The Effect of a Ketogenic Diet on Cholesterol Part 3

Cholesterol Part 3
As you can see with my cholesterol numbers, despite cutting back on my saturated fats for 3 weeks by restricting the amount of coconut oil and grassfed butter that I typically eat, my LDL-C and Total Cholesterol have continued to go up!

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:

  1. Increased consumption of saturated fats -> Increased liver production of fats -> High serums cholesterol
  2. Deficiency in certain micronutrients such as choline and copper -> Through some unknown mechanism -> High serum cholesterol
  3. Natural response of the body being in ketosis is to mobilize more fat for energy -> Higher serum cholesterol
  4. Chronic low carb -> Hypothyroidism (low T3) -> Decreased expression of LDL receptors in the liver -> Higher serum cholesterol

So it looks like I’ve eliminated #1 as a potential explanation.  While I wasn’t keeping a food log to document my exact macronutrient intake (which in retrospect I probably should have done), cutting out my normal cups of coffee and unsweetened hot cocoa filled with butter and coconut oil should have significantly reduced my saturated fat intake.  My blood ketones remained in the nutritional ketosis range for the majority of this 3 week experiment.

The next step in my experiment will be to add in a copper supplement taking the 2mg/day recommend by The Perfect Health Diet folks.  I’ll continue my consumption of eggs since yolks are a good source of choline and I’ll start eating coconut oil and grassfed butter again.

  1. Increased consumption of saturated fats -> Increased liver production of fats -> High serums cholesterol
  2. Deficiency in certain micronutrients such as choline and copper -> Through some unknown mechanism -> High serum cholesterol
  3. Natural response of the body being in ketosis is to mobilize more fat for energy -> Higher serum cholesterol
  4. Chronic low carb -> Hypothyroidism (low T3) -> Decreased expression of LDL receptors in the liver -> Higher serum cholesterol

Another thing to add is that when I got my cholesterol rechecked this time, I also checked my thyroid panel, so keep an eye out for a thyroid post as well as part 4 of my cholesterol series.

19 Responses to The Effect of a Ketogenic Diet on Cholesterol Part 3

  1. Dr. Timothe says:

    Did you get your blood drawn after fasting for 12 or more hours?

  2. I will be watching this with interest. My LDL and Apo-B are quite high (209 and 163). I’ve made a half-hearted attempt to cut down on the dairy fats, and started taking kelp for iodine in case I have a sluggish thyroid (the minimal thyroid testing my doc was willing to do came back normal). I’m hoping my doc will agree to order an NMR at my next appointment. All my other numbers (HDL, triglycerides, and various ratios) are superb, so I’m not sure what to believe.

  3. […] my most recent cholesterol blood work, I also checked my thyroid hormone levels in an effort to figure out why my cholesterol has gotten […]

  4. Bjorn says:

    Really interesting to read about others with increased cholesterol due to thyroid problems. Myself, been on low carb since 2005 and all values were good. Lipids in February 2011 showed total chol. 5.7 mmol/dl (220mg/ml) HDL 1.8 (70 mg/ml) and trig 0.81 (72 mg/ml)
    Very good said my doctor. Keep up what you are doing

    3 weeks ago ( 2. October 2013)I did the lipid test again. Now TC was increased to 7.7 mmol (297mg/dl ) and trigs to 2.17 (219). Fortunately HDL was even higher 1.9 mmol (73 mg/dl)

    My doctor wanted me on statins (sent the lab results in the mail together with prescription for a statin)

    Now, I am a biologist with good background in biochemistry and wanted to find out why my lipids had gone so much worse. Looked at the lab results and saw something named TSH was outside the reference range. TSH was 4.92 now while 1 1/2 years ago was around 2.3
    Free T4 was within reference range but lower than last time and also in the lower part of reference. did some internet research……..
    Now, I had lost 8 kg the last 3 months and had done it with low carb and low calorie. Could it be that my lipids had worsened due to hibernation hyperlipema (not enough food had slowed down my thyroid which then had reduced the clearance of LDL from the blood)

    Today, I did a new test in a pharmacy and TC was now 6.4 (247 mg/dl)
    That’s a 17% reduction in less than 3 weeks What did I do? Didn’t follow the advice from my doc but I increased carb intake and also reduced sat. fat somewhat and added some supplements (selenium, copper and iodine)

    The reason my lipids had increased was most likely due to thyroid function. Suspect it will improve further as I fix my thyroid


    • BJJ Caveman says:

      Looks like thyroid issues might be a problem with you as well!

      The one thing in your labs that caught my eye were your triglycerides of 219. Why did they bump up from 72 mg/ml 5 years ago to 219 mg/ml 3 weeks ago?

      Usually trigs are a good reflection of your carb intake. Do you know about how many gm of carbs you were eating up until 3 weeks ago?

      If you were hypothyroid or subclinically hypothyroid due to a very low carb diet, your trigs should be at least below 100. If you are hypothyroid DESPITE eating an adequate amount of carbs, then you would probably need to explore other potential causes with an endocrinologist.. such as underlying autoimmune issues or something else!

