The Effect of a Ketogenic Diet on Cholesterol Part 4

Cholesterol Part 4


After more than 30 days of increasing my carb intake it looks like my cholesterol numbers have all improved.  At this point I haven’t bothered to check my blood ketones because I know that I’m out of ketosis.  I’ve been trying to keep my carb intake to around 100 gm per day.  Sometimes I go over and sometimes I go under, but on average it’s around 100 gm.

When I last left off in Part 3, I was still trying to piece together the possible causes for my sky high cholesterols despite being in ketosis.  The possible explanations left were:

  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

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.

I was in the midst of taking the copper supplements when I finally started putting 2 and 2 together regarding my ketosis  rash, prurigo pigmentosa.  In an effort to explore my suspicions about the rash, I started to eat more carbs, which confirmed my diagnosis after the rash promptly went away (my skin is still rash free).

Unfortunately, during all this, the copper supplementation fell by the wayside, so I don’t really have anything to report on it.

What I think is most interesting however were the results from my follow up thyroid panel, obtained at the same time as this test.  After adding more carbs back into my diet we  see that my thyroid numbers (previously in the hypothyroid or near hypothyroid range) have normalized, while simultaneously my LDL and total Cholesterol have also improved.

This really lends credence to hypothesis 4:

Chronic low carb -> Hypothyroidism (low T3) -> Decreased expression of LDL receptors in the liver -> Higher serum cholesterol

As I was trying to piece all of this together, Chris Kresser put out a timely article discussing LDL particles and the different factors that affect them, with one explanation for elevated LDLs really catching my attention:

Poor thyroid function is another potential cause of elevated particle number. Thyroid hormone has multiple effects on the regulation of lipid production, absorption, and metabolism. It stimulates the expression of HMG-CoA reductase, which is an enzyme in the liver involved in the production of cholesterol. (As a side note, one way that statins work is by inhibiting the HMG-CoA reductase enzyme.) Thyroid hormone also increases the expression of LDL receptors on the surface of cells in the liver and in other tissues. In hypothyroidism, the number of receptors for LDL on cells will be decreased. This leads to reduced clearance of LDL from the blood and thus higher LDL levels. Hypothyroidism may also lead to higher cholesterol by acting on Niemann-Pick C1-like 1 protein, which plays a critical role in the intestinal absorption of cholesterol.

Studies show that LDL particle number is higher even in subclinical hypothyroidism (high TSH with normal T4 and T3), and that LDL particle number will decrease after treatment with thyroid hormone.

My little cholesterol n=1 experiment pretty much illustrated this exact point… it probably would have saved me a lot of trouble if he had only written this a few months earlier!!  But then again, something tells me I would have wanted to test it anyways.

Since it’s well established that eating a very low carb diet can actually cause your body to shut down thyroid production in an attempt to reign in your metabolism as it shifts into ‘conserve energy mode,’ I feel pretty confident that I’ve gotten to the bottom of my elevated cholesterols.  I’ll probably check it again in a few weeks to see if my numbers have normalized even more.


26 Responses to The Effect of a Ketogenic Diet on Cholesterol Part 4

  1. Richard says:

    Well done on reigning in those high numbers!

  2. Hemming says:

    I know it has been mentioned a lot of places to increase carb intake in your situation. I do think that you should read some of Jack Kruse’s blog where he also mentions iodine deficiency and a host of other more complicated and confounding variables.

    Peter Attia recently posted his lipid panel and his numbers are very good. That’s obviously no way to say that everyone will do well on a ketogenic diet but I think that one ketogenic diet can be better than another ketogenic diet.

    • BJJ Caveman says:

      Will check out Jack Kruse’ blog. Iodine deficiency was definitely something I was considering… and I actually bought some iodine to supplement with, but haven’t really gotten around to experimenting with it.

      If I do a followup exam and I’m not happy with the results, its something I can play with.

