High Cholesterol on a Ketogenic Diet
High cholesterol is a concern for many people as they begin following a ketogenic diet. The keto diet, or even just a higher-fat, low-carb diet, has now gained massive support as a modern-day healing strategy. In fact, our ideas about fats and cholesterol seem to have been almost completely reversed in recent years.
That being said, many people see their cholesterol go up after beginning more of a ketogenic lifestyle. Some people get concerned when this happens, so in this article, I am going to address the phenomena of high cholesterol on a ketogenic diet.
In general, cholesterol is traditionally misunderstood. I am going to show why high cholesterol is not inherently bad, and how to look for some real warning signs that you are in an inflammatory state. Knowing how cholesterol works in the body and how to interpret your cholesterol numbers will empower you to move forward on your ketogenic journey with confidence.
What is Cholesterol
Cholesterol is a substance made by the liver or consumed in the diet from animal-based products. Whether you consume food with high cholesterol or not, you will still produce cholesterol in the liver.
Cholesterol serves a number of important roles in the body. First of all, cholesterol is a critical structural element in certain tissues such as our brain and nervous system. In fact, it is estimated that around 25% of our cholesterol can be found in the brain. Just to highlight our failed fat philosophy over the years, higher saturated fat intake and high cholesterol levels are associated with better mental function in old age (1)!
Cholesterol also acts as a transport molecule to shuttle fat soluble nutrients into cells so that they can be utilized appropriately. Finally, cholesterol serves as an essential building block for progesterone, estrogen, testosterone, cortisol, and Vitamin D.
Is Cholesterol Bad?
High cholesterol has been vilified for a long time and most people have a very superficial understanding that “cholesterol is bad” without having any concept of how it actually works in the body.
As you saw above, cholesterol is critical to our health and well-being. What we’ve been told for a long time is that having certain levels of cholesterol, particularly LDL puts you at a higher risk for heart-related diseases.
Is high cholesterol the problem though? Based on what we know now, we can see how a necessary molecule can become so detrimental to our health. So, when we strictly look at cholesterol numbers, there certainly is some correlation with disease processes, however, there are other more important measurements to consider.
Heart Disease
Traditionally, it was believed that elevated blood cholesterol caused atherosclerosis. This is the process of plaque formation in the arteries that can ultimately lead to heart attack or stroke. This was postulated due to arterial plaques being comprised partly of cholesterol. This is not the full story though.
We know now that plaque formation is a culmination of inflammation at the plaque formation site along with a white blood cell mediated interaction between calcium, cholesterol, and other biological substances. In fact, it is thought that cholesterol is actually used by the body as a kind of internal bandage when our arterial lining becomes damaged by inflammation. This means that cholesterol build up in the arteries may actually be a protective mechanism.
Framingham Heart Study
A study called The Framingham Heart Study that was done in Framingham Massachusetts monitored a group of over 5000 participants for heart disease risk factors. This study has been ongoing, monitoring various test groups, since 1948.
In this study (as well as other similar studies), some shocking realizations have been made including:
- 40% of heart attacks occur in individuals with total cholesterol lower than 200 (considered desirable cholesterol levels)
- Having total cholesterol lower than 180 actually triples your chances of suffering a stroke (2)
- Total cholesterol levels below 200 (desirable range according to the American Heart Association) were associated with poor cognitive function in old age compared to both those who fall into the borderline-high (200-239) and high (240+) total cholesterol categories (3)
What this shows is that there is very little difference in heart disease risk relative to total cholesterol above and below 200. In fact, no significant increase in risk was measured until total cholesterol reached an excess of 240. There also seems to be a protective role that having total cholesterol above 180 serves both for heart disease and healthy mental function.
LDL
LDL stands for low-density lipoprotein, and this is the form of cholesterol generally deemed as bad cholesterol. In reality, LDL (and HDL) aren’t cholesterol, they are actually transport vehicles for cholesterol. LDL is actually very important as it serves the primary role of transporting fat-soluble nutrients into cell membranes for cells to use.
LDL also helps to deliver saturated fat to the cell membrane, which is another important component of cellular vitality. There are also different types of LDL particles characterized by their size. These different sizes of LDL particles can contribute to different health outcomes.
Pattern A VS. Pattern B LDL
A relatively newer concept when it comes to looking at cholesterol is actually the difference between LDL particle sizes. The type of LDL you have in your body actually makes a huge difference in the amount of risk for heart disease that it presents (4, 5).
Pattern A LDL actually has a larger particle size. So, one LDL particle that is pattern A is larger than a single particle of LDL that is pattern B. Pattern A LDL also tends to carry more fat-soluble nutrients and antioxidants. These antioxidants protect it from oxidative stress, making them cardioprotective.
Pattern B LDL, on the other hand, has a much smaller particle size and is much more prone to oxidation. Another thing about pattern B LDL is that it is small enough to enter into the endothelial lining of the artery where it can become oxidized and more likely to form plaque. There is a high association between these small dense particles and cardiovascular disease.
