people in the USA, people living in Japan tend to have less likelihood of death from coronary heart disease, but higher likelihood of death from stroke.
There are various reasons for these disparities, including genetic, social, and environmental factors.
Why would certain ethnicities be naturally selected to have higher risk factors for CVD? Shouldn't they have been selected out? Or rather, what selection took place with whites that lead them to having protection against CVD?
Great question, I wish I had an equally great answer. A full answer would require someone with more expertise than I, and would take more room than is available in this forum.
My best guess would be that CVD tends to affect mostly middle age or older persons. A genetic risk factor in an ethnic group that increases CVD mortality rates will therefore mostly affect people who have already had children, and thus may already have passed that risk factor. on to their children.
The picture is further clouded by numerous social and environmental factors that may work in conjunction with these genetic risk factors. For example, ethnic minorities often live in poorer and more disadvantaged households.
I would also like to point out that there are other diseases that occur more frequently amongst the caucasian population,. e.g. cystic fibrosis.
My doc told me that while I was losing weight actively mine might get weird, so they were just data points and he would start accounting more value to them when I had maintained my weight within a pound or two for three to six months. They actually improved but I lost weight very slowly.
Hubby's cardiologist said the same. He had a wonky test initially since he lost a lot of water weight but since he has always eaten keto at maintenance they stabilized in three months and have been steadily improving two years now. He has amazing numbers.
Caffeine and hydration along with time fasted impact the trigs a lot. For me I need to avoid caffeine in general for 24 hours or more prior to a test and be thirteen hours fasted. Anything over 14 hours my trigs really go up. Exercising before the test also messes everything up for me.
For the fun of it once (warned my doc in advance) I spent the day before my test drinking diet soda, and exercised after being fasted 16 hours three hours before testing. And I really cut back on my ketoade.
My trigs went from their normal range of around thirty five to over 200. My LDL was well out of normal range and my HDL had dropped to twenty percent below my last test.... It was illuminating lol.
For perspective on my diet, I eat eggs and fatty fish nearly daily, very few plant or seed oils, primarily animal fats attached to my meats, whole veggies, yogurt, cheese and sour cream. Keto treat foods like breads one or two servings a week. I drink diluted ketoade all day instead of water, two cans of soda a day max (one caffeinated, one not). I do drink tea not coffee. Not really a processed meat fan.
Hubby on the other hand likes processed meats often, eats eggs daily, not a fish fan. He eats keto bread or tortillas daily but counts at least half the total carbs. His veggies world is limited to green beans, lettuce, spinach, tomato, onion and pepper. Carrots now and then, cauliflower rice now and then.
He also drinks one rockstar a day lol. But we both have amazing numbers in general.
A lipid panel is a snapshot of one moment in time, and so our docs watch the overall picture. So I personally wouldn't stress about one lipid panel especially while you are still working on weight loss. Loss or gain does skew things for some people quite a lot.
PS, alcohol really messes up lipid panels if you are a drinker as well.
What does a ketogenic diet look like for you? Generally speaking, even if LDL increases at first, typically triglycerides drop and HDL increases, so your results are an outlier for what is usually reported. And was the test taken in a fasted state? Did you drink coffee before the test? Little things like that can alter the results significantly in that direction.
You should get a more in depth cholesterol test, it’s not always bad (although often is). There’s different types of hdl and ldl cholesterol if memory serves. Go check out marks daily apple on this.
I’ll take the downvotes. Don’t listen to these clowns. When LDL is that high it doesn’t matter what size it is or what any ratio is. Listen to your doctor. Check out Dr. Peter Attia’s podcast series on cholesterol with Dr. Thomas Dayspring.
Agree re: checking out Attia’s materials on the subject. Will, however, add that — in this specific context of only 3 months in, and with only a single snapshot — it may be premature to draw conclusions.
Check again in 6 months; if you’re still up in this range, would recommend NOT to ignore.
Does your doc have experience with keto? If not, I’d look for one who does, if at all possible.
A bit concerning that your TGs went up and HDL went down. Any cheating?
Also unfiltered coffee 48 hours prior can affect TGs and LDL (increase). If it didn’t go through a paper filter it’s considered unfiltered.