      I love Peter Attia’s site… even though I consider myself fairly active, he’s an exercise maniac! I read in a couple of his posts that he exercise 3-4 hours each session! His n=1 is definitely different than mine.

      • Hemming says:

        I can highly recommend Jack’s blog. His thinking goes far beyond ‘eat this and not that’ which is why I think he is really on to something. His blog is a truckload of information and he has his own way of writing but it’s definitely worth spending the time reading it.

  3. Richard says:

    Couple of questions:
    – when did you eat the carbs – with each meal, just with dinner etc?
    – did it affect your weight or waistline?

    • BJJ Caveman says:

      Added carbs in to lunch and dinner.

      Weight went up, although waist line hasn’t really changed. I’m guessing the increased weight is due to more water retention.

  4. Ken says:

    What carb’s have you added back in? I’ve tried adding in steel cut oats but they seem to bloat the hell out of me.

    • BJJ Caveman says:

      Carbs that I’ve added back in:
      – White Rice
      – White Potato
      – Sweet Potato
      – Sea Weed
      – And now more recently fruits such as pineapple, watermelon, blue berries, and black berries

      I’m still trying hard to avoid gluten since there’s enough research out there to support this, and it’s something that everyone in the paleo-sphere can agree on.

      It could be the gluten in the oats that causing the bloating?

      • Ken says:

        Have you by chance been keeping track of your glucose levels after eating carbs? I’m just curious if you’ve noticed any sugar rush eating rice and potato’s. How has your body responded to adding the carbs back in (bloating, indigestion, etc.)? Have you reduced your fat and protein intake any with the increase in carbs?

        I was eating the gluten free steel cut oats at breakfast either in place of or with my eggs but still felt bad. I’ve been pretty carb restricted for about a year, except for berries, avocado, chia and flax seeds, so perhaps my body wasn’t used to grain based carbs. I’m torn on oatmeal as I love it, but my body doesn’t always agree with it.

        I also seem to remember something on Jimmy Moore’s site about adding carb’s back in to reduce your particle count. I had an NMR done a few months back and had a particle count of 1,406. My small particles were just under 500, and the only carbs I eat are what I listed above.

        Thank you for doing this, and please continue to post your LDL results. I hope you’ve found what was creating the high particle count. Do you plan to do another NMR, or another lipid panel? I’ve love to see your particle count. Also, how do you cook your eggs? I read someplace that scrambling can oxidize the cholesterol (Dr. Mercola’s website I think). My NMR results were eating 2 scrambled eggs daily. I’ve since started to eat eggs sunny side up with just a luke warm yolk. I’m curious to see how that may or may not affect my results.

        Good luck!

        • BJJ Caveman says:

          Haven’t checked my glucose levels with the addition of carbs.

          No feeling of sugar rush while eating rice and potatoes. However on the occasions when I really fall off the wagon and have a slice of cheesecake or something like that, I DO get the rush.

          Overall decrease in protein intake, although I haven’t quantified it.

          I’ve read and heard from a couple places that even gluten free wheat products have other things like gliadin and wheat germ agglutinin that can be inflammatory and detrimental to gut health. I briefly touched upon it here.

          I like to scramble my eggs with the occasional over easy and hard boiled variation.

          Will definitely plan to do an NMR in the future and will definitely post it.

          • Albert says:

            Have you cutted back protein to make place to the added carbs? I say this because in order for the experiment to work I guess you might have better keep protein the same at the expense of some more extra calories. What if less protein has been protective to the liver and your transaminases got better and the liver can process LDL better? You might think it’s due to the carbs but actually from the lowered protein.

            Good work, it’s really very difficult to isolate just one thing even if you try, keep it up! 😉

  5. Usagi says:

    Have you tried Vitamin D?

    As a recovering diabetic, and someone for whom ketosis as a norm works, this was the last piece of the puzzle for me. I take 5000 units per day, sometimes more. I try to be out in the sun as much as possible – which is still not a lot due to my job.

