Dramatic Rise in LDL Cholesterol During Keto
July 1, 2022 3:02 PM Subscribe
I lost 26+ pounds from March to June using an aggressive mix of keto+intermittent fasting. All of my health stats look great (see here), except now my LDL cholesterol is REALLLLLLLLY bad (I sadly only have a post-keto LDL number; I don't have a pre-keto data point). I've seen two separate smart and capable GP doctors, who both admit that they aren't familiar with keto's effect on cholesterol -- regardless, they both advise that if I can't reduce by LDL to <190 after 3 months of switching from keto to a mediterranean diet and also exercising 150 minutes/week -- both of which I'm happy to do -- then I 100000% need to be on a statin, for life.
I'm not anti-statin, in the least (primarily because people I respect like David Sinclair and Peter Attia believe they are safe and effective). As a result, I'd be fine with going on a statin if necessary. In addition, I'm happy to switch to a mediterranean diet -- I'm not married to keto.
My question here is very specific: I'm very curious to hear if anyone else went on keto, then saw a big spike in their LDL cholesterol, and then saw their numbers come back down. If so, please share how it took for your numbers to come down and what you did to achieve the drop.
That said, just in case this question is too specific/targeted, please feel free to provide any other related anecdotal information you might have about any of the following: what life is like on a statin; experience with reducing LDL cholesterol in general (regardless of keto); or anything else you think might be interesting/helpful. I'm not looking for medical advise, just insights/data points.
(Lastly, just an FYI that I'm aware of Dave Feldman and his school of thought around this topic. Seems like a smart guy who has thought very seriously about the topic, and I'd love for him to be right about this. Unfortunately, when I present his model to my doctors, they have no idea what I'm talking about, and don't have time to investigate it (which is understandable). As a result, if I have to pick who to trust between MDs and non-MDs, I'm too scared to not to choose the MDs.)
I'm not anti-statin, in the least (primarily because people I respect like David Sinclair and Peter Attia believe they are safe and effective). As a result, I'd be fine with going on a statin if necessary. In addition, I'm happy to switch to a mediterranean diet -- I'm not married to keto.
My question here is very specific: I'm very curious to hear if anyone else went on keto, then saw a big spike in their LDL cholesterol, and then saw their numbers come back down. If so, please share how it took for your numbers to come down and what you did to achieve the drop.
That said, just in case this question is too specific/targeted, please feel free to provide any other related anecdotal information you might have about any of the following: what life is like on a statin; experience with reducing LDL cholesterol in general (regardless of keto); or anything else you think might be interesting/helpful. I'm not looking for medical advise, just insights/data points.
(Lastly, just an FYI that I'm aware of Dave Feldman and his school of thought around this topic. Seems like a smart guy who has thought very seriously about the topic, and I'd love for him to be right about this. Unfortunately, when I present his model to my doctors, they have no idea what I'm talking about, and don't have time to investigate it (which is understandable). As a result, if I have to pick who to trust between MDs and non-MDs, I'm too scared to not to choose the MDs.)
Answering your question more broadly, I am a doctor (but not yours, and this is not medical advice) and among my group of doctor-friends, we have basically all started ourselves on statins with the intention of staying on one forever, regardless of our baseline cholesterol levels. The benefits are significant, the adverse effects are exceedingly rare, and when you drill down to why the current guidelines don't recommend statins for everyone, the main downsides cited are cost and the burden of taking a daily pill. "Life on a statin" is exactly the same as life not on a statin except I take my birth control pill and a statin every morning instead of just my birth control pill. The evidence all indicate that cardiovascular risk is determined by cumulative exposure to elevated LDL; since you don't have any baseline values to compare to, it's possible your LDL has been elevated for quite some time.
posted by telegraph at 3:34 PM on July 1, 2022 [11 favorites]
posted by telegraph at 3:34 PM on July 1, 2022 [11 favorites]
Do you know your family history around cholesterol? Genetics influence your numbers and how hard it is to change them. Based on my relatives' experience, there's a pretty strong chance I'll need to be on statins even if I exercise a lot and eat a Mediterranean diet. Not everyone has side effects from statins and they work well to reduce your risk of heart problems, it's not a terrible thing if you need to take them.
