Ldl Cholesterol: Clearing The Confusion
The story behind LDL, or low-density lipoprotein, is more complicated. LDL transports cholesterol produced by your liver and cells throughout your body. Unlike HDL, LDL molecules move slowly through the bloodstream and are vulnerable to oxidizing agents known as free radicals. Once oxidized, LDL can easily burrow itself into the walls of your arteries and impede cardiovascular function. This triggers an inflammatory response in which white blood cells called macrophages rush to eat up the LDL.
Typically known as the bad cholesterol to its healthy counterpart HDL cholesterol, increased levels of LDL cholesterol are associated with an increased risk of cardiovascular diseases . Some studies show a strong correlation between LDL cholesterol and the risk of cardiovascular diseases in both men and women. Evidence also suggests that decreasing blood levels of LDL-C reduces the risk of CVD.
Recent research paints a more intricate picture of this peculiar molecule and has called into question the statement that elevated LDL cholesterol is bad for you. This is for two main reasons. First, LDL can be measured in two ways. The first is called LDL-C which measures the concentration of cholesterol transported by LDL in the blood.
In a large community-based sample, LDL-P was a more sensitive indicator of low CVD risk than either LDL-C or non-HDL-C, suggesting a potential clinical role for LDL-P as a goal of LDL management.
The Truth About Keto And Cholesterol
Most of what is known about how cholesterol works has been based on the standard American diet,, which typically includes high levels of carbs.
As scientists continue to show that low-carbohydrate diets like keto can improve your health and lead to better total cholesterol numbers, there will be more research and results to discuss.
To lower your heart disease risk and boost your HDL and lower your LDL cholesterol, try adding healthy dietary fats like avocado and coconut oil and monounsaturated fat like olive oil to your diet ASAP.
These are keto-approved foods and excellent for your heart health no matter which diet you ultimately choose.
Model Comparisons Suggest Prior Tg/hdl Cholesterol Plus Bmi Best Predicts Ldl Cholesterol Change
We compared the all-around performances of 4 models to explain LDL cholesterol change on a CRD, including the following: 1) prior HDL cholesterol and TG, 2) prior TG/HDL cholesterol ratio, 3) BMI, and 4) prior TG/HDL cholesterol + BMI. As shown in Supplemental Figure 2 and Supplemental Table 2, the model including only BMI performed better than TG/HDL cholesterol ratio alone however, the TG/HDL cholesterol plus BMI model performed best.
As a parallel approach for identifying the most important predictors of large LDL cholesterol changes on a CRD, without use of any preconceived definition, a machine learning regression tree was developed . BMI emerged as the first branch point, at 26 kg/m2. Prior HDL cholesterol and TG were also identified as meaningful branch points.
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Moderate Reintroduction Of Carbohydrate Lowers Ldl Cholesterol Among Patients Consuming A Vlcd
Five patients consuming a VLCD with < 25 grams/day available carbohydrate presented to a primary care practice with LDL cholesterol of 239 to 665 mg/dL, representing extreme elevations from pre-diet levels . Genetic testing for familial hypercholesterolemia was negative in each case. After refusing statin therapy, the patients chose to pursue an empiric clinician-supervised protocol with moderate reintroduction of carbohydrate . Case histories of each patient are presented in the Supplemental Case Series. As summarized in , this dietary intervention was associated with a large decrease in LDL cholesterol in all patients, ranging from 100 mg/dL to 480 mg/dL. The 2 patients who met criteria for LMHR showed the largest increases in LDL cholesterol upon initiation of a VLCD and the largest reductions in LDL cholesterol with moderate reintroduction of carbohydrate.
Should You Be Concerned If Your Cholesterol Increases With Low
This is an emerging area of research that is currently the focus of a great deal of debate and uncertainty.
Traditionally, experts in the field of lipids and heart disease have viewed elevated LDL cholesterol with concern because it typically reflects a high concentration of LDL particles circulating in the bloodstream.
Excessive amounts of LDL particles have been found to be associated with the development of atherosclerosis, the underlying cause of heart disease.11
Despite the associations between high concentrations of LDL particles and heart disease, research has consistently shown that keto diets help reduce many heart disease risk factors in people with diabetes and other insulin-resistant conditions.12
Granted, trials showing an actual reduction in heart attacks dont yet exist. Will the demonstrated improvement in risk factors result in a net beneficial effect despite increased LDL? That is unknown, but some evidence suggests that it may be the case.13
The fact that so many risk factors remain stable or improve with carb restriction even if LDL cholesterol levels increase demonstrates the importance of not viewing any one value in isolation. Instead, it may be better to look at the body as a whole system.
However, some experts urge caution. Prominent lipidologist and vocal lipid educator Dr. Thomas Dayspring states:
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What To Do If A Low
Low-carb and ketogenic diets are incredibly healthy.
They have clear, potentially life-saving benefits for some of the worlds most serious diseases.
This includes obesity, type 2 diabetes, metabolic syndrome, epilepsy and numerous others.
