Ketogenic Diet Case Study, With Advanced Lipid Testing

[@RenzorTheRed]

Thanks for this. I found you while trying to research and interpret my fractionated lipid panel. I'm currently discordant in a bad way with my LDL-P : LDL-C. But I also have insulin resistance for now. I'd never heard of the Triglyceride : HDL-C ratio before. That was valuable. Another good marker to watch. After hearing your description, I was happy to see that mine (over months of keto) has gone from 10.7 down to 4.9.

[@poppyz6816]

Fantastic video and graphics! Easy to understand 👍🏻👍🏻👍🏻👍🏻

[@rajendraupreti7318]

This is the best video and every doctor should watch before prescribing statin.

[@monnoo8221]

it is not the best video, and every doctor prescrbing statin as primary intervention should go to jail because intentional injury

[@james777ko2]

Very informative video. Interestingly enough, I've been on the Keto diet for about 4.5 months and just had an NMR test and my results are very close to yours. While many people look at the total LDL-P as the major risk factor, it's really more important how much of the LDL-P are the small bad particles. So if your total LDL-P is 1400 and your Small LDL-P is 300 there's not much of a risk factor. Another point to consider is the fact that the standard test ranges were made for people on a normal SAD diet. In ketosis your metabolism is very different, so I would think the test result parameters would be different, but more research would be needed to establish what would be "normal" for those in ketosis. Another factor that people talk about but don't really consider is the proven fact that heart disease is caused from inflammation and NOT cholesterol. If there's no inflammation cholesterol does not stick to the artery walls. In fact, cholesterol only sticks the the artery walls to help heal the damaged artery. So then, what's the cause of inflammation? Excessive carbohydrates cause heart disease by increasing free radicals and causing oxidation which then results in inflammation. So by increasing carbohydrates you are actually increasing your chances of heart disease and diabetes even though the numbers might "appear" to look better, they are not. I consider your test results on keto excellent and I think the same of mine. The bottom line is that if you do not have inflammation none of these cholesterol test results mean very much at all. To prevent the major cause of inflammation and heart disease lower your carb intake - it's really that simple.

[@rashoff]

Very informative, thank you

[@Take-a-Stand]

Thanks for your comments. I am told that having a higher Omega-6 Essential Fatty Acids (EFA) ratio increases inflammation in the arteries. Cooking Oils with high Omega-6 are the most likely source. There are charts online.

[@nutritioncoachjo]

ABSOLUTELY agree with everything you wrote! Excellent explanation and this concurs with the dozens of doctors I have watched over the years. This comment in particular is so spot on and doctors, including cardiologist who support a keto diet would agree as well with your statement.... " increasing carbohydrates you are actually increasing your chances of heart disease and diabetes even though the numbers might "appear" to look better".

[@jesseshaver2262]

Sure is a lot of speculation

[@marilynsingh4897]

Excellent! I agree with everything that you’ve written. Thank you so much for such detail.

[@TheShannonAdawn]

This was an amazing video! Thank you for sharing. My ldl sky rocketed after doing low carb. But my hdl and tri are normal. So I got the fractionation test and confirmed my small ldl is below 90. So I’m good.

[@johnny7808]

At minute 24:00 he discusses his LP-IR score. For those interested, here is a link to the lookup table used to calculate your score. Inputs are: VLDL size, Large VLDL-p, LDL size, Small LDL-p, HDL size, Large HDL-p. You total up your scores from those 6 markers and want your total to be under 25. If the llink does not work you can do a google images search using the search string "LP-IR Score Calculation Algorithm" www.researchgate.net/figure/LP-IR-Score-Calculation-Algorithm_tbl1_263396176

[@jenniferriley736]

Thank you! Just did mine- it was 22. I got several 0 scores:)

[@47445]

Excellent video!!!! I just wish you did the detailed blood work when you went back to the SAD diet...

[@traceydoman2032]

Hello Mike. Thanks for your presentation I found it very interesting. Have you seen all the work done by Dave Feldman relating to similar changes in lipid profiles to yours?

[@hdpunongbayan2603]

Hello Mike. This is extremely informative and a great way of breaking down and understanding the intricacies of a lipid profile. Did you go on the Keto diet to lose weight? If you are utilizing your body's fat stores during Keto, wouldn't your blood contain higher levels of LDL, HDL, triglycerides, etc since it is your body's main energy source during a Keto diet? Perhaps a Cornary Calcium scan in addition to the NMR Lipid profile would paint a better overall picture.

[@davidjones8164]

Wow! Thanks for that comprehensive explanation. 83yo. I have been keto for 1.5 yrs.

[@brentvan488]

Life extension sells the particle lab for about 100. No doctor required

[@bscsmscs1578]

@@brentvan488 NMR is a useless test according to Mike prevost. Only predictive thing according to same guy is TG/HDL.

