The Effect of a Ketogenic Diet on Cholesterol Part 2

Cholesterol 1

Here are my cholesterol tests from the past couple of years along with my most recent results.  My initial results from 2010 when I was following the standard american diet actually look remarkably ideal, despite the diet, however I was running almost 3 miles a day during this period AND I was carrying around more weight and a greater body fat percentage.  So while my blood work looked ideal, my outside appearance didn’t really reflect it… and I was exhausted from all the running I was doing.

While we saw in part 1, according to the scientific literature, on a ketogenic diet cholesterol can either increase, decrease or stay the same, no clear explanations were presented, so of course I had to do some more searching on my own.

It’s interesting to see that my numbers got worse as I continued to follow the Slow Carb Diet, all the while my body fat percentage and overall weight were coming down.  I dropped multiple pants sizes and had to buy a whole new wardrobe since my clothes were all becoming too loose.  I remember having some basketball shorts that I’d kept around since college that were always kind of snug and being confused as to why they kept slipping off while I was playing basketball.  It took me a while to realize that this was because I had lost so much body fat.

With this pattern in mind, I was truly fascinated to see what would happen to my cholesterol numbers while experimenting with nutritional ketosis.  If you’ve been following me for a while, you know that while my weight has been relatively unchanged since beginning, my overall body circumference has been decreasing which indicates that I’m losing more body fat.  This was my primary reason for starting this way of eating, so seeing those numbers come down meant that I was accomplishing the goal I initially set out for… which is pretty awesome.  On the other hand my cholesterol look even worse.

On a side note, during this last test I also got an NMR lipid profile to measure my LDL particle count which has been shown to more directly correlate with risk compared to a simple LDL-C.  I wanted to do this at least once because there are cases where the LDL-P and LDL-C numbers can be discordant which can cause misleading results… unfortunately in my case the LDL-C and LDL-P were concordant, and both extremely high!

Now I know from searching around on the net that this is not an isolated phenomenon.  For one thing, Jimmy Moore is in the same boat… despite losing almost 80 lbs, he’s observed a continued rise in his cholesterol numbers as well.  People who’ve been eating paleo and low carb (other examples here and here) have also observed this.

Now the question is why?  Why does cholesterol increase despite increased fat and overall weight loss?

Possible explanations that I’ve come across are:

  1. Increased consumption of saturated fats in some people can lead to an increased production in saturated fats by their livers for some unknown reason.  Dr. Dayspring, a lipidologist, has observed this phenomenon in 20-30% of his patients.
    1. If you have the chance, listen to his interview with Jimmy Moore.
    2. He recommends cutting back intake of saturated fats to decrease serum cholesterol
    3. This idea is supported by studies such as this animal experiment.
  2. A possible explanation put forth by Paul Jaminet, author of the Perfect Health Diet,  is that this might be due to deficiency in certain micronutrients such as choline and copper.
    1. I don’t think choline deficiency is a factor in my case since eggs are a regular staple of my diet (choline is found in egg yolks).
  3. Some people think that this is a natural response to weight loss in a low carb setting since your body is mobilizing more fatty acids for energy.  Remember, the whole purpose of nutritional ketosis is to allow your body to burn fat for fuel rather than carbohydrates, so there will be more fat floating around moving back and forth to be metabolized for fuel.
    1. I’m not too convinced of this because it suggests EVERYONE in ketosis should have these elevated cholesterol numbers, except that it’s only found in a small amount of people (20-30% according to Dr. Dayspring).  There are many low carbbers out there with phenomenal cholesterol levels.
    2. In my case, I’ve only lost a few pounds during my ketosis experiment, which doesn’t seem like it should be enough to warrant the high level of cholesterol that I’m seeing.
  4. Another explanation, best articulated in this post by Paul Jaminet, is that a chronic low carb state can actually lead to hypothyroidism manifested by a low T3 (the potent form of thyroid hormone), which then causes a decrease in LDL receptors (the guys that pick out LDL from your blood stream), which causes a higher serum cholesterol level.
    1. In the post above, a commenter named Gregory Barton, noticed the same phenomenon of having rising cholesterol numbers despite losing weight while on low carb.  He checked is cholesterol weekly for 15 weeks and noticed that the longer he went low carb, the higher his cholesterol went.  The once he began supplementation with thyroid hormone, his cholesterol numbers dropped precipitously.  The certainly lends credence to this theory… even though it was only an n=1.
    2. This explanation also helped me to remember that according to Tim Ferriss, one of the benefits of having the cheat day on the Slow Carb Diet was to prevent your body from getting to the point where it is so carb deficient that it tries to slow down its metabolism by becoming hypothyroid.

