EDIT: read the latest update to this topic written 07.03.2017 here
I recently got some blood work back and I wanted to share my results in hopes that it may offer some insight to others who may find themselves at the crossroads of the ketogenic diet and high cholesterol. I have been following a low-carb high-fat diet since July and generally speaking I have been really happy with how it has impacted my body composition, athletic performance, energy and blood sugar control. I’ve written an ebook about it (specifically in relation to type 1 diabetes) and I want to be fair and share the challenges that I’m having as well. What I am presenting here is in no way advice or even a solution that I have found for myself-but rather a question that I am working through. I’ve always had elevated cholesterol (last 10 years) and I’ve always prioritized my blood sugar management over cholesterol. Simply put, there are more questions about the risks of cholesterol than the risks of elevated blood sugar, so I focus on the “devil I know”.
I got my bloodwork back and found that my total cholesterol is 383 with LDL at 292. My a1c was 6.5. Neither of these individually are what I am shooting for and both in combination are a bit more alarming. Being perfectly honest it feels like a massive failure to be back at this point of reevaluating everything again. It’s hard not to be governed by numbers but it’s not responsible to ignore them either. I declined statin medication and I was told to switch to a low fat diet high carb diet. My blood pressure was 104/84 and I typically have a resting pulse rate of about 60.
I immediately did an internet search on the keto diet correlating to elevated cholesterol and found a whole lot of conjecture. There haven’t been conclusive tests done to evaluate the risk of elevated LDL while on a ketogenic diet. It’s speculated that it’s not such a big deal if all the other markers are on-but that’s speculation and given the upward creep of my blood pressure, I am looking to make some targeted changes and see if it’s possible to resolve some of this issue.
One thing that I found in my searching was that some people experience elevated cholesterol on a ketogenic diet in response to saturated fat. This is yet another facet of the cholesterol-fat-sugar triangle that is poorly understood, but it seems like it’s a genetic factor that predetermines which people will be overly sensitive to saturated fat. Given the fact that I’ve always had pretty high cholesterol (over 200 total) regardless of my eating habits I suspect that I may be in this category.
Those of you who are reading and thinking, ‘Duh, you eat fat and your cholesterol goes up!’ should keep in mind that many people who take on a keto diet find that their cholesterol actually decreases along with cardiovascular risk-simply from increasing dietary fat while restricting carbohydrates. It seems that I don’t fit into that category though!
My next steps are roughly as follows, because I want to tweak my diet as it stands first without completely abandoning it. I have experienced enough benefits from the ketogenic diet that I don’t intend to jump ship without seeing if there is another round of adaptation that needs to take place in order to make it “fit”.
- Increase Vitamin D- I have frequently tested low for Vitamin D which plays an important role in processing cholesterol. Sitting inside in the winter probably doesn’t help much either.
- Shift away from saturated fats- To start with I am cutting out dairy and not adding massive amounts of coconut oil to everything. It’s ironic that this is going to drastically change my enjoyment of coffee! Instead, I will eat more nuts and seeds, olive oil and fish. Prior to this I was eating a LOT of cheese and heavy cream in my coffee-as well as going out of my way to add coconut oil without restraint.
- Sleep, exercise and rest adequately- per my last post about “resolutions” for the 2016 year these variables have been suffering in the last few months-getting them dialed in can only help.
- More salads- for use as an olive oil vehicle and some good low carb greens.
- Targeted saturated fat consumption- rather than staying loaded on coconut oil (bulletproof coffee anyone?) on a daily basis, I am saving “deep” ketosis for situations where I am in need of elevated athletic performance. I hypothesize that if I maintain a low carb-moderate fat diet, I should be able to elevate ketones in short order by targeted saturated fat “doses” prior to an activity. Maintaining a carb deprived state should enable my utilization of those ketones for energy without missing a beat.
The bottom line here, is that no diet is as simple as tweaking some macronutrients and then standing back and letting the magic happen. Maybe for some people it’s like that but for me it’s a bit like playing whack-a-mole. It’s a lot of problem solving. In short, I am still sticking to a low carb-high fat diet, but I am modifying the types of fat I am consuming as a first step to see if my cholesterol changes in a few months. I’ll keep watching my blood sugar and my athletic performance in the meantime to see if there is a way to make my doctors happy and to climb harder while eating foods that I like.
I’m happy to get input from anyone who has experienced similar things-type 1 or otherwise. This is a Gordian Knot and it’s going to take a lot more than my paltry pin-the-tail-on-the-donkey experimentation to unravel it in a satisfactory manner!
Support LivingVertical by purchasing one of my photographs:
UPDATE:
I am going to resume writing about this topic for a few posts at least! I have some new information and I’d like to update everyone about my experience over the last few years. This podcast episode (note mine) is VERY VERY enlightening in relationship to the topic of a ketogenic diet and high cholesterol so I strongly urge you to take a listen!
I am curious about your preference to avoid statins, as I suspect this would resolve the cholesterol and triglyceride issue while allowing you to stick with the ketogenic diet. As you probably know, most clinical research on ketogenic diets is in children, not adults with T1D, so it’s hard to know what the long-term effects, if any, there are in this group. As a female with a 30+ yr hx of T1D and a strong family hx of cardiovascular disease, I have submitted to the use of statins. I could eat kale and olive oil for the rest of my life and still have high cholesterol. Your diabetes may vary, of course. Happy New year!
Thanks Leah! I haven’t 100% ruled out statin therapy but I want to exhaust my options before I go that route. I’ve heard too many stories of side effects and more than that I just want fewer variables if possible. If it’s not possible then I’m going to do what I must but I just want to make sure I’ve tried everything else first.
But there is the problem, is your elevated cholesterol really “bad”. Or is it your bodies natural level for proper brain health and hormone generation.
That’s the $64,000 question Ernie! I am choosing to prioritize my focus on the health risk that isn’t in question and is certainly problematic if it is left uncontrolled (blood sugar) and I’m fortunate to have an endo who is working with me on trying to determine the answer to the cholesterol question too. I am going to post up in the coming weeks as I learn more.
Steve, did you get the particle test done on your cholesterol? A being the fluffy type that haven’t been shown to “harden” in the arteries vs B which are like bullets that erupt and can quickly cause a heart attack etc. Just curious. Or am I barking up the wrong tree? Thanks.
I have the paperwork, will be going to the lab next week most likely. I will post about this once I get it done!