This means that two individuals with the same LDL, HDL, and Triglyceride levels could have vastly different heart disease risks depending on what type of LDL they are predominantly carrying in their blood. A ketogenic diet has been shown to reduce the number of pattern B LDL particles (6).
HDL
HDL stands for high-density lipoprotein and its primary role in the body is actually to sweep up LDL particles and return them to the liver for recycling. This is because LDL is actually very susceptible to oxidation so it must be cleared from the blood efficiently. This means when LDL is exposed to chronic inflammation, it becomes damaged. The longer LDL remains in the bloodstream and the higher your inflammation levels are, the higher your risk of heart disease.
This is why looking at markers of inflammation and LDL to HDL ratios is the best way to interpret cholesterol panels rather than raw isolated values. Having balanced ratios of these numbers suggests that your LDL and HDL are likely working together properly.
Triglycerides
Triglycerides actually serve as a source of energy for cells. LDL particles transport triglycerides to the cell membrane where they are broken down into fatty acids and metabolized to make ATP (cellular energy).
High levels of triglycerides in the blood are thought to be a sign of poor metabolism. Poor metabolism, or metabolic disorders, are associated with obesity, diabetes, heart disease, and cancer. Oftentimes, elevated triglycerides are a byproduct of insulin resistance. In these cases, a ketogenic diet is an excellent strategy to improve those numbers.
What You Should Know
So here is a good quick synopsis of what you need to know about LDL, HDL, and Triglycerides:
- LDL serves as a transport molecule delivering nutrients, building materials, and energy (in the form of triglycerides) to your cells
- LDL is prone to oxidation if in the bloodstream for too long
- HDL’s job is to sweep LDL from the bloodstream to be recycled, ideally before it becomes oxidized
- Having balanced ratios of these helps to facilitate cellular function while minimizing oxidation
- Reducing Inflammation may be the most powerful way to mitigate heart disease risk
Terrible Triad
Now that we have discussed the role of the primary cholesterol molecules, you should have a better understanding of how they work together. Having high LDL isn’t necessarily bad, given that you have adequate HDL to help clear it from the bloodstream and that you are not dealing with chronic inflammation. It is also important to have large particle LDL (pattern A) rather than small particle LDL (pattern B).
The combination of a high LDL, low HDL, and high triglycerides is known as the Terrible Triad and is associated with a drastic increase in heart disease risk.
The good news, however, is that following a well-formulated ketogenic diet should help increase HDL while lowering triglyceride levels. LDL will likely remain the same or potentially increase in order to efficiently transport triglycerides to cells to metabolize for energy. Again, LDL will likely become more of the pattern A type which is a highly beneficial shift.
In general, your cholesterol numbers should fall into the following ranges:
Total Cholesterol: 180-250 (But up to 300 is ok if LDL:HDL and Tri:HDL ratios are good)
HDL: 50-80
LDL to HDL Ratio: 3 to 1 or less (2:1 is ideal)
Triglyceride to HDL Ratio: 2 to 1 or less (1:1 or higher HDL than Tri are optimal)
If you do not fall into these ranges, there are often underlying issues that are contributing to alterations in your cholesterol that need to be addressed.
How a Ketogenic Diet Effects Cholesterol
Research has shown time and time again that following a low-carb, high-fat diet improves cholesterol numbers and reduces your risk of heart disease in 4 main ways (7).
A Ketogenic Diet:
- Increases LDL particle size to the less oxidation-prone state
- It increases the amount of HDL available to recycle LDL from the blood before it has a chance to become oxidized
- It improves the LDL to HDL ratio
- Lowers triglycerides and improves triglyceride to HDL ratio
If you do not notice these beneficial changes in your cholesterol levels after following a well-formulated ketogenic diet for some time, you may want to consider other potential underlying causes.
Reasons for High Cholesterol on a Ketogenic Diet
Now that you understand a little more about how these cholesterol numbers relate, there a few other scenarios you should become familiar with. Abnormally high or low cholesterol levels are typically an indication of metabolic adaptations or deeper issues going on.
There are several reasons for this such as pre existing insulin resistance, rapid weight loss, an increase in HDL, thyroid conversion, and chronic inflammation. Hopefully, this information will allow you to discern what it is going on in your body a little better.
Insulin Resistance
The number one reason for the terrible triad is insulin resistance. Many people have a pre-existing state of insulin resistance as they begin a ketogenic diet and often this combination results in a higher total cholesterol number.
As long as you are working on correcting the root cause of the insulin resistance this is just fine at first. The root cause is going to be related to poor diet, chronic stress, and chronic inflammation. A ketogenic lifestyle will help to address all of these areas and improve your insulin sensitivity.
Rapid Weight Loss
One theory is that an extreme increase in cholesterol may be common in those undergoing rapid weight loss. This is because the fat cells we have stored in our adipose tissue contain high amounts of both triglycerides and cholesterol. When we begin to break down our stored fat to be metabolized for energy, cholesterol in the blood goes up temporarily.