So at this point we’re left with 4 possible explanations as to why this happens…  and to further explore these explanations I have to embark on a few more n=1 experiments.

While I won’t be checking my cholesterol weekly like in Gregory Barton’s experiment, I think an interval of 2-3 weeks would be reasonable.

  • There’s nothing I can really do to test explanation 3, so I’m just going to leave that out for now.
  • I’ll first check baseline thyroid levels.
  • Then I’ll test explanation 1 by cutting back on my fat intake.  I will try to do this while staying within the parameters of nutritional ketosis since I still intend to continue this diet a while longer.
  • If I don’t notice any significant change with my cholesterol levels, I’ll then go on to test explanation 2 by taking some copper supplements and continuing to eat eggs.
  • If still no change, then I’ll test explanation 4 by first taking iodine supplements to help with my thyroid hormone levels
  • And if that doesn’t lead to a change in my thyroid or cholesterol levels, I’ll up my carb intake, stopping my nutritional ketosis experiment, and then recheck my cholesterol.

Stay tuned for part 3…

*A final thing I wanted to add is that despite having a high cholesterol, we still don’t know whether this is a even a bad thing in people who eat low carb.  Cholesterol only causes problems once it goes INTO your blood vessel wall as a result of inflammation.  If you have a high cholesterol, but all of it stays in your blood WITHOUT going into your blood vessel wall, then theoretically your risk isn’t higher than someone with normal cholesterol.

In people who eat a high carb diet, they are exposed to more inflammation, and if they also have high cholesterol, then the inflammation will cause the cholesterol to go INTO the blood vessel wall causing them to have a worsened cardiovascular risk.  In people who are low carb, with low levels of inflammation (both Jimmy and I have low inflammatory markers), it is unclear if having high serum cholesterols actually equates to a worsened cardiovascular risk.

So you see… what we don’t know still far outpaces what we know…

30 Responses to The Effect of a Ketogenic Diet on Cholesterol Part 2

  1. Hemming says:

    I’ve experienced the same as you, although there are a number of caveats to my numbers which there is no point in mentioning here.
    I’m not so worried that my total cholesterol has gone up as it’s with in the normal range (although at the very high end). My triglycerides also went up (they’re still low) which kind of makes sense to me as that would indicate that I’m mobilising more fatty acids.

    Generally I think there are so many individual variables of different kinds that it’s more or less impossible to set out the perfect diet.
    Anyway, just my two cents.

    • BJJ Caveman says:

      I think I have to agree with you… there really is almost an infinite amount of individual variation and at least for me… It’s still going to take a long time and much more experimentation to figure out what works best…

      Just when I think I’ve found a diet that works well for me in terms of body recomposition… now I have to start thinking about it’s effects on my cholesterol! sigh…

      • Hemming says:

        To me it’s about ‘picking your poison’ be it carbs or fat. You can do low carb/high fat or high carb/low fat but not low carb/low fat or high carb/high fat. At least I can say that low carb/low fat is a surefire way to ruin both you physical and mental health.

    • Richard says:

      Glad I came across your blog post on this subject. I’ve been low carb for the past 6 months. Lost stacks of weight, feeling great then got my blood work done and find my LDL levels are through the roof. I think it’s theory (3) makes sense to me – lots more lipid activity due to a substantially larger intake of food fats and liberation of adipose tissue combined. Still thinking through my response on this one…

      • BJJ Caveman says:

        Thanks for stopping by. I’ll be posting the results of my most recent cholesterol test, so stay tuned. I think you’ll find them interesting.

