What do you do if you get elevated cholesterol on a low-carb diet?
It’s a question I often get. Isn’t a low-carb and high-fat diet bad for the cholesterol? And what if you get an elevated cholesterol on LCHF, what should you do?
The good news
First the great news: A low-carb high-fat diet usually results in an improved cholesterol profile, indicating a lower risk of heart disease:
- New Analysis: LCHF Best For Long-Term Weight and Health Markers
- New Major Study: A Low-Carb Diet Yet Again Best for Both Weight and Health Markers!
The classic effect of a low-carb diet on cholesterol is a slight elevation, partly due to an elevation of the so-called “good” (HDL) cholesterol, indicating a potentially lower risk of heart disease. The cholesterol profile also typically improves in two more ways: lower triglycerides and larger, less dense LDL particles. All things that may reduce risk of heart disease, statistically.
It has also been shown that two years with low-carb, high-fat diet advice results in a reduction of atherosclerosis – people actually got less signs of heart disease, and after one year there is as a reduction of their cardiovascular risk based on standard calculations.1
The bad news
However, there are also potential problems, even if they are rare.
On average the elevation of total and LDL cholesterol is so small that most studies do not even pick up on it. But for a smaller number of people – possibly around 5-25 percent of the population – there can be worrying elevations of LDL and total cholesterol, beyond what can be considered normal.
This potential risk is worth taking seriously. It can also be worth taking steps to correct it. I’ve written more about it on the page about potential side effects of low-carb diets:
Low Carb Side Effects & How to Cure Them
More
My Health Markers After Eight Years on LCHF
Cholesterol Numbers After Six Years on a Low-Carb, High-Fat Diet
The HDL number is suggestive. The TG number has real value (esp. when concordant with HbA1c).
Get a real advanced lipoprotein test, such as NMR, VAP or electrophoresis. And sadly, the typical MD will have no clue how to interpret the numbers. If the LDL-P numbers are worrying, get an ApoE genetic test, or have your 23andme raw data analyzed by a third party.
The problem I have with all of these markers, no matter what they are, is that all of them are correlations. The best one can do is say a marker is correlated with an outcome. The follow on study of modifying that marker through diet to see what happens is never done.
And so many of them are useless. If you read Malcolm Kendrick's The Great Cholesterol Con, he lists many studies indicating many markers are useless for TC, LDL, HDL, etc. And when you debunk the usefulness of these markers, they come up with a new one. A new one that may or may not actually work.
Even though I get tested myself for these markers (using both NMR and VAP), I really don't have a lot of confidence that these numbers tell me anything.
Just when I was beginning to believe there was nothing to worry about The Diet Doctor is advising otherwise. Is all the information I have read/watched wrong? i.e. Older people with high Cholesterol live longer, that diet only has a minimal effect on cholesterol, that the Cholesterol test available in the UK is useless so don't pay any attention to it. Like you Bob, I also don't have much confidence in these numbers and now I am totally confused about the whole issue.
http://homepages.slingshot.co.nz/~geoff36/LDL_mmol.htm
The nurse told me I could not have another lipid panel "we don't measure your cholesterol again once you are on your statin" - they only use total cholesterol anyway, and she really didn't want to tell me the results when I cheated and got one anyway.
IMO the important part is the trigs/HDL ratio which is a marker for insulin resistance, cardiovascular risk and small dense LDL. I see the numbers as a marker rather than a cause: on low carb my HDL doubled and trigs fell to 1/10 of their original number. LDL went up a bit while I was losing the dietician-provided weight then came back down again when I ate more saturated fat. It dropped hugely when I was hypERthyroid, as much as a statin produced.
An NMR or VAP would be interesting but unavailable in the UK. Getting my blood glucose into a normal range is the most important thing I did for my health. I would like to see an insulinometer as available as a glucometer but that's not going to happen, the only people I know who have insulin measured (actually c-peptide) are those already diagnosed with Type 1 diabetes. I use the lipid results as a surrogate for insulin level/IR. I strongly suspect that is more causal than any actual property of lipids, it would be interesting to see what happens to it in those individuals whose LDL shoots up on low carb, and what other potential disease markers are affected, like CRP and homocysteine which tests are normally only available to hospital doctors not GPs.
