Keto and cholesterol - my bloodwork is concerning
Been keto for 14 months. Just got bloodwork. LDL went from 110 to 185. HDL went from 45 to 72. Triglycerides dropped from 180 to 85. My doctor is concerned about the LDL. Should I be worried?
This is a common pattern on keto. The good: HDL up, triglycerides down (both strongly associated with cardiovascular health). The concerning: LDL up significantly.
My recommendation: get an advanced lipid panel that measures LDL particle SIZE and COUNT (like NMR or ApoB test). Total LDL alone doesn't tell the full story. If your particles are mostly large and buoyant, the risk is different than if they're small and dense.
Trig/HDL ratio is arguably a better predictor of cardiovascular risk than LDL alone. Your ratio went from 4.0 to 1.2 — that's excellent. But the LDL increase is worth monitoring.
Some people are "lean mass hyper-responders" — they see large LDL increases on keto despite being metabolically healthy otherwise. It's a recognized phenomenon but the long-term implications are still being studied.
Talk to a lipidologist (cholesterol specialist), not just your GP. Many GPs only look at total LDL and don't consider particle size, count, or the broader metabolic picture. A specialist can give you much better guidance.
I know this will be unpopular here, but LDL of 185 is objectively elevated regardless of diet. If it were me, I'd consider adding more mono/polyunsaturated fats and reducing saturated fat, even within a keto framework.
Thanks everyone. Getting the advanced panel done next month. I'll also try shifting some of my fat intake from butter/cheese to avocado/olive oil and see if that helps the LDL while keeping me in ketosis.
My LDL also went up on keto but my doctor said the improvement in A1C, triglycerides, and blood pressure outweighed the LDL concern. It's a risk-benefit analysis specific to your overall health picture.
Adding 3g EPA/DHA omega-3 daily can help lower triglycerides further and may modestly reduce LDL. It's one intervention that works well alongside keto.