I got tested in November and then again today. I would like to understand the best way to decrease my triglycerides, LDL, and total cholesterol.

My numbers are below:
BP 134/80, now 120/71
Glucose 98, now 88
Total Cholesterol 295, now 370
Triglycerides 229, now 302
HDL 61, now 79
LDL 188, now 230
BMI 23.4, now 22.3

My diet may have something to do with this, but I honestly thought I was doing a low-carb, i.e., ketogenic diet. My weight has also gone down since the first of the year (see my stats) so I am genuinely puzzled. However, I've been consuming a lot of heavy cream, which I've come to remember, now, has carbs in every serving. Plus I also have the following questionable habits

1-I eat pickles regularly (with burgers, etc)
2-I drink unsweetened tea
3-I drink alcohol, not much though (*max* is 6-7 drinks per week, only clear liquors and club soda)
4-I cheat occasionally, I've had a frozen cappuccino once every couple of weeks (sort of like an Icee/Slurpee but with cappuccino)
5-I drink 1-2 cups of coffee (with heavy cream) every morning
6-Sometimes I get gas station coffee and use the little half and half packets, 3-4 per cup

All the above said, my triglycerides are *really* high and went *up* after starting low-carb. That doesn't make any sense, even with the above caveats/cheats. Hoping someone on here can make sense of this.

Hi ID4, I am no expert by any means but when I saw your post was unanswered, it seemed like you needed someone to jump in pretty quick with some reassuring words.

A few years ago my cholesterol seemed to be going up in a similar pattern to yours, I don't recall the exact numbers but my total cholesterol was even higher. What I was told back then -- and which has been reinforced many times since, on this forum and elsewhere -- is that the only thing to be concerned about is the size of your LDL cholesterol particles. Total cholesterol apparently does not matter, neither do any of the other numbers: find out whether you have the "large and fluffy" LDLs, (which are the good kind, you *want* them to be large and fluffy), or the small and dense kind (bad, very bad). This is not something that your GP is likely to specify when ordering your cholesterol tests, unless you ask him for the LDL Particle Size Test. You must *very specifically* tell him/her that you want this test. The results of this test will tell you if you need to make any diet or lifestyle changes.

I would strongly urge you to NOT go on any kind of cholesterol meds, at least until you have the answer to this! My doctor was aware of LDL particle size and how it is relevant, so thankfully, when we found that I had the "good" LDL, he told me there would be no point to going on meds and that I was not at risk. I don't know if he's one of the more unusually well-read GPs or if this is more common nowadays, but if your GP doesn't seem to understand how this works and why you need to know your LDL particle size, then I'd find another doctor who does understand it.

Meanwhile, if it's any consolation, the trend seems to be that LDL particle sizes when a person has been on a low carb diet for a few months, turn up as the large and fluffy kind. LC seems to help, rather than hurt, this issue. I severely doubt your "questionable habits" are harming your cholesterol so long as you are being accurate in how you have reported them in your post. Pickles aren't going to give you heart disease . For that matter, there is evidence that alcohol may actually help lower risk of heart disease in some cases, so keep it moderate and not necessarily every day, if you want a good metabolism that will help you stay in ketosis. And unsweetened tea should not be "questionable" at all!

I've never heard of anybody else's triglycerides rising with low carb. I'd ask for a retest if you really have been rigorous about low carb. I can see LDL and HDL going up - therefore total cholesterol going up, but not trigs - they usually plummet on LC.

Have you read Jimmy Moore's Cholesterol Clarity? Perhaps it would have some insights.

Ah-ha! I see the problem…you didn't start the LC plan until Jan 2014.

You are right at the 3-4 month mark, the dreaded time frame when your Trigs can indeed go up, because those 19 pounds of fat had to go somewhere! It is temporary. Advice is to hold off testing again until you are weight stable for a few months.

http://www.wheatbellyblog.com/2012/...sterol-went-up/

A few other thoughts than just the weight loss here:
http://www.marksdailyapple.com/why-.../#axzz2zowFPPDI

Also, 6-7 drinks a week is a fair amount in my book. Did you drink before the test?

Well... not bad advice expect for the fruit juice. I know being in ketosis can make alcohol hit you harder. Maybe it can also spike the trig. higher as well.