The most common heart disease risk factors tend to improve greatly, for most people .
According to these improvements, low-carb dietsshould reduce the risk of heart disease.
But even if these risk factors improve on average, there can be individuals within those averages that experience improvements, and others who see negative effects.
There appears to be a small subset of people who experience increased cholesterol levels on a low-carb diet, especially a ketogenic diet or a very high fat version of paleo.
This includes increases in Total and LDL cholesterol as well as increases in advanced markers like LDL particle number.
Of course, most of these risk factors were established in the context of a high-carb, high-calorie Western diet and we dont know if they have the same effects on a healthy low-carb diet that reduces inflammation and oxidative stress.
However it is better to be safe than sorry and I think that these individuals should take some measures to get their levels down, especially those who have a family history of heart disease.
Fortunately, you dont need to go on a low-fat diet, eat veggie oils or take statins to get your levels down.
What Are Ideal Cholesterol Ranges For Most People
- Total cholesterol should be less than 200 mg/dl. 200 to 239 mg/dl is a bit outside the safe zone, and 240 mg/dl or above is when itâs definitely time to get those levels down.
- HDL cholesterol should be over 60 mg/dl. For men, a measurement under 40 mg/dl is considered too low for women, the number is 50 mg/dl.
- LDL cholesterol should be under 100 mg/dl. If your levels are 100 to 129 mg/dl, youâre still doing alright. If your levels are above 130 mg/dl, itâs time to take it easy on the fast food. Some people can register levels of 190 mg/dl or more – at this point, theyâre at increased risk of a stroke or heart attack.
- Triglycerides should stay under 150 mg/dl. If your levels are between 150 and 199 mg/dl, thatâs considered borderline high. Once you pass the 200 mg/dl mark, thatâs blocked artery territory.
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The Drawbacks Of Calculating Ldl
The major drawback of using the Friedewald formula to calculate LDL-C has to do with the assumption that the ratio of TG to cholesterol in VLDL is always the same which is not the case. LDL-C will be underestimated if the ratio of TGs to cholesterol is higher than 5, and overestimated if it is lower than 5.
Following a fatty meal, blood levels of TGs will rise. However, raised blood TG following a meal is caused by chylomicrons produced in the intestine, whereas elevated fasting levels are due to VLDL produced from TGs in the liver. Chylomicrons disappear from the circulation soon after the TGs have been delivered to the tissues. Therefore, using the Friedewald formula to calculate LDL-C is only applicable when chylomicrons are not detectable, and all the TGs are being carried by VLDL. Hence, a fasting blood sample is necessary
The Friedewald equation is not applicable when TGs are high. A recent study even suggested that the Friedewald equation tends to underestimate LDL-C among people with low LDL-C if triglyceride levels are moderately elevated .
At present, only TG concentration higher than 400 mg/dL is considered a limiting factor for the application of routine Friedewald equation. However, the fact that low TG levels may overestimate LDL-C also needs to be highlighted, not least because this may have practical implications for the growing number of people who adopt an LCHF lifestyle.
What Happens To Triglyceride Levels On A Ketogenic Diet
âTriglycerides are among one of the most predictable changes when one adapts to and maintains a well-formulated ketogenic diet. For people starting out with elevated triglycerides, they almost always show a sharp and sustained reduction. On average, people with metabolic syndrome will see their serum triglycerides reduced by half when on a ketogenic diet .
Yes, there are people who may not respond this way, but the exceptions tend to be people whose serum triglycerides were already within the abnormal range. Increases in triglycerides during a well formulated ketogenic diet may occur, but this is rare. In those cases, it may be due to carbohydrate consumption that is greater than oneâs tolerance or due to alcohol consumption in the day or two prior to the blood test.
Citations
Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009 44:297-309. doi: 10.1007/s11745-008-3274-2.
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What Is High Cholesterol Symptoms Causes Diagnosis Treatment And Prevention
High cholesterol is a condition that occurs when levels of cholesterol in your blood are elevated enough to cause health problems, including heart disease and stroke. Sometimes known as hyperlipidemia, high cholesterol is painless and doesnt cause any symptoms until a person develops severe heart disease.
According to the Centers for Disease Control and Prevention , heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause.
Produced by your liver, cholesterol is a dense, fatty substance thats found in every cell of your body, and it is considered essential to many life-sustaining functions. It helps your body make hormones and vitamin D, and its also found in compounds that your body creates to help you digest food, such as bile.
Circulating in the bloodstream in small bundles of fat and protein called lipoproteins, cholesterol comes in two primary types: low-density lipoprotein , which contributes to the buildup of fatty plaques, and high-density lipoprotein , which is thought to protect from heart disease and stroke. A blood test known as a lipid panel can measure both LDL and HDL cholesterol, as well as triglycerides, the most common type of fat in the blood.
Replace Some Saturated Fats With Monounsaturated Fats
In the largest and highest quality studies, saturated fat is not linked to increased heart attacks or death from heart disease .