      Regarding the 17% variation in your cholesterol tests… I’ve heard people talk about numbers that vary up to 20% even in the same day from the same vial of blood, just as a result of normal laboratory error. So this may account for the change. It’d probably be more helpful to get a couple of followup numbers to see if there is an actual trend… or if there was just a statistical anomaly.

      • Bjorn says:

        Yes, the trigs value was very strange to me too as I did had a very low carb intake the weeks before the test and I have never had a trig value that high However, I did drink two glasses of red wine the night before. (about 10 hours before the test). I am pretty sure that’s the reason for the high trig value. I drink red wine almost every day, but usually not more than one glass. I have read after the last test that you should be without alcohol at least 24 hours before a blood test.

        • BJJ Caveman says:

          Interesting… keep us updated on your next lab tests! It’d be great to see what your labs are without the red wine.

  5. Bjorn says:

    One more thing. I bought a cardiocheck test a week ago and have had 4 test done on Total cholesterol. All showed under 6 mmol/dl (210-230 mg/dl). I suspected that this test was not accurate and that’s why I also did one test at a pharmacy.

    Concerning TSH. I assume you know about the connection here:

    Strangely, my doc didn’t even mentioned the elevated TSH even though it was marked H in the test. I suspect many docs are clueless about the thyroid lipid connection

    I also noted that my vitamine B12 level was less than half than 1 1/2 years ago, and although within reference range was in the lower part of the range. I will definitely ask for a full thyroid test and also include homocystein. Anything more I need to check?

    I really don’t have much confidence in my doctor in this matter. I am not absolutely against going on statins, but I would prefer to rather live a healthy life and let the body itself regulate my lipids. I have friend on statins and many have severe side effects

    • BJJ Caveman says:

      Sorry, I don’t have access to the medscape article.

      I agree that I think most doctors are clueless about the thyroid and LDL receptor connection… Most of the docs I’ve spoken to don’t realize that they’re connected.

      Depending on how much $$ you have and how good your insurance is

      IF I were you… I’d probably check an HBA1c and CRP level and a complete thyroid panel (including reverse T3).

      And then depending on the results of the cholesterol test, I’d consider an NMR lipoprofile.

      I also know many people who’ve suffered side effects from statins. IF you have the time and can read Jimmy Moore’s Cholesterol book or Mark Sisson’s Primal Blueprint, they both do a good job of describing the perils of and fallacy of statins!

  6. Bjorn says:

    HBA1c was 5 in this last test. 1 1/2 years ago it was 5.5. I think the highest it’s been is 5.7. So low carb is definitely good for my blood sugar

    Money is no issue with me, I am not rich but I live in Norway and the government will pay my statins the rest of my life 🙁 socialized medicine you know)

    However, it must be better for the tax payer to let me fix this with a healthy life style, right?

    • BJJ Caveman says:

      Wonderful to see the benefits of low carb on your hba1c!

      More and more research coming out now on the importance of blood sugar control… looks like you’re doing the right thing in that regard.

  7. […] I last left off in Part 3, I was still trying to piece together the possible causes for my sky high cholesterols despite […]

  8. […] continuing to remain in ketosis.  I cut out all the coconut oil and butter I was consuming and on 3/11/2013, only a few weeks after my initial NRM lipid profile, this really didn’t lead to any change […]

  9. […] The Effects of a Ketogenic Diet on Cholesterol Part 3 […]

  10. Max_Headroom says:

    Hi, “Caveman”,
    I’ve found your website searching for connections between ketosis and Cholesterol. Thanks for summarizing current knowledge and posting your results!
    I have a special interest in this since I’m having heterozygous familiar Hypercholesterolemia and suffer from elevated LDL-cholesterol levels. My family is somewhat burden with heart diseases – at least my grandma’s brother died from a heart attack.

    I’m treated with statins and ezetimibe. In 2013 I’ve tried lowCarb-HighFat for the first time ever and – while suffering from ketosis symptoms – went to my physician after 4 weeks to check my cholesterol levels and was surprised to learn that they’re better than ever. LCHF lowered LDL better than a dosage doubling of statins did!!

    After 8 weeks, those results were confirmed but I skipped the experiment then since the physician told me, that this diet would drive me sick…even with a low LDL internal inflammation would come up and promote artherosclerosis.

    But since I wasn’t able to keep those nice blood results and weight loss with a classical reduced, whole-grain died, I’ve started once again this year after reading Gary Taubes “Good Calories Bad calories”. I will check my CRP to rule out those “inflammations” (which is based on a pulication of 2007 but a later paper from 2013 noted a lowered CRP under lowCarb diets) and hope to achieve my weight goal!

    So it really seems to bee different among people how their cholesterol develops under ketogenic diets…

    Thanks for your input!!!


    • BJJ Caveman says:

      It’s great that you found something that actually helps your cholesterol numbers! Best of luck with your CRP results and your weight goals!

      come by and gives us an update!

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