Hi Steve,
I been finding good info.
It looks like around a 5% of people they Hiper-respond to the KETOGENIC diets and their cholesterol leves go to the roof. LDL-P counts, Type B, etc.. all the bad stuff.
Unfortunately nobody knows what is the real danger that this represent if your CRP and Homocysteine leves are low. Basically with low inflammation there is no way for a Cholesterol particle to create damage.
What Im doing is:
1- reducing my SAT FATS and do more MONO
2- INT FASTING
3- Eat Nutrient dense food and not focus on calories
I will test again to see if Im really a Hyper- Responder.
If after my test im still in the roof, I will try to modify my ratio to mabye 60% Fat. and do a Plant base diet, with some animal protein.
Jimmy Moore is also Hiper-Responder and he is fine, he did Calcium test and check his Arteries to see if there is problems and he is perfect. So this is something that we will have to figured out.
Check this research of David Feldman
What is a Hyper-Responder?
The term, “hyper-responder” has been used within the ketogenic / low carb, high fat (keto/LCHF) community to describe those who have a very dramatic increase in their cholesterol after adopting a low carb diet.
This increase can be anywhere from 50% to 100% or more of their original, pre-diet cholesterol numbers. There is quite a bit of debate as to how much or how little this affects risk for atherosclerosis and general heart disease given keto/LCHF is very anti-inflammatory. (See Research and Links)
http://cholesterolcode.com/hyper-responder-faq/
Hi Marko!
Thank you so much for sharing this info! This is encouraging-and lots of good info here!
Nice post. My LDL levels went through the roof after 3 months on a ketogenic diet. I reversed it within 2 months by going back to a 40-40-20 ratio (carbs-protein-fat). Made some monumental mistakes first time around, especially with saturated fat, so I’m trying a second time with some modifications. I am in the process of documenting all of this and will post on my own website soon. Best, Lee
Thanks for sharing this Lee! Please let us know when you have your own site up-would love to check out your results!
Hey Steve,
I’ve started posting on this subject so thought I’d share the articles with you. There’s a lot to cover so I’m doing it in stages with a view to educating my readers on the basics of the ketogenic diet, giving a bit of context etc. I haven’t posted on my cholesterol yet but should be getting round to it soon; especially keen to share my keto diet plan which caused the major spike in TC etc etc and how I reversed it within only two months. I’m currently at the tail end of another self experiment where I’ve cut down the saturated fat and replaced it with mono and polyunsaturated fats. Will be getting some blood work done in about two weeks so will be interested to see what happens.
Interestingly, replacing dairy with whole foods (avocados, nuts etc) seems to have allowed me to get even deeper into ketosis: when I first started out I was struggling to get over 1 mmol/l but not I’m hitting and maintaining 2-3 mmol/l quite easily. I’ll post the numbers, diet plan etc shortly but if you’d like to check out where I’m starting the story, please check out this link:
http://ingfit.com/from-weight-loss-to-longevity/
Also, I’m in the middle of developing a keto app so if you’re interested in getting involved you can visit this link:
http://ingfit.com/ketogenic-diet-app/
Keep in touch, love what you’re doing with this site 🙂
Thanks for sharing this Lee-it’s going to be interesting to see how this all works out! Thank you for the kind words about this site-while I’m no longer writing about my diet, I know there are others who are interested and I am interested on a personal level because optimizing my diet will only further benefit my time in the mountains.
Hi Steve, I’m 35 and have been T1 since age 6. Like you, I’ve had “high cholesterol” my whole life.
Anyway, I just want to say thank you. For reading your blog, if anything, has helped me feel less alone.
I just picked up this book and it has changed my life. My A1c is 6.2 and dropping… if you haven’t yet, give it a read.
Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars https://www.amazon.com/dp/0316182699/ref=cm_sw_r_cp_api_HBcFyb3ZDCKVE
Also, Who is your endo, as I live in MA too (Burlington) and am in search of an endo I can trust..
Thanks again Steve.
Hi Joe!
Great to hear from you! I am really excited to hear about this new development in your T1D! Dr Bernstein was my first read about low carb-the funny thing is that I had been doing almost exactly what Dr Bernstein advocates for but I hadn’t ever heard it articulated! I also learned a lot, specifically about the “why” and the “how” that had always eluded me…”how the heck does steak increase my BGs?!”
For me the big shift in terms of athletics came when I ramped up the fat. I’m really glad that you enjoy reading my blog. Feel free to reach out if you have other questions! My Endo is Amin Sabet (Brockton) and he is really really fantastic. Thank you so much for writing to me!
High BP, high cholesterol and diabetes go hand in hand, that is why our risk of heart attacks are way above normal. If you are predisposed to high cholesterol, I think you are underestimating the risks of heart disease vs seeing if you can take stating without side effects.
Personally I am.unable to take statins, but I am.able to keep my cholesterol numbers at healthy levels.
I’m very aware of the risks of cholesterol and heart disease as they relate to diabetes. The question is whether it’s better (or any different) to prioritize blood sugar control or cholesterol control, if it’s necessary to do so. The keto diet has unquestionably improved my blood sugar and much of the research I’ve seen suggests that the correlation between heart disease and high blood sugar is more detrimental than heart disease and high cholesterol. I’m still taking steps to try and bring my LDL down but I won’t do that at the expense of my blood sugar control. So far, reducing saturated fats has done really well by my blood sugar-even better than before, so I’m hopeful. We will have to see in March if any of this helps and then go from there.
Check your thyroid (if you haven’t already)! Low carb high fat is a great approach for bg management imho and I completely agree that there is a lot less clarity about high cholesterol/ hd than high bg/a1c/hd . Best of luck 🙂
Good call! I will talk to my hcp about the thyroid.
You are so interesting. I am so glad you share your experiments!
Thank you! I’m glad it’s useful!
Wow, your posts are insanely interesting! I will be back to read more very soon. Thank you for sharing your experiences and passions.
Thank you! I’ll try to keep them coming for you!
Any updates? I’m curious how you’re doing.
I’m doing great!
I experienced the same rise in cholesterol #’s due to using heavy cream and coconut oil in unlimited amounts. I don’t know if it was one or both, but I’m about to give up both.
Did you chill return to original state after stopping the BPC?
