Cholesterol or Saturated Fats ......??

Time2LoseWeightNOW

Hello!! Time2 here, sorry for the long post, I am reading both Cholesterol Clarity and Keto Clarity, Great books ,lots of info! Thanks for the Launch pad and all the great posts .
I got my lipid panel results, so I am not panic-ing too much,
but with extremely high Total cholesterol numbers,between Cholesterol or Saturated Fats, which would be the most important to watch and try to control until I get them to level out?
I have been trying to go LCHF since November of 2015 and mostly under 50 carbs for about the last 3 months with good days and bad days...
I have around 80 lbs to lose. I haven't lost many lbs yet , but I feel better and I can see where my body is doing calculus as I have read from the posts of one of our LCHF learned experts. ( maybe it was knit or miss? ) Diagnosed with T2D in 2015 ...hence the need for LCHF.

I can see an upward trend in most all of the others except the Total and the LDL .

...................................2016...................... 2014.............................................................................

Total Chol...................329........................259................................................................................
HDL..............................70.........................47.................................................................................
LDL .............................225.......................174................................................................................
TRY.............................171........................227................................................................................
TOTALRATIO ...............4.7.........................5.6..............................................................................
FBGLUCOSE..................114........................149................................................................................

Since I am eating more meat and drinking Bullet-proof coffee, I am seeing such high numbers of cholesterol and saturated fats....

Thanks for any help, ( I am at work, so I may not be able to reply until this evening.)
Time2

Dragonwolf

There are a few things that throw the cholesterol numbers off and make them seem scarier than the reality:

1. LDL is almost never directly measured.
2. Active weight loss can increase numbers temporarily.
3. Active healing and increase numbers temporarily.
4. LCHF increases the LDL number on the standard test due to how the test measures the particles vs the effect on the LDL particles themselves.
5. It takes a few months to see the effects of LCHF in the serum numbers.

Since you've read the Clarity books, you probably already saw some of these points explained (particularly 1 and 4). 2, 3, and 5 are also relevant here. You just started LCHF a few months ago, and your last numbers are from 2014. That's quite a span of time, and what you're seeing is more likely closer to what your numbers looked like before starting LCHF entirely (since, as I recall, it takes about 3-6 months for full turnover of the cells in the blood stream in general and to see the effects of dietary changes in blood numbers). The fact that you're a newly-diagnosed Diabetic further complicates the picture (why were you not diagnosed sooner? Your 2014 numbers are even more indicative of T2D than your current ones).

Your biggest concern right now should arguably getting the Diabetes under control and kept that way. LCHF will go a long way in that and by the looks of your numbers, should keep you off most, if not all, medications, which is great. Getting your fasting blood sugar below 100 would be great, and around 80 is ideal. Your cholesterol numbers should start falling into place once you've done that.

Your trigs dropped 50 points, which is awesome. You should see that drop even further as you continue LCHF, since that number is primarily driven by carbohydrates. It won't surprise me if it's very close to, or even under, 100 the next time you get bloodwork done.

Your HDL is superb where it's at right now, which is awesome. Higher levels of HDL have been shown to counteract LDL, which mitigates the issues a high LDL might represent. You should see this stay about the same as where it's at now (give or take about 5 points). If it goes too much above where it's at right now, you might want to consider further testing for a potential medical cause outside of the currently known factors.

Your LDL is high and arguably should come down. There are a couple of factors complicating this one, though. First, we don't have more recent numbers to speculate the cause of the increase since 2014. I suspect it's a combination of the switch to LCHF and the progression of your Diabetes before you got it diagnosed. LCHF means that it will likely stay higher than the lab will like (due to the changes in particle size), and while you're actively losing weight and healing the damage from the Diabetes. It should come down as your weight stabilizes and your body heals, though.

I suspect that what you'll find is that your glucose and trigs will come down in the short term. Then, as your body heals, you'll find LDL (and possibly HDL) slowly decrease. HDL will stabilize, and LDL will fluctuate, though with a downward trend as your Diabetes remits. Your numbers will likely stabilize, though your LDL will continue to appear high. Once your weight stabilizes, your LDL will come down more closely to normal levels.