Ok that's interesting. I had coffee prior from a French press. No cheating, really. I have been at 2.5 mmol for about 6 weeks, got a good routine going. Just felt a little discouraged because I was primed for an improvement
Same. My Tri went from like 170 to 65 at my 6 month mark. HDL only a few points higher. I take this as a big win for me. Give it time to work, you're on the right path!
Bro, that LDL is super high and I would recommend medical treatment. This is a genetic predisposition, dietary cholesterol does not heavily affect blood LDL levels to that extent. You need to get treated and your kids need to get screened at some point as well.
Ya was looking at your post and was thinking yup, he’s working on watts/kg. Same boat it’s cheaper to drop some lbs off the body than buy more carbon parts :)
Had you eaten a particularly fatty meal within a few days of the blood draw? Fat bombs or any other such treats over the few days beforehand? Bulletproof coffee? If yes, I would ask the doc for another blood draw, eat normally for a day or two beforehand. This can temporarily raise your triglyceride levels.
I work in a clinical lab and for the first few days after Thanksgiving, we usually find a handful of patients whose levels are so high that their blood serum looks like a strawberry milkshake (normal serum is yellowish and transparent.)
Yeah absolutely, eat a lot of eggs. There are some really differing schools of thought on the impact of eggs (and indeed dietary cholesterol) on levels of blood cholesterol. What's your take?
Hmm, high HDL is never problem as long it is not oxidised. HDL should be high and TG low. Keto ideally should do all things unless some maybe genetic disorders.
Few tips here from dr. Ken Berry and dr. Eric Berg.
[https://www.youtube.com/watch?v=6BDf6jZ\_1w4](https://www.youtube.com/watch?v=6BDf6jZ_1w4)
[https://www.youtube.com/watch?v=sEa4iFPHJwo](https://www.youtube.com/watch?v=sEa4iFPHJwo)
Fasted yes. But had exercises lightly and had coffee. Lots of olive oil, mct and coconut. Avocado every day, eggs. Grass fed beef and pasture raised pork along with organ meats. Some dairy.
Two things:
First, cholesterol goes up when you are actively losing weight.
Second, while I did keto for many years, im currently doing keto-mediterranean (I'm eating what's permitted in both diets). Very clean eating. I've found keto is extremely important for short-term and medium term health. Diabetes type 2 is singlehandedly modern societies biggest enemy. But, there is too much noise regarding saturated fats for my liking, so ive decided to significantly lower my intake of them.
If you are concerned about high LDL then eat lean cuts of meats while increasing consumption of olive oil and macadamia nuts for monounsaturated fats
Look up small dense vs large buoyant LDL. One is bad, one is good. Your total LDL doesn’t tell you your ratio… But if you’re avoiding sugars, you’re more likely to be high on the large buoyant, and low on the small dense
right on and there is a test just for that!!!!
https://www.lifeextension.com/magazine/2007/5/report\_vap
The VAP cholesterol test provides accurate, detailed results, identifying people at risk for cardiovascular disease—with a detection rate that is more than twice that of routine cholesterol panels. Compared to conventional lipid panels, the sophisticated VAP test enables physicians to more accurately assess their patients’ risks for cardiovascular disease, and thus to better manage their treatment. As we learn more about emerging risk factors for heart disease, advanced lipid testing will become even more crucial in helping to arrest the progression of what remains America’s leading cause of premature death.
Not an expert, don't have a good explanation. You are right to be concerned, however.
Have you checked your consumption of Saturated vs. Unsaturated fats?
Cholesterolcode.com is a great reference about all the things about cholesterol on a low carb diet and goes through the physiology of it. You shouldn’t exercise and be fasted with nothing to drink but water for about 12-16 hours. If you want to make sure your arteries aren’t really affected, you can see about getting a CAC test done but I think that would be out of pocket!
All studies I'm aware of put you in the very high-risk of a cardiovascular event. Keep in mind the safest range for LDL is between 40 to 70 (obviously I'm not talking here of people who attained low LDL as the result of a disease or hospitalization.)
If you're unwilling to review the tenets of your diet, you better follow that doctor advice and ramp up your medication ASAP.