I think the problem here is that the blog post didn't define the term "worrying elevations of LDL and total cholesterol, beyond what can be considered normal." WHAT does that mean?
To my health care provider, 220 TC (e.g. 221) is considered a "worrying elevation of total cholesterol" and anything over 70 (!) LDL. Ridiculous. This article would be more useful with a definition of what LDL and TC levels put people into that 1 -2 % who have an increased risk.
I have seen people who do fall into that category get better numbers by reducing saturated fat and replacing with mono-unsaturated fats (e.g. olive oil, NOT processed seed oils). Whether that has any bearing on health and life expectancy I'm not sure we know.
Copied the following from the Diet Doctors page about potential side effects of low-carb diets:
"For example a small subgroup of people, probably partly due to genetics, can get total cholesterol values over 400 mg/dl (10 mmol/l) on a strict low-carb diet, with LDL values of over 250 mg/dl (6.5 mmol/l). This is not normal. Even if the cholesterol profile is otherwise good – with high HDL and low triglycerides – it may be unhealthy."
I am in that small subgroup, total cholesterol 9.7 mmol/L, LDL 6.9 mmol/L, HDL 2.3 mmol/L Triglycerides 1 mmol/L
I have been eating LCHF for around 7 years and feel great, interestingly, my husband eats EXACTLY the same food as I do (every meal) and he has very low cholesterol. So, I'm guessing it is genetic. I will cut back on saturated fat and see if I can get the numbers down, I will not take a Statin.
Eric
I did a ton of research over 3 months. My conclusions?
High LDL means squat.
You are at no greater risk with than with low LDL and TC.
Older people, like me, live longer with high cholesterol.
We are more likely NOT to get sick.
Not giving up LCHF.
http://www.drperlmutter.com/ldl-friend/
I'm not in the least bit worried by "high cholesterol" when still in the normal range and with a normal profile. I'm only worried about cholesterol numbers way outside the normal, e.g. 500+... which occasionally happens on a very high-fat diet, likely due to genetic susceptibility.
Yes, that's ridiculous and what people believe after listening to Big Pharma propaganda ("marketing"). Those numbers are as normal as they get.
I'm afraid nobody in the LCHF community ever addresses this problem and I'm sure I'm not the only one who experiences elevated fasted blood sugar.
I don't think that's "definitely too high" at all. Fasting glucose can be slightly higher on LCHF than on other diets. You get a more stable glucose without the fasting "dip".
BTW, in Sweden we still consider below 110 fasting to be normal in healthy people. Lowering the cutoff to 100 in the US has produced an enormous number of pre-diabetics. I'm not at all sure that's reasonable.
Why do you think this could be happening? Definitely not due to overconsumption of carbs in the evening or at night, so the only mechanism could be hepatic glucose production. The question again is why? As said, it only/mostly happens at night.
Also, what would you consider a healthy H1bc?
do glucose tolerance test - do not pay attention to glucose, pay attention what insulin is doing.
https://www.youtube.com/watch?v=aRUWTWsIAXI
Don't be afraid of saturated fat, its one of nature's bounties.
Volek and Phinney demonstrated that saturated fat increases LDL diameters and pushes LDL profile towards Pattern A (Pattern A is light/fluffy/cuddly while Pattern B is small/dense/deadly).
http://ajcn.nutrition.org/content/83/5/1025.long
Also exchanging fat for carbohydrate pushes LDL profiles towards Pattern A very dramatically, see this (R=-.95 P<.001 is remarkable).
http://jn.nutrition.org/content/131/2/340S/F2.expansion.html
One thing that came out repeatedly in my readings of the actual science was that LDL becomes modified under certain conditions and can become deadly because of this.