Regarding fat intake -- the idea that cholesterol or saturated fat intake has any effect on serum levels have been debunked pretty well entirely. The vast majority of our serum cholesterol is created internally, in response to demands for it. Even if you ate zero cholesterol or saturated fat (or fat entirely), your body would still make it if there is damage that needs to be healed, and because you have Diabetes, you have damage that needs to be healed.

Blaming cholesterol for our problems is like blaming firefighters for house fires. After all, there are always firefighters at a fire, and the more firefighters there are, the bigger the fire, so they must be the problem. If we get rid of firefighters, we'll no longer have house fires, right?

That makes no sense, does it? There are more firefighters at larger fires, because more help is needed to handle the problem, not because they're causing the problem. And firefighters are there in the first place because something else started a fire.

The same goes for serum cholesterol. Contrary to conventional beliefs, serum cholesterol is not the bad guy, nor is it the cause of issues. Rather, it's the symptom of other issues.

It's higher for you right now, because you have more problems that need to be fixed. Depending on what your blood sugar levels have been doing right before you switched to LCHF, you could have a lot of damage in a lot of different places. At the very least, your pancreas and liver are in need of repair. Odds are good, too, that your nervous systems need some repairing, as well, same with your adrenals and thyroid. These are the things that get damaged first, when metabolic syndrome sets in (which you've had for a while and has finally escalated to diagnosable T2D).

Give it some time and a couple of more tests. Trust the LCHF system and get your Diabetes managed and in remission. The cholesterol should follow, and if it doesn't, then you can cross that bridge. As it stands, you're very likely jumping the gun for blaming the saturated fat.

reblazed

OMG ... @Dragonwolf that is the BEST explanation I have ever read "regarding fat intake ... etc". Thank you, Wish I had a printer to be able to pass it out to others.

wabmester

This article is for you:
http://eatingacademy.com/cholesterol-2/random-finding-plus-pi

However, some readers may interpret the data I present to mean it’s perfectly safe to consume, say, 25% (or more) of total calories from SFA. I realize I may have to turn in my keto-club card, but I am convinced that a subset of the population—I don’t know how large or small, because my “N” is too small—are not better served by mainlining SFA, even in the complete absence of carbohydrates (i.e., nutritional ketosis). Let me repeat this point: I have seen enough patients whose biomarkers go to hell in a hand basket when they ingest very high amounts of SFA. This leads me to believe some people are not genetically equipped to thrive in prolonged nutritional ketosis.

In one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L (i.e., more particles than could be measured by the NMR machine so the report simply said “>3,500 nmol/L”) despite feeling, performing, and looking great. Based on his through-the-roof desmosterol and cholanstanol levels, and a curb-side consult from the Godfather I mean Dr. Tom Dayspring, I decided to try an experiment. You see, the logical thing to do in this setting would have been to start two drugs immediately (a potent statin to address the hypersynthesis and ezetimibe to address the hyperabsorption) or tell him to abandon ketosis altogether. But this patient was adamant about staying in ketosis given the other benefits, though obviously worried about the long-term coronary implications. So, we agreed that for a 3 month trial period he would reduce SFA to an average of 25 g/day (vs. about 75 to 100 g/day) and make up the difference with monounsaturated fat (MUFA). Parenthetically, we also reduced his omega-3 PUFA given very high RBC EPA and DHA levels.

So, on balance, he consumed about the same number of calories and even total quantity of fat, but his distribution of fat intake changed and he heavily swapped out SFA for MUFA.

The result?

His LDL-P fell from >3,500 nmol/L to about 1,300 nmol/L (about 55th percentile), and his CRP fell from 2.9 mg/L to <0.3 mg/L (and for the lipoprotein cognoscenti, both desmosterol and cholanstanol fell).