        • Dale says:

          I’ll be looking forward to those results too. Earlier I had reported “TC:334, LDL:228 (last year TC:247, LDL:150). HDL has been rock steady for five years at 85 to 90”, but I just had the LDL subfractions test done [LDL-P:1619 (normal <1000), Small LDL P#:134 (normal <527), real LDL size: 21.7 (normal <20.5), LD-IR Score: 4.0 (normal 30.5)]. So I don’t know how to interpret these numbers except to say that although I’m over normal on LDL-P, I kill the small LDL, which are the “bad actors”, from what I understand.

  2. Daytona says:

    Consider that 75% of people who have a heart attack had “normal” cholesterol. In the elderly, those with “higher” cholesterol have a lower mortality rate. In women, at any age, there is no association between cholesterol levels and heart attacks or mortality.

    Over the past few decades the “normal” level of cholesterol have been drastically lowered, to the point that the majority of American’s are now considered to have “high” cholesterol even though as a nation our cholesterol levels have decreased significantly in the past 50 years.

    My point is this: Do you feel healthy? If yes, then why concern yourself over a number that no one can agree upon and isn’t proven to directly cause disease? I prefer to focus on making changes in my life that directly and immediately improve my overall health and feeling of well-being, rather than worry about risk factors.

    • BJJ Caveman says:

      Great point!

      While I do agree that cholesterol is a controversial number, especially since it only offers an incomplete picture if anything, especially since you need to take into consideration your inflammatory markers and your vascular health at the same time.

      The reason I’m concerned is actually because of the LDL-P (number of LDL particles), because at least according to Peter Attia and some other people, it’s the number of particles that actually correlate with disease risk, more than the concentration (LDL-C, which is inaccurate since it’s only indirectly measured by being calculated from a mathematical equation and not directly measured). Since I now know that at least in my case, number LDL-C and LDL-P numbers are both concordantly high, I’m just using LDL-C as a surrogate marker (since it’s a cheaper test than the NMR lipid panel).

      In actuality, since I’m still relatively young, and this diet hasn’t been for very long, the effects of having such high cholesterol numbers probably aren’t very clinically significant… but I just can’t help being curious as to what other factors can effect my cholesterol… and what the exact cause of these numbers are! I guess I just want to know since none of the explanations I’ve looked up have been proven or seriously researched.

  3. Justin says:

    Agree with Daytona – not sure the high cholesterol matters at all. I’d be more concerned about the effects on thyroid and hormone status.

    I bet monitoring morning temps is going to make it clear pretty quickly if there is a thyroid issue.

    • BJJ Caveman says:

      Well, I got my thyroid tests back… which is pretty telling, but I’ll be writing a post on that later.

      How do morning temps correlate with your thyroid function? Can you point me to any literature or good articles on this?

  4. mike says:

    I just got a basic quick check done and my total cholesterol was in the moderaly high range and my ‘good’ cholesterol was in the low side. I’m going in here in a few weeks for a more thorough exam. Most of what I eat is supposed to boost the good cholesterol but doesn’t seem to have much of an effect.

    • BJJ Caveman says:

      Best of luck! What kind of things are you eating to bring up your good cholesterol? Fish oil? Red Wine?

  5. Dale says:

    So cool to stumble on your blog with all the recent entries! I’ve been moderating carbs for a decade but just went VLC to lose 15-20 pounds that gathered over the last few years of too many beers (when you’re over 50, it’s easy to pickup pounds). Today’s test was a shock with TC:334, LDL:228 (last year TC:247, LDL:150). HDL has been rock steady for five years at 85 to 90, the 90 being today. After reading lots of posts here, I’m no longer going to worry about the TC or LDL, as I’m in major fat burning. You are an inspiration. Keep it up.

