If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing cohosts are shooting them down one at a time. Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona osteopath and certified bariatric physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at email@example.com. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam blitz through the Keto Talk mailbox and dedicate this episode to answering your cholesterol questions in Episode 54.
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KEY QUOTE: “Triglycerides are the fuel of life when you’re on a ketogenic diet.” — Dr. Adam Nally
Here’s what Jimmy and Adam talked about in Episode 54:
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HOT TOPIC: LDL-P vs. Small LDL-P—which matters more?
Hi Jimmy and the Doc!
The age old debate of which is more important between LDL-P vs. LDL particle size rages on. There seems to be strong opinions from both sides of this issue and I’d love to have you guys discuss this on Keto Talk. It seems a lot of us Ketonians are hyper-responders to a ketogenic diet in our lipid panel and it’s concerning about whether those of us who have elevated LDL-P and LDL-C should consider moving away from LCHF.
Thank you and God bless you guys!
David from Australia
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1. How do I explain to my doctor why my very high total cholesterol isn’t cause for concern?
I’m a 46-year old man and have been following low-carb keto for four years. My total cholesterol has risen to 383 while my triglycerides are below 100 and HDL is 77. My hsCRP is 0.2. My blood glucose ranges from 65 to 90 with ketones over 2.0, so I’m confident I’m doing well. My question is what do I say to my conventional doctor about my high total cholesterol when I go to see him for my regular physical. I usually just avoid seeing him and run the tests on my own so I don’t have to be lectured to. But I would rather use insurance to pay for these tests.
2. Can I take a low-dose statin to help lower my high LDL-P from eating a ketogenic diet?
Jimmy and Adam,
Thanks so much for all the great information you put out there! I’m a Type 1 diabetic, and my blood sugar numbers have been much easier to control since adopting a low-carb diet. I have both your Cholesterol and Keto Clarity books and have taken solace in them every time the doctors have tried pushing statins.
My latest test showed I had an LDL-P of 2300 and I’m now seriously considering taking a statin to deal with it. I really don’t want to give up on my low-carb diet because the higher blood sugars are a more clear and present danger to me than my cholesterol. Should I play it safe and take a small dose statin to see what happens to my LDL-P? Would that be a good strategy for those of us who are concerned?
Thanks again for your help!
3. How is it possible that your triglycerides can go up when you eat keto?
Jimmy and Adam,
Is it possible to eat a strict ketogenic diet and triglycerides go up, not down? That’s exactly what happened to me. My triglycerides have gone through the roof beginning last Fall rising to 379 while my blood sugar levels dropped to 68 with strong blood ketones. My HDL cholesterol is 59 and all my other numbers are fantastic, but what’s going on with my triglycerides? I’m an oddball in the keto community because I’m a skinny guy at 5’8” tall and 130 pounds and so I never suspected my triglycerides would do this.
Perplexed, I decided to try an extended fast to see if that might help. In January, I completed an 84-hour fast, but my cholesterol test results were shocking:
Triglycerides: 379 – up from 279
Cholesterol: 343 – down from 359
LDL: 208 – down from 230
HDL: 59 – down from 73
So what the heck is up with my triglycerides? I know, I know, I know. You always talk about the cheating, Dr. Nally. But I swear on the graves of the saints that this was not happening. I am the NERD’s NERD when it comes to tracking, data, and all that. I am meticulous and keep tons of data, including a food diary app I’ve had since before 2011, and countless spreadsheets. I have too much invested in my health to cheat.
One last thing to add is I’ve been going through a divorce for the past three years and it has been the most stressful time of my life. Is it possible this intense stress is having an impact on my lipids for them to become this deranged?I’m kinda at my wit’s end, and would be forever grateful for any help you could provide.
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4. Why do keto-adapted athletes see rises in total, LDL, and HDL cholesterol levels?