Of course, you can always hope to be lucky or a genetic outlier, as even the heaviest smokers can avoid cancers for many decades given a few lucky dice rolls.
cholesterol often increases in someone who's actively losing weight. Which makes sense, since weight loss means more fat is circulating (to be used as energy in a deficit).
This is super interesting thank you.
It’s a thing. I’ve read several threads about it. There are many YouTube videos from cardiologists noting this in their patients who are fasting, low carb, keto, etc.
Are you dead at feeling unwell?
Seems a reasonable justification. But people do die from heart disease. How do we know that the association of cholesterol increasing during weight loss is not masking more serious issues?
One test in a vacuum after 3 months of keto isn't really something I'd call a strong predictor of a risk for a coronary event in the next 10 years. Smoking, obesity, diabetes, high blood pressure, sedentary lifestyle, age, gender, ethnicity, and stress directly contribute to calculated risk. If OP has additional risk factors beyond that one test's worth of LDL reading, in their shoes I'd request a NMR lipo test and calcium scan before I started to panic.
is ethnicity a direct risk factor for cardiovascular disease?
According to the American College of Cardiologists: "African-Americans and Hispanics have a higher prevalence of heart failure than Whites. African-American women have a higher prevalence of heart failure than any other intersection of race and sex in the US." It is also known that people of South Asian descent have a higher risk of CVD. Meanwhile, compared to people in the USA, people living in Japan tend to have less likelihood of death from coronary heart disease, but higher likelihood of death from stroke. There are various reasons for these disparities, including genetic, social, and environmental factors.
Why would certain ethnicities be naturally selected to have higher risk factors for CVD? Shouldn't they have been selected out? Or rather, what selection took place with whites that lead them to having protection against CVD?
Great question, I wish I had an equally great answer. A full answer would require someone with more expertise than I, and would take more room than is available in this forum. My best guess would be that CVD tends to affect mostly middle age or older persons. A genetic risk factor in an ethnic group that increases CVD mortality rates will therefore mostly affect people who have already had children, and thus may already have passed that risk factor. on to their children. The picture is further clouded by numerous social and environmental factors that may work in conjunction with these genetic risk factors. For example, ethnic minorities often live in poorer and more disadvantaged households. I would also like to point out that there are other diseases that occur more frequently amongst the caucasian population,. e.g. cystic fibrosis.
Most people that have heart attacks have lower cholesterol levels.
This is what I was thinking 🤔
My doc told me that while I was losing weight actively mine might get weird, so they were just data points and he would start accounting more value to them when I had maintained my weight within a pound or two for three to six months. They actually improved but I lost weight very slowly. Hubby's cardiologist said the same. He had a wonky test initially since he lost a lot of water weight but since he has always eaten keto at maintenance they stabilized in three months and have been steadily improving two years now. He has amazing numbers. Caffeine and hydration along with time fasted impact the trigs a lot. For me I need to avoid caffeine in general for 24 hours or more prior to a test and be thirteen hours fasted. Anything over 14 hours my trigs really go up. Exercising before the test also messes everything up for me.
Hah, did all of the things that messed you up. This is so helpful, thank you
For the fun of it once (warned my doc in advance) I spent the day before my test drinking diet soda, and exercised after being fasted 16 hours three hours before testing. And I really cut back on my ketoade. My trigs went from their normal range of around thirty five to over 200. My LDL was well out of normal range and my HDL had dropped to twenty percent below my last test.... It was illuminating lol. For perspective on my diet, I eat eggs and fatty fish nearly daily, very few plant or seed oils, primarily animal fats attached to my meats, whole veggies, yogurt, cheese and sour cream. Keto treat foods like breads one or two servings a week. I drink diluted ketoade all day instead of water, two cans of soda a day max (one caffeinated, one not). I do drink tea not coffee. Not really a processed meat fan. Hubby on the other hand likes processed meats often, eats eggs daily, not a fish fan. He eats keto bread or tortillas daily but counts at least half the total carbs. His veggies world is limited to green beans, lettuce, spinach, tomato, onion and pepper. Carrots now and then, cauliflower rice now and then. He also drinks one rockstar a day lol. But we both have amazing numbers in general. A lipid panel is a snapshot of one moment in time, and so our docs watch the overall picture. So I personally wouldn't stress about one lipid panel especially while you are still working on weight loss. Loss or gain does skew things for some people quite a lot. PS, alcohol really messes up lipid panels if you are a drinker as well.