Hi Brent, I’m going to get follow up bloodwork done tomorrow actually! My endo actually thinks my cholesterol is something genetic…but he’s super thorough so he’s ordering more in depth testing to try and get to the bottom of it!
Skimmed this blog when you posted it, but am now finding myself in a similar result today after getting my latest labwork done. LDL and total cholesterol is fine, but my triglycerides and something called homocysteine were both rather high. While not “keto”, I’ve been becoming more and more LCHF over the last 6 months and suspect it may be the culprit. As far as I can tell I’ve never had my homocysteine checked, so not sure I can totally blame the recent diet changes on that.
My PCP recommended taking Vitamin B12 and folic acid and I’ll probably stop adding tons of half and half to everything. Seeing my endo tomorrow so I’m curious to hear what she’ll say.
Keep me posted Chris-I have heard cream in coffee blamed for this type of thing a lot. However I suspect it may also be genetic because dietary cholesterol/fat can’t contribute more than 15% plus or minus to blood cholesterol. I don’t fully understand the dynamics but my endo has been fully supporting my LCHF diet due to the blood glucose control that it’s giving me-and we are putting statin meds on the table if the deeper tests (cholesterol density and particle size) show concerning results. I’ve never had homocysteine checked but my trigs have always been pretty good…it’s like playing whack a mole!
Hi! I’m so glad that i came across to your story, because I’m going to similar but worst I guess, just yesterday my doc told me after seeing my blood results that was very concern for me, never seen this high cholesterol in his life, said was 750 and LDL of 600, I been doing keto for 4 months and eating a lot of fat like they say you should, but I’m wondering now I went to far with the fat intake and now I’m just scare that any moment I could have a heart attact, think if I lower my fats I could lower my cholesterol? What number of cholesterol should be ok doing keto diet? You have any advise for me after your personal experience? I’m desperate to fix this mess I’m in.thx!
Hi Cristina,
I wonder what types of fat you have been eating-if it’s possible to eat less saturated fat and more unsaturated fats. That’s one thing I’ve been trying to do. It’s unclear if that’s working at this time, but we will see in the future. There are likely other factors at work besides diet if your cholesterol is that high. Dietary fat can only do so much. Genetics and other factors can play a role. Have you had a problem like this prior to going Keto? Did you lose a lot of weight recently? There are a lot of questions here that require a bit of lab work with a doctor. As far as what number you should be shooting for, that’s a relative question. I think particle size and density are much more significant. The problem is that determining those answers require lab work and a supportive physician. Keep me posted on how this works out for you!
Hi Steve thx! For getting back to me so fast, I don’t know if u have heard of Stephanie Person well she’s the one I follow and mostly she says animal fats is what gets you in ketosis not olive oil and chicken breast or tuna, so of course I was eating egg yolks w bacon and butter, lard for cooking and adding coconut oil so overall like 200 gr minimum, grassfed ground meat cooked in butter and lard again with spinach kale and avocados 2/day, like I was eating a lot and more in the beginning cause she said we wouldn’t adapt if not taken at least 300 gr of fat so I went overboard like 400 gr fat, I started this diet to regulate my hormones naturally and be healthy I gain weight no surprise right but not a lot so I supposed was healthy weight, but still wanted to loose a couple of pounds that I know I have extra that’s why I lower to 200 gr of fat this last month I thought I was doing good even though wasn’t loosing any weight is been the same since I gain weight in the first month doing keto, but now with this high cholesterol got scare so just started with adding more olive oil, I hope is just the quantity and not the fats right? Cause I’m puzzle about this I was following exactly what Stepanie says in her videos so I don’t have any explanation why this happen to me, anyway I’m suppose to go back in 2 weeks and get more blood work cause they didn’t give me specifics about LDL particles or markers of inflammation, they just told me high cholesterol but everything else was good, so yeah I’ll keep you inform. Because I’m guessing there’s going to be more peoplle like me eventually, no? Too much fat maybe is not for everybody like we heard.
Hi Cristina- I am not familiar with Stephanie Person. I have heard that deeper ketosis is more difficult to achieve with less saturated fats-however coconut oil is saturated fat and not animal. Chicken breast and tuna are low fat and contain mostly protein. I believe there is a middle ground where reasonable levels of ketosis can be achieved through moderate protein and high fat-but with significant preference given to unsaturated fats. Olive oil, nuts, seeds and fish. I have to disagree with her assertion that you won’t adapt if you have under 300 grams of fat a day. That was not my experience at all. To me, consuming 3-400 grams of any macronutrient in isolation can lead to some imbalance. Part of what I liked about the keto diet is that I didn’t need to eat food in that sort of quantity.
Diets and how they react to our bodies are very personal. I know many people with type 1 who are on the keto diet, eat unrestricted saturated/animal fats and have great cholesterol and blood sugar. There are others of us who have adverse cholesterol reactions and so this is something we have to monitor and problem solve individually. The best answer I have is that I don’t know what will work for people in our situation but I think that a “keto-lite” version might be the best compromise. Unsaturated/plant fats with lots of leafy greens and cruciferous vegetables. Cut the dairy and cut the meat and restrict the eggs. That’s the hypothesis I am working on currently. There is no downside to this approach that I have found so far-the question is whether or not there is actually a benefit to the lipid profile…
Hi Steve!
I want to make sure I understand what u said, so I should cut saturated fats like butter, lard and coconut oil too? And eat more fish, olive oil, avocado and seed and nuts oils, cut red meat like forever? Or just for now and then reduce it later. Like the eggs not everyday I’m guessing. And leafy greens and cruciferus vegetables right.
So do I have to watch for quantity in oils or is more like the type of oils like the saturates ones that I should avoid and if this should be forever?
Are you in ketosis all the time? Eating like this? Do you think is more the reduction of carbs than the excess of fats that gets us in ketosis?
Hi Cristina- I’m not saying what you should do. I’m saying what I am trying. If it works in the short term with no major downsides then it will become permanent. I don’t know if it will work for me and if it does, that’s no guarantee of what impact it would have on you. The only thing I can say is that if you try something and it doesn’t work, try something else. That’s a personal process and needs to happen apart from what anyone else is doing or recommending. I don’t know about the quantity of oils for you. I’m not restricting my unsaturated fat. I’m simply eliminating saturated fats as much as possible. I have no idea if this will be temporary or permanent. I am not in ketosis all the time. Being in ketosis isn’t a black and white affair. There are degrees of ketosis. The deeper in ketosis you are, the more noticeable it is. To get deeper you need carbs and fat. The point of this diet for me is not getting into deep ketosis all the time but rather the health benefits of blood sugar control with energy for being active. Ketosis is a means to an end, not the end itself. For a non t1d this might be different. That’s why I don’t care if I’m in a lesser stage of ketosis because I’m eating less animal fats-if it improves my health outcome, I’m ahead of the game.