Hi Jimmy and Doc Nally,,
I love this podcast and really appreciate all the work you guys put into it each week. People like Dr. Jeff Volek say that keto-adapted athletes will tend to have very high total cholesterol, high LDL’s and high HDL’s. I run 4-5 times a week and have seen this happen to me. My total cholesterol has gone from 202 to 303, LDL from 118 to 194, and HDL went from 72 to 92. Peter Defty from Vespa says these number changes are a sign of being in superior health. What do you think about why this happens?
Thanks so much,
5. How can people outside the United States convert cholesterol numbers from American units?
Hi Jimmy and Doc Nally,
I’ve been on a real food-based ketogenic diet since May last year and have lost 50 pounds so far with 50 more to go. I recently went to my doctor here in the UK to get my cholesterol numbers run and the numbers are all different from what you have in the states. When you share about numbers using the American units, it doesn’t mean anything to me. My doctor says my numbers are all good and to keep doing what I’m doing. What formula can I use to understand my numbers better. Here are my current results in English measurements (Adam, I added the American conversions parenthetically for our knowledge during the show):
Total cholesterol – 3.7 (143)
Triglycerides – 0.7 (62)
HDL – 0.9 (35)
LDL – 2.5 (96)
Blood Sugar – 4.4 (79)
A1c – 29 (???)
Thanks in advance and keep up the good work!
Mark in England
6. Can blood pressure lowering medications reduce your total cholesterol?
I’m a 41-year old man currently taking Losartan for high blood pressure. I have been doing the ketogenic diet for a little over a month and have lost 27 pounds. My lab results show that my total cholesterol is very low at 111, HDL 44, LDL 57, and triglycerides 49. Additionally, my Carbon Dioxide level is high at 32 and my Alkaline Phosphate is low at 29. Are these levels along with my very low total cholesterol related to my blood pressure medication? I love your podcast and thank you for answering my question.
7. Can BCAA’s and sweeteners be the culprit in rising cholesterol levels?
Hello Jimmy and the Doc,
First of all, thank you for bombarding us Ketonians with knowledge, science, and humor. I have learned a lot about not only the ketogenic diet, but food and diseases in general. I’m 30 years old with no real markers of chronic disease. I workout 3 to 4 times a week for about 2 hours and started the ketogenic diet six months ago. I feel great with tons of energy, very little appetite, clear mind, and fat loss. When I ran my blood work after a 24 hour fast, my doctor demanded that I stop my diet immediately because the cholesterol went up too much. Total cholesterol went from 182 to 433 with most of it happening in the LDL-C. HDL rose from 54 to 62 and triglycerides rose from 89 to 102.
Adam was kind enough to explain to me in an email that fat doesn’t spike cholesterol…insulin and stress does. SO it got me thinking about what I’m eating and the only thing I can think of that could be the culprit are the branch chain amino acids I use on a daily basis. They have ACE-K in them and so does the sugar-free sweetener in my Starbucks coffee. Is it possible this is what is spiking my cholesterol so high? My A1c was 5.2 and fasting glucose 103. I temporarily stopped eating eating to please my doctor because I don’t want to challenge his authority in my health. But I want to gather as much information as I can before my next visit to try to show the science.
Thank you guys, and keep up the great work.
8. Does eating keto eventually lead to the development of higher levels of Small LDL-P?
Hi Jimmy and Adam!
I listened to Dr. Sarah Hallberg’s presentation from the Low Carb Vail conference last year where she discussed changes in blood lipids in response to a ketogenic diet. She noted during her talk that a subset of ketogenic patients show a shift in LDL to the less favorable small, dense LDL particles over time eating keto. She hypothesized a mechanism that involved insulin possibly getting too low which leads to this negative effect on Small LDL-P. Have you seen this in your patients, Dr. Nally? If it does happen, what’s going on? And the real question is whether this matters at all in the context of a good A1c and low hsCRP levels.
Thanks for your great podcast! I love everything you guys are doing. I listen to lots of podcasts every week and I must say this one is my favorite. It makes my Thursdays feel like Friday because it always puts me in a good mood.
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9. Is having high HDL cholesterol a cause for concern when you’re eating a ketogenic diet?
