Thank you so much, Ken! Your reply makes me feel a lot better. I will bump up my fiber intake. And I agree with you: no statins. Thanks for the links.

Your journal is interesting. Glad to see you had dinner with both the Diet Doctor and Eric Westman.

Can anyone answer this: If high LDL numbers result from a LCHF diet, could it mean that you are in ketosis and the LDL is carrying around the fat for you to use as energy and that's why the numbers are so high?

Is that what some people (Feldman?) are positing?

It doesn't necessarily mean that you're in ketosis--but yes, that's the basic idea. In starvation, free fatty acids in the blood are elevated and so is ldl. The more of the fat you're metabolizing you get from your fat cells as free fatty acids (or the more the fat cells are releasing, whether you metabolize it or not), the more the lipid profile is going to approach the sorts of increases in ldl that happen in starvation. This provides a direct fuel source, but sometimes more fat is required locally--by the heart or muscle during exercise, etc., VLDL particles produced by the liver are rich in triglycerides and serve this purpose, and in the process as they lose their triglycerides they become smaller LDL particles. Eat fat, and chylomicrons are formed, these serve much the same function as those VLDL particles so the lipid profile changes, even though the total amount of fat being metabolized might not be much different.

One of many things that I don't understand is why my LDL nearly doubled in a 9 month span when I hadn't really changed my diet all that much. In June 2014 - 5 months into my LCHF experience - my LDL was 129. It had actually improved over what it was 3 months earlier. At the time I was eating less than 30 net carbs per day and losing weight at a crazy fast rate. I lost 50 pounds the in first 3 months and I continued to lose more than 10 pounds a month for several months after that. Yes - I had a lot to lose. But I was clearly operating at a significant caloric deficit. In June 2014 I was burning loads of my own fat, but the LDL was still OK.

Fast forward 9 months to March 2015. My LDL came in at 250. That almost gave my doctor a heart attack. In the months leading into that checkup I was still losing at a nice clip, but well under 10 pounds a month at that point.

What changed in that 9 month period? Here are a few things that I can think of...

1) My carbs might have been a little higher in the early months on the diet. I wasn't tracking my food. Perhaps I was simply eating more carbs than I thought that I was.

2) My insulin resistance was resolved or at least significantly improved. Between December 2014 and February 2015 my FBG normalized (dropping from around 110 to the upper 70's low 80's)

3) I was eating less frequently. I wasn't snacking between meals or in the evening anymore. I was getting a 12 hour fast in almost daily -- with a few 18 and 23 hour fasts tossed in for good measure.

4) I was eating far fewer calories in March 2015. I was eating less than the normal BMR of a typical lean person my height and making up the rest with my own body fat. Early on in the diet I was eating more calories, but I also had a much higher BMR at the time.

5) By June 2014 I had started a regular walking routine. But I had not been doing it very long, I wasn't walking everyday, and the duration was quite short compared to the daily walking I was doing by March 2015. Walking - nothing more - was my main form of exercise for the first 2 years on this WOE.

I really have no solid explanation for why my LDL doubled. I suspect that it had something glucose availability and my energy needs. There seems to be a fine line with me and carbs. If I eat too few carbs an alternative source of energy kicks in and it is delivered on LDL particles.

I've tested my lipids after a 4 day fast. My LDL had shot up over what it had been just a few weeks earlier. I looked up studies on fasting effects on LDL. Not surprisingly, LDL rises significantly in most people during a fast, peaking at about day 3. Is high LDL from a fast unhealthy? If not, then why would it be unhealthy when I eat very low carb? I don't think that it is a problem, personally. My doctor thinks otherwise. So my dilemma is... do I aim to please my doctor. I can make my LDL do what she wants. Or do I forget about the LDL issue and eat LCHF the way that I want to. More carbs does put me at risk for gaining weight. I'm leaning towards just eating how I want to eat and letting my LDL fall wherever it may. I only see my doctor once a year.


You are welcome. This super high LDL thing does not seem to happen with everyone. I'm not sure why. But when it happens to you it is alarming. Dangerous? I still don't know for sure. But I know it was hard to find answers after it happened to me. Advice like "Don't worry about it" was insufficient. Since then I've learned a lot more. I'm more comfortable about all of this now, but I can't say that I'm totally at ease.

One tip about the fiber... ease into it. Adding loads of fiber to my diet all at once really clogged up my system for a while. After a few weeks things normalized. Still, laying that first egg was tough and a little painful. I was sort of expecting the other problem. That's not what happened though.

I found a good video from Dr. Westman on this issue. I especially appreciated his reference to the cvriskcalculator, which takes a more nuanced approach to heart health. When I put in my numbers, it showed that I was fine. (It doesn't even ask for LDL.)

Here is the video

(Check out the comments section with it.)

Around 2:30 he talks about the cvriskcalculator

I do not care what my cholesterol is, and fortunately I have an enlightened GP who isn't bothered, saying higher cholesterol is protective as one gets older.

I figure the whole theory relied on cherry picked data in the first place, everything else they've told us has been WRONG -- seriously, aren't we doing the exact opposite of what we are told?

I eat a lot of fat and salt, ditched the hearthealthywholegrains, and eat one meal a day sometimes -- had a nearly 48 hour fast at the beginning of the week -- never snack.

Why should I listen to them about this?

> Why should I listen to them about this?

Because 'them' includes some people who are generally 'on our side' e.g. Dr. Peter Attia. Let's stick with science rather than just doing the opposite of conventional wisdom.

Having said that: after my Chol topped 500, I weighed the incomplete evidence and neither panicked nor (except for some experiments) abandoned low carb or high saturated fat. But it's quite reasonable for others to come to different conclusions and make some modest changes (discussed and/or linked in this thread) in case it matters.