Hi Steve!
I know I’m just taking advise and of course is my decision on what to do, I’m thankful that you are chairing your journey in this, but it makes sense to me thats why I’m making changes too, and I agree like you always looking for a healthy stage, do you have any signs besides the blood work that your cholesterol was getting high because I don’t know but I notice my eye lids getting little swollen since 2 weeks ago, hope is nothing related but will see. So when is your next check up?
Thanks Cristina,
Happy to share! I haven’t had any signs of high cholesterol other than the blood work which is otherwise perfectly normal. I’m going to get more tests done in late June so we will see what happens then!
Hey Steve!
Well I’m hoping everything turns good for you since u made those important changes I’m sure it will.
Btw I just realize in something I been doing for a couple of months now I started to rub coconut oil on my skin after shower everyday and now I’m wondering if that could also added those levels of cholesterol, I don’t know you think could’ve affected? I even did it too, maybe I should stop just incase.
Thank you! I hope things work out well for you too! I don’t think topical coconut oil could be harmful to your cholesterol level though.
Thank you so much Steve
Hi, I am curious if you have had your LDL-P measured instead of your LDL-C. I need to have my yearly blood work done and if my LDL is high, I am going to press my doctor to get an LDL-P test. My PCP is affiliated with the Cleveland Clinic and they are pushing low fat/low sugar diets, but newer research seems to indicate the LDL partial size is more closely related to CVD than the LDL count is. My BP was 110/70 and my doctor was happy with that, so no BP issues from ketagenic diet heavy on fish, eggs, etc. and only some cheese and occasional home made ice cream (with only a tad of Stevia) from a dairy perspective.
Hi Doug,
I haven’t had the particle size tested yet although that’s next on my endos list. This most recent round of tests was to make sure that the original high test (around the time I wrote this blog) wasn’t a false positive. My bp has always been good and so we are hoping to figure out more in time with additional testing. We think it may be a genetic issue too. In the meantime I’m going to cut down the animal fats and skew towards unsaturated fats/fish/nuts/olive oil just to see if that changes things!
When a cardiologist wanted me to take statins back in 1999, and I wasn’t up for it (and I’m still not 17 years later), my endo sent out my blood work for the particle test. Even back then, he was and advocate of what you said, that CVD risk is more closely aligned to particle size and density. May also explain why individuals, not necessarily T1, drop dead from a heart attack with perfectly normal lipid profiles. JMHO.
That makes a lot of sense Deb. I am looking forward to getting the tests done and then circling back with you!
Hi Steve,
Nice post! I’m in a very similar position having tested super high for LDL after about 5 months on a ketogenic diet.
I’ve been studying the work of Dr Peter Attia who puts a very different spin on how much of an issue high LDL is. Apparently it’s the ratio between total C and LDL, and/or LDL and TG which are the key markers; all of which were really good for me.
That said, I’ve also heard the same guy suggest that anyone with LDL over 200 is a candidate for statins: mine was 200 with TC 302 so my alarm bells started ringing.
Also, not sure if you’re familiar with the work of Dr Rhonda Patrick but she has suggested that there’s a link between the Apo4 gene and the bodies inability to metabolise saturated fat thus increasing LDL levels.
Anyway, my conclusion over the last few months of quite intensive research is that the whole thing is a mine field of confusion and nothing is conclusive. As such, I decided to come off a ketogenic diet, reintroducing some carbs, getting back to a 40/40/20 macro ratio which has always kept my C levels down.
I was toying with the idea of reducing saturated fat like you’re doing but decided against it. I would be very keen to hear about your next results to see if there has been an improvement.
All the best, Lee
Thanks Lee!
Im happy that my endo seems to have some knowledge of what you referenced from Peter Attia. He’s also said that he plans to do some genetic testing for the Apo4 gene. I definitely agree about the minefield of confusion! I am going to keep going like this for a while anyhow until all the testing is done and we determine if it’s the dietary cholesterol or saturated fat that is really creating the problem-or if need be I will come off the keto and do something similar to what you mention. I have a hard time letting go of the keto because of the athletic benefit, but I suspect that it’s possible to linger on the borders of ketosis and drop in during some sort of harder performance and then pull back when it’s not needed…but that’s a tightrope I have yet to walk!
Hey Steve! Did you ever find out if your cholesterol improved?
Not yet-I’m going back for more “work” in a few days actually! I’ll update down the line! Thank you for remembering and checking in, that means a lot to me!
Hi Steve how were the tests?
So my endo said that it’s too soon to do another round of tests because they won’t have had enough time to show anything different-so hopefully in the fall I will get them re done and update from there. Sorry for the nail-biter!
Steve, your journey is definitely helpful and interesting. I follow the Keto lifestyle and so far my numbers look good after 8 months. My husband however just had a CT heart scan and he scored in the 90% (for CVD). We of course are concerned and I’m trying to decide if he should try HFLC or follow his own research to go vegetarian. Keep posting your results! Thx
I see you don’t monetize your page, i know how to make good passive income using
one simple method, just search in gogle for: Coisin’s tricks
Hi Steve, I stumbled across your blog last night and downloaded your e-book. Thank you for making public what you’re learning. I’m really not very familiar with the keto diet yet - stumbled on it via Bulletproof coffee. I have had T1D for about 14 years now…came out of the blue at age 39. Have always been lean, healthy and active. I follow a low carb and primarily organic diet. And I don’t eat a lot of animal fats.
I’m experiencing what I think is inflammation, mostly in my hands and feet, and I wonder if this diet could also help with that. Do you happen to know if there are anti-inflammatory benefits to a keto diet? And by the way, how does one know if they’re ‘in ketosis’?
I really appreciate your distinction around this being your experience rather than what others should be doing and I also agree that we’re each unique and what works for one may not work for another.