Jimmy and Doc Nally,
I am one of your oldest listeners and followers living low-carb for the past twenty years. I’ve been explicitly low-carb, high-fat for the past five years. I started taking your BerberinePlus supplement five days before my latest lab work and my blood glucose fell to 84. However, my HDL rose to 180 with triglycerides at 51. I’ve read that having high HDL can be a bad thing. My LDL is 108 and total cholesterol 277. I do consume more C-8 MCT oil in my diet now. Is that why my HDL went up? To make matters worse, my doctor has gone vegan and we’re butting heads on nutrition. Is this very high HDL cholesterol level a concern? Thanks for sharing your thoughts. I always listen Keto Talk and really appreciate the time you invest in sharing your knowledge.
Love you guys,
10. Why would eating carbs like bread decrease LDL-P and LDL-C?
Hello Jimmy and Dr. Nally,
I have a question about my LDL-P and LDL-C numbers eating keto since December 2015. They have both increased dramatically and my doctor is panicking pushing me to start taking a statin. I refused since my triglycerides were 56 and HDL was 60. I got depressed in August 2016 and stopped eating keto for a period of time eating lots of bread and other very high-carb foods during that time. When I tested my cholesterol again in December 2016, I was stunned to discover my LDL-P and LDL-C both went way down. Why did eating carbs make these numbers better than when I was eating ketogenic?
Thank you so much for providing great information! I love Keto Talk!
11. Does knowing your Apo E genotype determine what kind of fats you can consume for ketosis?
I’m wondering if you have any information on how your Apo E genotype affects fat metabolism on a LCHF diet. I’m an Apo E 3/4 and I’ve always been told to avoid saturated fats and opt for mono and polyunsaturated choices instead as my genotype has a harder time metabolizing saturated fats. Interestingly, statin drugs would have no effect on me because my cholesterol levels relate more to the way I process ingested fats. I’ve heard you guys say on the podcast that saturated fats are better for ketone production. So does your Apo E genotype determine what kind of fats you should be eating on a ketogenic diet?
12. What can a Ketonian do to lower Lp(a) and is it something to be concerned about?
I would like to ask a question about the results of my Lipoprotein(a). It came back at 158 with a reference range of less than 30. My total cholesterol is 197 and all the other cholesterol numbers are perfectly within the reference range. I realize cholesterol is not something to be worried about, but should I be concerned about my Lp(a)? Apparently, diet and lifestyle changes don’t do much to help with this. My doctor told me about a pill called Heart Plus (which consists of vitamin C, lysine, and proline) and said it takes a long time to lower Lp(a). Is this something to be concerned about?
Any advice you can give would be appreciated greatly.
13. Will a ketogenic diet raise low cholesterol levels to help restore proper hormone levels?
Jimmy and the Doc,
I started keto on January 2nd as a 30-year old female with two children, 4 and 6. I’ve been experiencing very low cholesterol levels since the birth of my second child and my doctors have been struggling to find the appropriate doses of hormones to maybe fix these numbers. My most recent results showed my total cholesterol is 110. Will the ketogenic diet help me raise my total cholesterol up to a healthier level so my body will start producing appropriate levels of hormones again? I’ve already noticed short-term memory loss from the low cholesterol and I’m desperately looking for an answer. Is keto going to be the answer for me?
Thanks fromThe KetogenicTooLowCholesterolMom,
KEY QUOTE: “There is strong evidence that cholesterol to triglyceride ratio is something to really pay attention to, moreso than other indicators.” — Jimmy Moore
14. Why do middle-aged women see a dramatic rise in their cholesterol and is it a cause for concern?
Dear Jimmy and the Doc,
I am a 50-year old female who has been living low-carb for several years and doing keto fairly strictly for the past six months. Going keto has allowed me to finally take off that last ten pounds and I feel so good on this lifestyle. Last year at this time my cholesterol numbers looked fine with HDL 170 and LDL 109. I just had a more extensive blood panel done and my numbers now look scarily high with an LDL-C of 179. A few of my friends who are the same age as me and not eating keto have seen a similar jump in their cholesterol and been prescribed statins (something I want to avoid). I read that this LDL jump seems to be common in women around menopause and is the biggest factor in driving the large increase in statin prescriptions in my age group. What’s going on in women like me seeing increasing cholesterol levels and is it cause for concern? I would like to keep eating keto, but I fear my family history of heart disease on my father’s side will have my doctor telling me to get on a statin immediately.