    • BJJ Caveman says:

      Thanks for the kind words!

      Looks like you’re in the same boat as I am! I think as long as your other markers are doing well (no inflammation), your blood sugar is controlled, it probably isn’t something to be worried about… my only concern is lets say for insurance purposes. There’s no way they would accept numbers this high as being in a healthy range even if everything else looks good. If we can at least understand why the cholesterol jumps up the way it does, it would at least give us a way to modulate it…

  6. […] Here is a brief summary of potential explanation as to why LDL and total cholesterol can be elevated in people who are in ketosis from Part 2: […]

  7. David says:

    Thanks for sharing your n=1 experiment. When I changed to the LC way of eating, I read as much as I could. I recall from the Atkins books, and it’s been a while since i last read the books, that the body will need 6 months to a year before blood tests become normalized as you body is fully adapting. Try testing 6, 9, and 12 months out. After a year if your blood test do not improve maybe ketosis is ideal for your genetics. Keep it up and hopefully things get better as time passes. BTW, I’m going to start my own n=1 experiment. you mentioned you ordered ketone test strips from Canada. How are they (reliable source) and do they come with a calibration strip for each set?

    • BJJ Caveman says:

      They are very reliable. I’ve ordered from them multiple times. Shipping takes 1-2 weeks though. Each box does in fact come with a calibration strip.

      Thanks for the suggestions!

  8. […] discoveries during my n=1 experiment with nutritional ketosis regarding my cholesterol (Part 1, Part 2, Part 3), thyroid hormone (Part 1), and skin rash, I decided to take a break from nutritional […]

  9. Sue says:

    I’ve been doing the hcg diet for the past couple of years – the homeopathic one (which may well be a silly placebo on the part of the hcg) – which incorporates the low carb theory but also utilizes a low FAT parameter. My cholesterol levels have improved dramatically. The diet only lasts for 6 weeks on the drops, then 3 weeks of no processed sugar and very low carbs. You basically get 200 gr. of lean protein, 4 cups of approved veggies, 2 servings of approved fruit and like 2 melba toasts a day. I think maybe the difference might be the time frame and low fat parameter – with only 6 weeks at a time, and a lower fat intake? Dunno, but thought I’d share. I’ve lost basically an entire person (122 pounds). 😀 I would like to stay posted on how you do! 😀

    • BJJ Caveman says:

      I’m not familiar with the HCG diet, but congratulations on losing 122 pounds and improving your cholesterol! That is quite an accomplishment! It seems like you’ve found something that works wonderfully for you.

  10. […] can read about my thoughts on my prior cholesterol numbers here: Part 1, Part 2, Part 3, Part […]

  11. […] that there is actually plenty of food around and aborts the typical drop in energy.  This is a similar concept Tim Ferriss employs with his Slow Carb Diet and weekly cheat […]

  12. Sg says:

    I started this diet in Aug’13 and had my blood work done in January. My LDL has gone up dramatically. Trying to make sense of your posts. I’m supposed to repeat my blood work in 3 mos.

    • BJJ Caveman says:

      Have you been in strict ketosis thus far?

      You may want to have your thyroid numbers checked. Make sure the doctor asks for the whole panel, TSH, Free T3, Free T4, and reverse T3.

  13. Lee says:

    I was on high protien and high fat diet over a week. I lost 3 kg, still overweight. Got my blood test. My cholestrol is so low and my LDL is borderline low… I will recheck in 3 weeks time. Really like your blog, especially the research part.. Been doing that as well.. 🙂 I have the technical parts calculated, making sure my calories deficit is optimal. By reading urs, I will be cautious,

  14. […] The Effect of a Ketogenic Diet on Cholesterol Part 2 […]

  15. […] The Effect of a Ketogenic Diet on Cholesterol Part 2 […]

  16. […] the second part of that series, The Effect of a Ketogenic Diet on Cholesterol Part 2, I went over my numbers and came up with 4 possible explanations to what the hell was going […]

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