I recently got some blood work back and I wanted to share my results in hopes that it may offer some insight to others who may find themselves at the crossroads of the ketogenic diet and high cholesterol. I have been following a low-carb high-fat diet since July and generally speaking I have been really happy with how it has impacted my body composition, athletic performance, energy and blood sugar control. I’ve written a lot about it and I want to be fair and share the challenges that I’m having as well. What I am presenting here is in no way advice or even a solution that I have found for myself–but rather a question that I am working through. I’ve always had elevated cholesterol (last 10 years) and I’ve always prioritized my blood sugar management over cholesterol. Simply put, there are more questions about the risks of cholesterol than the risks of elevated blood sugar, so I focus on the “devil I know”.

I got my bloodwork back and found that my total cholesterol is 383 with LDL at 292. My a1c was 6.5. Neither of these individually are what I am shooting for and both in combination are a bit more alarming. Being perfectly honest it feels like a massive failure to be back at this point of reevaluating everything again. It’s hard not to be governed by numbers but it’s not responsible to ignore them either. I declined statin medication and I was told to switch to a low fat diet high carb diet. My blood pressure was 104/84 and I typically have a resting pulse rate of about 60.

I immediately did an internet search on the keto diet correlating to elevated cholesterol and found a whole lot of conjecture. There haven’t been conclusive tests done to evaluate the risk of elevated LDL while on a ketogenic diet. It’s speculated that it’s not such a big deal if all the other markers are on–but that’s speculation and given the upward creep of my blood pressure, I am looking to make some targeted changes and see if it’s possible to resolve some of this issue.

One thing that I found in my searching was that some people experience elevated cholesterol on a ketogenic diet in response to saturated fat. This is yet another facet of the cholesterol-fat-sugar triangle that is poorly understood, but it seems like it’s a genetic factor that predetermines which people will be overly sensitive to saturated fat. Given the fact that I’ve always had pretty high cholesterol (over 200 total) regardless of my eating habits I suspect that I may be in this category.

Those of you who are reading and thinking, ‘Duh, you eat fat and your cholesterol goes up!’ should keep in mind that many people who take on a keto diet find that their cholesterol actually decreases along with cardiovascular risk–simply from increasing dietary fat while restricting carbohydrates. It seems that I don’t fit into that category though!

My next steps are roughly as follows, because I want to tweak my diet as it stands first without completely abandoning it. I have experienced enough benefits from the ketogenic diet that I don’t intend to jump ship without seeing if there is another round of adaptation that needs to take place in order to make it “fit”.

  • Increase Vitamin D- I have frequently tested low for Vitamin D which plays an important role in processing cholesterol. Sitting inside in the winter probably doesn’t help much either.
  • Shift away from saturated fats- To start with I am cutting out dairy and not adding massive amounts of coconut oil to everything. It’s ironic that this is going to drastically change my enjoyment of coffee! Instead, I will eat more nuts and seeds, olive oil and fish. Prior to this I was eating a LOT of cheese and heavy cream in my coffee–as well as going out of my way to add coconut oil without restraint.
  • Sleep, exercise and rest adequately- per my last post about “resolutions” for the 2016 year these variables have been suffering in the last few months–getting them dialed in can only help.
  • More salads- for use as an olive oil vehicle and some good low carb greens.
  • Targeted saturated fat consumption- rather than staying loaded on coconut oil (bulletproof coffee anyone?) on a daily basis, I am saving “deep” ketosis for situations where I am in need of elevated athletic performance. I hypothesize that if I maintain a low carb-moderate fat diet, I should be able to elevate ketones in short order by targeted saturated fat “doses” prior to an activity. Maintaining a carb deprived state should enable my utilization of those ketones for energy without missing a beat.

The bottom line here, is that no diet is as simple as tweaking some macronutrients and then standing back and letting the magic happen. Maybe for some people it’s like that but for me it’s a bit like playing whack-a-mole. It’s a lot of problem solving. In short, I am still sticking to a low carb-high fat diet, but I am modifying the types of fat I am consuming as a first step to see if my cholesterol changes in a few months. I’ll keep watching my blood sugar and my athletic performance in the meantime to see if there is a way to make my doctors happy and to climb harder while eating foods that I like.

I’m happy to get input from anyone who has experienced similar things–type 1 or otherwise. This is a Gordian Knot and it’s going to take a lot more than my paltry pin-the-tail-on-the-donkey experimentation to unravel it in a satisfactory manner!

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