This is because the triglycerides from those fat cells are metabolized for energy while the cholesterol is not. The cholesterol is simply released into the blood where it will remain until removed by the liver, making it appear that our cholesterol has suddenly skyrocketed. Many people are quick to assume that this is due to an increase in dietary fat and cholesterol intake.
This effect should diminish as weight loss reaches a plateau. If it does not, it could be a liver issue or one of the other underlying issues I will go into in a moment.
Increase In HDL
High-fat low-carb diets have been shown in research to increase HDL more effectively than low fat diets. In fact, in many cases people will see LDL levels remain the same or only decrease slightly, along with an increase in HDL. This would, of course, increase total cholesterol and lead to a high cholesterol reading.
Ideally, HDL would remain in the range of 50-80 and possibly up to 90. Anything over 90 could be an indication of infection or leaky gut. Sudden increases in immune reactions that create systemic inflammation can even result in HDL becoming inflammatory (8). This is another mechanism for a high cholesterol reading.
Poor Thyroid Conversion
Many people don’t know this but the active version of thyroid hormone, T3, actually plays an important role in activating the LDL receptors on our cells. There are primarily two scenarios in which this process is inhibited, leading to an increase in LDL cholesterol being manufactured.
When the thyroid makes thyroid hormone, it is predominantly in its inactive form, T4. This T4 must then be converted by the liver and partially by the gut into the active T3. If you have liver or gut issues, then this could inhibit T3 conversion and therefore ability to activate the LDL receptor on the cell.
Next, if there is chronic inflammation in the body for any reason, this can damage cells. Not only can this inhibit interactions with LDL, but remember that cholesterol is also a repair mechanism for cells. If the body perceives cell damage, it will increase cholesterol as a means of fixing that damage which can result in high cholesterol numbers.
Finally, if someone has certain micronutrient deficiencies that result in poor conversion of thyroid hormones, this could also inhibit LDL receptor activation and elevate LDL leading to high cholesterol numbers.
Chronic Inflammation
There are multiple ways that chronic inflammation can set the stage for elevated cholesterol and increased heart disease risk. They oxidize LDL particles, damage the arterial walls (attracting plaque accumulation), and signal the manufacture of more cholesterol to heal damaged cells.
One of the primary culprits of chronic inflammation in our society is a poor diet full of sugars and processed vegetable oils. In fact, blood sugar and measurements of insulin resistance are a much more accurate predictor of heart disease risk. I often look at values such as fasting glucose, HbA1c, and fasting insulin as a means of determining the inflammatory state of someone’s body.
For more information on determining the inflammation levels going on in your body, check out this article on the Top 5 Blood Tests For Inflammation. Remember, high cholesterol isn’t the problem, the issue is high levels of inflammation.
Summary
Cholesterol is necessary for everyday health and we have been misled about what healthy levels are. There are a number of reasons for high cholesterol on a ketogenic diet that are of no concern. If you have been following a ketogenic diet for some time you should have cholesterol numbers within the following ranges:
Total Cholesterol: 180-250 (maybe up to 300 if the LDL:HDL ratio and Tri:HDL ratios are good)
HDL: 50-80
LDL to HDL Ratio: 3 to 1 or less (2:1 is optimal)
Triglyceride to HDL Ratio: 2 to 1 or less (1:1 is optimal)
If any of your numbers are significantly different from what is listed, there may be deeper underlying health issues to be addressed. These are things that can be great to work on with a functional medicine or nutrition practitioner to find the root of your issues. You can get a comprehensive idea of your cholesterol and inflammation levels with our Comprehensive Blood Analysis.
If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. Our website offers long-distance functional health coaching programs with our world-class team of health coaches. For further support with your health and other goals, just reach out—our fantastic coaches are here to support your journey.