Thanks so much for your advice,
Large Ldl Particle Number 1356
Large/Med Vldl Particle Number 11.1
Medium Hdl Particle Number 5.2
Small Vldl Particle Number 35.9
Vldl Triglycerides 49.5
Vldl/Ldl Particle Number 1533
Small Hdl Particle Number 20
Vldl Particle Number 46.3
Hdl Particle Percentile 95.4
Idl Particle Number 14
Ldl Size Percentile 99.4
Large/Med Hdl Particle Number 23.4
Small Ldl-P <90
Medium Vldl Particle Number 9.3
Vldl Size Percentile 2.1
Lp-Ir Score <25
Prot And Pffa Calc 643
Lp-Ir Score Percentile 1.5
Hdl Size Percentile 97.7
Large Hdl Particle Percentile 99.2
Large Vldl Particle Percentile 33.2
Small Ldl Particle Percentile 0.0
Ldl Size 21.9
Hdl-P (Total) 42.5
Cholesterol, Total 290
15. Are triglycerides a good or bad thing when you are consuming a ketogenic diet?
Can you explain the different types of fats in the body? I keep hearing about how bad triglycerides are on your cholesterol panel. And yet I also hear about triglycerides being oxidized in the liver for increasing ketone production? This seems like a contradiction! Do we want triglycerides in our body or not while pursuing nutritional ketosis?
16. Should I be concerned by my own test results if I have a family history of high cholesterol?
Hello Jimmy and the Doc!
Thank you guys for everything you do. Your books, knowledge and podcasts are changing the lives of so many people in such a beneficial way. I feel lucky to have discovered keto about four months ago and the journey so far has been nothing short of spectacular.
I’m a healthy, active male who enjoys rock-climbing in my home state of Colorado. I’ve noticed a tremendous improvement not only physically as it relates to my sport, but mentally as well. Since adapting I’ve been able to break down both physical and mental barriers that had stalled me for some time. It took me around 8 weeks to feel fully keto-adapted and get my blood ketone levels ranging consistently from .5-1.5.
Recently I made a visit to Dr. Jeffry Gerber’s office and everything checked out great except for my cholesterol. Here were my results: Total Cholesterol 315, HDL 91, LDL 210, and triglycerides 68. My blood glucose was 79 and my A1c was 5.3. Thankfully Dr. Gerber didn’t freak out about my numbers and he concluded that my LDL particles are very likely the healthy fluffy kind with my triglyceride/HDL ratio being so good. Given my family history of high cholesterol, It’s a bit concerning when I think that I may be one of the few that can’t handle the ketogenic diet.
My question for you guys is this—what do you think the next steps should be for me given my recent lipid results? Should I have my numbers checked again at some point in time? Or should I order the expensive NMR Lipoprofile or similar test? Or should I stop worrying and just assume all is well? I’m not the type of person to assume anything, especially when the consequences could be so high. But I wanted to ask of your opinion before I drop $600 or more on a particle test.
Any input would be greatly appreciated. Again, thanks for all you guys do!
17. Can a ketogenic diet help reduce or completely eliminate calcified plaque?
Hello Jimmy and The Doc,
I love Keto Talk as well as Jimmy’s book Keto Clarity. The advice really helps those of us who are going against our doctors’ advice in an attempt to take control of our health. I have been keto for three years and wondered if it would help improve or possibly even reverse calcified plaque? I had a CT Heart Calcium Score done and saw it drop from 69 in 2014 to 64 in 2016. Will these improvements continue to get me back closer to a score of 0 or is the condition merely stabilized? Heart disease runs in my family and so I’m hoping going keto will buck this trend.
Thanks for your help!
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