Cholesterol Levels

UPDATE: July 21, 2020
Since I have been at this low carb thing for over 7 years, I thought it was a good time to share an update on my lipid (cholesterol) panels as it is one of the more asked questions. I charted all my lipid panels since 2012. Once they were relatively stable in 2017, my Dr was no longer ordering them every year. For 2012 I was on a high carb diet, the rest I have been varying degrees on low carb/keto/OFM. ​
For an in-depth explanation of all these terms, please read the entire post. Enjoy!

UPDATE; Nov 26, 2016
This is one of the most shared blogs I have done, because cholesterol is a huge concern for people when I start talking about eating bacon, eggs, cheese and all these other foods that were vilified for so long by the 'low-fat' police. 
I have been eating OFM for 3 years and 8 months. Last week I had my cholesterol measured again, almost exactly 3 years after the most recent numbers in the original blog and the results were not that surprising to me. But those who are worried about the long-term effects of OFM might find them interesting.
Total Cholesterol; 217 (no change)
Triglycerides; 79 (+6)
HDL: 73 (+3 improvement in 'good cholesterol')
LDL; 128 (-4 decrease in 'bad cholesterol')
VLDL: 16 (+1)
These results, combined with the fact that I have been able to keep my weight in check for over 3 years- despite greatly reduced physical activity- only makes me want to share this lifestyle with more people. 
​

ORIGINAL POST: Cholesterol might be one of the most misunderstood of all things you hear about on your annual Dr's visit. This is a complex subject so there are going to be a lot of words and not many pictures (don't worry, the next post is on my Greece trip and has lots of pics).

When I got my first checkup after starting OFM the following were my cholesterol numbers were as follows. 

The first number was on my normal high carb diet; the second number is 8 months into OFM. (My numbers have remained relatively close to the second numbers since)
​​Total Cholesterol: 196-217
Triglycerides: 135-73
HDL: 61-70
LDL: 108-132
VLDL: 27-15

Of course I wanted to know what the heck all these numbers meant, and most importantly, was I going to die from high cholesterol that day. I don't want to ruin the suspense....but clearly I didn't. Anyway, I did a little research and asked some health professionals.

The basic cholesterol equation is below, The Friedewald Equation . Using this we can solve for any missing variable if we have the other variables- or at least that is what my HS math teacher taught me. If you are not good at math there is a Friedewald calculator on the internet!

Total Cholesterol = LDL + HDL + (Triglycerides/5)

Here is what the Mayo Clinic Website has to say about each cholesterol number:

Triglycerides: A type of fat (lipid) found in your blood. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals.

• Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)
• Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
• High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)
• Very high — 500 mg/dL or above (5.7 mmol/L or above)

Mine dropped from 135 to 73! Yes! One tick in the not going to die column.

HDL (high-density lipoprotein), often called "good cholesterol". They act as cholesterol scavengers, picking up excess cholesterol in your blood and taking it back to your liver where it's broken down. 
Men, At risk=Less than 40 mg/dL; Desirable=60 mg/dL or above.
Women, At risk=less than 50 mg/dL; Desirable=60 mg/dL or above
Mine went up from 61 to 70. Another "not going to die" tick.

LDL (low-density lipoprotein), often called "bad cholesterol". These lipoproteins carry cholesterol throughout your body, delivering it to different organs and tissues. But if your body has more cholesterol than it needs, the excess keeps circulating in your blood. Over time, circulating LDL cholesterol can enter your blood vessel walls and start to build up under the vessel lining. Deposits of LDL cholesterol particles within the vessel walls are called plaques, and they begin to narrow your blood vessels.

• Less than 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease (those with metabolic syndrome)
• Less than 100 mg/dL for high risk patients (for example: some patients who have diabetes or multiple heart disease risk factors)
• Less than 130 mg/dL otherwise
• Note: LDL guidelines are currently a topic of much medical discussion and will be covered later.

Mine went from 108 to 132. Oh shit, I'm over 130...mark one in the going to die column. (Keep in mind I'm still alive, so keep reading)

VLDL (Very low-density lipoprotein), at present there is no simple, direct way of measuring VLDL cholesterol. It is usually estimated as a percentage of your triglyceride value. An elevated VLDL cholesterol level is more than 30 milligrams per deciliter (.77 millimole/liter).
Mine went down from 27 to 15. Feeling better about this....

Simple right? No. I still had no idea what was going on with my numbers or how they were measured. I find out they probably only really measure a few things, total cholesterol, HDL and triglycerides and then use formulas for the rest. But my 'bad cholesterol', LDL, was over the recommended level and my total was over 200! Am I totally #@%#^#$^ed?!?! I panicked, then emailed some actual Dr's.  One who knew what diet I was on and the other who did not. 

Dr. with no prior knowledge of my diet when I sent my numbers:

• Dr: Did the Triglycerides go from 135 to 73? Or was that supposed to be 173?
• Zane: 135 to 73
• Dr: Then your numbers are great. The bump in total cholesterol is mostly from the bump in HDL (which is good). The LDL is a calculated number, and as the triglycerides go down, that number will go up based purely on the calculation.

Dr. with in-depth knowledge of diet and the fact that I was on it:
"You experienced the classic TG [Dr talk for Triglycerides] lowering and HDL boost.  The total cholesterol and LDL-C response is more variable but a small increase as you experienced is not uncommon.  Given the drop in TG it is almost certain the increase was due to larger LDL particles, which are not as atherogenic [I googled this, it means:tending to promote the formation of fatty plaques in the arteries] as the smaller one.  Those likely went down."​

The good news- I wasn't going to die that day from cholesterol. Bad news- this is some complex shit! Now we are talking about the size of LDL particles....and atherogenic particles. (I just had to use that word again to sound smart). So I emailed Dr. Volek to get some more info, since he is one of the world's experts in this area. Here is what I found in his response that might help us understand a small portion of this.

• My results overall were pretty close to what was observed in scientific tests. Although results are very individual and can vary widely.
• Small LDL particles are atherogenic (BAM!) and probably not good for you. ""We need to remember cholesterol does not cause problems in the circulation, it’s only when it gets into the arterial walls. We have come to appreciate that LDL particles vary in size, and it is the smaller particles that are most likely to get into arteries." -Dr. Volek
• A very low carb diet study saw a 106% increase in large LDL particles and a 78% decrease in small LDL particles. When compared to the low fat study it became clear larger LDL particle size is closely related to increased CHO (carb) intake
• Remember the old The Friedewald Equation (Total Cholesterol = LDL + HDL + (Triglycerides/5)? It turns out this could be complete crap. "When serum TG is low [under 100, like the fine piece of meat typing this] and total cholesterol high, the equation over-estimates LDL-C!" More good news for me
• (TG/HDL)<3.5 indicates that you probably have...a predominance of small LDL particles, and there’s a good chance you may also have insulin resistance. For me this is 73/70=1.04. More good news!

Bottom line: "The cholesterol response [to a low carb/high fat diet] can be quite variable, especially the LDL. The question still remains should we be concerned if it [LDL] goes up? We have a 2 year research project ongoing that will address that question." -Dr. Volek

So that was a lot of words and you probably stopped reading right after the Friedewald Equation....I know I would have. Every person's body is going to react differently to a OFM type, low carb diet. The key is to know what your baseline was before you started the diet and then get another test after several months (over 6) on the diet.  Then you can use the information above to decipher all those numbers. 

If you are dying for more cholesterol talk (I mean, really, who isn't!?!). Just click here to see a lot of videos by Dr. Volek discussing the subject.