Sources For This Article Include
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2. Iso, H., Jacobs, D. R., Wentworth, D., Neaton, J. D., & Cohen, J. D. (1989). Serum high cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. The New England Journal of Medicine. PMID: 2619783
3. Elias, P. K., Elias, M. F., D’Agostino, R. B., Sullivan, L. M., & Wolf, P. A. (2005). Serum high Cholesterol and Cognitive Performance in the Framingham Heart Study. Psychosomatic Medicine, 67(1), 24–30. PMID: 15673620
4. Dreon, D. M., Fernstrom, H. a., Miller, B., & Krauss, R. M. (1994). Low-density lipoprotein subclass patterns and lipoprotein response to a reduced-fat diet in men. FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology, 8(1), 121–6. PMID: 8299884
5. Krauss, R. M., & Dreon, D. M. (1995). Low-density-lipoprotein subclasses and response to a low-fat diet in healthy men. In American Journal of Clinical Nutrition (Vol. 62). PMID: 7625363
6. Noakes, T. D., & Windt, J. (2017). Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. British Journal of Sports Medicine, 51(2), 133–139. PMID: 28053201
7. Raygan, F., Bahmani, F., Kouchaki, E., Aghadavod, E., Sharifi, S., Akbari, E., . . . Asemi, Z. (2016). Comparative effects of carbohydrate versus fat restriction on metabolic profiles, biomarkers of inflammation and oxidative stress in overweight patients with Type 2 diabetic and coronary heart disease: A randomized clinical trial. PMID: 28607566
8. Van Lenten, B. J., Hama, S. Y., De Beer, F. C., Stafforini, D. M., McIntyre, T. M., Prescott, S. M., … Navab, M. (1995). Anti-inflammatory HDL becomes pro-inflammatory during the acute phase response. Loss of protective effect of HDL against LDL oxidation in aortic wall cell cocultures. Journal of Clinical Investigation, 96(6), 2758–2767. PMID: 8675645
I recently applied for life insurance after following the ketogenic diet for about six months. I was initially quoted the lowest rate based on the fact that I have no health issues whatsoever. However, my cholesterol readings were very high so they came back and said that I had elevated total cholesterol readings of 378 which alarmed me. They have now doubled my life insurance rates because of it. Even though my total cholesterol was high everything else seems good according to this article. LDL – 272, HDL – 92, Triclycerides – 70. This all translates to an LDL/HDL ratio of slightly under 3:1 and a Triglyceride/HDL ratio of close to 1:1. I don’t know if I should be concerned that my total is well over the 300 that is sited in this article. Does anyone know?
Hey Cathy,
This may be slightly elevated. Looking at your inflammation markers can be very helpful. You can read more about this here: https://drjockers.com/complete-thyroid-report/%20
Thank you, Dr. Jockers. I really appreciate your reply. I was wondering if insulin resistance would make my cholesterol go up on the ketogenic diet from a total of 220 before I went on it to 378 after being on it for six months. I have always been in a healthy weight range for my height, but I have always been extremely hungry most of the time. I really got on the ketogenic diet hoping that this would be regulated after being on it for some time, but it hasn’t helped that much. Would this signify that insulin resistance may be the culprit for my sudden rise in cholesterol even though I am following the ketogenic diet perfectly?
Hey Cathy, have you looked at your individual numbers? I would see what kind of inflammation you’ve got going on in your body using something like our Complete Thyroid panel: https://drjockers.com/complete-thyroid-report/%20
I am truly puzzled. After going more keto my lipid panel has turned ugly and I have the so called terrible triangle.
This is embarrassing for a health freak like myself.
HDL is still low and stuck on 45 even after hoping strongly with more healthy saturated fats organic bone broth from lamb bones, etc. LDL way up 170 and triglycerides a a record high of 170, Non HDL choleseterol at 203. Kinda surprizd I cannot more that HDL number aftyer all the keto stuff. And unsure why the LDL has exploded since stress has always been with me these last 9 years.
CRP is up to 2.5 from 1.6 and eosinophils crazy high at 521 after re-infection of mold. Only a tiny parasite has shown previously so I think mold exposure responsible mostly for this number.
Fasting glucose still at 86 no change but GFR at only 76 and I am normally at 90-110 I fret a lot over kidneys and I interpreted increased urination to the mold issue in my home in Washington DC that I visit about twice a month and it can’t be fixed.
My uric acid is way high at 7.6 with last test at 3.5 and this is obviously a big deal. I am putting strong efforts into fixing this and the bubbles in my urine likely uric acid although previous testing of 24 hour urine showed protein in the urine. No doctor will see my as a kidney patient. I am back to juicing and going low protein since I sense I have kidney issues with kidney pains and too much urination. Maybe it is all just the mold?
But the great video fails to answer the basic point as to how to test for LDL pattern A vs. B. Happy to do this.
I can get the uric acid down quickly but best without protein or animal fats.
I seem to have uncommon trouble getting base numbers balanced.
I am doing direct labs testing–will go your testing. Help me be proactive. I take a boatload of the best supplements I have researched and self-tested them with compulsive bio feedback.
I think I deserve near perfect numbers with all my research and now my baseline profile is all whacked. Medical doctor so the Terrible triangle and advocated for lipitor immediately. I am not doing that obviously,.
Hey David, You will definitely want to do everything you can to mitigate the mold issue. If you cannot remove it from your environment (or yourself from that environment) then you will want to use things like glutathione, liver support, activated charcoal, and daily detoxification strategies as much as possible. For the LDL testing, this is one of the best I know of https://drjockers.com/cardiopower-testing/
Also, definitely check this article out: https://drjockers.com/chronic-inflammatory-conditions/
Wow, David, your story reads a bit like mine though I am a woman who eats a healthy diet, also researches the heck out of things and weighs 120 lbs at 5’2″. So I was shocked to see a terrible lipid profile! Did you figure out any answers????? 🙂 DK
Hi,
I’m 50 and have been working out with weights and cardio for over 30 years, 6-7 days per week. I have always had controlled weight in the 180’s for 5′ 9″ due to strength training. I went on a “version” of the Keto diet—per day goals: 35 net carbs/85-95 grams protein/35-40 grams fat. I didn’t want to go all-in with high fats. I weighed 188 at the start and in 6 months dropped 26 lbs to 162, and bodyfat at 9%. My cholesterol levels have mostly been 220 with 50-75 HDL.
