High LDL & Total Cholesterol, normal ApoB -- worried.

Answered on August 19, 2014
Created July 27, 2013 at 4:03 PM

Hey all,

I lost 20kg (75% of my excess body weight) on a keto diet and changed my life. Got a blood test done now, about 7 months into the diet. Everything seems to be normal but my total cholesterol and LDL are really, really high. These are the numbers:

Note: I had gotten little sleep the nights before and I had cycled 16km while fasted, including cycling to the blood test lab. Had also been IF'ing the days previous. I'm also undergoing pretty rapid weight loss.

I'm a 5'1" 36 year old Asian Indian man. Symptomatically, I feel perfectly goddamn fine but the sky high TC and LDL numbers are scary.

I'm going to return to the lab on Monday, this time with some better sleep, psyllium husk, some coconut oil, Omega3 and multimineral+multivitamin supplements inside me. Going to also keep that up for a month and re-test. Also going to stop measuring after cycling while fasting.

Any feedback or comments?

ApoA-1 135mg/dL

ApoA-1 Reference Range: 95 - 186

ApoB 168 mg/dL

ApoB Reference Range: 49 - 173

ApoA-1:ApoB ratio 0.804

ApoB:ApoA1 ratio 1.244

Total Cholesterol: 256mg/dL

Total Cholesterol Reference Range: 130 - 220

Triglycerides: 134 mg/dL

Triglycerides Reference Range: 50 - 150

HDL Cholesterol: 38 md/dL

HDL Cholesterol Reference Range: 30 - 75

LDL Cholesterol (Friedewald): 191

LDL Cholesterol Reference Range: 30 - 100

VLDL Cholesterol: 26.8mg/dL

VLDL Cholesterol Reference Range: 10 - 30

Trig:HDL ratio: 3.5

TC:HDL ratio: 6.74:1

TC:Trig ratio: 1.91:1

Sodium: 137mEq/L

Sodium Reference Range: 132 - 150

Chloride: 100mEq/L

Chloride Reference Range: 100 - 115

Fasting Blood Glucose: 84 mg/dL

Fasting Blood Glucose Reference Range: 60 - 100

Fasting Insulin: 8.66 muUI/mL

Fasting Insulin Reference Range: 2.6 - 30

HOMA2 Beta Cell function as percentage of normal adult: 118.4%

HOMA2 Insulin Sensitivity as percentage of normal young adult: 90.7%

HOMA2 Insulin Resistance: 1.1

Free T3: 2.74pg/mL

Free T3 Reference Range: 1.8 - 4.6

Free T4: 1.45ng/dL

Free T4 Reference Range: 0.93 - 1.70

TSH: 3.81 muIU/mL

TSH Reference Range: 0.27 - 4.20


on August 11, 2013
at 02:03 PM

Also, without knowing what the numbers were before the diet and weightloss, maybe this is an improvement on where the OP was before.


on July 27, 2013
at 05:52 PM

You say you are on a keto diet. Can you give more info into your eating habits.

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6 Answers



on August 11, 2013
at 07:11 AM

Your low HDL compared to your TG is a bigger problem. Given your weight loss I'm not surprised to see that your LDL (I assume) has gone up. You should listen to Ben Greenfields podcast with Jimmy Moore here where he explains a lot about cholesterol and answers your questions.


on August 11, 2013
at 05:50 PM

As Hemming mentioned, your HDL is low (considering you're physically active) and Triglycerides is relatively high. The TG/HDL ratio is 3.5 which is the start of insulin resistance range.

I have read about very few people sustain chronic-cardio levels of activity on low-carb/ketogenic state. Sleepless night, fasting, 16-km cycling all are inflammatory and will affect your blood tests. Take advice from MDA and convert your low-carb/ketogenic mode activities to 'move frequently at a slow pace' - leisurely cycling, easy hiking or just walking around. Reducing chronic inflammation is vital to increasing hdl and reducing tg. You may also be intaking very low MCT/Coconut-Oil by paleo standards - I have personally found that increasing Coconut oil and decreasing sugar intake itself can have lowering effects on TG.

