If You’re Keto, Your Lipids May be Misleading - New Report Suggests (April 2020)

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In science and medicine, your conclusions are only as good as your tests.

You don’t need to be a researcher or doctor to understand this concept. Take the simple example of body weight. If I tell you only that someone weighs 207 lbs and ask you to tell me about the mystery person’s health, what would you say?

You could make a guess based on population averages, but it would be a pretty poor guess. If I forced you to guess, you’d probably comment that this person is overweight or obese and may recommend that s/he try to lose a few pounds. But, of course, your guess and advice are handicapped by your lack of relevant information. Is this person tall? Muscular? Pregnant? This last would be unlikely, as the person I had in mind was Usain Bolt.

Let’s alter the scenario such that I tell you the person wasn’t 207 lbs, but rather had a cholesterol of 450 mg/dL (for reference, “high cholesterol” is considered to be anything over 200). Similarly, if I forced you or a doctor to tell me about the mystery person’s health, you could make a guess based on population averages and would probably comment that this person is at high risk for heart disease.

This was precisely the scenario in a new report entitled, “A Standard Lipid Panel is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet,” published in Frontiers in Medicine ( 1).

This report shows how, just like by only knowing Usain Bolt’s weight you could misdiagnose him as overweight, standard lipid panels (which include total cholesterol, LDL, HDL, and triglycerides) can lead to misdiagnoses and harmful medical recommendations.

The subject of this report was a young man who adopted a ketogenic diet to treat his inflammatory bowel disease. Just before he started the diet, he had an in-depth blood lipid panel. He then had the in-depth lipid panel redone seven months later. Strikingly, the ketogenic diet made the subject’s total cholesterol almost triple from an “optimal” 160 mg/dL to a “high-risk” 450! His LDL cholesterol also jumped from an “optimal” 90 mg/dL to a to a “high-risk” 321. I place “optimal” and “high-risk” in quotes because the report explains how these changes from “optimal” to “high-risk” might not actually be bad, but good!

When the subject changed his diet, his body responded by shifting his metabolism from carbohydrate-burning to fat-burning, which required an increase in his total and LDL cholesterol levels. Importantly, the in-depth lipid panels revealed that the specific types of cholesterol-containing particles that increased were all the healthy forms (like HDL and big fluffy LDL), whereas the heart-disease-causing particles (small and medium LDL) actually went down!

In our weight analogy, it was as if someone gained 10 pounds, but that plus 10 pounds was actually plus 12 pounds of muscle and minus 2 pounds of fat.

Whether or not you choose to delve into the nitty-gritty details found in the report itself, I recommend downloading the PDF and keeping in your back pocket, if you are someone on a ketogenic diet. I know far too many people who have improved their chronic diseases by choosing to eat a ketogenic diet, only to have their doctors order a standard lipid panel and then suggest they abandon the life-improving diet when their total and LDL cholesterol levels increase. But, as we now know, there may be more to the metabolic story and more rigorous testing may be required.

So, if you’re on a low-carb diet and had such a discussion with your doctor (or anticipate one), perhaps hand your doctor this report and simply ask, “Do you mind taking a look at this? Do you think I could get some more in-depth testing?” A responsible doctor should be open-minded and receptive.

A standard lipid panel (total cholesterol, LDL, HDL, and triglycerides) may not be sufficient to determine heart disease risk in those who follow a ketogenic diet.

For more science-backed articles related to this topic, read the posts below:

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Nicholas Norwitz MD-PhD candidate at Oxford University Nicholas Norwitz is a Harvard medical student and Oxford PhD researcher who specializes in ketone metabolism. He a rising star in the scientific community, with peer-reviewed publications on topics ranging from brain health to bone health to heart health to gut health. Informed by his own medical history, he has an infectious passion for food as medicine and a drive to find innovative ways to teach the general public about the latest nutrition science. More posts by Nicholas Norwitz Expert Article This article was written by Nicholas Norwitz who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page. Evidence Based Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.