After going on this version of the Keto diet my typical Lipid #’s have improved slightly (230 to 220 cholesterol) but my Triglycerides have SOARED from 75-100 to 290.
WHY????? I eat mostly Arugula and grilled chicken salads, single Whey protein shake per day and couple snacks like string cheese and/or 2 tablespoons of peanut butter with stalk of celery. No more pizza, chinese etc….
Hey Mike, this could be due to poor metabolism, food sensitivities, poor thyroid hormone conversion, a source of underlying chronic inflammation, or a number of things. This is something that could potentially be spotted on a Complete Thyroid Report here: https://drjockers.com/complete-thyroid-report/%20
You can reach out to michael@drjockers.com for continued support with this!
This is an excellent post that’s worth sharing! The graphics alone are phenomenal, not to mention the great content. Cholesterol is so often misunderstood…thanks for clarifying this complex topic!
Thanks for reading Zana!
The biological changes of the lipid metabolism during ketogenic diet are very well explained. It is convincing and interesting specially the rise of cholesterol during keto diet.
How about the Uric acid during ketodiet. My Uric acid levels shooted up to 463 umol/L from 360 umol/L
How this can be explained?
Also my liver enzymes (ALT, AST)have increased from 46 U/L to 76 u/L,but I noticed a slight decrease of GGT from 112U/L to 104 U/L(of course I have fatty liver). does this keto diet increase the liver enzymes? please explain.
thanks for the interesting answers.
Hey Dr. Murthy, elevated uric acid levels and liver enzymes are typically only temporary and should return to normal with time. If they don’t you will need to do some deeper investigation to figure out why. This article may help in the meantime: https://drjockers.com/top-4-strategies-to-beat-gout-naturally/
Dr Jackers,
I can’t thank you enough for this content. Great illustration and easy to understand of all the content I found.
I have been on keto for past 7 months. Triglycerides improved from 117 to 86 and HDL from 53 to 55, VLDL from 23 to 17 compared to last year. My problem is, LDL has been increasing by an average of 20 points every year for past 5 years, it was 130 in 2014, My metabolic panel is normal. Below is my lipid panel done a couple of days ago. Could you please advise me on how to improve my LDL level?
I have been intermittent fasting for upto 16 to 19 hrs daily for past 5 months and exercise at a moderate intensity daily for 30 min. I am 40 years old, 5.7” height and waist 31”, I weigh 125lbs.
My current lipid panel:
Cholesterol, Total 288 H
Triglycerides 86
HDL Cholesterol 55
VLDL Cholesterol Cal 17
LDL Cholesterol Calc 216 H
Hey Dheer, email this question to our nutritionist at nutrition@drjockers.com! Thank you for reading and sharing your successes!
Hello, I got almost identical results in my blood test and was about to ask the same question. Really worried about the high levels of LDL and LDL/HDL ratio. I will email to the suggested address as well. Thanks in advance!
Hey Juan, be sure to follow the suggestions in this article to get those levels under control!
Hello, following a Keto diet with IF but cholesterol ratios not proper. Diet fats come mainly from olive oil, avocado oil, once a week beef, no butter, bacon etc. Had to go back on statins. Goal is stay away from drugs. Is there a doctor/clinic in the Boston area that you can recommend that understands/tests what you explain in this article? Please advise.
Total Cholesterol: 162
Trig: 76
HDL: 46
LDL: 101
Those numbers look great. You definitely do not need statins. For a good doctor or health practitioner to work with, read this article: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
In your opinion my LDL to HDL ratio is ok?
Dr Jockers just a clarification: the cholesterol numbers above are while I am taking 10 mg statin. If I come off that my total cholesterol goes above 200.
Yes it is and you actually want your cholesterol over 200. An ideal healthy range is between 200-275
Hi
We have been following a ketogenic diet for over a year now
My partner has had a cholesterol check
Cholesterol 7.6
TG 1.5
HDL 1.92
LDL 5.0
The GP has advised a low fat diet
We don’t understand what’s going on
Any advice?
These are very good numbers. It seems like you are doing well. Be sure to read the article you posted this on to help you understand why.
Thanks for replying. How do I convert theses numbers to match your article?
Dr. Jockers, thank you so much for this clear and detailed article! I began a keto-style diet around August 2019. By late November, I had fallen from 197 lbs. to under 175 lbs., dropped from 28% to 18% body fat, and anecdotally felt much better in all aspects of my health. All of this occurred exclusively due to diet, I believe– I had almost no exercise routine to speak of, and my desk-based job is pretty sedentary. My family practice doc was surprised and happy with the results as well when I met with him in January… until my blood work came back showing total cholesterol at 257, triglycerides at 236, LDL-C at 162, and HDL at 50.