    I stay totally away from wheat of any sort, as well as potato (not including sweet potato). I have very limited intake of corn. I am more moderate with rice and beans. 50 carb grams per day or less as a norm. 1 cheat day per week with diabetic medication to normalize my glucose levels.

    • BJJ Caveman says:

      Was not trying Vitamin D at the time of the exam, however it is something that I’ve added in recently.

      My next post will go into what I’m doing now and where I intend to go from here… and it will probably include vitamin D.

      Congratulations on being on being so dialed in and figuring out what works best for your blood sugars. Looks like you’re a bit of a self experimenter as well.

  6. Peter says:

    Ever consider changing your paradigm, as we long-term lob carbers are using markers levels for general populations who eat mostly SAD.
    Instead of measuring and interpreting SAD bio-marker levels as proxies for probable risk, why not actually verify if you have the disease itself. For example, (hat tip to Dr. Rakesh Patel) carotid intima-media thickness (CIMT) measures occlusion or arterial plaque buildup in one’s carotid artery. According to a quick Google, a CIMT runs about $200.

    An NMR runs about $100 and Lipid panel $60. These results are surrogates of health, not health itself. Aren’t we wasting our $$?

  7. Albert says:

    I’m in pretty much the same situation you are so you don’t know how badly I’d like to see more updates on this and the different strategies you follow!

    I’ve been tempted to go higher carb again to see if it makes a difference but my problem is that I don’t have a doc that would support doing so much testing for my curiosity purposes so right now I go by feeling and I’m trying to overcome my issues with other approaches than getting back to moderate carb again.

    Have you measured your sex hormone levels? I’m low in my free testosterone and this seems to go hand in hand with high cholesterol and low thyroid activity. Also how’s your libido on low carb and back to higher carb?

    JK says that there must be a reason you cannot be fine on low carb and that carbs are only a quick fix so that’s why I hesitate to upper them again (weight wise I, like, you, did amazing on low-carb) but honestly I’m starting to doubt this and more even when seeing your most recent labs… might the PHD be right in the end? I’m very confused…

    • BJJ Caveman says:

      I’ve measured my testosterone levels and here is the post where I wrote about it all with a bit of background info.

      My libido has been fine throughout this entire process.

      Request a Test is the service I’ve been using to check my labs. You just order it online and go to a lab and get your blood drawn. This is the most affordable company that I’ve found. Though if you go nuts, things can get expensive!

      I’m also currently experimenting with the PHD after reading the book. I plan to do a post on that in the near future once I have a little more time. Given my activity level, my body is probably in a place that needs more carbs.

      • Albert says:

        I’ll have a look at the Request the test site but here in Spain going to a lab to get blood drawn to send it to another place, I don’t know if it is even possible but pretty sure will seem really weird if I ask for it… and sure they will charge me. Thanks for the info though!

  8. Richard says:

    Interesting to calculate your LDL using ‘Iranian’ formula which is supposed to be more appropriate for folks with low trigs.
    You end up with 135 which is even further out of the ‘red’ zone.

    • BJJ Caveman says:

      Thanks for introducing me to this site. I don’t know much about the Iranian formula but its something I’ll definitely look into.

      I plugged in my numbers from March which still left me with an LDL-C of 195.1

      Because LDL-C is calculated by formulas (very well described by Peter Attia), it can be very inaccurate which is why NMR cholesterol tests are all the rage now! It offers direct quantification of the number of LDL particles. Apo-B is also supposedly a good estimate of the number of LDL particles… but not as accurate as LDL-P.

      I intend my next cholesterol test to be an NMR measurement.

  9. Brian says:

    Taking any supplements? When I add carbs I add weight. Does that scare you?

    • BJJ Caveman says:

      I’m currently not taking any supplements at all with the exception of Vitamin C.

