Type 2 Cholesterol / Lipid profile after low-carb

[finsit]

So here is the result I have been waiting for. Expectedly LDL went high, though I was not expecting it to go that high. HDL has improved and TGs have decreased. What do you make of this result? I am on 30-40 gm carb/day diet and been enjoying full fat cheese, nuts and cream etc. I also lost about 15 KGs of weight but that was during Jan-March. What's your interpretation ? Should i reduce dietary fat intake. One a positive note, my a1c came back at 26 mmol/mol.

Here are the readings from last week (June 25th, 2021)
TGs: 1.4
HDL: 1.2
LDL: 9.5

These were my readings in Dec when my a1c was 78 and i was diagnosed as diabetic
TGs: 1.9
HDL: 0.88
LDL: 4.1

I understand LDL alone is not a cardiac risk factor and it depends upon the particle size, but should i be okay continuing like that or should i modify my diet? I am definitely not going on meds for this.

 

[Ronancastled]

I know nothing about Lipid panels but I'm here to congratulate you on an amazing A1c.

 

[finsit]

I know nothing about Lipid panels but I'm here to congratulate you on an amazing A1c.

@Ronancastled thank you but the irony is that to fix one thing you must mess up the other. They don't come all together ever?

 

[bulkbiker]

Had you water fasted before the blood was taken for the full lipid panel? 12-14 hours is recommended.

 

[Daibell]

Hi. It's unusual for the Total/HDL ratio to get worse when low-carbing and I can't offer any guidance.

 

[Mbaker]

There are 3 big factors ahead of LDL associated with heart health risk, being obesity, diabetes and insulin resistance. Looking at your profile, I would use a shorter jogging routine as a warm up and build up resistance training. Here are some references:

https://academic.oup.com/qjmed/article/102/9/609/1553520
https://www.sciencedirect.com/science/article/pii/S0021915011008185

The above should improve your HDL further and improve insulin resistance further, so no harm. As for the diet I would use the fats you mention as a treat and push the protein.

 

[finsit]

Had you water fasted before the blood was taken for the full lipid panel? 12-14 hours is recommended.

Yes, i did.

 

[finsit]

There are 3 big factors ahead of LDL associated with heart health risk, being obesity, diabetes and insulin resistance. Looking at your profile, I would use a shorter jogging routine as a warm up and build up resistance training. Here are some references:

https://academic.oup.com/qjmed/article/102/9/609/1553520
https://www.sciencedirect.com/science/article/pii/S0021915011008185

The above should improve your HDL further and improve insulin resistance further, so no harm. As for the diet I would use the fats you mention as a treat and push the protein.

@Mbaker thanks. I got rid of all my belly fat and insulin resistance back in March. I did a fasting Insulin level test which came back at 3. I have started more vigorous jogging, improving my VO2 max and already doing resistance training since couple of months (due to lockdown). I will reduce saturated fats and quantity and see. Does anyone recommend introducing a little carbs from bread/lentils/fruits or let it be?

 

[bulkbiker]

Yes, i did.

OK so.. your Trigs are coming down.. which is good and your HDL is rising which is good too
Your Trig/HDL ratio has gone from 2.16 to 1.17 .. anything sub 0.87 is considered excellent so while you're not quite there it is certainly moving in the right direction. Excellent.
And no I wouldn't recommend introducing carbs? What would be the point?

 

[Ryhia]

Wonderful HbA1c result - congratulations!

I can't really help you with what to do re your cholesterol as I am in a similar predicament to yourself. I started my low carb journey with a total cholesterol score of 4.7 after a few months cholesterol had gone up to 6.7 but I was losing weight and folks on this forum pointed out that losing weight can temporarily lift cholesterol. Move on a few months when my weight was stable and the results of a further lipid panel showed that cholesterol had gone up to 10. Doc referred me to a lipidologist who blamed the keto diet - she asked me a few questions and decided my issue was Polygenic Hypercholesteremia, which is a genetic condition but they haven't worked out all the genes that are involved, she would not arrange any genetic testing so didn't convince me re her diagnosis. Its seems just as likely that I am a hyper responder.

