Cyclic Ketogenic Diet and Cholesterol

Carb Night Cholesterol

Cyclic Ketogenic Diet and Cholesterol

Brief Summary:

Recently I completed a 10 week experiment doing a variation of a cyclic ketogenic diet called the Carb Nite Solution, which basically entails eating strict low carb (less than 30 gm per day) with one 6-8 hr window of massive carb loading per week.  At the end of this experiment, before going on a trip to Italy, I had a series of fasting labs drawn.

So far we’ve looked at my:

It’s time to go into my cholesterol numbers.  For reference, here are links to my prior cholesterol labs:

Since I’ve definitely become ketotic while doing the Carb Nite, it looks like my cholesterol numbers are pretty close to what they were after doing 3 months of nutritional ketosis.

I can confirm that I’m definitely one of those folks that has the LDL bump after going keto.  It’s interesting to see that even with the addition of the Carb Nites to push me out of ketosis a few times a week it till wasn’t enough to keep my LDL-C and LDL-P from sky rocketing back to my strict ketosis levels… in fact the LDL-P went higher (3009 vs 2800).  At least my small LDL-Ps didn’t go up as high (1072 vs 1226) although this is still way out of the normal range (< 527 fo small LDL-P and < 1000 for LDL-P).

My triglyceries took a bump up to 96, which probably has to do with the increased carb intake on Carb Nite vs strict nutritional ketosis.

I can’t explain why my HDL is still so low, despite all the fish oil that I’ve been taking.  One of the purported benefits of eating a ketogenic diet is a higher HDL, but as you can see, this doesn’t quite happen in my case.

It seems that my body really does need a steady stream of carbs in order to maintain more normalized cholesterol numbers, with the whole thyroid thing playing a big role (hypothyroidism which is a side effect of ketosis is associated with higher LDLs).  With my thyroid numbers, we can see that my TSH bumped up slightly indicating and my RT3 is still way high indicating some degree of thyroid dysfunction.

Despite all this I’m still not too worried because my overall cardiac risk factors are still good:

  • My CRP is less than 1, telling me that there isn’y underlying inflammation going on… and I’m in the camp that believes that it’s inflammation causing oxidation of cholesterol that is truly the problem rather than cholesterol itself.
  • My Triglyceride to HDL ratio is still optimal (2 or less is ideal)
  • I’ve been losing body fat and losing weight
  • My fasting insulin indicates that I’m not insulin resistant

One thing I am certain of is that whatever diet I’m on or experiment I’m running, I’ll definitely continue to check my NMR lipoprofile numbers to see where they go.

I suspect I may have to accept the fact that I’m just one of those people that needs a higher level of carbs and shouldn’t remain in ketosis for prolonged periods… but I’m not quite ready to give up experimenting yet.

32 Responses to Cyclic Ketogenic Diet and Cholesterol

  1. N says:

    There is most mush scientific data out there to clearly measure and quantify the role of inflammation in heart risk, however, there is compelling evidence out there to prove the fact that ldl-p is the driver of heart risk regardless of size. Looking at your numbers your lpl-p has increased, your trigs and hdl have not improved and your crp has also increased. So in this situation I would definitely try adding some carbs back on daily basis to see where it takes me instead of sitting on ketosis and seeing my lpl-p rise.

    • BJJ Caveman says:

      Pretty much my conclusion as well…. I just want to do a few weeks of messing around with ketosis and resistant starch first.

  2. N says:

    Sorry “most mush” was supposed to be not much

  3. N says:

    Too much saturated fat might be the issue, may be too much omega 6 fats with regards to ldl during kerosis. Dr Ron Rosedale in his book ROSEDALE DIET considers saturated fat as second generation of carbs and seems kind of okish with it when one is fat adapted.