      I’ve experimented with supplementing Vitamin D and probiotics in the past, but never really felt a difference.

      Adding weight with carbs is normal because of all the water weight you add. More carbs = more glycogen = more retained water (an oversimplification). The added water weight is documented to range up to 6 lbs, although I’ve found that in my case it can be almost 10 lbs.

      So these first couple pounds don’t really scare me since I know it’s all water. Anything after that.. well then I start getting worried, especially if my clothes start feeling tighter.

  10. […] (Parts 1, 2), and our cholesterol can either stay the same, go down, or go way up (Parts 1, 2, 3, 4), among many other things.  It could be any of these […]

  11. Jack Kruse says:

    Why do humans need iodine at its core compared to its nearest ancestor the chimps?

    It turns our sufficient dietary iodine is crucial for proper ketogenesis in our liver and in our brain for full immune and neural development. Ketogenesis is needed to make a hominid brain at a foundational level as you learned in Energy and Epigenetics 1 blog. Iodine however, does a lot more to humans than most realize.


    Iodine is the link back to autoimmunity and the neurogenesis connection of the MHC 1 gene. Iodine absorption falls in the human gut when estrogen levels rise from any cause. This helps explain why women have much higher rates of autoimmune diseases like Multiple Sclerosis and hypothyroidism than men. It also explains why women have less myelin formation than men in adulthood. Remember from Energy and Epigenetics 1 we must be ketotic to make myelin in humans. Women have less iodine absorption by design. Women have higher estrogen levels to bear children. Lower levels of myelination allow women to be “more sensitive” to environmental triggers to pass that information to their offspring’s DNA. Myelination, also happens to be a proxy for mammalian regeneration. This was proven by Robert O. Becker. This now explains why women also make T2 thyroid hormone from their ovaries and breasts. This helps them offset their decrease ability to absorb iodine from their guts.

    BIOLOGY GEEKS: Until recent years, T2, because of its very low affinity for thyroid hormone receptors (THR), was considered an inactive metabolite of thyroid hormones. However, several recent studies indicate that T2 is more important than originally thought. In fact, T2 is necessary for production of the deiodinase enzyme that converts the less active T4 into the potent T3 in the body. Early studies on diiodothyronine revealed its ability to stimulate cellular/mitochondrial respiration during the activation of the Pentose phosphate fat burning pathway by a receptor-independent pathway. Mitochondrial and energy-releasing mechanisms seem to be major targets of T2, although outside the mitochondria T2 also has effects on carriers, ion-exchangers, and enzymes.

    Significant increases in the liver actions of glucose-6-phosphate dehydrogenase and malic enzyme were found in studies cited below. These enzymes are
    necessary for fat metabolism and liberation of energy in the form of beta oxidation. T2 exhibits significant increases in Growth Hormone release from the pituitary have been found in studies. Both T2 and T3 increased Growth Hormone release by 5-fold. This makes sense when you consider women need growth hormone to stimulate their breast and ovarian tissue for fertility and reproduction.

    NON GEEKS: In women, iodine is also critical in making breast milk, tears, and saliva. The higher your estrogen level, or the lower your SHBG level, the more likely your eyes, mouth, skin, and vagina will be dry. You also won’t make a lot of breast milk to feed a child. Your ability to sweat will also be altered.

    I personally believe this is why women go through menopause now. It is because of their evolutionary design. No one seems to have a clue why menopause exists. I think I do. Women need to lower their estrogen levels as they age, to reclaim their total body iodine levels, to help them have a longer lifespan as they age by increasing their ability to myelinate to increase their regenerative DC current by increasing their iodine absorption. This also helps explain why diabetic women have a higher incidence of peripheral neuropathy than men do. They have less myelin, so any further decline in iodine assimilation impairs ketogenesis to regenerate myelin and diminishes their ability to heal and regenerate. This is where the decreased immunity seen in diabetes rears its ugly head for those with metabolic syndrome.