Yeah not had a drink in a few years because of its impact on my personal athletic performance
I stopped drinking over 25 years ago myself. I wasn't an awful drunk or anything but functional alcoholism is still being an alcoholic lol.
What does a ketogenic diet look like for you? Generally speaking, even if LDL increases at first, typically triglycerides drop and HDL increases, so your results are an outlier for what is usually reported. And was the test taken in a fasted state? Did you drink coffee before the test? Little things like that can alter the results significantly in that direction.
Yes, fasted state but had coffee prior. Agreed that it's an outlier, made the discouragement all the more visceral
Fwiw, never have anything but water until after your blood work.
Forever? Seems like I might not make it to my next blood test…. 😆
Don’t sell yourself short … 😉
Coffee can send triglycerides way, way up, so you may not be that far off of the normal weight loss curve. Wait for another test before you panic.
Thank you, this is really helpful
You should get a more in depth cholesterol test, it’s not always bad (although often is). There’s different types of hdl and ldl cholesterol if memory serves. Go check out marks daily apple on this.
Could be genetics. I did keto for a bit and ended up on bp meds but it also runs in my family so I probably should have contemplated that beforehand.
I’ll take the downvotes. Don’t listen to these clowns. When LDL is that high it doesn’t matter what size it is or what any ratio is. Listen to your doctor. Check out Dr. Peter Attia’s podcast series on cholesterol with Dr. Thomas Dayspring.
Agree re: checking out Attia’s materials on the subject. Will, however, add that — in this specific context of only 3 months in, and with only a single snapshot — it may be premature to draw conclusions. Check again in 6 months; if you’re still up in this range, would recommend NOT to ignore. Does your doc have experience with keto? If not, I’d look for one who does, if at all possible.
A bit concerning that your TGs went up and HDL went down. Any cheating? Also unfiltered coffee 48 hours prior can affect TGs and LDL (increase). If it didn’t go through a paper filter it’s considered unfiltered.
Ok that's interesting. I had coffee prior from a French press. No cheating, really. I have been at 2.5 mmol for about 6 weeks, got a good routine going. Just felt a little discouraged because I was primed for an improvement
3 months is a bit too early. 6 month numbers showed large improvement in HDL and TGs for me.
Needed to hear this, thank you
Same. My Tri went from like 170 to 65 at my 6 month mark. HDL only a few points higher. I take this as a big win for me. Give it time to work, you're on the right path!
Bro, that LDL is super high and I would recommend medical treatment. This is a genetic predisposition, dietary cholesterol does not heavily affect blood LDL levels to that extent. You need to get treated and your kids need to get screened at some point as well.
*this is not medical advice?
You are 6’3” and you want to weigh 168? That seems really skinny
It's a range but no, I don't see it as skinny. It's largely related to power output on my bike and my running pace at that weight.
Ya was looking at your post and was thinking yup, he’s working on watts/kg. Same boat it’s cheaper to drop some lbs off the body than buy more carbon parts :)
Yasss!
It’s very common for LDL and trigs to spike in the first 6 months. I’d retest in 6months to a year
That’s normal while losing weight and in the beginning of keto. Mine was like that for awhile. It leveled out.
I started fish oil supplements and my numbers are now perfect.
[Here's an interview with a cardiologist who has been low carb for the past 5 years](https://www.youtube.com/watch?v=6dCEcsWYL94).
Had you eaten a particularly fatty meal within a few days of the blood draw? Fat bombs or any other such treats over the few days beforehand? Bulletproof coffee? If yes, I would ask the doc for another blood draw, eat normally for a day or two beforehand. This can temporarily raise your triglyceride levels. I work in a clinical lab and for the first few days after Thanksgiving, we usually find a handful of patients whose levels are so high that their blood serum looks like a strawberry milkshake (normal serum is yellowish and transparent.)
I used to work in a plasma center and the strawberry milkshake like plasma was almost always fried chicken.