Medium avatar


on August 11, 2013
at 12:33 PM

Your TC doesn't seem extreme, but the TC/HDL ratio of 6.74 is something you should work on. http://www.mayoclinic.com/health/cholesterol-ratio/AN01761 Personally, I've had more success raising HDL than lowering TC, and have raised my HDL up from the 40 level to the 80-90 range with daily exercise and weight loss (from obese to normal). Currently my TC/HDL is 2.6, down from 7.6 eight years ago.


on August 11, 2013
at 08:05 AM

In addition to what other people suggested, high LDL is a very common issue in low carb diets and AFAIK it's still not certain wether it really posses a problem despite that these particules are large fluffy LDL type A... although it's more or less clear that high inflamation is the real cause for CVD and all that stuff... having high LDL particle count means that LDL is not being cleared at a proper fast rate and that might be a problem as time goes on, seems that more research and studies should be conducted in long-term VLC diets.

The cause for the LDL seems to be a mix of high fat in the diet (you must do something with so much fat!) and a poor LDL receptor activity due to lowered metabolism from poor T4 to T3 conversion. What does that mean? Where we can question if carbs are really needed in our diets, it seems a true fact that they raise free T3 conversion and speed up metabolism. When this happens, LDL receptor also upregulates and cholesterol is recicled more eficiently. If you eat low carb, this upregulation does not happen and you see high LDL (more or less would be somethink like that, excuse my poor layman explanation).

You don't have that bad free T3 numbers and I bet this is why you are not surpassing a 300+ total cholesterol. But TSH is slightly high... you'd do well to keep monitoring your thyroid function and see how everything evolves. I'd also monitor your body temperature, if you start feeling cold hands and feet and low temperature... bet your having lowered thyroid activity (and notice that although this could be seen as a bad thing, some docs like Kruse and Rosedale do not think that way, problem is not bad functioning thyroid but one that is working lower because less stress is put on it, so to say).

See this interesting debate regarding this topic.


Also, I'd have a look at great Chris Masterjohn cholesterol series.


And keep an eye to this dude N = 1 experiment.


If you are really concerned about cholesterol numbers, I'm pretty confident that you could revert that by lowering a little bit fat intake and upping your carb intake until it reaches a 1 to 1 ratio with your protein intake. Cutting back on saturated fat will surely help, whether it is healthy or not.

Also, you say your going to have coconut oil prior to your next bloodwork, I'd not do it, despite all the magical things that CO can do for you, it's pretty well know that it raises total cholesterol (both LDL and HDL) so if you're looking to get your numbers down, 'd cut on it. Just add some fiber to your diet, plenty of veggies and cut fat a little bit, and get some starches to up carb intake. That would be in the aim to lower TC, keep in mind that this does not really mean that adding starches is definitely a good idea, just a trick to get to your goal, then you decide to which diet you stick on the future. LC brings low triglycerides and low blood sugar as well as lower blood presure and low HS-CRP inflamation markers which seems a pretty good deal for just a raise in LDL and TC that we are not really sure it is really such a big deal...



on July 28, 2013
at 12:38 AM

You just can't trust those cholesterol numbers because they're in the process of stabilizing from your recent, rapid weight loss. Who knows, you may still be losing weight. That's why your trig number doesn't make sense. For someone ketogenic, that should be under 100 if not 50. You're at 134. Did you have fatty liver? Your HDL is also low for someone cycling probably for that same reason.

Also, your TSH is a bit high while your Ft3 is low-normal and FT4 high-normal. You could develop hypothryoid symptoms if you're sensitive to VLCing. But then you may not. Those numbers could be in flux, too.

The only reliable conclusion you can draw is that your blood sugar control is ok (fasting insulin of 8). You may have had fatty liver but made an escape from insulin resistance.

I would not get another blood test until you're 6 months away from losing weight. Then keep an eye on FT3 in case the ketogenic weight loss goes awry.


on July 27, 2013
at 04:51 PM

Total cholesterol isn't that bad. However, as you point out, LDL is high and HDL is quite low, especially for someone that exercises a lot. TSH is also pretty high and definitely puts you in hypothyroid range. Lipid numbers can get pretty wacky when you're losing a lot of weight. You may see things stabilize as your weight does.

What's your typical diet?


on August 11, 2013
at 02:03 PM

Also, without knowing what the numbers were before the diet and weightloss, maybe this is an improvement on where the OP was before.

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