Thanks so much LeeAnn! Great to meet you and I am pleased that you’re enjoying my work! I have definitely heard of the Keto diet being anti-inflammatory but I have no personal experience that I know of with inflammation. Knowing if you’re in ketosis can be determined through urinalysis (keto-stix) or a far more accurate and reliable measurement via a blood ketone meter-which is not cheap. Personally I have been comfortable going by feel-energy combined with far less hunger are the main markers that I have seen, particularly after a high fat meal. Keeping protein on the moderate to low side and getting minerals sufficiently supplemented is key as well.
Hello. Thankful that you’ve posted your as I am having the same experience. I have been on keto for 6 months now. My last blood work (June2015) showed high cholesterol (223). This round however it is at 331 with high LDL (no capacity to measure LDLp in my country). I decided against statins too and hoping that tweaking my diet would help. I ought vitamin B (for the nicacin), and fishoil supplements. I am tweaking my diet to remove or decrease saturated fats. I don’t have any problems with blood sugars and would like to keep keto or at least low carb. Looking forward to your updated results.
Thanks! So far I haven’t gotten another test done (probably in the fall) and then I’ll follow up.
Hi Steve, I’ve had similar issues and did the same as you in replacing the saturated fats with unsaturated fats as Micah as possible. It sliced my total cholesterol and LDL almost in half in 6 months. I’m addi some adaptogens into the mix as well (medicinal mushrooms), as they have good evidence in reducing LDL as well. I also only drink filter coffee as the koweal and cafestol are removed through this route, and those compounds can increase cholesterol by around 5%. Hope that is helpful too.
Hi Dianne,
This is news to me! I am going to get back on the cholesterol topic once I get another test (hopefully in a month or two). I will look into these tips you’ve left for me-they are very interesting! I’m looking forward to seeing how things are going. I wish I could get more frequent testing done with cholesterol-I feel like that could be very useful.
Hi Steve, I just had another blood lipid profile down, and can confirm that my LDL has dropped from 9.5 to 3.7 (pretty much normal now), which was the same result for all of my lipid markers - all normal. My doctor was amazed how I chopped them down whilst still consuming a diet consisting of 70% fat, 20% protein, and 10% carbs. A bit like you, I swapped the saturated fats with MUFAs - lots of fish (salmon especially) - in fact almost went pescatarian, and other omega 3’s, olive oil, avocados, macadamia nuts/oil etc. Consumed filtered black coffee - love my Aeropress! Still made a Bulletproof version - just with macadamia oil instead of MCT/butter/cream. No diary. As I was filtering out the koweal and cafestol in coffee (which is associated with increased cholesterol), I added in specific medicinal mushrooms/adaptogens that have cancer prevention properties that koweal and cafestol have, and only used medicinal mushrooms/adaptogens that have evidence of reducing LDL cholesterol (chaga, astragalus, maitake), and in the evening, some ashwaghanda in a herbal tea or ‘hot chocolate’. Meditation & yoga have also been shown scientifically to reduce cholesterol, so I amped those in my exercise regime. Certainly all worked! Hope this is helpful.
Thank you for sharing your news Dianne. I see my endo on Monday and I’m curious how all my numbers will look. You didn’t mention how you’re feeling so I assume the swapping of sat fats with MUFAs didn’t have an adverse affect? I haven’t gotten serious about all this to the degree I’m truly eating a high fat diet - still more protein I think. It’s a little intimidating to follow this blog and be exposed to what you all seem to know and are doing.
Thanks to everyone here for sharing your experience and resources!
Hi Steve,
Im in the same problem!! Im an athlete, I been feeling great with KETO, no inflammation, more energy, less body fat, etc..
BUT!!!
My cholesterol level wen nuts!!
total 406
ldl 316
HDL 62
TRIG 140
LDL-P 2455
small D 545
CRP 0.4 ( THIS IS GREAT)
HOMOCYSTEINE 10.2
so my inflamation is great, but im still worry about this LDL numbers, how long have you been in KETO?
Wen do you recomend to do a new test?
Im also was thinking on increasing the CARBS and reduce the animal FATS, and do a 60% fats intead of 75%.
please let me know if you find out anymore information!
thanks!
Hi Marko,
Your numbers look a lot like mine at last measurement! It looks like your small (545) looks good and your trigs look pretty good too. I feel like the inflammation markers seem like a good sign too. I feel like it’s really hard to get a straight answer about this topic. I feel as though I have to choose which risk I want to manage-the known risk of blood sugar or the disputed risk of cholesterol. I haven’t gotten LDL-P measured or my inflammation markers. I will be doing that at my next appointment (soon). In the meantime I am starting to take berberine-I’ve heard it can help people on Keto drop cholesterol who have this reaction. The reaction seems like it’s a genetic issue of some sort. I will keep posting up as I find out more. In the meantime I am keeping carbs still low and trying to add more unsaturated fats when possible. It definitely makes ketosis a little less “great” but if it helps drop the LDL I’d be happy.
Hey! I been doing a big research, and also talking with people that understand this.
I was doing 250G of total fat
120g of SAT from coconut oil but also beef, butter, 3 full eggs per day, etc
50g of MONO from nuts and olive oil.
What they recommend is that I stop for one month SAT fats and do my KETO basically with MONO, also do OMEGA 3 supplement, and eating more fiber.
So basically, Macadamia nuts, Almonds, olive oil, avocado, fish, lean meats for protein if you do chicken or MEAT.
and test again in 1 month to see if the body react to it. If there is no a big reaction, then I will need to eat more Cabrs and do maybe 60% fat instead of 75%.
This is great that you start this post! Lets stay in touch and I will be letting you know how I do with my process,
all the best!
This is really interesting, check this post from Ben Greenfield.
1. Triglycerides
Not only are high levels of circulating triglycerides a good way to get fat fast, but studies have consistently linked high triglyceride levels with heart disease, heart attacks and stroke. Fructose is one quick way to elevate triglycerides, but this really doesn’t seem to be an issue with high-fat, low-carbers. However, vegetable oils and animal fats can also raise triglycerides. The big issue here is that if these oils and fats have been exposed to high amounts of temperature and processing, triglycerides are getting dumped into your body chock full of free radicals. So if your high-fat diet includes a high amount of roasted seeds or roasted nuts, nut butters, heated oils such as heated coconut oil or heated extra virgin olive oil, barbecued meats or meats cooked at very high temperatures, then your triglyceride count is going to go up. You should have triglycerides that are less than 150mg/dL, and a triglyceride to HDL ratio that is no more than 4:1, but in most of the healthiest people I’ve worked with, triglycerides are under 100 and the triglyceride to HDL ratio is less than 2:1.