Not surprisingly, he immediately and strongly advised that I abandon the keto lifestyle in favor of the Mediterranean diet. I was incredibly disappointed, given the ease with which I had lost weight, though I understood his position and followed his counsel. In the past several weeks, I have gained some weight back, though certainly not all, and generally feel unhappy about the direction I seem to be headed. I have not had cholesterol levels checked again. I very much want to return to the keto lifestyle I was following, but I respect my provider and don’t want to make decisions that might lead me to poorer health down the road.
I know you can’t dispense medical advise, but I am hoping you might answer these questions:
– Are these elevated markers normal, in the early stages of keto adaptation, i.e. within the first few/several months?
– Do LDL and triglyceride levels trend toward normal with more time?
– This seems like a stupid question, but I’m going to go for it: Would an exercise regimen perhaps have been the missing piece to keep the ‘bad’ markers in check, in your experience/opinion?
Thanks for reading!
Hey Chad, was this lab work done in an overnight fasted state? That is really important because if you had eaten within 12 hours of the lab, it will impact your triglyceride levels.
Yes, absolutely exercise, especially high intensity training, will help you lower triglyceride levels, lose weight and boost up your HDL.
Thanks for the quick response.
No, my labs were not drawn while fasting, oddly. I wondered about this. I think I am going to return to keto, re-acclimate my body, and then redraw labs under the proper conditions.
Also, I came across some interesting data re: coffee raising triglycerides fairly significantly, and plan to go cold turkey and see what impact that has. Any thoughts there?
Yes these labs are invalid if you are not in a fully fasted state of at least 12 hours. 12-14 hours is ideal. So finish dinner by 7pm and get your blood drawn between 8-9am
Hi Dr. Jockers, I had a LabCorp NMR LipoProfile (13 hours fast) done and my levels were scary:
LDL-P 960 (<100)
LDL-P small 643 (39)
HDL-P 33.4 (>30.5)
LDL Size 19.7 (>20.5)
Triglycerides 684 (<149)
T Cholesterol 217
LP-Insulin Resistance Marker 100 (<=45)
The cardiologist that I have familial hypercholesterolemia. My father died of a heart attack at 49. At 48, I just had a CABG (5 grafts) in February. I had no symptoms just based on cardiac catheterization results.
I just hate to follow the run-of-the-mill, conveyor style diet that is prescribed by the dietitian in cardiac rehab. Is keto still appropriate for me? Or are there any types of diet/protocol I can follow?
Thank you for taking the time to read this.
Hey Jack,
Yes, you absolutely need to be on keto and you should work with a functional health practitioner to get those triglycerides lowered naturally. Resistance training and HIIT are very effective ways to get that lower in conjunction with diet and key supplements. https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
Thank you for your super quick response! I will definitely go back to lifting and HIIT as soon as my sternum heals and when my cardiologist clears me to do so. I’ve been walking for 45 minutes to an hour around the neighborhood.
And right now, keto it is! Are there any good fats that I should avoid (such as coconut, avocado, type of meat – lean or fatty, or even eggs)?
Great Jack, I would be sure to work with a functional health coach so they can review all your labs and best customize the right nutrition plan. Michael here would be an excellent coach to use: https://drjockers.com/michael-fdn-p/
Hello Dr. Jockers,
I have been Keto since July 2017 and lost 60 lbs. All of my labs, with the exception of my cholesterol, are perfect and I feel amazing. I am 5′ 9″ and weigh 148 lbs. Just to note, I do have family history of high cholesterol.
I’m really confused about my numbers because the total and LDL looks terrible, but the ratios are all great. I’m not sure what I should focus on.
Total Cholesterol – 362
LDL – 242
HDL – 102
Triglycerides – 89
My doctor is not super concerned about my cholesterol, and definitely does not want to put me on Statins; however, he has mentioned trying Welchol. What are your thoughts on this drug? Any other ideas?
Hi Jenn, I would not recommend the medication as it is not going to address the root cause of any sort of dysfunction that may be leading to what we are seeing on the lab. When I see elevated cholesterol levels with good Triglyceride:HDL ratios, I most commonly see an underlying thyroid issue with low free T3 levels. I would want to test your thyroid in detail and you may need some additional thyroid hormone support. With very high HDL over 90, I will also see chronic infections and food sensitivities as an issue.
I would highly recommend working with a well trained functional health practitioner that can help you get to the root of this: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
Hello Dr. Jockers
I have been on keto for just over 3 months and I have lost 34 lbs. I am a 5″4′ male. I went for my yearly physical yesterday and my blood works came as follows.
Glucose 95
BUN 13
Creatinine 0.67
GFR 19
Sodium 142
Potassium 4.7
Chloride 103
Calcium 9.6
Total Cholesterol 245
Triglycerides 64
HDL 68
LDL 164
VLDL 13
Now the doctor is freaking out and gave me an ultimatum to either drop the diet or go to taking medications and I dont want to to either one of them.