[@monnoo8221]

TRG/HDL of 3.3 ??? if it is true that you are thinking you are on keto, you are either drinking sugary beverages or lots of alcohol or you use fructose as sweetener ::: all three are pure poison note that the lab does not lie.

[@Ron-rk6iz]

It's a great video, very straightforward, and nonbias, thank you.

[@sharonillenye8036]

nice presentation. I came here to see if I can find how to convert my LDL particle number which is given in nmo/L to the US unit of mg/dL because when I do it the number is so huge it doesn't make sense. I got an nmr panel done but not the regular lipid panel as I assumed you could easily convert LDL, HDL.

[@sjacobson005]

Superb video. I am a hyper-responder. I have not made a final decision on whether to return to my usual diet. I am having a coronary artery calcium CT scan today.

[@randomdiyguy1883]

Just had mine (CAC) done after one year full carnivore. Was zero :) NMR is pattern a. Particles are high though. Tri's are very low, LDL C is very high, Total cholesterol is very high, HDL is very high. BP is perfect. HR is very low. Never been stronger in the weight room at 48. Zero bowel or stomach issues. Mind is sharp as ever. Sleep is good. CBCs are all in range. PSA is good. Best of luck.

[@ylcalif3681]

What was your CT score? I'm close to being a hyper responder. After low-carb, LDL spiked to 171. CAC score of 11 (very good for 72 yrs. old). HDL 98 & Trig of 58. Low risk but Dr. wants me to take statins because of LDL spike. Today I did a blood draw for the Advanced Lipid panel and will be ordering a treadmill stress test. If all tests are good, I don't want to hear anything more about statins.

[@gslsss]

Not many doctors can't read a keto lipid panel.

[@luting3]

Great video. I am seeing the exact the same things.

[@dsonyay]

Your triglyceride to HDL ratio is below 1.5.. and it is 1 which is excellent. To me.. nothing else to look at :) It indicates large fluffy ldl particle size.

[@SongbirdRanch2005]

Thank you for sharing. Very useful link.

[@billandpech]

Good presentation! Thank you!

[@dsonyay]

And when you upped your carbs to over 100gr per day your triglyceride:HDL went up to 1.3. Still under 1.5. But I feel you were better at 1. I’m basing this on Dr’s Ive listened to at various leto congregations. Good video

[@Hellocali1]

My ldl is high so I stay away from keto diet. I focus on Mediterranean and plant based

[@bachartesla9853]

Very informative, thank you

[@dsonyay]

After going from standard American Diet to carnivore diet (zero carbs), my LDL went from about 125 to 250. My HDL went from about 45 to 66 …. My triglycerides went from 150 to 65. Trig:HDL ratio of 0.98. This was after about 4 months on carnivore diet. I didn’t do particle size testing at the time… but will pay out of pocket for it on my next evaluation in a few months. My weight dropped 30 pounds as well! BP dropped a lot too: avg BP has been 110/65. I also bike 200 miles a week. Avid cyclist. Oddly enough, I never take along carbs while biking.. I never seem to run out of energy. Maybe I’m fat adapted. Btw- I’m retired USN: 1987-2007

[@alchemy1]

know what you mean... I think it is one complicated business. Here is my result. After 6 months on Keto: A1C went from 5.7 to 5.3 Weight dropped from 210 to 170 Total C from 150 to 500 HDL-C from 40 to 75 TG from 225 to 50 LDL-C from 104 to 350 TG/HDL-C 0.6. Right? Next week I will most likely do the particle count. I maybe a dead man. 🙂 Aside from that. I have had so many improvements in my health so many symptoms gone that I can barely count them all. The best of all no more heartburns.

[@msemmahale4608]

EXCELLENT VIDEO!!! THANK YOU!

[@satxsatxsatx]

Ketogenic diet pushing up LDL is one of the bag of peanuts thrown from the peanut gallery to play down. Ketogenic But it looks like there is a shift going on about LDL after Dave Feldman and Nicholas norwitz presented preliminary results of their LMHR study The LMHR study showed some extremely high LDL with seven Tesla scans showing no arterial plaque

[@satxsatxsatx]

ASCVD is a multi-factorial disease My observation is one factor like LDL and being bad is not a problem when all other factors are within range and preferably lower range If high, LDL is one negative in a group of negatives like metabolic disease, then LDL is clearly a negative contribution

[@davidzip8841]

These are frightening results. The triglyceride to HDL ratio is very useful for predicting risk on a population level, but it does not predict risk on an individual level and is not used in clinical practice. My ratio has never been above .6 and I am at a high risk for cardiovascular disease.