However if you have problems with cholesterol, then it is a good idea to try to replace some of the saturated fats you are eating with monounsaturated fats.
This simple modification may help to bring your levels down.
Cook with olive oil instead of butter and coconut oil. Eat more nuts and avocados. These foods are all loaded with monounsaturated fats.
If this alone doesnt work, then you may even want to start replacing some of the fatty meat you are eating with leaner meat.
I cant emphasize olive oil enough quality extra virgin olive oil has many other benefits for heart health that go way beyond cholesterol levels.
It protects the LDL particles from oxidation, reduces inflammation, improves the function of the endothelium and may even lower blood pressure .
It is definitely a superfood for the heart and I think anyone at risk of heart disease should be using olive oil, no matter whether their cholesterol is high or not.
It is also important to eat fatty fish that is high in Omega-3 fatty acids, at least once per week. If you cant or wont eat fish, supplement with fish oil instead.
Bottom Line:
Monounsaturated fats, like those found in olive oil, avocados and nuts, may have cholesterol lowering effects compared to saturated fats.
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The Bottom Line On Trying The Keto Diet To Lower Cholesterol
If you have high cholesterol or triglycerides, speak with your medical team first before embarking on a keto diet. If you get the green light, continue to seek their help. There are a lot of popular books out on how to follow a keto diet, but I think patients need additional support and guidance and ongoing conversations about if its working for you, says Ryskamp. Its a tool that someone can use to improve their health, but it may not be the right tool for them, or the right tool the way theyre doing it, she says.
The Pros And Cons Of Total Cholesterol Hdl Ldl And Triglyceride Testing
Time to get your cholesterol checked. Okay, but which test should you get? Its not so simple anymore. Here is a rundown of some of the choices and their pros and cons:
Total cholesterol. This is the simplest and least expensive test. The test doesnt require any sophisticated lab work, either. The simple, do-it-yourself home cholesterol tests measure total cholesterol.
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Normal Range Of Ldl Hdl Ratio : 05
Ideal values of LDL HDL ratio depending on age :
| Age | |
|---|---|
| > 100 years | 0.62696 |
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High Cholesterol High Hdl Low Triglycerides
Dr T
Question:Answer:
There are 2 kinds of LDL cholesterol, A and B, of which B is associated with heart disease.Most labs calculate LDL as follows:
LDL = Total Cholesterol HDL triglycerides/5.
This doesnt explain the difference between LDL A or B .
Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A .
On the other hand, a high triglyceride/low HDL level is strongly associated with LDL pattern B . Thus high triglycerides are an independent risk factor for heart disease.
From this you can calculate that in your situation a high LDL is mostly Type A , confirmed by a high HDL and low triglyrerides and that therefore there a very low risk of heart disease.
Having high cholesterol may still be healthy if good cholesterol levels, triglycerides, and other markers of cardiovascular health are good. You can calculate this here. People with high good cholesterol levels and low levels of triglycerides may actually be at a lower risk for heart disease than people with normal cholesterol levels who have lower levels of good cholesterol and higher levels of bad cholesterol.
Hope this helps,
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How To Measure Cholesterol Levels
A standard lipid panel measures the concentration of cholesterol within each lipoprotein. This panel includes:
- TC : over 200 is considered high
- LDL-C : over 160 is considered high
- HDL-C : under 40 is considered low
- Triglycerides: over 150 is considered high
But the standard lipid panel isnt the only relevant cholesterol test. Its probably not even the best.
For instance, evidence suggests that tests like APoB and LDL-P that measure the number of LDL particles in the bloodstream track more closely with heart disease outcomes.
It also appears that smaller LDL particles are more dangerous than larger LDL particles, all things equal, from a heart disease risk perspective.
So whether or not your standard lipids look normal, you may want to follow up with more advanced testing.
Carbohydrate Moderation Increases Hdl In Healthy Non
The majority of studies assessing the effects of carbohydrate restriction on HDL have been conducted on primarily Caucasian, obese subjects.
In 2006, researchers sought to investigate the relationship between carbohydrate intake and HDL cholesterol in a healthy, diverse population. Scientists examined data from Canadians of South Asian, Chinese, European, and Aboriginal origin from two cross-sectional studies conducted in the late 90s.
They included participants who were 35-75 years of age and who were not born in Canada but had lived there for at least 5 years. Subjects who suffered from moderate to severe medical conditions such as diabetes, heart diseases, and active cancer were not included. Subjects of all different weights and BMIs were included as long as they were considered healthy.
Scientists then randomly selected 619 subjects who met these inclusion criteria and examined their carbohydrate intake and levels of HDL cholesterol.
After adjusting for demographic factors such as age, sex, and ethnicity and lifestyle factors such as smoking, researchers noted that subjects in the lowest third of carbohydrate consumption had significantly higher levels of HDL cholesterol than subjects in the highest third of carbohydrate consumption.
Fewer servings of sugary drinks were also associated with higher levels of HDL. Because of their findings, the researchers attributed differences in HDL concentration to carbohydrate intake.
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