Also, I believe fish oil lowers them too. Consider supplementing that. Do you smoke? Do you have a family history of very high triglycerides? (Early heart disease?)

Make sure your Vit. D3 levels are optimized too.

Another thing, were you fasting? Some people forget and eat/drink something before the test and that will invalidate it. Unless it is black coffee, plain tea, or water.

Thanks everyone. I appreciate your support, girlbug. I did a little reading yesterday and noted that in several posts I read the main things to consider were the ratio between total cholesterol and HDL, I think 3.2 or lower is considered OK.(?)

Also I did read yesterday that having high triglycerides combined with high HDL is a good CVD risk indicator...hence my concern.

Liz I will ask for a retest. The goal was to improve my various health metrics and I hope they will allow me to 'pass' if I retest well in a few weeks. I was a bit overconfident and signed up for the first round of screenings...I had no idea I might end up in this situation :P

Jey, I think you nailed it. Thanks for posting the links. How long do you think the high TG will last? Nancy, I don't smoke. I smoke occasionally, and had smoked a 3-4 cigs a couple of days before the screening.

My guess is my vitamin D3 levels are good. I'd been taking 5K+ a day in the early part of the year (Jan/Feb?) till I felt I was getting the flu, then I stopped completely. Not sure what everyone else thinks, but too much D3 makes it easy for you to get throat/sinus infections. At least in my experience. Both times in my life I've had the flu were when I was supplementing D3. Topic for another thread, I guess.

I fasted well, I was concerned about my blood sugar reading and did not eat dinner the night before, so my fast lasted around 15 hours, I think.

High BP in my family, but not trig, cholesterol, etc., as far as I know, though my mom and dad are high carbers.

I will give up alcohol if I have to. It has hit me harder since I've been low-carbing it. It doesn't seem fair to not be able to have 2-3 drinks, twice a week...seems ridiculous to me.

I have a follow-up based on my November readings with my GP in a couple of months...hoping things will be good by then. But also want to be sure, that 'fat loading' wouldn't raise my TG...

If I:
1-drink 3/4 cup of heavy cream plus 1/4 cup coconut milk
2-eat 6 pieces of bacon
3-cook 2 eggs in the bacon grease
4-top with cheese

Would a meal like that raise my triglycerides through the roof?
I'm hoping not.

Maybe you can. But in the interest of testing, go without and see what happens. But you said you have 6-7 drinks a week, not 2-3. And the definition of "a drink" is very specific. 1 oz of hard booze, 3 oz of wine, etc.

I don't know as I would define completely optional behavior that has potential negative consequences for many things (cancer, alcoholism, liver damage, driving under the influence) as unfair. You learn the risks and you either accept them or you don't.

However, I do understand the emotion behind giving things up. When I realized my diet had to be a permanent lifestyle change, I struggled against it and felt that life was "unfair".

Actually, now that I've been doing it a long time, I'm probably much better off for having made these changes permanently and I no longer feel there is anything unfair about it at all.

Garbage-in Garbage-out applies to our bodies, too.


Yes, but only temporarily. Eating anything at all raises your TGs. On a low carb diet they clear pretty quickly. On a high carb diet they take much longer to clear (booze may play into this too). Eating carbs means they don't clear before your next meal so after the 2nd meal they're even higher. Then after the 3rd meal they go even higher yet.

Dr. Davis (cardiologist) has written about this in his blog (and book "Wheat Belly").

http://www.wheatbellyblog.com/?s=tr...earchsubmit.y=0

Know I read the 3-4 month mark is the usually the worse time for fat in the blood effect somewhere (maybe Phinney & Volek?), but Dr. Westman writes in Cholesterol Clarity that he does not repeat blood cholesterol tests until weight loss goal is achieved and you are weight-stable for a month. Dr. Davis writes the same advice in the link above.
I only have my numbers because regular blood work is done for other reasons, Dr. Westman would not have until after my goal was met.