    • MB says:

      I believe he tried reducing saturated fats and his blood lipid test results actually got worse.

      http://bjjcaveman.com/2013/04/06/the-effect-of-a-ketogenic-diet-on-cholesterol-part-3/

      • N says:

        Thanks for the link, would be interested to know if coconut oil and butter were the only sources of saturated fat consumed and also when they were cut down what were they replaced with. Still too much omega 6 can come even from unsaturated fats. For most of the guys adding some carbs back seems to work. For others, cutting omega 6 and replacing with green veg has worked on a low carb diet.

        • BJJ Caveman says:

          Was replaced I think with overall more protein….

          I was eating my fat as fat bombs… coconut oil chocolate squares… 2-3 bulletproof drinks a day..

      • BJJ Caveman says:

        Yup. Cut out the coconut oil and butter and bacon fat. No help…

        • N says:

          I am quite surprised that your hdl and trigs have stayed almost the same, it is very unusual on a low carb diet. I would recommend a read of rosedale diet if you have not already. With your ldl-p being higher I would go for lp-PLA2, CIMT and MPO tests if possible to further define the risk of heart disease.

  4. MB says:

    Great blog! I just discovered this. Since following a low carb Paleo type diet my CHO has increased dramatically (to 230) along with my LDL-C. My Dr. is just about begging me to take a statin. I refuse to. Your self experiments are very intriguing and informative.

    I lift weights 4 days a week and play sports on occasion and I have determined that I need way more carbs then I thought. I was having some symptoms of hypothyroidism and adrenal fatigue. Since adding more carbs to my diet I am gradually feeling better. I wonder how my blood lipids are going to be after adding more carbs ( Carb Back-Loading). I am going to try to get an NMR through “Request A Test” hopefully I can even though I live in communist N.Y.

    I am curious if your Copper supplementation had any effect on your blood lipids? I see that you mentioned it once but didn’t see any results.

    Thanks for the great information.

    Mike

    • BJJ Caveman says:

      Keep us posted on how your cholesterol numbers turn out!

      Copper supplementation didn’t help much… in fact there is even copper in the Damage Control supplements I was taking… no help.

      At least for me, copper isn’t the issue.

      I think my activity level may have also played a role….all that BJJ and crossfit probably requires more carbs

  5. Rick says:

    As I told you recently in your HbA1C post we share a physiology. My numbers looks almost the same. I follow Dr. Jack Kruse closely and he’s said the fat adaption takes awhile even coming from a Paleo diet. Having been keto (80% fat, 5% carbs) for over 2 yrs I was starting to think adding carbs back in was the answer as well, but my recent bloodwork has given me hope. While my lipid profile is unchanged my TSH dropped from 5 to 2.5 and my CRP has fallen from .8 to .6. Both still above where they were 2 yrs ago but steps in the right direction. From an athletic performance perspective that last anaerobic gear that seemed to be missing last year has also improved. Bottom line for me is that I’m going to give awhile longer

    • BJJ Caveman says:

      Looks like you’ve found what works for you! Interesting to see that your lipids stayed the same while your TSH improved…. means that your thyroid hormone levels aren’t playing much of a role in your cholesterol levels…

  6. Doug says:

    Thanks for the blog – seriously good stuff.

    I also find myself in the group of LC dieters who present with sky-high LDL-C. I am fit, lean, healthy, feel good, and have typically had “excellent” cholesterol numbers. Recently I had a basic panel done, and LDL-C has gone nuts:

    Cholesterol: 367
    HDL_C: 88
    LDL-C: 221
    Triglyceride: 53

    LDL is up from 104 three years ago when I was probably doing closer to 30-40% calories from carbs.