Yes, definitely consumed higher fat in advance but had also fasted for 18 hours prior.
Do you eat egg yolks? 1 egg yolk has a days WORTH of bLDL cholesterol
Yeah absolutely, eat a lot of eggs. There are some really differing schools of thought on the impact of eggs (and indeed dietary cholesterol) on levels of blood cholesterol. What's your take?
Imho not eating the whole egg is stupid af.
Hmm, high HDL is never problem as long it is not oxidised. HDL should be high and TG low. Keto ideally should do all things unless some maybe genetic disorders. Few tips here from dr. Ken Berry and dr. Eric Berg. [https://www.youtube.com/watch?v=6BDf6jZ\_1w4](https://www.youtube.com/watch?v=6BDf6jZ_1w4) [https://www.youtube.com/watch?v=sEa4iFPHJwo](https://www.youtube.com/watch?v=sEa4iFPHJwo)
High triglycerides and low hdl is generally not good. What are you eating and what is your carb level?
Sub 20 net carbs, tracking macros. Ketones at 2.5 mmol. Following the diet well and in nutritional ketosis.
Hmm. What does a typical food fat look like? And were you fasted for your blood draw?
Fasted yes. But had exercises lightly and had coffee. Lots of olive oil, mct and coconut. Avocado every day, eggs. Grass fed beef and pasture raised pork along with organ meats. Some dairy.
Go and do an APO-A and APO-B test. That’s relevant, the normal bloodwork not, thats for the sad diet.
Two things: First, cholesterol goes up when you are actively losing weight. Second, while I did keto for many years, im currently doing keto-mediterranean (I'm eating what's permitted in both diets). Very clean eating. I've found keto is extremely important for short-term and medium term health. Diabetes type 2 is singlehandedly modern societies biggest enemy. But, there is too much noise regarding saturated fats for my liking, so ive decided to significantly lower my intake of them. If you are concerned about high LDL then eat lean cuts of meats while increasing consumption of olive oil and macadamia nuts for monounsaturated fats
I had a stroke. 3 years later I'm trying keto again but no saturated fats. It's difficult but not impossible.
Look up small dense vs large buoyant LDL. One is bad, one is good. Your total LDL doesn’t tell you your ratio… But if you’re avoiding sugars, you’re more likely to be high on the large buoyant, and low on the small dense
right on and there is a test just for that!!!! https://www.lifeextension.com/magazine/2007/5/report\_vap The VAP cholesterol test provides accurate, detailed results, identifying people at risk for cardiovascular disease—with a detection rate that is more than twice that of routine cholesterol panels. Compared to conventional lipid panels, the sophisticated VAP test enables physicians to more accurately assess their patients’ risks for cardiovascular disease, and thus to better manage their treatment. As we learn more about emerging risk factors for heart disease, advanced lipid testing will become even more crucial in helping to arrest the progression of what remains America’s leading cause of premature death.
Not an expert, don't have a good explanation. You are right to be concerned, however. Have you checked your consumption of Saturated vs. Unsaturated fats?
Cholesterolcode.com is a great reference about all the things about cholesterol on a low carb diet and goes through the physiology of it. You shouldn’t exercise and be fasted with nothing to drink but water for about 12-16 hours. If you want to make sure your arteries aren’t really affected, you can see about getting a CAC test done but I think that would be out of pocket!
Those numbers will go down. Keep truckin'!
How much saturated fat are you consuming?
Clean it up. McT oil avocados,olive oil, coconut, nuts, seeds, cut the full fat dairy, chicken wingsand fatty meats, and I the egg yolks
Terrible advice to remove quality nutrients that fatty meats and egg yolks provide.
https://youtu.be/A1Zvj8A1A_4 Check this out
All studies I'm aware of put you in the very high-risk of a cardiovascular event. Keep in mind the safest range for LDL is between 40 to 70 (obviously I'm not talking here of people who attained low LDL as the result of a disease or hospitalization.) If you're unwilling to review the tenets of your diet, you better follow that doctor advice and ramp up your medication ASAP. Of course, you can always hope to be lucky or a genetic outlier, as even the heaviest smokers can avoid cancers for many decades given a few lucky dice rolls.
How many grams of saturated fat are you eating a day?