The Effect of a Ketogenic Diet on Cholesterol Part 5

Cholesterol 4b

As you know, the past couple of months have been a bit of a whirlwind. During this time I wasn’t trying too hard to eat low carb… unlike the militant way I was counting carbs during my initial n=1 experiment.  I know there were a some weeks when I was definitely eating very low carb and spent at least a few of those days in ketosis (I hadn’t been testing my blood ketones these past few months), and there were other days when my carb intake increased due to social situations as well as my desire to avoid the keto-rash: prurigo pigmentosa.

So I estimate my average carb intake was in the range of 50 -150 gm per day.

I wanted to get another baseline as to where my labs are.  I added columns onto this table to also track my CRP and Triglyceride:HDL ratio, both of which are good indicators of cardiovascular health.

In terms of my cholesterol, they look essentially identical compared to 5 months ago.  My triglycerides are still pretty low, so that confirms that I’ve been doing a pretty good job of staying low carb.  Despite having a persistently high LDL, I’m not too concerned because my low CRP tells me that my body isn’t in an inflammatory state and my Triglyceride:HDL ratio is favorable.

I had originally intended to get an NMR, but the location I got my labs drawn ran out of the necessary test tube.  I’ll be sure to get an NMR lipoprofile during my next set of labs.

You can read about my thoughts on my prior cholesterol numbers here: Part 1Part 2Part 3, Part 4

Thyroid 3

To asses my thyroid hormones, I only had my TSH drawn.  It’s good to see that my TSH has improved from before.  I’m not sure what to attribute this to.  This may be due to the fact that I’ve had periods of increased carb intake in these past few months.  Or it can be due to one of the supplements I’ve been taking, albeit with very poor consistency – 150 mcg of Potassium Iodide as a way to support my thyroid.

It’s interesting to see that despite an improvement in my TSH, my LDL didn’t really budge this time.  Previously, there was an improvement in my LDL from 231 down to 168 as my TSH came down from 4.35 to 1.82.  This raises an interesting idea that I hadn’t considered:  perhaps the high LDLs seen on a ketogenic diet is caused by a combination of things, only one of which is low thyroid.  I improved my thyroid levels and my LDL responded accordingly… but only up to a point.  This is definitely warrants further exploration.

You can read about my thoughts on my prior thyroid numbers here: Part 1, Part 2

I also got my HBA1C checked and it measured 5.7%, which hasn’t changed at all.

26 Responses to The Effect of a Ketogenic Diet on Cholesterol Part 5

  1. Jason says:

    Thanks for sharing. I just got my results today and my doctor is not happy. Total was 250, LDL 199, HDL 41 (stayed same after using HDL RX and tripling Fish Oil and continued Kettlebell and bodyweight exercise). In that time I was ketogenic to control type 1 diabetes (A1C was 6.2%). My TSH was slightly above normal range and my free T3 was in range but on the low side. My doctor is giving me 2 months to improve my LDL by 20 points or else he’s putting me on a statin.

    As of Monday I switched to the 4 hour body diet to add more carbs into my daily intake (about 100 g). I will try a controlled cheat day as a carb and calorie reset. I knew my cholesterol was on the rise so switched my diet before my results today.

    I’m bummed that your LDL hasn’t improved. Do you know what your next step will be? Perhaps more fiber?

    Thanks for your blog.

    • BJJ Caveman says:

      I’m in the midst of experimenting with a cyclic ketogenic diet sort of thing. I plan on posting more details soon. We’ll see how this works!

  2. Sterling says:


    I hope you mean you were ketogenic to help control type 2 diabetes, as a ketogenic diet is strictly contraindicated in type 1 diabetes due to the risk of diabetic ketoacidosis.

  3. Jason says:

    Just a quick update: I did the slow carb diet (ala Tim Ferris 4 Hour Body) for 5 weeks, which was 50-100g carbs per day, with 1 day carb reload. For the following 3-4 weeks I had modest carbs , but made sure to get at least 70g of carbs total per day (apples, bread, wine etc.)

    My doctor called today and said my total cholesterol was 198, my LDL was 143, and HDL was 33. It was a nice improvement just by adding carbs back in.

    My thyroid results haven’t come in yet.

    • BJJ Caveman says:

      Thanks so much for the update.