posted by momus_window at 3:37 PM on July 1, 2022 [1 favorite]
posted by momus_window at 3:37 PM on July 1, 2022 [1 favorite]
That happened to me when I went on a Keto diet. My normally fine cholesterol skyrocketed and I stopped doing it.
posted by yes I said yes I will Yes at 3:50 PM on July 1, 2022 [3 favorites]
posted by yes I said yes I will Yes at 3:50 PM on July 1, 2022 [3 favorites]
Statins Here's a short YouTube discussion of the benefits of statins by UK Cardiologist Rohin Francis who discusses clinical data on these drugs. Dr. Francis also has some nice informative clips on Keto diets and other topics on this channel, Medlife Crisis.
posted by effluvia at 3:51 PM on July 1, 2022 [1 favorite]
posted by effluvia at 3:51 PM on July 1, 2022 [1 favorite]
I've been low-carb for decades and currently enjoying keto/IF. My numbers are pretty much perfect. I have heard anecdotally about peoples' LDL going nuts and then stabilizing, and I've heard that there are some for whom it goes up and doesn't come back down. Generally it seems like the overall numbers do come down but LDL acts weird sometimes.
You could search on /r/keto for individual stories, with varying responses and levels of medical reliability.
posted by bink at 4:06 PM on July 1, 2022 [1 favorite]
You could search on /r/keto for individual stories, with varying responses and levels of medical reliability.
posted by bink at 4:06 PM on July 1, 2022 [1 favorite]
I don't want to scare you off statins completely, but I'm one of those people who react really badly to them. After less than two weeks on a statin, I wound up with excruciating muscle pain in my legs, especially my calf muscles. I stopped taking the statin right away, but I am still dealing with the effects 6 months later, and it seems like I have permanent damage even after a very short time taking a statin. If you are able to control your LDL by diet, that is by far the best solution.
posted by gudrun at 4:47 PM on July 1, 2022
posted by gudrun at 4:47 PM on July 1, 2022
I'm not a doctor, but I do have a serious interest in physiology and nutrition, and I have followed a ketogenic diet for 5 years and have been intermittent fasting for 8 years. My understanding is that the distinction here between Pattern A LDL and Pattern B LDL is important; this is a lucid unpacking (by a youngish Australian doctor who advocates a ketogenic diet). The graph he cites at around 17:30 minutes is especially interesting. If you poke around on PubMed, you can find less accessible explorations of the same thing - for instance, this article looking at the triglyceride to HDL ratio as being predictive of Pattern A vs Pattern B. In other words, while I'm open to being convinced otherwise, I'm not currently convinced that one's LDL number (or, indeed, one's total cholesterol number) in and of itself is predictive of much.
posted by ClaireBear at 5:18 PM on July 1, 2022 [7 favorites]
posted by ClaireBear at 5:18 PM on July 1, 2022 [7 favorites]
There’s a new FDA approved injectable drug called Leqvio that can be used instead of or as a complement to statins to reduce LDL.
posted by limbicdigest at 5:39 PM on July 1, 2022 [1 favorite]
posted by limbicdigest at 5:39 PM on July 1, 2022 [1 favorite]
experience with reducing LDL cholesterol in general (regardless of keto)
When I was eating a pretty standard American diet, my LDL was 131. I switched to a very low fat (roughly 10%), mostly whole foods, vegan diet. Following that diet, my most recent LDL was 61. I've never taken statins.
I first changed my diet because of blood pressure, not cholesterol - and it did resolve that problem. It's not always the easiest way to eat (though it gets easier over time), but I prefer that to taking meds. YMMV of course.
posted by FencingGal at 6:24 PM on July 1, 2022 [2 favorites]
When I was eating a pretty standard American diet, my LDL was 131. I switched to a very low fat (roughly 10%), mostly whole foods, vegan diet. Following that diet, my most recent LDL was 61. I've never taken statins.
I first changed my diet because of blood pressure, not cholesterol - and it did resolve that problem. It's not always the easiest way to eat (though it gets easier over time), but I prefer that to taking meds. YMMV of course.
posted by FencingGal at 6:24 PM on July 1, 2022 [2 favorites]
I wasn’t keto, but there were long stretches where for similar-ish reasons i sought high-protein high-fat content as a large part of my diet.
In my mid 40’s i was told my total cholesterol was well over 300. Dr said, “Statin, ASAP.” I had great fear of the potential negative effects of a statin, so i took a much lower dose than my dr proscribed.