What seems to happen (and I am no expert but I can supply the references if you are interested) is that excess triglycerides in the form of VLDL can act on normal LDL and HDL to extract the lipids from these cholesterol fractions thus reducing their size (this action is not present or very much reduced under normal blood conditions). Thus LDL becomes small and dense and is able to penetrate the endothelium more readily and it resides in circulation longer. HDL also becomes smaller and at some point cannot retain the ApoA protein which is detached and rapidly cleared from ciculation. This seems to be why high triglycerides, high LDL and low HDL occur together in heart disease situations.
I agree with Paul - Insulin is the killer.
The source of the excess VLDL seems to be denovo lipogenesys in the liver when carb input goes past the tolerance point (about 50g/day) or when insulin resistance has advanced to the point where insulin cannot hold fat in the bodies fat stores. Under both conditions there is excess triglycerides in the blood and the mechanism can be triggered.
As I said I am not an expert but I have seen the same set of conditions described many times in the literature and it makes sense, to me anyway.
I don't know how this is modified in my case (i.e. being in the 1-2%) but as all other markers are good and getting better I am inclined to believe the high LDL is benign.
If you look at the hundreds of studies available for cholesterol and longevity, freedom from illness it seems the higher the cholesterol the better.
I do understand about pattern A and B, my GP had never heard of different particle sizes, she immediately suggested a statin and when I refused this she gave me a cholesterol lowering diet plan, produced by the NHS in association with Flora, it was a nutritional disaster. i.e. Butter, cream and full fat hard cheese should be replaced with "Flora" soft margarine, skimmed milk, 0% fat yogurt and cottage cheese, for cooking and salad dressings use sunflower, corn and safflower oils. Eat lots of wholemeal or wholegrain bread, pasta, rice and breakfast cereals. For desserts, fruit sorbets, fruit puree, whips and puddings made with skimmed milk.
Wonder where the figure 1-2% came from, how do they know LCHF raises cholesterol way above normal levels in only 1-2% of people. I don't get sick and actually feel very healthy, there is absolutely no history of heart disease or early death in my family and not one case of dementia. I have healthy relatives well into their 90s still living at home with no support. So if my high cholesterol is Genetic perhaps it may also be protective (who knows for sure). I only went to the doctors for a cholesterol test because I was eating LCHF and was curious about my cholesterol level. Despite my doctor freaking out about my TC 9.7 mmol/L she never checked my insulin, I have never had my insulin checked.
Thanks again.
You are welcome. Your family history seems to parallel mine. I am nearly seventy with both parents alive and well and in their 90s. In fact my dad, a WW2 vet, just had a medical and the doc said he was in perfect health. Both are mentally ok but my father is beginning to fade mentally a little bit but still 99% there (short term memory is fading). Both are taking cholesterol meds so it would be high without them. My other relatives are all long lived, although they do get mentally frail at the end.
My doc also freaked out as my cholesterol is similar to yours but as I was adamant on no statins he agreed to work things my way.
What I did was to do a long inquiry into exactly what cholesterol is and how it affects the body.
I took about 1,000 pages of notes from my readings and condensed this down to about 150 pages of discussion, like you I became much more knowledgeable than my doctor.
I went through the history, the science etc and came to pretty much the same conclusions as the skeptics. Hypercholesterolemia is a scam, its an invented disease. The campaign against cholesterol was and is designed to induct large numbers of people into the medical care system for profit.
The campaign against saturated fat is in the same category. There never was any evidence to back it up, but vilifying it gave rise to the low fat industry and the junk we eat today.
I am now expanding the doc by looking at what good health actually is and how it is achieved.
I'm currently looking at Weston Price's observations from his trips in the 1930s. The stuff he uncovered is truly amazing.
There is little doubt that fat in the diet raises cholesterol. Saturated fat raises it the most followed by monounsaturated and then polyunsaturated. In most people this rise is modest but it is statistically significant.
The question really becomes is high LDL cholesterol dangerous.
The link from plasma cholesterol levels, particularly LDL levels to heart disease is the true test however. If the hypothesis is true, then higher total cholesterol/LDL levels must be associated with a higher incidence of heart disease all else equal. Equally lowering of total cholesterol/LDL levels should be accompanied by lower heart disease rates.