      It’ll be interesting to see what your thyroid levels come back as, but I’m going to guess they’re back to normal… or at least much closer to normal.

      Your HDL seems pretty stubborn doesn’t it?

      Any idea of what your Trigs are? I’m guessing they shouldn’t be too high since your carbs are still 50-100 gm…. although I guess depending on how epic your cheat days have been… they can be out of whack.

      Brings me fond memories of my slow carb cheat days… couldn’t wait to wake up and head to the donut shop and pick 5 of my favorites.. and then eat them until I felt sick. Good times!

      • Jason says:

        The interesting thing is that I don’t feel like my thyroid is back to normal. I’m still fatigued all the time and I noticed I’ve had more hair loss lately. So, I definitely want to keep a close eye on it and I’ll be sure to provide updates.

        I’m assuming that my triglycerides are still okay. I’ve never had an issue with them being high and my cheat days might go up to 130 carbs at the most, so definitely no donuts for me! Being type 1 diabetic, I still need to be careful.

        My HDL is stubborn, always has been. This is the lowest I’ve seen it, but it could be due to the rapid loss of overall cholesterol. I’d like to keep it up to 40 if possible, and try to get by LDL back closer to 100.

        I’ll probably have repeat labs in February/March 2014, so I’ll post the results then and hopefully I’ll get my thyroid in soon.

        One other side note. Going slow carb did increase my weight from 198 lbs to 206 fasting. It did go back down to 201 within the past two weeks, but I was also sick. My body fat percentage is around 25%, and I wonder if my thyroid has something to do with that as well because I used to be 12-15% my entire life until about 1.5 years ago.

        • BJJ Caveman says:

          If possible, you may want to get your Revers T3 levels checked.

          I wrote about it a little bit here.

          May explain why you symptomatically feel hypothyroid, despite numbers that come back normal (if they do). This may explain your weight gain too!

    • April says:

      Your HDL is too low, should be much higher, above 40 minimum.
      My numbers are high also, 268 total, 94 trig, 168 LDL, 72 HDL.
      I am thinking coconut oil can raise cholesterol from what I have read.
      TSH levels 2.4. I am going to add red wine daily, that should help raise HDL. Still researching this whole thing which is how I found this great which I found very interesting.

      • Jason says:


        My low HDL is due to genetics. Exercise they say is the best solution to low HDL, but I’ve proven that working out hard several days a week doesn’t guarantee a high HDL number. What’s gained much attention lately is Total Cholesterol/ HDL ratio – should be 4/1 or less, which you are in that range.

  4. […] came in at a stable 5.7%!  It hasn’t changed one iota since I started measuring it here and here.  I still have concerns with the calculated estimated average glucose of 117 mg/dL, especially […]

  5. […] (subclinically hypothyroid depending on who you ask).  You can see that after adding carbs back into my diet, my thyroid numbers drastically improved!  So it looks like having some carbs/insulin onboard is […]

  6. […] a bit of travel, a wedding, followed by a honeymoon, and it wasn’t until another 5 months on 10/4/2013 when I re-checked my cholesterol just to get sense of where I stood.  The small bit of weight that […]

  7. MITBeta says:

    This is a great series of posts. I started the Slow Carb Diet back in Jan 2013. It went great until October of 2013 when my weight loss began to plateau. Sometime around then, I cut out “cheat days” and eventually found myself striving for Nutritional Ketosis. Unfortunately, I don’t have good records about which came first.

    Anyway, fast forwarding to today, I had my first physical in about 4 years a couple of weeks ago and EVERYTHING looks great, except for total cholesterol and LDL.

    CRP: 0.5
    Blood Press: 100/60
    Glucose: 81
    BMI: ~24
    HDL: 66
    Trigs: 128 (higher than I expected…)
    LDL: 254 (it’s even higher with the Iranian calc…)
    Total: 346
    TSH: 3.31
    Age: 38
    Height: 66″
    Waist: 29″

    My previous blood panel, back in 2010, had my TC at about 240. Given that all my other markers are pretty good to great, I’m not concerned much about keeling over at any moment, but of course my doc wants to put me on statins right away (strike one, dietary interventions were not even suggested…). Nevertheless, I suspect I probably have a lot of LDL-P, though I haven’t had it tested, and would like to lower my LDL-C to a more reasonable level.

