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Is Elevated LDL from a Ketogenic diet a Health Concern?

Discussion in 'Ketogenic diet forum' started by pdmjoker, Sep 20, 2018.

  1. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    My GP was happy I went Keto short-term to lose weight, but concerned that my LDL would rise so wasn't keen on long-term Keto. I researched and put together the following to put before him should my next blood test show elevated LDL. I hope it is of use/interest to others:

    --------------------------

    Is Elevated LDL from a Ketogenic diet a Health Concern?

    That very much depends on the context (which should include HDL and Triglycerides):

    The concern with elevated LDL (''bad'' cholesterol) is that it may lead to the formation of arterial
    plaque and then narrowing and hardening of the arteries (Atherosclerosis) which in turn could
    lead to Cardiovascular diseases (eg: angina, blood clots, stroke and heart attacks).

    LDL particles come in various densities and sizes. Particles of small dense LDL (sdLDL) are small enough to penetrate the arterial wall BUT research shows that people on a Ketogenic diet tend to have less sdLDL (Pattern A) than those eating a diet rich in carbs (Pattern B) and that starting a Ketogenic diet will reduce a person’s percentage of sdLDL.

    If the sdLDL in the arterial walls is oxidised or glycated, Atherosclerosis is encouraged by the macrophages it attracts. (Small dense LDL particles are deficient in vitamin E and are highly susceptible to oxidation.) Consuming seed/vegetable oils, which are high in polyunsaturated fatty acids (Omega 6), can cause LDL oxidation, but I’m careful not to consume any seed/vegetable oils. Also, glycation is highly unlikely since a Ketogenic diet is extremely low in carbs (I’m eating <20g daily excl. fibre) so very little glucose is present in the blood.

    Also, why is LDL high? If someone is eating a Ketogenic diet, they are burning fat for fuel instead of glucose. Their blood supplies the energy to body cells in the form of triglycerides by packaging them up in a vLDL in the liver. When the triglyceride payload is delivered, an LDL particle results. In this case, the LDL can be considered benign as it is relatively quickly recycled by the liver to transfer more energy, so it isn’t left lingering in the blood to possibly become small and dense.

    Of course, there are other possible reasons for elevated LDL, eg: an infection, an injury or cancer as the body works hard to repair itself, but LDL levels fall again when the problem has resolved. In these cases, elevated LDL is a sign of a problem, and isn’t the problem itself. Familial Hypercholesterolemia (FH), though, causes elevated LDL and results in high levels of small dense LDL, too. (I gather that Statins can be prescribed to reduce the amount of sdLDL in people with FH). Diabetes causes higher levels of sdLDL because the LDL particles linger twice as long in the blood, and Cardiovascular diseases are certainly associated with Diabetes.

    I gather that cardiologists use the ratios Total Cholesterol/HDL or Triglycerides/HDL as better indicators of Cardiovascular disease risk that serum LDL Cholesterol.

    (I gleaned most of this information from a talk by Asst Prof. Ken Sikaris called 'Making Sense of LDL', which is viewable on YouTube, but it also agrees with what I have learned from other sources, eg: episodes of The Low Carb Cardiologist Podcast hosted by Dr Bret Scher.)
     
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  2. HSSS

    HSSS Type 2 · Well-Known Member

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    I’m curious how a person would know which type of ldl they have. My tests have never differentiated it
     
  3. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    There is a specific test (a Low-Density Lipoprotein Subfraction Profile) to establish what percentage of LDL is small dense LDL. More info can be found here:
    https://labtestsonline.org/tests/ldl-particle-testing-ldl-p
    but I wouldn't advocate their dietary advice to improve your LDL profile: "by adopting a diet low in saturated fats" :)
     
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  4. kokhongw

    kokhongw I reversed my Type 2 · Well-Known Member

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    The triglycerides/HDL ratios are likely a better marker for CVD...

    Using statins to lower LDL don't necessary significantly improve any endpoints...lots of examples why new drug trials ended in the last couple of years.
     
  5. bulkbiker

    bulkbiker Type 2 · Oracle

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    This is where the Triglyceride/HDL ratio is meant to come into play.. the lower this ratio is then the more larger LDL particles should be present in the blood. Assuming that you are worried by LDL at all..
     