I did try to change my diet, I reduced my fat intake and switched to extra virgin olive oil as my main source of cooking fat. I also increased my fibre and cut down on dairy. A test in November showed my cholesterol to be 7.9 so some reduction had taken place. Don't know if this was achieved through diet changes or just the passage of time. Still trying to find a solution to bring my cholesterol down, I have a blood test next week and my cholesterol is still definitely too high according to my cholesterol test meter.

 

[finsit]

OK so.. your Trigs are coming down.. which is good and your HDL is rising which is good too
Your Trig/HDL ratio has gone from 2.16 to 1.17 .. anything sub 0.87 is considered excellent so while you're not quite there it is certainly moving in the right direction. Excellent.
And no I wouldn't recommend introducing carbs? What would be the point?

Hi I guess you need to calculate tg/hdl ratio on mg/dl only because of the conversion factors. So My tg/hdl ratio in Dec was 4.94 and now it is at 3. So still its improving. I have a question though, is it a good increase in HDL from 0.88 to 1.2 in 6 months?

 

[finsit]

Wonderful HbA1c result - congratulations!

I can't really help you with what to do re your cholesterol as I am in a similar predicament to yourself. I started my low carb journey with a total cholesterol score of 4.7 after a few months cholesterol had gone up to 6.7 but I was losing weight and folks on this forum pointed out that losing weight can temporarily lift cholesterol. Move on a few months when my weight was stable and the results of a further lipid panel showed that cholesterol had gone up to 10. Doc referred me to a lipidologist who blamed the keto diet - she asked me a few questions and decided my issue was Polygenic Hypercholesteremia, which is a genetic condition but they haven't worked out all the genes that are involved, she would not arrange any genetic testing so didn't convince me re her diagnosis.

The lipid doc basically said I needed to lower my cholesterol because of a higher risk of heart disease, however the only treatment they could offer was statins and/or ezetimibe. Rather than accepting statins I asked if I could try to reduce my cholesterol through diet (she did say I would never be able to reduce my levels through diet alone but she did allow me to try.) Over the last few months I have still kept to low carb but increased my fibre, cut out a lot of dairy and changed my fats from butter to virgin olive oil. My last bloods in November showed my cholesterol at 7.6 so some improvement made but whether that was achieved through diet or just the passage of time, I am not sure. I am due my annual HbA1c and I know that my cholesterol is still too high, I have my own testing device and I checked my cholesterol the other day, Total cholesterol showed 6.76 with LDL - 4.9 HDL -1.5 and Trigs .80. Not sure how accurate that will be compared to "a proper" cholesterol test although the tester I use is supposed to be able to be used in GP surgeries. Its quite disheartening that whatever I have tried, I have not yet found a solution. As a short stop measure I think I may be trying the Feldman protocol prior to my next blood test. Cholesterol Drop Protocol (“Feldman Protocol”) – Cholesterol Code I need every help I can get.

That is really useful information and exactly the case i am going through. However, i intended to increase my fat intake in the last couple of months to see how this affects my LDL, which rose to double. I have been eating clotted cream, double cream in coffee/team, full fat soft cheese cheese cakes, buttered veggies - you name it. But i can see when you reduced the fats and you did improve your lipid, that extra fat still does the harm in some genotypes (like ours). My last two lipid profiles never went above 5 for the LDL component so it can not be a genetic or hereditary issues, its all due to low carb but its still not well-researched area on how to keep your LDL in line on low carb. I will be happy even if i have it at 5 mmol as long as i can increase my HDL and reduce TGs. My question to you is whether my increase in HDL from 0.88 to 1.2 in 6 months reasonable ?

Edit: What equipment you use to test your lipids at home if you don't mind asking?