2. Inflammation
If you have high levels of cholesterol (which you probably do if you’re eating a high-fat, low-carb diet, then you need to be worried if your HS-CRP levels (a primary marker of inflammation) are above 1.0 mg/dL – even if you’re a hard charging athlete. I like to see most people under 0.5 for CRP levels, and here’s why: a high amount of inflammation in your body is going to make the cholesterol circulating in your bloodstream more likely to become oxidized, generating a high amount of heart and connective tissue-damaging free radicals. As a matter of fact, it’s more dangerous to have high levels of cholesterol and high levels of CRP than low levels of cholesterol and high levels of CRP – even if your high levels of cholesterol are “healthy”, big fluffy LDL particles, and not small, dense vLDL particles. In other words, no matter how many healthy fats you’re eating, these fats may actually come back to bite you if you’re creating high inflammation from too much exercise, not enough sleep, exposure to toxins and pollutants, or a high-stress lifestyle.
3. Glucose/HBA1C
Free-ranging glucose molecules in your bloodstream can adhere to cholesterol particles and cause those particles to remain in the bloodstream for long periods of time, since your liver can’t properly process cholesterol when it has a glucose molecule attached to it. The longer cholesterol circulates in your bloodstream, the higher the likelihood that it will dig its way into an endothelial wall and potentially contribute to atherosclerosis or plaque formation. This is why it’s so dangerous to eat a high-fat diet, but to also have your nightly dark chocolate bar, overdo it on the red wine, or have weekly “cheat days” with pizza, pasta, or sugar-laden ice cream. If you’re going to eat a high fat diet, then you need to ensure your fasted blood glucose levels are staying at around 70-90mg/dL, and your hemoglobin A1C (a 3 month “snapshot” of your glucose) is staying below 5.5. If not, your high fat diet could actually be significantly hurting you.
4. Thyroid-stimulating hormone (TSH)
Carbohydrates are necessary for the conversion of inactive thyroid hormone to active thyroid hormone, and if you’re on an extremely strict low carbohydrate diet, then you may actually be limiting this conversion. Your TSH is what tells your thyroid gland to “release more hormone,” so your TSH rises when your thyroid gland is underactive, or conversion of inactive to active thyroid hormone is inadequate. A high TSH means that the pituitary gland is releasing its hormone to try to get the thyroid to respond and produce more thyroid hormone. Because of inadequate carbohydrates, TSH will often elevate in a high-fat, low-carber – indicating potential for long-term thyroid and metabolic damage. If I see a TSH above 2.0 or a trend towards higher values in someone who is testing repeatedly, I get worried – and prefer to see TSH at 0.5-2.0. Of course, this doesn’t mean that you begin to shove carbohydrates indiscriminately down the hatch. However, it means that your high-fat, low-carb diet should include thyroid supporting foods rich in iodine and selenium, such as sea vegetables and brazil nuts, and should also include carbohydrates timed properly, such as before, during or after workouts, when the carbohydrate is more likely to be utilized for energy and less likely to spike blood glucose levels.
Hey! Marko-would you be willing to be on my podcast? I’d like to dig into this! I think it could help folks out a bunch. Shoot me an email if you’re open to it- [email protected]
Also-thank you for this in depth reply! I promise I will read it all-just have to run right now. Let’s talk soon!
will be great!
Keep writing, feels like you’re writing my story!
Have your read the book Cholesterol Clarity by Jimmi Moore with Eric Westman, MD
I haven’t-I have listened to Jimmy’s podcast and I am leery about taking too much of his opinion as gospel because I feel like he doesn’t take seriously the legitimate objections and gaps in research-which may be fine for some (those without adverse reactions to cholesterol or extenuating risk factors like type 1 diabetes) but that doesn’t sit well with me. I’ve read a lot from Peter Attia (MD) who is much more cautious albeit still an advocate for low carb eating.
Hi Steven,
Glad to have found your page and appreciate the information and personal experiences you’ve provided. I wonder now almost a year out how you are doing? I went in search of others who were concerned with the same issue: Keto diet and an increase in cholesterol. Or for people like me who already have “genetically” elevated cholesterol levels. I recently began a very low carb, low fat diet because I need to lose nearly 100 pounds AND because my cholesterol is very high. You’ve talked a lot about “genetic” factors in some people with High Cholesterol - well I’m one of them. Both of my very lean parents had HC and all my siblings do as well. 2 of them are on statins. Sadly both of my parents died in their early 70s - my father from a sudden massive heart attack. For a number of years he had changed his eating habits and was on statins and in addition some years earlier had stents put in. An autopsy showed those stents failed during the event.
Now, honestly, I would look OK and attractive enough if I lost 50 pounds and I know I’d physically be in better shape so that’s the goal I’m going for. I LOVE carbs but have to get them out of my life; for me they are addictive. Now here’s where I’m going with all of this and really have to ask…. I LOVE CHEESE and I believe in order for me to sustain this diet plan long term I have to allow myself some cheese. A lot of people I see on youtube keep cheese out of their Keto diets, but my thinking is if I’m going to have any fats in smaller amounts (due to my elevated cholesterol), I’d at least like it to be cheese, nuts and perhaps a bit of MCT or Coconut oil but by no means to excess. Other than this, my main source of protein is chicken and eggs though I probably need to start limiting the yokes. Any IDEAS?
Honestly it sounds like you’ve got some good ideas right here already. If you want to hit any fats “harder” aim for things like olive oil since it’s supposed to counter high cholesterol. Fish is excellent too. Macadamia nuts also. The issue of cholesterol is up in the air in terms of what it actually means and how closely it correlates with CVD. I have chosen to prioritize my blood glucose management over cholesterol management. I could be signing my own death warrant by making that decision but one can only do so much. Pick your battles and aim for highest quality of life. If eating cheese gets you to ditch carbs for a year, drop 50 lbs, feel healthier, look better and have more energy to be active and keep the weight off, I feel like it’s a reasonable trade. You can wait and see how your lipids respond after the weight loss and long term on keto. Please keep in mind that I’m not a doctor and this is all just my opinion. Thanks for taking the time to write and share your experience!