[@davetoms63]

Im confused and frankly a little scared. My LDLP = 2246, but my tri/HDL = 1.82 so is this reason for concern? I do high fat/zero carb carnivore

[@davidzip8841]

This is a fantastic explanation of how a ketogenic diet can be incredibly harmful for some people. His standard lipid panels and advanced lipid panel confirm this. That keto test was a bad LDL-P result. And pattern A does not prevent cardiovascular risk. People with FH are universally pattern A. Meaning they have large fluffy particles, and they have more cardiovascular disease than any other population type. The only difference is they have lifelong exposure whereas he only had 4.5 months. But if he had continued a ketogenic diet for the next 10-20 years, then he would have had a similar outcome. The new ketogenic diet with higher carbs was better, but the old non-keto diet was better still.

[@sharonillenye8036]

do you have reference for FG are universally pattern A?

[@satxsatxsatx]

If I remember correctly, it's been a couple decades Running guru influencer/ Jim Fixx, was out running one day and had a fatal heart attack

[@bugmanmech]

Too bad no LDL-P at the end instead of speculation.

[@chrispaulick]

If I am discordant bad then how to I get the LDL-P number down?

[@gtcih]

I have been studying lipid metabolism and NMR testing. Having said that, you have put together an excellent presentation. I have learned quite a lot about particle numbers that I did not know. I’ve been on a low carb diet (not sure if it’s keto but basically no bread, pasta, pastries, high carb vegetables). I now have excellent markers for low CVD risk (no longer pre diabetic, no longer over weight, no longer have metabolic syndrome, no hypertension, never smoked). However my NMR results are lousy. After starting my diet, my LDL-C and cholesterol doubled. Prior to my diet, all of my lipid results were normal (NMR lousy). So what am I supposed to do? Go back and starting eating crap again?!

[@alchemy1]

I know what you mean... I think it is one complicated business. Here is my result. After 6 months on Keto: A1C went from 5.7 to 5.3 Weight dropped from 210 to 170 Total C from 150 to 500 HDL-C from 40 to 75 TG from 225 to 50 LDL-C from 104 to 350 TG/HDL-C 0.6. Right? Next week I will most likely do the particle count. I maybe a dead man. 🙂 Aside from that. I have had so many improvements in my health so many symptoms gone that I can barely count them all. The best of all no more heartburns.

[@gtcih]

Keep up the good work!

[@msemmahale4608]

@gtcih If you have time, consider looking at Dr Ken D Berry’s youtube videos which discuss this issue. Find the interview with Dave Feldman and Nick Norowitz also the interview with Dr David Diamond And/or find the video titled, “Keto made my LDL Crazy - High! Lean Mass Hyper-responders.”

[@mpoharper]

Your insulin levels are probably quite low. My blood glucose tends to stay in a very small range with little elevation and little decline. My ldl-p was also in moderate range.

[@luckyhanger1326]

Great analysis but I disagree with some of your final conclusions! I think the TG/HDL is simply a marker for metabolic disorder and if you do not have metabolic disorder that ratio means nothing. Same thing with the LP-IR test. HDL has been shown to be a marker only and changing HDL using drugs does not change the CV out come of the test populations. For somebody who has been healthy his whole life, like yourself, I doubt those tests are meaningful. I need to go review that last study you quoted....do you have a link? I'll say it again....GREAT ANALYSIS! 🙂👍

[@pastryshack551]

Thi gs in the medical field is so complicated it difficult to follow. Dr Cywes says if you are a carnivore you will never get diabetes, well in the morning my sugar was 6.9. I had meat only for breakfast just to check things out. After 1 hr my sugar went to 10.4. So I have come to the conclusion no one has the answer.

[@jimking6484]

Great overview on LDL but without measuring APOB and LPa you will never have an accurate understanding of true atherogenic risk. You could have LDL C of 200 and LDL P of 1800 but if your APOB is 30 and your LPa of 20 you have virtually zero CVD risk. Please know your APOB and LPa before judging ASCVD risk.

[@michaelgalloway8786]

What about insulin resistance?

[@alchemy1]

In a nutshell this is how it all sounds: Possibly, could be, maybe, chances are. Those are the lingos used to describe the various numbers. In other words nobody knows.

[@hollybrabeau]

LDL-P is not that important. Too simplistic. Please watch Dr Boz on understanding cholesterol.

[@Hellocali1]

What was your normal diet?

[@heatherkoellmel6848]

How do I figure out my Triglyceride/HDL ratio. My cholesterol is 12.82 mmol/L. triglycerides 1.57 mmol/L, HDL2.39 mmol/L. LDL 9.72 mmol/L. A1C is 5.4%. I have been on keto for 1 1/2 years and feel good but now I am being called in to see the Dr for high cholesterol 😩.