Then i had a heart attack.
I went on a high dose statin, but then had some musculoskeletal problems that manifested during intense cardiac rehab, which may or may not have been influenced by the statin ( i was deconditioned even before the heart attack), but my dr decreased my statin dose & started me on Repatha . Within a few months LDL was down in the 50’s. That was two years ago and my LDL has fluctuated somewhat but it’s much more controlled. 6 months ago it was 104 - too high for someone with a heart attack. Now it’s 54 and yes indeed i had made diet changes before that score but no i was not perfect and did not live like a monk. Mostly i just paid much closer attention to volume of fat consumed, esp saturated fat. Almost no dairy at all.
Ask if anyone in your family has had chronic high cholesterol that was hard to change/control with diet. If yes, please tell your doctor. There’s a thing called heterozygous familiar hyperlipidemia . Genetic. I got it from Dad. The Repatha targets that. Your Dave Feldman article mentions it. He makes a point about needing to know what your benchmark was before it got high. That sounds sensible buy I’m not sure whether a cardiologist would consider that a hard requirement for treating it. Oh, and: my cardiologist is adamant that it’s the combination of the Repatha AND statin that’s what does the trick.
OR: listen to Telegraph’s advice.
Good luck!
posted by armoir from antproof case at 8:22 PM on July 1, 2022 [1 favorite]
In my mid 40’s i was told my total cholesterol was well over 300. Dr said, “Statin, ASAP.” I had great fear of the potential negative effects of a statin, so i took a much lower dose than my dr proscribed.
Then i had a heart attack.
I went on a high dose statin, but then had some musculoskeletal problems that manifested during intense cardiac rehab, which may or may not have been influenced by the statin ( i was deconditioned even before the heart attack), but my dr decreased my statin dose & started me on Repatha . Within a few months LDL was down in the 50’s. That was two years ago and my LDL has fluctuated somewhat but it’s much more controlled. 6 months ago it was 104 - too high for someone with a heart attack. Now it’s 54 and yes indeed i had made diet changes before that score but no i was not perfect and did not live like a monk. Mostly i just paid much closer attention to volume of fat consumed, esp saturated fat. Almost no dairy at all.
Ask if anyone in your family has had chronic high cholesterol that was hard to change/control with diet. If yes, please tell your doctor. There’s a thing called heterozygous familiar hyperlipidemia . Genetic. I got it from Dad. The Repatha targets that. Your Dave Feldman article mentions it. He makes a point about needing to know what your benchmark was before it got high. That sounds sensible buy I’m not sure whether a cardiologist would consider that a hard requirement for treating it. Oh, and: my cardiologist is adamant that it’s the combination of the Repatha AND statin that’s what does the trick.
OR: listen to Telegraph’s advice.
Good luck!
posted by armoir from antproof case at 8:22 PM on July 1, 2022 [1 favorite]
This happened to me (38F). I eased out on dairy products and it went back down. Makes it tough in terms of food choices as I’m vegetarian, so basically that leaves only eggs for me as a source of animal protein. Been going on 5+ years now as veggie keto and my LDL is now normal.
posted by PardonMyFrench at 2:05 AM on July 2, 2022 [1 favorite]
posted by PardonMyFrench at 2:05 AM on July 2, 2022 [1 favorite]
Best answer: Just to concretize my answer above a bit, since your question asked for specifics: I guess what I'm saying is that it might be worth trying to get some additional tests to try to determine your CVD risk profile before you do something drastic like go on a statin or stop a diet that is improving your other health metrics. In particular, I might consider:
- A coronary artery calcium (CAC) test, to see whether there is already evidence of calcium deposits in your coronary arteries. This seems to me to be extremely important, because many of the other tests (e.g. the lipid panel you got done) are only testing risk, and so are used as proxies, but a CAC determines evidence of the actual presence of calcification or lack thereof.
- A C-reactive protein (CRP) test, preferably a high-sensitivity one. This measures inflammation in the body, and CVD is increasingly being understood as a chronic inflammatory disease. From the first link:
CRP seems to predict the chance of having cardiovascular problems at least as well as cholesterol levels. A recent study found that elevated levels of C-reactive protein were associated with three-times-greater risk of a heart attack.