Hi Steven
Love the blog. I embarked on a keto diet in January of this year and recently got my cholesterol checked and it was through the roof. My doctor is excellent and well educated on new science regarding cholesterol management and the dangers of low fat high carb diets. My LDL is currently 401 with my total cholesterol at 463. My triglycerides are low and all other blood levels are perfect showing no signs of inflammation that may lead to heart disease. I am 36, fit strong and active but I am an aviation professional so I can’t have cholesterol outside of the defined limits to pass a medical. My doctor has judged that I have FH and has prescribed ezetrol. I am also removing saturated fats from my Keto diet. I will post a reference to my progress when I get retested in a few months. I just want to add a thank you for posting on your experience because it gave me good guidance having received my current cholesterol values.
Thank you Brian! What is FH?
That would probably refer to familial hypercholesterolemia
Ah, that makes sense. Got it!
Yeah - it’s familial hypercholesterolemia. Sorry for not getting back to the thread sooner. I too am focusing more on my trigs than my overall number but as I said my profession demands certain tolerances that I must meet. Thanks for again for posting about your own journey with your health and I’ll continue to follow the blog.
Hey gang, I wanted to post a follow up comment about my situation with cholesterol and type 1 diabetes and the keto diet. I am no longer devoting my site/blog to this topic as you may know but I wanted to let you know about my results. I recently got a more in depth panel done and I haven’t gotten all the results back but my endo hasn’t called me in a fright and it’s been a couple months. What I know from previous panels is that my inflammation markers are low and my trigs aren’t elevated.
I have decided that I am not going to chase my cholesterol around. I am prioritizing my blood glucose management. There is a lot of debate around what cholesterol actually means to CVD risk. There is much greater clarity around what A1C means to CVD risk. That’s why I made this decision-also because a high carb diet might appease the cholesterol but I know it would negatively impact my quality of life and ability to manage blood sugar day to day. It’s a hard choice and it’s risky/unknown/adventurous? I take full responsibility for this choice and I don’t suggest this as a method for anyone else. It’s a personal thing.
Since adding saturated fats back in without feeling bad or trying to remove them for MUFAs and PUFAs my a1c has checked in at 5.6 and I am taking almost NO rapid insulin-I have a standard deviation of 30 points in my BGs, meaning that I’m not achieving that A1C through highs and lows. I feel great. I’m climbing well and recovering quickly. I’m done living my life in adherence to data. I am living my life in accordance to what works. I know some of you here have other experiments going on and that’s admirable. I have done enough experimenting to reach a conclusion that I’m satisfied with for now. I hope you’re all doing well and finding new freedom to explore distant horizons in your life through whatever methods you are implementing. I would leave you with one thought-we only get one shot at life and no diet, no technology or experiment will change that. Please be diligent for your own sake to make sure that the numbers are there to facilitate your journey and that your journey does not become about the data. It happens easily to us all.
Be well!
Hi Steve,
THANK YOU SO MUCH for this very helpful and honest blog. The extra time you’ve taken to answer to all the comments/questions has added even more perspective and I have gained a LOT of insight into why my own data has suddenly jumped since starting on a LCHF diet 4 months ago. I have been following your story hoping to hear if there was a “happy ending” after your latest blood tests this Fall, but it isn’t clear if you had a positive outcome or not. Can you please share some of your latest cholesterol test results with those of us in a similar boat? Did your dietary modifications have much effect on your cholesterol numbers? Did you do a 40-40-20 (med protien, more mono/less Sat Fats, lo-carb)
I applaud your decision to do what seems to be working best FOR YOU and not trying to chase the cholesterol numbers as an end game. We are all striving to learn what will work best and it’s been great to hear how your own experiments have been going. You are lucky to have a great endo who seems to be working with you and gets what you are doing and it seems like you are doing well, which is wonderful!
Hi Denise,
You’re very welcome-I’m happy to add this info to the internet. I got a deeper dive done on my cholesterol in the fall (Sept) but I never heard anything from my endo. I’m actually seeing him on Jan 5th so maybe he will have something for me then. I assume that my numbers didn’t change dramatically. I stopped cutting saturated fat and trying to do the “mediterranean keto” thing. It wasn’t working for me-higher bgs and lower energy and the cholesterol didn’t deviate much. Basically I was getting the lesser half of the benefits from the diet without significant improvements to my lipids. I went back to full fat and my BG has been unreal-1 unit of rapid a day-often times 0 units of rapid a day, just running on tresiba (16 units) and im staying between 70 and 140, eating when I’m hungry and climbing better than ever. I’m not going to give up that glycemic control for cholesterol. I’m willing to take that risk.
Great threads here.
Before I started Keto my LDL was 78, I am 53 and have subclinical asymptomatic 20% LAD blockage on a coronary CT. No other RFs.
My LDL after 3 months on Keto and 5 mg Crestor went to 194, and LDL P from 1500 to 2055. ,!!! Yikes
This confirms I’m a cholesterol hyper absorber.
So since I’m not at all averse to meds I’m on 20 Crestor and Zetia 10 mg.
I’d like to continue Keto but to do so I’d have to be on meds, unless I went all MUFA, which could be ok.
I just like my SFs.
So going forward the plan is drugs and see how well I’m doing, another NMR in 4 weeks.
Btw, I don’t buy that ” big fluffy LDL p is fine even if high #s.” imo, numbers count, at least given the current state of lipid technology. So I want LDL p <700.
I had great levels of cholesterol before I started keto. My HDL was 77 and my LDL was 66, after a month and a half on keto my HDL went down to 61 and my LDL went to 120. I completely freaked out. Not to mention I ended up in the er with tachycardia and prolonged qt. I know a lot of people think Keto is the holy grail for better health, but I truly believe there are people like me to which their body can’t handle it. People really need to be careful when doing this diet. It really does help with weight loss though, so monitored by a doctor it could be good and see if you aren’t too sensitive like me.
I think the biggest mistake people make when doing Keto is eating large amounts of unhealthy fats (animal meats, butter, heavy cream, coconut oil and so on). Kato is a great way to lose weight and get healthy but if you’re putting unhealthy fats into your body, it will not magically make you healthy and your cholesterol will skyrocket. And then instead of adjusting a diet, people start taking Cholesterol medication which pretty much means putting more unhealthy things in your body. There are some people who need to take drugs but a lot can be done naturally to control cholesterol (for example, eating 2 cups of beans a day will drastically reduce bad cholesterol and quickly too). Kato diet, when done correctly, is extremely healthy and beneficial. Fats on Kato diet should come from nuts, olive oil, flaxseed oil and fish. Meat should be the leanest possible and fat should be trimmed off of it before cooking it. Lots and lots of green vegetables. There is a huge difference between healthy and unhealthy fats - they are not all just fats. Also, exercise is a must to keep blood pressure stable.