    This also helps explain why women in menopause get hot flashes and night sweats. Iodine stimulates uncoupling proteins and it stimulates the sweat glands. When they had their menstrual period, they did not have the stimulatory effect of iodine, but now without their cycle they do, rather suddenly. It is not from a lack of estrogen, as most physicians believe, it is from more iodine in their bodies. Sweating is a new evolutionary design in hominids. Primates do not have the sweat gland we do. It is a change to the mammalian body plan unique to humans. This was done to be able to cool our bodies down to save energy, because they work better cooled down because it increases semiconducting currents. Primates use vitamin C as an endogenous antioxidant but humans evolved to use iodine as their peripheral antioxidant. We have large brains so we have a lot more semiconductors to cool everywhere on our body. Iodine also helps lower the oxidation of DHA in synapses in humans. This is why the brain has its own thyroid hormone control system because we have way more semiconduction circuits in our brain. When we lose our iodine function in the brain we lose the ability to offset some of the inflammatory cytokines in the brain circuits. In the frontal lobes this causes ADHD or depression and in the leptin receptors it causes an inability to sense energy balance and leads to obesity. When humans become energy inefficient they usually gain weight, as I laid out in EMF 2 and recently in Energy and Epigenetics 4, using Kleiber’s law.

    Sweating is another buffer that we use to become more energy efficient, before we need to expand out fat mass to have the same effect. This is why women gain fat mass in menopause too. It happens because they are less energy efficient because of their loss of progesterone and prolactin. This reflex sweating, seen in humans, is done to cool down women’s new found rediscovery of efficient semiconduction, as their estrogen levels fall in menopause. Once they acclimate to their new increased iodine absorption, their symptoms resolve because they adapt by increasing their myelination and their DC current improves. Many menopausal women, get placed upon estrogen and sometimes their symptoms of hot flashes goes away, but so does their ability to reclaim iodine to myelinate. This implies they can alter their immune balance as they age. Iodine happens to increase neurogenesis in humans, so when iodine is low cognitive haze is also a result. The brain has its own thyroid hormone system to control neurogenesis even if the body stores are low. This is an example of how the brain controls energy partitioning for itself over vegetative systems in the thyroid gland. This patterns what we see in atoms too.

    So if you get placed upon estrogen, or happen to be estrogen dominant for any reason at all, male or female, you may get cognitive haze. Iodine increases our ability to become ketotic to myelinate and regenerate our immune system and our brain because of the MHC 1 evolutionary connection. If you do not eat a ketotic diet when these changes happen these benefits will be hidden from you. For most of the blogosphere they remain a mystery.
    All this from here:

  12. […] 2 months after terminating my nutritional ketosis experiment I checked my cholesterol again on 5/9/2013 and found that despite putting on a little bit more weight, my LDL-C had come down.  This occurred […]

  13. […] out of ketosis.   After a few weeks of doing this, I checked another lipid panel on 5/9/2013 (The Effect of a Ketogenic Diet on Cholesterol Part 4) and lo and behold, my LDL-C came down to 168 AND my thyroid numbers […]

Leave a Reply

Disclosures: Please note that some of the links provided are affiliate links, and at no additional cost to you, I will earn a commission if you decide to make a purchase.  Please understand that I have experience with all of these products.  If they're books, I've read them cover to cover, and if they're products or supplements, I've used and/or continue to use them, and I am not shy about giving my honest opinion of them, positive or negative.  The small commissions I make help me out a tiny bit, and if you've found my site helpful then feel free to purchase these products through the links I've provided.  If not, that's fine too, no pressure, I'll still continue to write!  Please do not spend any money on these products unless you feel you need them or that they will help you achieve your goals.

We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to and affiliated sites

Medical-Legal Disclaimer:

This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, provides general information for educational purposes only. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. BJJ Caveman and are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.

Privacy Policy

See the privacy policy here.