 

[KK123]

Doc referred me to a lipidologist who blamed the keto diet - she asked me a few questions and decided my issue was Polygenic Hypercholesteremia, which is a genetic condition but they haven't worked out all the genes that are involved, she would not arrange any genetic testing so didn't convince me re her diagnosis. Its seems just as likely that I am a hyper responder.

Hi Ryhia, similar to me. My levels were around 8 (although just prior to diagnosis they were 10) but all the way through my HDL was 2.45 and my trigs 0.5. I was referred to a Lipidologist and lucky for me my area were starting up a new DNA lipid testing scheme, I think they were glad to finally get a patient/specimen. I had a variety of DNA tests done to establish primarily whether I had FH which I knew I didn't as I'd managed nearly 60 years unaffected, all fascinating. Mine did come back as having several DNA markers for overall higher cholesterol and was told I had polygenic hypercholesteremia. Meaning no matter what I did my LDL would always be above the so called average. They did suggest statins but I refused based on my ratios being fine. I think around 10 genes were looked at and it really was interesting stuff. When I did a keto diet for a few months my LDL rose but my HDL did too and my trigs have always remained at 0.5.

 

[bulkbiker]

Wonderful HbA1c result - congratulations!

I can't really help you with what to do re your cholesterol as I am in a similar predicament to yourself. I started my low carb journey with a total cholesterol score of 4.7 after a few months cholesterol had gone up to 6.7 but I was losing weight and folks on this forum pointed out that losing weight can temporarily lift cholesterol. Move on a few months when my weight was stable and the results of a further lipid panel showed that cholesterol had gone up to 10. Doc referred me to a lipidologist who blamed the keto diet - she asked me a few questions and decided my issue was Polygenic Hypercholesteremia, which is a genetic condition but they haven't worked out all the genes that are involved, she would not arrange any genetic testing so didn't convince me re her diagnosis. Its seems just as likely that I am a hyper responder.

I did try to change my diet, I reduced my fat intake and switched to extra virgin olive oil as my main source of cooking fat. I also increased my fibre and cut down on dairy. A test in November showed my cholesterol to be 7.9 so some reduction had taken place. Don't know if this was achieved through diet changes or just the passage of time. Still trying to find a solution to bring my cholesterol down, I have a blood test next week and my cholesterol is still definitely too high according to my cholesterol test meter.

Why do you care what your total is?
It tells you nothing about your heart health.
Have you had a full lipid panel with the breakdown of cholesterol?

 

[bulkbiker]

Hi I guess you need to calculate tg/hdl ratio on mg/dl only because of the conversion factors

Sorry I don't understand what you mean here.

 

[Dark Horse]

Sorry I don't understand what you mean here.

I suspect that the OP is concerned (quite rightly) that you can't use the same values for ideal triglyceride:HDL ratio if you use different units. (This is because you are comparing substances with different molecular masses.)

For example, with a triglyceride level of 120 mg/dl, and and HDL of 40 mg/dl, you would get a Tg:HDL ratio of 3. However, coverting to mmol/l, you would get a triglyceridelevel of 1.36 mmol/l and an HDL level of 1.03 mmol/l which would give you a Tg:HDL ratio of 1.32.

Thus, if someone reads an American website which says that a triglyceride:HDL ratio of less than 2 is ideal, they could be falsely reassured by their results if expressed in mmol/l.

A ratio of 2 when triglyceride and HDL are measured in mg/dl is equivalent to a ratio of 0.87 when triglyceride and HDL are measured in mmol/l.

 

[bulkbiker]

I suspect that the OP is concerned (quite rightly) that you can't use the same values for ideal triglyceride:HDL ratio if you use different units. (This is because you are comparing substances with different molecular masses.)

For example, with a triglyceride level of 120 mg/dl, and and HDL of 40 mg/dl, you would get a Tg:HDL ratio of 3. However, coverting to mmol/l, you would get a triglyceridelevel of 1.36 mmol/l and an HDL level of 1.03 mmol/l which would give you a Tg:HDL ratio of 1.32.