Steve, been reading through your blog. I noticed that last summer you decided to replace Saturated fats with unsaturated fats with the hopes of trying to get your LDL level down. Did this work for you? Thanks, AJ
Hi AJ,
Here is my honest experience. Take it for what it’s worth-I did replace saturated fats with unsaturated fats. It worked ok but I felt like I had a hard time getting the same energy and ketogenic output. It also elevated my bgs and wound up increasing my insulin dosage. Granted, the elevation in BG was relatively minimal and the increase in my insulin dosage was also relatively minimal. It didn’t really help my LDL from what I’ve seen in my tests and so I made a decision to stop worrying about my LDL. The only way to absolutely reduce my LDL is to adopt a method of eating that compromises my BG control and energy. I’ve decided to prioritize BG control and the quality of life that comes with it. I know that there is controversy surrounding a decision like that and I’ve mentioned in this comment thread (somewhere up the line?) that this is not something I can advocate for everyone but it’s something I feel really good about. I have been active, good BG control and feeling great. I wish I had a better answer-there are some other commenters (Marko Z.?) who have experimented with the unsaturated fats and found it to work really well.
Hi Steve, thanks for updating us on your progress. I was just wondering, what are you basal and boluses typically look like on a Keto diet, compared to what they where before? Did you have trouble adjusting? Have you had any hormonal issues from eliminating most of your carb intake?
As always, thanks a ton.
Hi Joe!
Great to hear from you! Glad you’re enjoying the blog and resulting discussions! I am including a link to my youtube playlist all about my use of the keto diet. I think you will find some details of interest in these videos: https://www.youtube.com/playlist?list=PLH7S7KFt6dZwnjaiZFDM8N1k1kh664iLm
In short answer, my insulin usage decreased between 40-60% from non-keto dosage. Adaptation is a bit tricky and requires careful attention to detail and replacement of electrolytes-specifically magnesium, potassium and sodium. After the first month or so it is much easier. I have not had any hormonal issues that I’m aware of-just more energy and faster recovery and better overall performance in athletic endeavors.
Thanks!
Hi,
Here is my testimonial on trying different approach to be in nutritional ketosis.
I can see that each person respond different to saturate fats, I coach some people and some people do great on lost of saturate fats and some people get their numbers mess up. In my case I was doing lots of it and I did see my numbers go to the bad side.
Here you can check my blood work on different diets and you can see how it respond.
http://www.markozaror.cl/about-cholesterol-and-why-i-decided-to-go-on-a-ketogenic-plant-based-diet/
I will really worry if i see Triglycerides go up and also the you want you LDL to be a type A.
Hope this can help,
all the best,
I think is not only switching to unsaturated fats, I think is to find the right balance that works for you, for me for example is ok if i do around 50 /50 .
Making sure you don’t do tu much of polyunsaturated fats.
Basically what i did was:
-B complex shot ( deficiency due to stress)
-Omega 3 supplement ( this is because the 6/3 ratio is really easy to get it wrong wen you eat keto is you don’t do fish
- stop over eating fat boms and bullet proof coffee
- make sure I get a nice balance on my fats.
If you check my blood work you will see that there was a incredible respond on my lipid number and my blood glucose wen down.
But what really is making my numbers and my energy better is that I m doing a Keto with no meats, only eggs as the only antes mal product and this is been giving me really good results. (2 to 3 eggs x day)
Much better and stable Fasting blood sugar and ketones.
Better lipid numbers
Good muscle tone
Good performance.
I’m still experimenting, been already 5 month into it and so far is great and I’m sticking to it.
Hi Steve, as a fellow T1D (30+ years), I enjoy following your blog on the Ketogenic diet, and I agree with your Action Plan on getting your cholesterol down, even though it’s not been proven that cholesterol is all that important to heart disease.
I also agree with avoiding statins like the plague they are to millions of people, causing high blood sugars and T2D, muscular pain, and permanent muscular damage for many. I expect that statins will eventually be pulled from the market as a pox on mankind and a fraud.
One question: what were your HDL and Trig numbers? From everything I’ve researched, it seems that these two numbers may be a bit more important than the LDL and Total Chol anyway. Best wishes!
Thank you! Agreed about statins…my last trigs were just under 150. It’s been a long time since I’ve gotten things tested-health insurance hasn’t been optimal.
One additional thought on high cholesterol and blood pressure, Steve: I wonder if there’s a relationship between those two problems and sex hormone levels in both men and women. For women, it’s well known that a decline in estradiol (active estrogen) in middle age often does a few things: 1) it raises blood pressure, 2) it reduces insulin sensitivity, and 3) it raises cholesterol. Treatment with estradiol reverses these problems. Can the same hold true for men (in relation to T)?
Some research shows that a drop in testosterone in middle age, or at any time, can do the same for men. I’m a big believer in doing the most natural and benign thing to put the human body back in balance. So, as a female, I add back my estradiol by taking a patch with a tiny amount of bioidentical E2. It works for me, and all my numbers are in a great range despite my advancing age (48). My Google review is saying that the same principle may hold true for men with higher cholesterol and increasing blood pressure. Here’s one study, for example: https://www.ncbi.nlm.nih.gov/pubmed/16937606
Very interesting-I haven’t heard about this but it could be a thing. I’ve been ok on the testosterone front based on all other “anecdotal” measurements. It’s certainly possible that a decrease in testosterone would impact blood sugar and other variables too.
Good to read your information. My husband, too, has naturally high cholesterol with a family history of heart attacks. This is concerning for him and me. However, my friend has that same problem. She has started increasing her B6 (niacin) and take vitamin D and it has brought down her cholesterol levels to a mid normal range. Check it out for yourself and see what you find!
I am going to resume writing about this topic for a few posts at least! I have some new information and I’d like to update everyone about my experience over the last few years. This podcast episode (note mine) is VERY VERY enlightening and I strongly urge you to take a listen!
https://itunes.apple.com/us/podcast/ep8-high-cholesterol-levels-on-keto-diet-experiments/id1228136261?i=1000386782883&mt=2