More exactly, as a scientific hypothesis, it is open to falsification: if the concentration of LDL‐cholesterol or total cholesterol and the degree of atherosclerosis do not correlate, or if there is no exposure‐response, e.g. if there is no association between the cholesterol changes (ΔLDL‐cholesterol or Δtotal cholesterol) and atherosclerosis progression then the hypothesis is falsified.
The lipid hypothesis bears the burden of proof.
It is generally true however that a very large percentage, possibly most studies concerning cholesterol are false and even then there are no strong indications of support for total or LDL cholesterol as a single causative agent. In evaluating cholesterol research it is necessary to understand the enormous pressure to find positive results resulting from the support of factions predisposed to the lipid hypothesis and the hostility shown to those who find results that run counter. In spite of this bias there are only tepid indications of support and only where cholesterol is associative with other risk factors but there is at least as much counter evidence and in general the lipid hypothesis fails on both counts. There is no correlation between cholesterol levels and heart disease or atherosclerosis and there is no dose-response relationship.
In “Primal Body, Primal Mind” Nora Gedgaudas states,
“Dr. George V. Mann, noted researcher in the Framingham Heart Study, stated, “On-going issues of pride, profit and prejudice cause out-dated and never-proven notions of the saturated-fat /cholesterol hypothesis to persist despite a lack of supporting evidence in the medical literature”. In fact, the Framingham study-long considered the most important dietary-heart related study to date-presented data that can only be a secretly shattering disappointment to those keen on promoting the dietary heart disease hypothesis. Claims by biased investigators that the difference in cholesterol values from 182 to 244 led to an increase in heart disease by 240 percent were shown clearly by forty years of Framingham data to be in actuality a potential increase in risk of no more than 0.13 percent. This is hardly damming evidence in favour of reducing saturated fat and cholesterol in the diet. In this range, there is virtually no difference among any individuals relative to their risk of coronary heart disease. Interestingly, those people with cholesterol levels between 244 and 294, the rate of coronary heart disease actually declined.”
As I said before its a scam.
And as Dr. Eenfeldt said, a strict LCHF diet is going to often cause a slightly higher (according to American standards) fasting blood glucose reading. No big deal as long as it is stable and creates no problem.
As far as Cholesterol, my totals (which were to me already okay) went down somewhat (174) and the other readings all "improved" also within two months of going strictly LCHF.
To put things really simply as a woman, according to Framingham data with a TC of about 5mmol/l you have a 1% chance of a cardiac "event" per year - could be heart attack but survived, could be death.
At TC 8mmol/l your chances of a cardiac event per year rise to about 1.1% per year.
At TC 30 mmol/l (no typo) your chances of a cardiac event rise to about 1.4-1.5% per year.
Relative risk is "scary" 40-50% greater risk but in absolute terms its a trivial .4-.5% for 30 mmol/l.
So at 10mmol/l your chances look pretty good to me.......:)
For men the the odds are about double but the chances of an actual cardiac death for men is about .1% at about TC 5mmol/l and doubles to about .2% at TC 8mmol/l using MRFIT data (362,000 men studied).
Bear in mind the error on any one cholesterol test is about 12%+-
Bottom line, don't worry about saturated fat and tell your doc to do some reading.
Oh me too. This made my LDL go UP. I was accused of "failing to comply" with the diet.
Er no, the diet was failing to comply with ME! (N=several thousand)
Anyway, I'm 52, my TC has always been high; like 270 range, and my doctor for years has been putting me on statins. We've done this dance for 15 years; he gives me a drug, I take it for 3 months, my muscles ache, I stop taking it...and we do the same dance again with another drug when I go back a year later for an annual physical. he yells at me, gives me a new drug. ,,,,yadayadayada.
Last year (Dec 2014), after he yelled at me again, I said "Hey doc, what we are really worried about here is that I have plack and/or sludge building up in my arteries and it is going to give me a heart attack or stroke - right?" ...he said right. I said - "well, about 5 years ago I had an eye exam and the eye doctor commented on how great the veins in my eyes were - "They are beautiful!". I asked what he meant and the eye doctor advised that they are the smallest veins in my body and they were crystal clear. So I said; well then, does that mean the larger veins and arteries and my heart are crystal clear too? - The eye doctor said: "Maybe, that seems logical."
