Strange stuff is afoot with that blood work... Were you able to find any correlation for why some people end up with an LDL spike from Keto? I would be very curious on that one.
A couple excerpts from some things I stumbled across:
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some people have seen their total, HDL and LDL cholesterol levels increase anywhere from 50% to 200% or more after switching to a low-carb or keto diet. Although a few are overweight or metabolically unhealthy, many of these individuals belong to a group that Dave Feldman at Cholesterol Code calls Lean Mass Hyper-responders (LMHRs): healthy, thin and/or athletic people with LDL cholesterol values of 200 mg/dL (5.2 mmol/L) or higher.
Over the past two years Feldman, a software engineer with a strong interest in science, has performed several dozen experiments on himself and collected data from a number of other keto and low-carb dieters whose cholesterol levels have increased far beyond the “optimal” range. However, whether this is problematic or not isn't entirely clear, especially since their other biomarkers typically improve or remain stable."
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Within those averages, it appears that a subset of people on a low-carb ketogenic diet DO get a rise in Total cholesterol, LDL cholesterol and LDL particle number.
“I and other lipidologists and many patients themselves are starting to see that the above lipid response to a high fat diet as not being very rare response in people who abandon carbs and replace it with saturated fat, especially so in those doing extreme carb restriction to achieve nutritional ketosis.”
“The true incidence remains to be determined but experienced colleagues who have a lot of patients on low carb diets advise it is about 1/3 of patients” - DR. Thomas Dayspring (lipidoligist)
What is a Hyper-Responder?
The term, “hyper-responder” has been used within the ketogenic / low carb, high fat (keto/LCHF) community to describe those who have a very dramatic increase in their cholesterol after adopting a low carb diet. This increase can be anywhere from 50% to 100% or more of their original, pre-diet cholesterol numbers.
Typically, a keto/LCHF hyper-responder will have LDL cholesterol (LDL-C) at 170 mg/dl or higher.
How many of those practicing a keto/LCHF diet are hyper-responders?
Because the keto/LCHF community is relatively small, the total number of hyper-responders as a percentage of the whole is unknown. But estimates vary between 5% to 33%.
Is having high LDL cholesterol (LDL-C) on a keto/LCHF diet dangerous?
This is the important question, of course. The short answer is – we don’t know.
As of this writing, I have much more confidence there are good reasons LDL-C could be high and bad reasons LDL-C could be high. And these reasons aren’t mutually exclusive.
Good reasons:
The body is transporting more fat for energy to your cells due to being on a high-fat diet. Since cholesterol “ride shares” with these fatty acids in LDL “boats”, it shows up in higher quantities in a blood test. This is typically shown in a blood test where there are low triglycerides (the cargo is distributed easily).
The body is healing from a temporary injury. (You probably want that)
The body is recovering from a temporary infection. (You probably want that too)
Bad reasons:
The body is attempting to provide energy to your tissues via LDL, but cells are insulin resistant or they are overloaded, and thus unwilling to take in more. This leads to more residence time of VLDLs (the precursor to LDLs) in a “traffic jam” of the bloodstream. This is typically shown in a blood test where there are high triglycerides (the energy “cargo” is difficult to distribute). Often, this suggests a particular profile with the LDL particles which — when combined with low HDL-C — is known as Atherogenic Dyslipidemia.
The body is trying to heal from a chronic condition, yet failing. This leads to chronically elevated LDL.
(More will be added to this section soon, but the above two cover the largest categories…)
Are there any factors that might predispose one to be a hyper-responder?
In my research to date, I believe the largest influence of one being a hyper-responder is how lean and/or fit they are while likewise following a keto/LCHF diet. While unintuitive, those who are lean and/or fit often exhibit the highest LDL-C and LDL-P numbers we see (along with impressively high HDL and incredibly low triglycerides). At the furthest end of this spectrum is a profile I call “Lean Mass Hyper-responder” and detail it here. [Geeky technical explanation: This makes perfect sense mechanistically, as the body is both fueled by fat while likewise working with adipose tissue (body fat) mass for “staging”, thus theoretically, there is the likely greater need for “global distribution” of fat-based energy via VLDL turnover than “local distribution” via adipocytes. more on that in an upcoming post.]
These are the four other most commonly referenced factors to becoming a hyper-responder:
Familial hypercholesterolemia (FH) – A genetic disorder that presents early with higher cholesterol, and in particular, high LDL. However, this is less likely if the hyper-responder had “normal” ranges of cholesterol before starting the low carb diet given FH would have likely shown beforehand as well. (See here for more information.)
One or two copies of the ApoE4 gene – this gene has long been identified with higher risk for elevated cholesterol. Anecdotally, many hyper-responders find they have one or two copies of the ApoE4 gene; 3/4 or 4/4 pattern. (I myself have the 3/4 pattern, which I found through my test with 23andMe. See here for more information.)
Hypothyroidism – when the body’s thyroid slows down, it leads to a slow down in the production of LDL receptors. These receptors are important for usage, and, ultimately, clearance of LDL from the bloodstream. (See here for more information.)
Hyper-synthesizer. Generally in reference to someone with insulin resistance who experiences an abnormally high production of cholesterol. (See BJJ Caveman’s lecture notes for more information.)
