Ken is our super star loser, 170 pounds and still actively dropping weight. As Dr Hallberg explained in the video GRB just posted, and Dr Davis explained here, http://www.wheatbellyblog.com/2015/...nfuses-doctors/
...his lipid panel results are transient until he is weight stable (Dr Westman use to say for two months)

Thanks, Janet. That's exactly what I thought my physicians would say, but that was not the case. This is another example of why patients must be informed, as not all doctors are active students of current health research, and in particular, blood lipid research. I appeased one of my doctors, who supposedly recommends a ketogenic approach to patients dealing with obesity, by agreeing to a Coronary Arteries Calcium Scan. This test, while not universally covered by health insurers, is supposed to reveal the "real" CVD risk by measuring current plaque build up. If I get a low risk score on this, I'll have my answer, and I'll forgo any future blood lipid tests.

I won't "retire" that HWC just yet!!!

I'm another person who just says no to cholesterol testing. I tell my doctor that I won't take a statin drug so why bother with testing. She seems to accept it. I imagine that she doesn't have too many patients who manage to lose 100 pounds and then maintain that weight loss. I think that should be powerful evidence that I am doing something right.

Jean

Wow, quite impressive testimonies!

I found this article on The Low Carb Dietician website...

Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience

This woman (a dietician and low carb advocate) appears to have the same wacky lipid experience with a VLCHF/Keto diet as I do. She was not even trying to lose weight -- she just changed from a lower carb to a very low carb diet for a deeper ketosis and that made her LDL spike. It appears that a small percentage of those who follow a very low carb/keto diet have this type of response and I appear to be one of them.

She is a supporter of the LC lifestyle, anti-statin and had the same struggle with deciding whether or not to be concerned about what was happening as I have. Citing lack of any real clinical data for people in our situation, she decided to error on the side of caution and adjust her diet. She reverted back to a mildly ketogenic/lower carb diet that she was on before and made a few other changes with respect to saturated fat. After 2 months, her LDL improved significantly. This was the only material that I've been able to find where someone in my shoes with the LDL issue had tried something and succeeded in making a positive change in their lipid panel. She includes her test results in the article and makes some really good points as to why she chose to add more carbs back to her diet.

About 3 weeks ago, I started a TDC 90 day challenge with the aim to tighten up my diet even more. I'm now doing Less than 20 net carbs per day - just like the person in that article did. I've never done this few carbs for an extended period of time before. I plan on completing the 90 days at less than 20 net carbs. I'll then request another lipid panel and see where I'm at. If my LDL is still double what it was a year ago (or worse), then I will strongly consider backing off of my VLCHF/Keto diet and make plan adjustments like what the author of this article did. It will be interesting to see if I have the same results. Maybe deep ketosis is not for everybody. Like the author of this article, I'm just not sure I want to accept without question that my LDL numbers are safe - given that my response to deep ketosis may not be the norm. There are no studies for people in my situation. I wish there were.

I had this happen to, but I think it might be more due to increase in sat. fat than ketosis. The reason I think this is I read something in my genetic analysis that said my LDL may rise as my sat. fat intake rises. I haven't really tried any experimentation.

When you have to cut protein and you can't increase carbs, you usually tend to increase saturated fat to make up the difference. But what if instead you ate a lot of avocados? Or mayo made with olive oil?

I'd been tracking my food before both my March 2015 and June 2015 cholesterol tests. In my N=1 experiment (after my results in March) I increased my saturated fat intake by 50% over what I had done in the months prior to my March test. Carbs, protein, and overall calories were up, too - but I was still eating low carbs in the ketogenic range. Eating 50% more saturated fat did not increase my LDL -- in fact it went down by 6%. It was 233 in June and 248 in March.

So maybe increased saturated fat increases LDL to a point and then reaches some sort of max level -- or perhaps I just don't respond the same way most others do.

In June of 2014 - 5 months into this WOE - my LDL was 129. I was not tracking my food back then -- but I was eating low carb and likely eating more than I am now. I weighed 375 lbs and could still eat LC like a horse and still lose weight. I ate pretty much the same foods - so I'm sure my saturated fat intake was higher than today. I was probably eating more carbs than I thought I was. Once I started tracking, I learned that I had likely been underestimating my carb counts.

So I guess my point here is that in June of 2014 I was eating a higher carb and higher fat diet than I am now - and my LDL was so much better than now. Other than food and weight loss, about the only other thing that has changed is my blood glucose. In June of 2014 my A1C was still at prediabetic BG levels. My BG rarely goes over 100 these days.