Thus, if someone reads an American website which says that a triglyceride:HDL ratio of less than 2 is ideal, they could be falsely reassured by their results if expressed in mmol/l.

A ratio of 2 when triglyceride and HDL are measured in mg/dl is equivalent to a ratio of 0.87 when triglyceride and HDL are measured in mmol/l.

But the whole thread has been mmol/l including the OP's results.. so not sure where or why any conversion is needed.
The Trig/HDL ratio I quoted is also mmol/l so...
Dunno.. maybe the OP will respond.

 

[LaoDan]

If it were me, I’d try swapping fat sources.. cut the cream and cheese and go towards fish, salmon, avocados, olive oil.

been reading about gut health lately, I’d try upping the greens and add in some fermented foods.

your a1c is amazing which is the most important thing. You can fiddle around with your diet and exercise to see something changes .

seems hard to track progress, wonder if there’s a home test for lipids

 

[finsit]

But the whole thread has been mmol/l including the OP's results.. so not sure where or why any conversion is needed.
The Trig/HDL ratio I quoted is also mmol/l so...
Dunno.. maybe the OP will respond.

Hi guys, i initially thought the same as the ratios whether in mg or mmol should be the same if divided in any units, and was happy with my low ratio however then i bumped into this calculator page https://www.omnicalculator.com/health/cholesterol-units and it explains why we can't calculate TG/HDL ratios in mmol simply because conversion from mg to mmol ratios are different for TGs. Please read the article for details.

excerpt:
The rules for converting cholesterol units of TC (total cholesterol), HDL (high-density lipoprotein) and LDL (low-density lipoprotein) are the same:

• To get from mmol/L to mg/dL, you need to multiply by 38.67.
• To get from mg/dL to mmol/L multiply by 0.02586.

Conversion for TG (triglycerides) is calculated differently:

• To get from mmol/L to mg/dL multiply by 88.57.
• To get from mg/dL to mmol/L multiply by 0.01129.

 

[Ryhia]

That is really useful information and exactly the case i am going through. However, i intended to increase my fat intake in the last couple of months to see how this affects my LDL, which rose to double. I have been eating clotted cream, double cream in coffee/team, full fat soft cheese cheese cakes, buttered veggies - you name it. But i can see when you reduced the fats and you did improve your lipid, that extra fat still does the harm in some genotypes (like ours). My last two lipid profiles never went above 5 for the LDL component so it can not be a genetic or hereditary issues, its all due to low carb but its still not well-researched area on how to keep your LDL in line on low carb. I will be happy even if i have it at 5 mmol as long as i can increase my HDL and reduce TGs. My question to you is whether my increase in HDL from 0.88 to 1.2 in 6 months reasonable ?

Edit: What equipment you use to test your lipids at home if you don't mind asking?

The meter I use is a Veri-q which has the option to measure a full lipid panel, total cholesterol, LDL, HDL, trigs and also shows the ratios, a different test strip (cheaper) can be used to test just cholesterol against HDL. There is a third test strip which just checks glucose but haven't tried these. The equipment was quite expensive (for me) as are the test strips and when compared against the bloods taken at the hospital which were done within half an hour of my own testing, the results were lower than what the hospital found, so I was a little bit disappointed but at the same time its a good way for me to keep a basic check on my cholesterol. I don't test very often because of the cost of strips 5 test strips for £29.95. .

As I said in my previous post, I am not sure that diet actually changed anything. or if it was simply due to the passage of time. I still eat a fair amount of saturated fat basically just changed to extra virgin olive oil for cooking and stopped snacking on butter. Did much what @LaoDan has said, I eat a lot more fish and avocados. Also my results could have quite easily been due to just what my cholesterol was on the day. Cholesterol is very dynamic as shown by Dave Feldman at cholesterolcode.com. I actually tested his "Feldman Protocol" and sure enough when I ate very low calorie my cholesterol went up but eating lots of fat and lots of calories my cholesterol went down. Currently its around the same as what my cholesterol was in November so no obvious improvement for a few months.