Hey Mike,
Your blood work looks great. All the ratios are right in order. A total cholesterol of 245 is very healthy. Unfortunately, your doctor dosn’t understand the importance of cholesterol, I would highly advise not to listen to him on this one. Blessings!
Dr. Jockers,
I recently had labs done, my ldl was high and my hdl was a bit low. I am planning on getting labs done again in 4-5 months. In the meantime what adjustments can I make to improve my numbers? I eat a strict ketogenic diet with 70-75% fats and eat less than 35 grams of carbs per day. Exercise consists of cardio 3X a week for 30 minutes along with weight training 4X a week. Any help would be appreciated.
• Total Cholesterol – 249
• Triglycerides- 64
• HDL – 43
• LDL – 193
Thanks, Viktor
Hey Viktor, For low HDL like this, I would recommend looking to optimize sleep. It is possible that you may have sleep apnea or disturbed sleep. Here is a helpful article: https://drjockers.com/bad-sleep/
I’ve been doing keto for 2 months. I’ve lost 25 pounds, feel good and look good. I have had high cholesterol for many years and about 8 years ago my Dr put me on statins. I stopped taking my statins by accident initially about when I started keto and have heard reports like your that state it doesn’t matter if cholesterol is high. Well, I just went to the Dr today and she said I have one of the highest levels she has ever seen but all of my other tests came in normal.
Total Cholesterol: 416
Triglyceride: 75
HDL: 56
LDL: 315
I’m not sure what to think anymore. If cholesterol isn’t a big factor in health issues then great but at this high a level I am tempted to go back on statins.
Hey Kevin, We have an upcoming article where we will discuss cholesterol in more detail. High cholesterol on keto like this will be due to one or more of the following 1) Poor thyroid hormone conversion and activation 2) Sunshine Deficiency 3) Food Sensitivities (often to nuts, eggs or dairy). This article offers more information about making sure you receive the proper nutrients to maintain healthy thyroid hormone levels while on a ketogenic diet: https://drjockers.com/ketogenic-diet-hypothyroid/
Awesome. Thanks
Hi Dr. Jockers, I’m 25 and I am on keto diet with intermittent fasting for 3 weeks now. However, on my 2nd week, I had my lipid panel drawn and I am kind of scared of my results since it was a big jump from my previous ones. I fasted for maybe 16H before the blood draw and I don’t take any medications. The only change in my lifestyle is my diet and fasting. Here are my results:
Total Cholesterol: 239
HDL: 63
Triglycerides: 43
LDL: 163
Should I be worried?
I should definitely be back on exercising more often. Thank you Dr.
Hey Zhaine, This is a fantastic lipid panel as your LDL:HDL ratio is less than 3:1 and your Tri:HDL ratio is under 1. You should not be concerned at all.
Hello Dr. Jockers
I’m a 62 year old women. I’ve been on Keto for about a year now. I’ve had a weight loss of 14 lbs (was down to 142lbs) My Dr. is concerned about my Cholesterol.
Total Cholesterol: 230
HDL: 83
LDL: 133
According to what I’ve read in this informative pc., my levels are fine…? Keto is the only method that has worked for me. Since my Dr. is concerned with my levels..I’ve tried going to a more plant based diet..salads, vedgies, and chicken, no red meat..or pork products. I’ve been told to go lightly on the cheese, mayo,butter, eggs and nuts.
Needless to say..the weight is coming back. I do watch the carbs, trying to stay at 20-30 percent a day..but it’s hard to figure out what I should be eating…Low cholesterol products mostly mean high sugar, including fruits and vedgies…and vice versa…I’m confused..and a bit angry. There’s so much information out there…My Dr. says..everything in moderation..sigh..big help there…I’m really ready to just go back on my Keto diet…and refuse meds which I know are coming.
My husband’s total cholesterol is 114!!! This can’t be good!!! He tries not to eat meat, and is on meds. for his cholesterol. He has been for years. This is the lowest it’s ever been.
Am I really doing ok? Is my Dr. stuck in a backward way of thinking?
Thanks for reading….Have a lovely day…
Hey Sue,
Your cholesterol leves are perfect! It fights right into the proper ratios. Unfortunately your doctor dosn’t understand the new science of cholesterol. Yes your husband should not be taking any cholesterol lowering meds as his cholesterol is way too low. Here is a helpful article: https://drjockers.com/cholesterol-what-is-it-and-what-are-healthy-levels/
Just had a fasting blood test for insurance purposes. I am 68 year old female. Started Keto last year and lost 30 lbs. fell off the wagon for a few months and am back on.
My recent labs:
Total cholesterol- 279
HDL – 81.3
LDL- 181.5
Triglycerides – 81
I thought ratios etc were pretty good, but my Doc reached for the statins (she isn’t a Keto fan apparently). What do you think?
Yes these levels are totally fine. Your doctor isn’t trained in how to read lipid panels correctly and has been taught that a cholesterol over 200 is a problem. It isn’t.