[@alchemy1]

1.57/2.39 = 0.66 is your TG/HDL ratio Mine. 2.74/4.16 = 0.65 You and I know are both the same. My A1C is 5.3 ================= But my below reading beats yours by far. 🙂 My LDL-C 19 Total C 27

[@xiuqingli105]

@alchemy1 your Triglyceride/HDL calculation my not be correct. The correct calculation is 1.57*88.8 divided by 2.39*38.6

[@Master-AGN]

Very informative, however the total average fatty fish consumption would have been interesting.

[@reneronquillo2245]

It would be helpful to know your height and weight. Thanks good video.

[@mikeprevost9914]

5'10" and 183

[@sms9106]

Interesting, been KETO 7 months, just had a NMR > very high particle count (2400) total + small ...but... Triglycerides were cut in half, HDL went up so TG/HDL went from prior 2.2 to 1.3, insulin score less than 25, particle size is pattern A , so appears something is working but the LDL-P marker has me confused. BMI is 20.5.

[@SongbirdRanch2005]

My LDL P IS very high after keto for about 8 months.

[@Take-a-Stand]

I am told that having a higher Omega-6 Essential Fatty Acids (EFA) ratio increases inflammation in the arteries. Cooking Oils with high Omega-6 are the most likely source. There are charts online that show amount of Omega-6 in oils.

[@Rene-uz3eb]

Regarding your improved results going back to a balanced diet vs the all over the place results on ldl averaging out to zero, you are probably more representative of a reasonable person, than people coming from a completely random junk diet going keto.

[@monnoo8221]

you are still alive? and healthy? the numbers at @14:30 are not good, even if you like to declare them as good. TG is too high, absolute, and in relation to HDL, and LDL is way too low. You total cis iini fact so low that your risk for ACM is 2x increased. Keto improved your numbers,, but then re-introducing the carbs in the range of 40..50% of calories worsened it again. and there you have it. TG/HDL of 1.3 is not good, it is bad average. it should be less than 0.7 to be good ... which is underlined by the chart @26.00. you would certainly be interested in the new finding about LMHR = lean mass hyper responder phenotype, presented in the channel of nick norwitz

[@Ron-rk6iz]

The problem is; what is the Keto diet........? Also in the video that is not clear, which food has been consumed? which is crucial. Was it 100% red meat or was it 20% meat/fish plus veggies etc., ? A Mediterranean diet is still the best diet in my opinion, make sure you consume at least 40ml EVOO, it is an enormous help to lower your risk of getting Cancer ( 30%) and or Heart problems. ( 50% ) I think the overconsumption of animal Saturated fat might be the problem for many on Keto.

[@russbrown6453]

My problem is the minute I add in more carbohydrates I become addicted to sugar, and gain weight. Not to mention insulin resistant. By eating carbs I increase my small dense LDL particles. I'm on the carnivore diet. My LDL particle count is some 2000, but all are large size 22. From what I understand insulin resistance is some 10 times more predictive in CVD risk than LDL. I guess I need to pick my poison...

[@bettywhill]

You only showed LDL. What about your triglycerides and HDL?

[@rebeccarobbins1135]

my LDL-P numbers are over 3000. What can I do? I have been keto for 3 years.

[@rebeccarobbins1135]

and my small particles are VERY elevated...

[@aresrin]

Dr. Hallberg commented that she had a patient with the same problem, though she did not have an explanation at the time of the video. kzbin.info/www/bejne/rWnNhqB5mpitetU

[@aresrin]

I'm not a doctor, but if I was in your shoes, I would get a Coronary Artery Calcium scan, to see if those LDL numbers are actually translating into physical evidence of heart disease.

[@doctorbhalu9320]

All ur struggle shows no conclusion.i mean u didn't explain keto is good or bad for health....if people reacts differently than one should seek factors which showed variation and must conclude the factors responsible for increasing and decreasing cholestrol levels.

[@mikeprevost9914]

Not enough data yet to draw strong conclusions. In my case, I just don't know. However some newer research shows that my response is common for endurance trained athletes on a keto diet. Good or bad? Who knows.

[@SongbirdRanch2005]

Thank you. Great presentation. My NMR test doesn’t show my LDL C but LDL P 😅

[@nancyevans5176]

Mike, nurse here. You should look up on U Tube; Ron Krauss MD. Very well respected has been on P. Attia. He says the same as your experiment in that you should be at 40% carbs in his research. He is also a lipidologist researcher that states; lowering your carbs to 40% instead of the higher carb percentage most people are eating will lower your cardio risk. He is not a proponent of the Keto diet. I’m apparently the same in that on plant based/pescatarian diet I have an automatic lower carb diet. LDL-C is 125. APOB 98, tri/hdl 1.5.but yet LDLP is 1948 pattern A. On some people a carb count should be around 40%. I am going to get my healthy carb count to this and retake labs. Thank you for the video. @@mikeprevost9914