Dragonwolf

wabmester wrote: »

This article is for you:
http://eatingacademy.com/cholesterol-2/random-finding-plus-pi

However, some readers may interpret the data I present to mean it’s perfectly safe to consume, say, 25% (or more) of total calories from SFA. I realize I may have to turn in my keto-club card, but I am convinced that a subset of the population—I don’t know how large or small, because my “N” is too small—are not better served by mainlining SFA, even in the complete absence of carbohydrates (i.e., nutritional ketosis). Let me repeat this point: I have seen enough patients whose biomarkers go to hell in a hand basket when they ingest very high amounts of SFA. This leads me to believe some people are not genetically equipped to thrive in prolonged nutritional ketosis.

In one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L (i.e., more particles than could be measured by the NMR machine so the report simply said “>3,500 nmol/L”) despite feeling, performing, and looking great. Based on his through-the-roof desmosterol and cholanstanol levels, and a curb-side consult from the Godfather I mean Dr. Tom Dayspring, I decided to try an experiment. You see, the logical thing to do in this setting would have been to start two drugs immediately (a potent statin to address the hypersynthesis and ezetimibe to address the hyperabsorption) or tell him to abandon ketosis altogether. But this patient was adamant about staying in ketosis given the other benefits, though obviously worried about the long-term coronary implications. So, we agreed that for a 3 month trial period he would reduce SFA to an average of 25 g/day (vs. about 75 to 100 g/day) and make up the difference with monounsaturated fat (MUFA). Parenthetically, we also reduced his omega-3 PUFA given very high RBC EPA and DHA levels.

So, on balance, he consumed about the same number of calories and even total quantity of fat, but his distribution of fat intake changed and he heavily swapped out SFA for MUFA.

The result?

His LDL-P fell from >3,500 nmol/L to about 1,300 nmol/L (about 55th percentile), and his CRP fell from 2.9 mg/L to <0.3 mg/L (and for the lipoprotein cognoscenti, both desmosterol and cholanstanol fell).

Yep, this would be step 2, in my opinion, and what I'd suggest looking at next (the "we'll cross that bridge when we get there," part), if the Diabetes was corrected, but the cholesterol issues were not.

I didn't mention it in my earlier post, because this is a relatively small subset of the population, and the Diabetes is currently a confounding factor in the above numbers. For a new person, the super-responder situation is likely to freak them out (due to confirmation bias of all the stuff we've been been told regarding saturated fat) and take their focus away from the more pressing current issue (the Diabetes/metabolic syndrome).

Time2LoseWeightNOW

Thank you so much ,Dragonwolf!! I had to read it quickly to run to break, but it is so helpful! I will read it again later , and as reblazed suggests, copy it off .

I do realize I have so much repairing to do from years of carb abuse... so I am not to upset at the numbers. I was pleasantly surprised at the higher HDL.

I lost my 2015 numbers , but they were pretty close to the 2014 .
Thanks again.
Time2

Time2LoseWeightNOW

Wabmester , Thanks for the article! I am trying to read it quickly, also, so I will read it in length after work and reply. Thanks!!

wabmester

Personally, I think the link to increased SFA intake and high LDL is pretty solid. The mechanism is understood.

http://jn.nutrition.org/content/135/9/2075.full

Most people show the same trends -- decreased TG, increased HDL, and increased LDL. There's almost no evidence that it's a short-term condition caused by weight loss.

But, as @dragonwolf said, that doesn't mean it's a health risk.

The pattern of LDL should change. CRP should be low. If your doc or you are concerned, next steps should be to test CRP and to get a better picture of the LDL: NMR or VAP (in the US).

If the LDL remains a concern, then changing the mix of dietary fats is worth a shot.

Dragonwolf

wabmester wrote: »

Personally, I think the link to increased SFA intake and high LDL is pretty solid. The mechanism is understood.

In retrospect, I worded that poorly. I felt something was off while I was writing it, but couldn't pinpoint what. Yeah, it's the risk factor aspect of it that's been debunked, not the number changes, themselves (though the dietary cholesterol -> serum cholesterol thing has been debunked to the point that even the federal recommendations are starting to concede that point).

wabmester

Yeah, I think the take-away from Taubes and the rest is that SFA isn't as bad as they originally would have had us believe, but we still don't have all the pieces of the puzzle. The biggest missing piece, IMO, is whether high LDL is still bad when no inflammation is present or when carb intake is low. I would guess not, but nobody's done that study AFAIK.