I wish I could put a finger on exactly why my LDL doubled in a year's time. For some reason, that happens to some of us and I'm not sure anyone has a real grasp as to why. I'm just trying to figure this thing out as I go along.

This has got to be frustrating for you. I read the article you posted. I hope this doesn't happen to me but if it does I will follow your progress with great interest. I'm pretty sure with the determination you seem to possess and "self" research you are doing now that you will get this under control. It is a bummer that there's never been any research on very high lipids and low carb eating as the lady you posted mentioned.

FYI: Franziska Spritzler, RD recently did a follow-up to her Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience article. It too is a good read, especially for people in my situration. Here is the link:

Update: Recent NMR Results, Cardiovascular Disease Risk, and What I Eat


I'm thinking that I will eventually land on a diet similar to hers. It is not that far off from what I've been doing -- just a few more carbs and an adjustment to saturated fat intake. But for now - I'll stick with my < 20 net carbs and try and get this last 60 pounds of excess flab gone.

Just had an NMR Lipid panel done on Thursday of last week. The last panel I had done was a little over a year ago, and when I had the blood drawn, I had been fasting for 60 hours. I did that on purpose to see what that would do to my "health markers." In that test, I had higher than normal (for me) total cholesterol of 230. My HDL was 63 and my TG was 62. My IR score was off scale on the low end of sensitive, so all in all, I was fairly pleased.

However, the TC score of 230 started the statin conversations with my doctors. Fast forward to last Thursday when I asked for the following:
- NMR Lipid Panel
- CRP
- HbA1c
- Electrolytes

My doctor, reviewing my last results, started up the statin discussion. I stated that I wouldn't consider statins, as my other markers indicated that I was very low risk for CVD, but I stated that we should see the results of the test I was about to have.

For this recent test, I decided to play it straight, and was fasted since my evening meal the night before, about 14-15 hours. Also, I was curious about whether dairy was causing any issues, so I had stopped all dairy for 30 days before my blood test. Here are my results with any relevant previous scores in ():

TC - 149 (230)
LDL-P - 952 (1398)
LDL-C - 86 (161)
HDL-C 54 (63)
TGs - 46 (62)
HDL-P Total - 28.1 (26.7)
LDL Size 21 (21.1)
LP-IR Score <25 (<25)
CRP - 0.40 (1.6)
HbA1c - 5.5 (no previous measurement)

Well, my doctor is no longer recommending statins based on the above results. His remark was to keep doing whatever it is I'm doing. Right.

The significant differences between the two tests was the amount of time I fasted, and the elimination of dairy 30 days prior to the blood draw late last week. In terms of analysis, I can hypothesize that my TC went down because I was not in the process of gorging on my own fat stores this time, having fasted only since the previous day's evening meal. My guess is that when one is actively burning fat for fuel, the fat is mobilized in the blood to such a degree that it measures higher for TC, LDL-P, and LDL-C. My TGs are down and below my HDL for a >1:1 ratio, and that's consistent with all previous tests, but my TGs are even lower this time. I'm happy with that. However, TGs aren't clearly understood at this time, so I'll temper my reaction here.

Also, my insulin resistance score shows me as very insulin sensitive. However, my HbA1c at 5.5 is somewhat disappointing to me, as I was expecting something around 5.0 given my very low carb consumption.

The CRP score is very good at 0.40 and has gone down since my last measurement at 1.6. I'm wondering if this is the dairy elimination at work. Could dairy have been causing a bit of inflammation? Not sure, but from these results, it wouldn't hurt to minimize dairy at this time.

Bottom line is that if I ever get another test, I need to play it straight with the amount of fasting time prior to the blood draw, as it's clear that being in a strong fat-burning mode due to a longer fasting period causes our medical professionals to get all excited. The humor here is that the previous, fasted numbers are likely very normal, and since we don't have a lot of samples of what should be baseline from tests of fasted people, there is no basis of comparison. By the way, I never mentioned to my doctor that my previous tests were done during a long fast.