My family doctor advised there are two tests I could do to show me (us) what level of build up I have in my major arteries and heart. 1 is called a "Calcium Score Test" which basically is a CAT Scan and program that gives a score of between 0 and 100 points. The higher the points the more calcium the program is estimating is in your arteries - it costs about $200. The 2nd test shoots you up with blue die uses an MRI to actually see inside your arteries and "show you visually" how much build up is in the arteries - this test is about $1200. My family physician sent me to a cardiologist to get the testing done.
After meeting with the cardiologist he recommended me only doing the $200 Calcium Score test since I have had no history of heart disease. We did the test... my score? ...a 0. Crystal clear just like the veins in my eyes! The cardiologist advised I never have to worry about heart disease, having a heart attack or a stroke and I no longer need to take statins; ...but he added I should keep eating right , exercising and lose a little weight because my blood sugar was on the high side of normal.
I said all that to say this: I began a Low Carb High Fat diet about 3 months ago. Lots of energy; lost a few pounds, feel great. but, I just had my physical and my TC is now 327... up like 50-60 points. TC 327, HDL 41mg/dl, LDL 221 mg/dl, triglyceride 323 mg/dl , fasting glucose 116 mg/dl
Reading all the other comments above I'm encouraged to that it's still all good. What's your opinion?
ps- I am thinking about doing the Calcium Score test again; just to make sure it wasn't broke that day when I got a "0".. :)
Most people eating LCHF will not have worsened cholesterol. You can read more about this here:
http://www.dietdoctor.com/low-carb/side-effects#cholesterol
We are flexible with times to fit in with your schedule and are offering a £50 amazon voucher or charity donation voucher to say thanks. Please email me if interested: anna@workshopcookbook.com
I have been on keto diet for 2 months and have quit a few days ago, my cholesterol was through the roof
and my doctor was not happy!
Don't get me wrong, I lost weight and I am small to begin with, I was doing this to feel better and I somewhat did minus the leg and feet cramping at night.
If only I did not have a cholesterol issue, I would have continued doing this but my risk of having a heart attack has doubled, so I am not willing to take that chance.,
I always felt full and was eating well which makes me sad that I have to stop :(
Was I doing something wrong on Ketogenic diet?
I really don't know, and if anyone has answers, I'd appreciate hearing from you.
Thanks
Lucy
More reading about side-effects here:
https://www.dietdoctor.com/low-carb/side-effects#cholesterol
Thanks
Anyways, I did a research last night on what causes high cholesterol and guess what... Its all that's included in the LCHF diet!!! The cream, the eggs, the cream cheese, bacon and else.
I'm very confused because if I follow the LCHF again I'm afraid I won't be able to lower my cholesterol, however I'm in medication right now which I hate but that's what I keep on reading everywhere! That a LCHF diet will lower the cholesterol....
I searched for breakfasts for someone with high cholesterol and all the recipes are full of sugar or carbs which is what I'm trying to avoid. Lunch and dinner I are easy. My challenge is breakfast.
Can someone help me figure this out please? Thanks
PS: lucie here also had the same issue with cholesterol on this diet I see...
I have been on the LCHF diet for about 4 years and feel great. I have just had my cholesterol test done and the Dr is concerned:
Total cholesterol 8.2 Recommended below 5.0
LDL cholesterol 5.0 Recommended below 3.4
HDL cholesterol 2.87 Recommended above 1.0
Triglycerides 0.7 Recommended below 2.0
HDL/Cholesterol ratio 2.8 Recommended below 4.5
I had a retina bleed and the Dr said I had experienced a stroke. There has been no permanent damage.
I have asked for a further blood test to determine the ratio of dense LDL to 'fluffy' LDL
Should I be concerned
Thank you
I was curious to know what were the results after you did further blood tests. My results were almost the same after a year of LCHF.
Thanks
Jack