My understanding is that a high CRP result isn't dispositive in diagnosing CVD, but that it indicates relative risk (similar to what is claimed about cholesterol tests), and so can be helpful in concert with other metrics.
- Advanced lipoprotein testing: the testing that Paul Mason mentions in the video that I linked, described more in this article:
Standard tests of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) misidentify coronary heart disease (CHD) risk status in a substantial portion of the population. Tests of apolipoprotein concentrations are superior to standard LDL-C tests, and it can be argued that they should replace standard lipoprotein cholesterol testing... Over the past 2 decades, evidence has revealed that standard lipoprotein measurements of triglycerides, total cholesterol, LDL-C, and HDL-C fail to identify many lipoprotein abnormalities that contribute to CHD and peripheral vascular disease risk.1 Advanced lipoprotein tests (ALTs) lend insight into subtle yet important aspects of lipoproteins and atherosclerosis that help to explain the relative failure of the LDL-C–lowering strategy to stem the epidemic of atherosclerosis
This more granular look at lipoproteins should give a better sense of your LDL (Pattern B ["small dense"] vs Pattern A ["large fluffy").
- If you are seriously considering going on a statin, it might be worth getting your HbA1c tested, if you haven't already, as well as any other markers of insulin resistance that you are able. There is some evidence that statins increase insulin resistance and can promote diabetes, at least in certain doses and in certain individuals, so if I were you, I'd want to know my existing risk to the extent to which it could be determined, especially as those with diabetes are twice as likely to have heart disease or a stroke. (I'm not saying that that relationship is necessarily causative - as I mentioned above, the degree to which chronic inflammation underlies many diseases of aging, as well as aging itself, is now being understood - but the relationship isn't necessarily nothing either.)
posted by ClaireBear at 3:11 PM on July 2, 2022 [4 favorites]
- A coronary artery calcium (CAC) test, to see whether there is already evidence of calcium deposits in your coronary arteries. This seems to me to be extremely important, because many of the other tests (e.g. the lipid panel you got done) are only testing risk, and so are used as proxies, but a CAC determines evidence of the actual presence of calcification or lack thereof.
- A C-reactive protein (CRP) test, preferably a high-sensitivity one. This measures inflammation in the body, and CVD is increasingly being understood as a chronic inflammatory disease. From the first link:
CRP seems to predict the chance of having cardiovascular problems at least as well as cholesterol levels. A recent study found that elevated levels of C-reactive protein were associated with three-times-greater risk of a heart attack.
My understanding is that a high CRP result isn't dispositive in diagnosing CVD, but that it indicates relative risk (similar to what is claimed about cholesterol tests), and so can be helpful in concert with other metrics.
- Advanced lipoprotein testing: the testing that Paul Mason mentions in the video that I linked, described more in this article:
Standard tests of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) misidentify coronary heart disease (CHD) risk status in a substantial portion of the population. Tests of apolipoprotein concentrations are superior to standard LDL-C tests, and it can be argued that they should replace standard lipoprotein cholesterol testing... Over the past 2 decades, evidence has revealed that standard lipoprotein measurements of triglycerides, total cholesterol, LDL-C, and HDL-C fail to identify many lipoprotein abnormalities that contribute to CHD and peripheral vascular disease risk.1 Advanced lipoprotein tests (ALTs) lend insight into subtle yet important aspects of lipoproteins and atherosclerosis that help to explain the relative failure of the LDL-C–lowering strategy to stem the epidemic of atherosclerosis
This more granular look at lipoproteins should give a better sense of your LDL (Pattern B ["small dense"] vs Pattern A ["large fluffy").
- If you are seriously considering going on a statin, it might be worth getting your HbA1c tested, if you haven't already, as well as any other markers of insulin resistance that you are able. There is some evidence that statins increase insulin resistance and can promote diabetes, at least in certain doses and in certain individuals, so if I were you, I'd want to know my existing risk to the extent to which it could be determined, especially as those with diabetes are twice as likely to have heart disease or a stroke. (I'm not saying that that relationship is necessarily causative - as I mentioned above, the degree to which chronic inflammation underlies many diseases of aging, as well as aging itself, is now being understood - but the relationship isn't necessarily nothing either.)
posted by ClaireBear at 3:11 PM on July 2, 2022 [4 favorites]
This thread is closed to new comments.
posted by fingersandtoes at 3:13 PM on July 1, 2022