    So now I am going down the rabbit hole of LC health and high LDL. Everything I’ve read suggests I don’t need a LDL-P: it _will_ be high. And my most trusted sources think high LDL-P is serious business. If you are unconvinced check out Peter Attia’s excellent series (http://eatingacademy.com/cholesterol-2/the-straight-dope-on-cholesterol-part-i) or Dr Thomas Dayspring’s comment to Jimmy Moore’s blog post: http://livinlavidalowcarb.com/blog/6-month-lipid-panel-update-on-my-nutritional-ketosis-n1-experiment/16449. Dayspring says:

    Using all the knowledge we possess today, all of the numbers that you are thrilled about have no meaning in the face of a 99th percentile LDL-P. … No one with an LDL-C of 285 with the exception of a Type III dyslipoproteinemia patient have a low apoB or LDL-P. If you have an LDL-C that high, particle testing is not needed. You need to significantly reduce the saturated fat in your diet and see what happens: repeat the NMR in 3 weeks and you will know if your nightmare LDL-P is sat fat related. I’ll bet your LDL-P drops. If it does not, you need serious lipid-modulating medication. We have seen this paradoxical horrific rise in LDL-P in some people who are on ketotic diets.

    Dayspring is apparently a well regarded lipidologist who is generally all over dietary fat and low carb. Sobering words; I think we should be very careful about discounting high LDL.

    I’ll admit to feeling rather sluggish lately, so maybe I don’t respond well to extended really low carb (<10% of calories) and I am hoping my LDL numbers are a result of down-regulated thyroid conversion, so am bumping my carbs back up to ~20%, hoping to fix LDL and not undo all the great benefits I've realized.

    • N says:

      I completely agree. It is either too low carbs or too much saturated fat. LDL-P is the established heart disease risk DRIVER NOT the inflammation. May I also recommend this link:

      http://www.lecturepad.org/index.php/lipidaholicsanaonymous/1140-lipidaholics-anonymous-case-291-can-losing-weight-worsen-lipids

      • BJJ Caveman says:

        Great link, thanks for sharing.

        I think dayspring is more willing to pull the trigger on statins than folks in the paleo community are willing to accept.

        I’m definitely in the camp that believes in avoiding statins at all costs.

      • Doug says:

        Great link, thanks. He seems to suggest the driver is both – he has observed atherosclerosis with no inflammation but with high LDL-P.

        Another interesting link: http://azsunfm.blogspot.com.au/2012/09/font-definitions-font-face-font-family.html

        I guess the bottom line is that no one really knows if a low carber with low TG and high LDP-P is at risk – although all existing trials suggest that they are.

        How can Dayspring be so at odds with Eades on the topic of statins?

    • BJJ Caveman says:

      Let me know how things go with the added carbs.

      You can see with my history that despite adding carbs in (I gained weight and abdominal circumference) my LDL C improved… but not to normal levels.

      So I haven’t quite figured out where the sweet spot is for me. May have to further restrict my sat fats.

      there are a few other things I want to try though…

      and statins are something I absolutely intend to avoid.

      • Doug says:

        Improving your LDL-C on higher carb is certainly to be expected, but the lack of a drop on lower saturated fat is surprising.

        I do think that not all saturated fat is created equal with it comes to elevating LDL: http://thepaleodiet.com/wp-content/uploads/2012/04/Dietary-Fat-Quality-and-Coronary-Heart-Disease-Prevention-A-Unified-Theory-Based-on-Evolutionary-Historical-Global-and-Modern-Perspectives.pdf.

        I think coconut oil generally has little effect, but butter usually does, and you cut that out. I wonder if you need to try another trial severely restricting palmitate/palmitic acid? Do you do much dairy in addition to butter? Some studies suggest cheese raises LDL much less than butter.

        • BJJ Caveman says:

          Nope… only dairy is butter…

          when i travel I get the occasional starbucks coffee with heavy cream, but that isn’t mroe than maybe 3-4 times every 2 months.

      • Doug says:

        After running on carbs around 60-70 g/day for a few months, I nearly doubled them back up to ~120 g/day. Almost immediately, I started displaying symptoms of ketosis: metallic taste at the back of my throat, and the wife complaining about keto breath. Weird. I can only guess I was in ketosis (didn’t know, and didn’t plan to be there), add as I transitioned out, I started spilling some ketones.

        My protein was steady, as were calories. Without really planning to, I replaced some saturated fat with mono and poly. So I basically replaced 240 kcal/day of saturated fat with carbos, and probably a similar swap of saturates for unsaturated.