Why is that doctors never worry about TC being too low?
Your NMR looks like an excellent profile of a consistent low carber.
Interesting observations about how long you fasted for each test and dairy.
I solved worrying about my cholesterol and higher Hba1c by not having the tests done in about two years. Had a CAC instead. Have you read Chris Kresser's ideas on A1c not being a reliable marker...we LCers have old blood https://chriskresser.com/why-hemogl...eliable-marker/

Dr Westman mentioned last night a young man came a long way just to discuss his cholesterol numbers with him. His doctor tried to scare him into medications when the numbers weren't that bad...and he was only 29 (age being the biggest risk factor for heart attacks) He thinks some doctors use cholesterol numbers to avoid discussing the lifestyle factors that should be addressed first, e.g. Stop drinking soda, lose the fat around around your belly, etc. Instead, throwing a med at the patient is a quick way to avoid having to delve into sensitive issues like what they eat and drink. Cholesterol is just a big distraction.
After 20 years, he is now aligned more with THINCS. http://thincs.org

I solved the cholesterol problem by deciding not to have the test done ever. It's been about 10 years. I told my doctor that since I had no intention of ever taking a statin, after one experience many years ago with Lipitor that caused me disabling joint pain, there was no point in having my cholesterol checked plus I believed my diet to be about as healthy as I could get, which she couldn't argue with since she is impressed with my weight loss. I recently did a home HbA1C and it was 5.0. I did that test because my bg's tend to run a bit higher than I like despite being in ketosis. I've stopped testing bg's and ketones too Don't know how accurate the home HbA1c test is but the result is good enough for me. Clearly one of the problems with many of these tests is that they are calibrated assuming the standard American diet filled with high carbs. What they mean for us low carbers may be entirely different. I've reverted to an "if it ain't broke don't fix it" attitude when it comes to my health, in other words if I'm eating OK and feeling OK I don't need the tests to get me worried about risk factors.

Jean

Janet, the Kresser article is very much relevant to this, and puts my HbA1c results in perspective. I'll no longer ask for that test, as I believe, after reading the article, that it's useless. It makes perfect sense that glycated red blood cells would have varying life spans rendering the HbA1c meaningless. Very interesting in that since I no longer have a hint of pre-diabetes, it's likely that my hemoglobin has a different life span. After reading Dr. Joseph Kraft's book, the lack of a simple widely practiced method to accurately determine whether one is on a path to diabetes is real.

Thanks for the THINCS link. I love the irreverence and the stand they're taking. More good information to review.

Jean, I had threatened to no longer take blood lipid tests, but as long as my insurance covers them, I'll take them annually in an attempt to use the results for my own purposes. Now that I know enough not to get blood drawn in the midst of a long fast, I can appease my doctors with what they consider "great" numbers. Once I no longer have insurance coverage, I'll go to the private lab testing companies with a more targeted battery of tests. I like to get the LP-IR score, LDL Size, and CRP to gauge how I'm doing. The first two may be inconsequential, so I fully agree with your observations and approach. If my doctor knew how much fat and salt I consume while still having "great" blood test results, he'd think I was an anomaly.

Nice post, Rob. Thanks for sharing. I just dug through my journal to find my NMR results from last December. My results were very much like your previous results. I was still in weight loss mode then and consuming my own fat much like you were on your extended fast. One thing I find very interesting is how both you and I made a few simple tweaks to the diet and greatly altered the results. Gotta love those N=1 experiments.

Now that I am weight stable and have been for months, I am considering having another NMR. I have stopped worrying about my cholesterol. My last results were fine. They made my doctor happy. But I am curious, nonetheless. I like data and since I still eat much the same as I did a year ago, I'd like to see if simply becoming weight stable has any effect on my results.

As far as the rise in your A1C score... Mine went up a little from my last annual checkup to this past one, too. In 2015 it was 5.1 and last March it was 5.3. I mentioned the Kresser info to my doctor at that last visit and she thought it was poppycock. She bluntly retorted that red blood cells have a 90 day shelf life, period. Not very open minded, is she? Anyway, I was hoping for a 4.8 to a 5.0 A1c, too - so I was disappointed with the results. But since then it occurred to me that the A1C score is rather pointless for a low carber like me. I still spot check my BG fairly often, both FBG and post meal. I can't remember the last time it was over 120. The great majority of my BG tests do not crack 100. So if the A1C is intended to measure your track record of high BG events over 3 months, then it strikes out with me. I don't get high blood sugar anymore. So the test results are actually kind of pointless.



That is what my doctor said to me when my LCHF diet started taking care of my diabetes. They must teach that line in medical school. It is what you are supposed to say to your patients that do not follow the rule book, yet gets unexpected positive results.

A good response to a doc saying "keep doing what you're doing" would be - "what do I need you for?"