Westman believes "Knowing your Triglyceride to HDL Ratio is Critical to Assessing Heart Health" (page 109) more than TC:HDL. Ideally you want it a 1:1 ratio, so your number does not look so great right now, but it is temporary!
What do you do to get that ratio up? "Cut your carbs and increase your fat"

It was because my triglycerides were at 360(!!!!) that I began low carb at my doctor's suggestion. I was seriously scared when I walked out of her office. I finally understood that I could have a heart attack at any second. The way I had been eating for decades was insane, I'd subsisted on practically nothing BUT sugar and starch for decades. So, I immediately cut out all sugar and all starch of any kind whatsoever. That includes fruit, and alcohol (which was really hard for me). All I can tell you is that at my next blood test, taken 2 weeks later, my triglycerides were 75. The nurse was astounded but the doctor was not. She knew her advice would work if I took it seriously enough. So please be encouraged. If you want to bring your number down quickly plunge in and don't cheat. Once your health is under control you can ease up and add a few things back in, like fruit and a little wine for example. Good luck!

Nancy, thanks again. I hear you...my frustration is that 6-7 drinks a week, or 2-3 drinks, twice a week, however you slice it, is considered moderate. A normal, healthy person on the SAD can have that, eat a moderate amount of grains, fructose containing foods, etc., and end up with excellent numbers...at least I think...or so the mainstream writers say...so why not me?



Janet, sorry I did not catch your name before (even though it's right there in your sig ... I was sort-of thinking cutting carbs and increasing fat will help. I am going to start assuming my vices have carbs in them (cream, pickles, tea, coffee, etc.) and make sure I am counting them. I will increase my fat. I was, at times, eating hamburgers, atkins style, with butter on the side. I will just continue doing that. I wonder if there are any carbs in a hot dog? Some days I make a meal out of those, too Thanks, I am really encouraged by your words



Thanks Whofan. I might be in denial right now ... I'm still upset about possibly not having alcohol. I'm going to take the middle ground here, and focus on the fact that when doing low-carb, and, guaranteed, consuming less alcohol than I had in the past, my TG went up. So I'm going to assume I'm doing the right thing and stick to my plan for a bit. If in about 3 weeks I still have high TG, I'll cut alcohol for sure. I may cut it anyway in a couple of weeks. I'm not a big drinker, but I go out a lot, and a little bit goes a long way.

I actually don't think that's true. In a decade or two, many of these folks end up with a lot of problem. They say something like 1/3 of the people out there have pre-diabetes nowadays. Even children!

So, best to come to terms with the fact that you've decided to grapple with it before things get really bad. I know it is hard to think about now, but it gets easier just so long as you focus on the good stuff... BACON!

Besides the alcohol, 2 more things that you are eating jump out at me: the frappacino (that stuff is LOADED with sugar) and the "little half and half packets, 3-4 per cup" - is that real half and half or is it a non-dairy creamer? If the latter, it is primarily High Fructose Corn Syrup.

Thanks for clarifying the rise in trigs, Janet. I knew LDL and total might go up, but had never heard trigs included with them. But sure enough, on page 158 of Cholesterol Clarity by Jimmy Moore and Eric Westman MD, trigs are included with other markers going higher at the beginnings of an LC diet.

Good point. I had high-normal blood sugar 5 years ago and didn't know anything about LC back then. I had a moderate diet, but to be fair, I was coming off of mainstream 'healthy recommendations' hard, such as "tomatoes are a superfood because they contain Vitamin A and lycopene" ... LOL. I used to believe that sh*t...I have come such a long way. So happy to be here, too!

Update ... my TG are still high. But I am starting to think I was 'overdosing' on calories. I cut all of the added fat from my diet. So no bacon and egg meals, no adding butter to my atkins-style burgers, and no snacking on cups of cream & coconut milk. I also eat seafood (salmon, usually) a couple of times a week. I've lost about four pounds in two weeks, as a result. I am also taking fish oil pills as I remember them (average of two a day)...and I am taking a whey protein supplement as I am about to enter my 'diet phase' where I start gaining muscle weight.

I suspect my numbers will look like what you expect on a ketogenic diet by the beginning/middle of next month, which is when I follow-up with my PCP. Thanks, all for your responses.

Most of us got really good numbers by eating lots of added fat. Everyone is different. If you've got diabetes, then your triglycerides might not respond quite so well. Some people have familial hypertriglycerides too.