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  6. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    Since I’ve been low carbing my LDL and HDL have crept up, therefore my total cholesterol has gone up too. However my trigs have gone down so my ratios have improved. This has been enough to persuade my GP that I have made a considered decision to decline Statins :)
     
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  7. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    Thank you. I had inferred that from the Ken Sikaris talk, but wasn't 100%...
     
  8. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    Same here. My LDL didn't go up for about 2 years, but my HDL increased very quickly and is still increasing slightly. However, my LDL did go up last year and has stayed up, but not really increasing any more. Therefore the total has gone up. Ratios excellent so no worries at all.
     
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  9. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    In case someone hasn't found this yet, Dave Feldman's talk at KetoCon explains LDL rise in the context of a low carb diet:
     
  10. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    Just got my blood test results.

    I'm having trouble at the moment finding a single reference which gives the recommended levels and ratios of the various parts of the results.

    Previously I can recall finding them, but Google is not my friend at the moment.
     
  11. BrianTheElder

    BrianTheElder Type 2 · Well-Known Member

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    Hi @pdmjoker
    I am a big fan of Prof Sikaris. I particularly like his graph below.
    upload_2018-9-25_19-28-17.png
    This shows that people with triglycerides less than 1.0 are more likely to be in phenotype A, ie have normal LDL rather than sdHDL. He also says that triglycerides themselves are not a good measure of triglycerides! That is because they vary almost constantly. He says that the TC/HDL ratio is a better measure of triglycerides (less than 3.5 is good).
     
  12. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    Trigs under 1.9 fasting (under 2.3 non fasting)
    HDL above 1.2
    LDL under 3
    Total/HDL ratio under 5
    Non HDL under 4
    Trigs/HDL ratio ideally under 0.87
     
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  13. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    Great graph - thank you! I remember him saying Trigs vary according to energy-requirement. That makes sense...
    Didn't he also say HDL and Trigs are inversely related, HDL being a less volatile measure? I guess so, re-reading your post...
     
  14. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    Pure gold! Many thanks!
     
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  15. Salvia

    Salvia Prediabetes · Well-Known Member

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    I've found this discussion to be really helpful, because I've had some worrying results this year. Short version: Total cholesterol has risen, up to 10.4, HDL fallen a bit from 2.18 to 2.15, but LDL is very high at 7.83. Total Chol/HDL is good, and Trigs/HDL is ideal, but HDL/LDL is much too low.

    Dave Feldman's site gives a lot of info, and his section on hyper-responders is useful - but he doesn't say what to do about it (or at least, I can't find anything). Ken Sikaris doesn't say either, though he does say that statins can be helpful. It appears to be a case of "we don't know".

    Anybody have any ideas about how long it takes for LDL to fall again after the initial rise? The increase for me seems to have happened since about Nov 2016 (no tests since then till March, then Sept this year) and it's still rising. Or should I just be happy that ratios are ok and forget about LDL?
     
  16. BrianTheElder

    BrianTheElder Type 2 · Well-Known Member

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    I just remember him saying how variable trigs are. He did get a lot of fun from the fact that TC/HDL was the best measure of triglycerides and was also the ratio favoured by cardiologists, but for all the wrong reasons!
     
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  17. pdmjoker

    pdmjoker Prediabetes · Well-Known Member

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    Considering the graph, does that imply the percentage of sdLDL is considerably variable too? Just pondering...

    I'm very glad you have benefited. :) I have a more recent thread elsewhere entitled Experts Say High Cholesterol Does Not Cause Heart Disease and the link:

    https://www.diabetesdaily.com/blog/experts-say-high-cholesterol-does-not-cause-heart-disease-595056/
     
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  18. BrianTheElder

    BrianTheElder Type 2 · Well-Known Member

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    I am not an expert, but I believe that LDL does vary depending on what you have eaten etc. I therefore think it is safer to use TC and HDL in the ratio because they vary less.
     
  19. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    If LDL varies - and we know Trigs vary a lot, (which is why we fast before a test) then surely the TC must also vary? It is a total of the lipids and trigs so must vary if they do. I judge my cholesterol by my trigs/HDL ratio.
     
  20. BrianTheElder

    BrianTheElder Type 2 · Well-Known Member

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    Well, I would too, only I don't get triglycerides by default when I have a test. They just post me a blood form for a standard test with instructions to get a blood sample taken. It would mean a docs appointment to get it changed. On the other hand, Prof Sikaris did look at a number or ratios for trig estimation and concluded that TC/HDL was best. I get both of those from a standard test.
     
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