        After 6 weeks I went back for a lipid panel. Basically no change:

        15jan2014: TC/HDL-C/LDL-C/TG: 367/88/221/53
        25feb2014: TC/HDL-C/LDL-C/TG: 363/88/222/44

        The trigs look like they went down, but I’m in Australia, so they actually went from 0.6 to 0.5 mg/dL; probably not statistically significant.

        My thyroid, however, came back as subclinical hypothyroidism:
        TSH: 4.4 mU/L, fT4 14 pmol/L.

        The elevated TSH is small, so I have trouble imagining it is the cause of my elevated LDL. Maybe I am just a hyper-responder to dietary saturated fat.

        • BJJ Caveman says:

          Thanks for the followup. Have you considered checking your Reverse T3? It might be elevated like mine is… It’d be interesting to see how much this correlates with LDL-C levels as well.

  7. N says:

    When one has quite a bit of body fat to lose then eating saturated fat makes little sense to me…in ketosis or low carb, body is fat adapted where it is eating body fat which is saturated fat. In this situation to me it makes a lot more sense to avoid saturated fat (long chain fatty acids) as much as possible as it is already available from the body and use MUFAs to curb hunger IF one gets hungry which is unlikely when you are fat adapted and keep protein upto 1 gram per kg of body weight. Once desired body fat level is achieved then I think saturated fat can be added in the diet.

  8. MB says:

    BJJ Caveman,

    Have you tried Carb Back-Loading? I am currently experimenting with this and I feel and look much better. With all of your training, this may work well for you.

    • BJJ Caveman says:

      Been doing it while I was messing with resistant starches…. just not as rigorously as possible.

      Will be part of my next experiment.

      • MB says:

        Great! I haven’t purchased the program from Kiefer yet because I guess a new version is coming out soon. It will be great to hear how you make out.

  9. Dustin says:

    BJJ –

    Fascinating. I’m a 26 old make who’s been having success with the Paleo diet. I eat a ton of MUFAs, and a good bit of saturated (eggs, venison/grass-fed beef, some coconut oil), and I don’t touch PUFAs. My carbs are around 150g, coming from veg almost exclusively. Maybe an apple and some berries a day.

    Still, my yearly physical cane back with a Cholesterol of 285, HDL of 69, LDL-c of 170 something.

    Needless to say I’m a bit scared!

    I’m hoping to get retested in a few months, but I don’t know my course of action. I have improved health markers on everything except my LDL shot up almost 100 points

    Could losing weight be throwing off the numbers? Is the release of adipose tissue driving up my LDL number?

    Maybe my body is adapting? I don’t know.

    I’m not low carb (prob 25%), and I’m not pounding saturated fats really.

    At a loss

    • Doug says:

      It is scary. There is minority group, of unknown but non-trivial size, that responds to a hf/lc carb diet with high LDL-C and LDL-P. If your triglycerides were high and your HDL were low, I think we could confidently say you should be updating your will. But it seems there are really no good studies for folks on a hf/lc diet who present with high LDL. Most qualified people who consider this typically conclude that so long as systemic inflammation is low (check CRP) you are probably fine (assuming high HDL and low trigs), but they are just guessing.

      Yet another link discussing this (read the comments): http://denversdietdoctor.com/ldl-cholesterol-on-the-rise-omg/

  10. Dustin says:

    My TSH was 4.3 though? Could it be as simple as adding in some iodine (that my paleo diet might be missing) because my thyroid isn’t functioning great? That and a combo of slow but steady weight loss metabolizing adipose tissue?

    Like I said, ~ 150 g carbs (~40-50 fiber) on a 2100-2200 cal day (when I don’t run)

    • BJJ Caveman says:

      With a TSH as high as 4.3, this is probably playing a significant role in your elevated LDLs.

      How much weight have lost so far? How much more do you want to lose?

      Have you checked your ketones just to make sure you haven’t accidentally wandered into ketosis territory?

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