    Your research on this has been most helpful. I had already read about theories 1, 2, and 4, but was skeptical about 1, didn’t think I was deficient in 2, and thought I would try 4 right away. So I’ve increased my carbs to still under 100gm/day (estimated…) to see what effect it will have.

    Unfortunately, they did not test T3, T4, and rT3, so I don’t know where those are, but given my moderately elevated TSH (it was 2.375 in 2010), I’m guessing I’m a little hypothyroid, which may be why my weight loss progress stopped along with the elevated LDL levels.

    I have not discussed any of this with the doctor yet (I’m not even sure I want to see her again based on the knee jerk reaction to prescribe statins, but I will need someone to order the new labs for me), but I will be sure to get the full thyroid panel on next check. If it still comes back high, I’ll consider supplementing with copper, etc. For now, I want to change as few variables as possible at the same time.

    • BJJ Caveman says:

      Thank you for sharing! Be sure to come back and let us know how things go!

      If you’re interested in retesting without going back to the Doctor, check out some online places. My favorite is

  8. DSK says:

    I’m glad i found this page, as i was starting to lose my mind…

    I’ve been experimenting with ketosis the past several months and i just got some blood test results from my doc – 345 Total Cholesterol!!! Triglycerides 160. I got this over the phone, and i won’t have the full lipid panel details until next week.

    I’m already on thyroid hormones for hypo, and i’ve been battling chronic fatigue for 3.5 years. My normal total cholesterol has been in the upper 200s my entire adult life, but i’ve never broken 300 before. Not sure if i should be concerned or not…

    I’d really hate to give up my bulletproof coffee in the morning.

    • BJJ Caveman says:

      The only question I would have is with the triglycerides. 160 seems high in the Trigs for someone who’s been in ketosis. Have you been testing to confirm your ketone status?

      • DSK says:

        No, that’s the next step. I need to get test strips. But I was eating a very low carb diet for a couple of months when the blood was drawn – always under 50 grams, often under 30 grams.

        But what do you think of the high total cholesterol? Is that something to be concerned about?

        I go to the doctor on Tuesday and should have more details on the cholesterol numbers then.

  9. pillu says:

    Dear BJJ
    after 3 months of VLC below 50 gms of carb
    my lipids on 11/11/2014
    TC 315 LDL 242 HDL52 TG 82

    After carb loading ie 150 gms of carb results on 14/12/2014

    TC 172
    LDL 90
    HDL 51
    TG 193

    I m sure it was due to Thyroid bcoz i had all symotoms of it
    body cleared it without any medicines or supplements

    its strange

    i donot know if i m hyperabsorber or hypothyroid

    Whta should i do bring down TG now bcoz if i m reducing carb then my thyroid will be prob again

    • BJJ Caveman says:

      I think the trick will be to lower carbs slowly. Try bringing it down to teh 75 – 100 gm range and see how that changes things.

      Keep us posted!

  10. Lynn says:

    I have to be below 30 carbs to get myself into ketosis. I recently had my labs drawn and too am shocked at my LDL – 176 HDL 94, total 283 ..yikes. Trigs are 67 and TSH 1.04. I am going to see what I should change. I usually try to stay below 30 carbs during the week days and then carb up on the weekends. Not sure what to attribute the LDL too.

    • BJJ Caveman says:

      Looks, like you might respond similar to me!

      I’ve written a couple of posts on the subject that you can find here:

      I’m still working through my issues as well

      • Eric says:

        Love your blog ! Your labs are identical to mine. The more I’m in ketosis the worse things get. I think that all of the ketones lead to excess cholesterol production . Dayspring does a great job explaining this on Lecturepad, I believe case 291? Basically, acetone converts to acetyl CoA which is the basic building block for cholesterol (or something like that? ). Increasing the building blocks leads to more cholesterol. All this increased production is even worse if you are a “hyper absorber” of cholesterol as well. I’m trying over the counter Cholestoff which is a plant sterol to see if that will help. It’s suppose to help block the reabsorbtion of cholesterol. We’ll see. Good luck!

  11. […] I tried a Carb Nite, a cyclic ketogenic diet, which also left my HbA1c unchanged at 5.7% in October 2013. […]

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