Here is another helpful article for you: https://drjockers.com/cholesterol-what-is-it-and-what-are-healthy-levels/
Hi Dr. Jockeys,
I am doing the keto diet for almost two months now. My recent blood work is showing a rapid increase in LDL cholesterol. I am a little confused about the reading of this results because I live in Canada and we have a different scale.
Would you suggest me what can I improve in my diet or live style?
My numbers are:
Total cholesterol – 7,32 mmol/L
HDL – 1,11 mmol/L
LDL – 5,48 mmol/L
Triglycerides – 1,61 mmol/L
Fasting glucose- 5;5 mmol/L
Insulin – 39,3 pmol/L
T3 – 3;9 pmol/L
T4 – 16,5 pmol/ L
TSH- 2,12 mlU/L
Ferritin – 53 ug/L
AST – 16 U/L
ALT – 15 U/L
Hemoglobin – 5,3 %
Thank you in advance for your help.
Hello,
I am not familiar with those measurements but if you translate them we will be happy to help!
Hi Dr. Jockers,
Thank you for your reply.
Here are some of my test components I was managed to convert.
Total cholesterol- 283
HDL – 43
LDL – 212
Triglycerides- 143
The others ( T3; T4; TSH; ALT; AST ) I believe has the same measurement in US as in Canada
Hey Tanya,
These ratios are not healthy, it is a sign you have insulin resistance. Thyroid and liver enzymes look good. I would recommend reading this article: https://drjockers.com/insulin-resistance/
Hi Dr,
I have before and after low carb diet,
Before low carb (3nov22)
Total cholesterol- 259
HDL – 66
LDL – 159
Triglycerides- 179
HDL/Tri Ratio 2.7
LDL/HDL Ratio 2.4
weight: 172 lbs @ 5ft 10in
After low carb (13Feb2023)
Total cholesterol- 329
HDL – 75
LDL – 236
Triglycerides- 105
HDL/Tri Ratio 1.6
LDL/HDL Ratio 3.1
weight: 161 lbs @ 5ft 10in
I was not trying to lose weight. I am a fit 40-year-old.
Yes the raise in LDL is due to the lipid energy model for lean mass hyper responders.
Your trigs went down and your HDL went up and so those are great. The raise in LDL is a way your body responds to being insulin sensitive and a good fat burner. Here is a helpful video for you: https://www.youtube.com/watch?v=TKhV-T1OqdQ
Hi Dr.
I am so very confused since last year (Oct 2022) my labs looked like this:
-Cholesterol 156 mg/dL (<200)
-Triglycerides 46 mg/dL (=40)
-LDL-Cholesterol, calc 85 mg/dL (<100 optimal)
-Insulin 4.9 (optimal range: 2.6-24.9)
-Hemoglobin A1c 5.3 % <5.7
-Estimated Average Glucose 105 mg/dl
At this time I was under-eating if anything due to so many food restrictions but eating a lot of vegetables and plant-based foods with some meat but barely any red meat if any.
Today (Dec 2023) they look like this:
-Total cholesterol 231mg/dL
-Triglycerides 98 mg/dL ( or =50)
-LDL-Cholesterol, calc 123 mg/dL (<100 optimal)
-Insulin 5.1 (optimal range: 2.6-24.9 according to labs but many say keep it under 10)
-Hemoglobin A1c 5.7 % <5.7
-Estimated Average Glucose 117 mg/dl
I have been low carb for some time, then did keto for a few months this summer, and recently switched over to carnivore or more like ketovore. I am eating a lot of red meat and wondering if I need to add other meats. I am so very confused about how by eating less carbs my glucose and A1c are higher. Is it possible I am eating too much protein which is converting to glucose and pushing me out of keto? Do I need to be concerned about the cholesterol? I see my naturopath in a few weeks but not sure how well-versed she is in keto and carnivore labs. Any guidance would be helpful!
Hi Dr.
So…
LDL: 233.6 mg/dl
HDL: 51.8 mg/dl
Triglycerides: 86.2 mg/dl
The ratio is not that good.
My diet consists of:
– 6 eggs, 600g of steak and butter per day, 4 days a week.
– 6 eggs, 600g-1000g of salmon and butter per day, 2 days a week
– 6 eggs, 600-1000g of chicken liver/heart and butter per day, 1 day per week
I train 6 times a week with heavy weights. I want to mention that I did my tests on a Thursday. On Monday I hit a PR on deadlifts, 240kg, on Tuesday a PR on bench press, 140kg and on Wednesday a PR on squats, 180kg. Last week I didn’t respect my diet (I ate a lot of carbohydrates) and only on Monday (the day I hit a PR on deadlifts) I returned to the diet above.
Is there any correlation between the lifestyle I had this week and the results I obtained? Maybe the stress put on the body with those heavy weights somehow influenced the cholesterol levels or maybe the fact that I had only 4 days on the keto/carnivorous diet and the body has not adapted yet.
Thanks 🙂