Guide] What your cholesterol results mean

[Beta edition]

Fats, Lipid System, O3/6/9

This post is to serve as a way to help r/ketoscience and r/keto members interpret their

cholesterol results. The person most likely to benefit from this is the typical person who was told
"your LDL is too high, you should take a statin". This statement from your doctor potentially
shows one thing: he or she looked at the LDL alone and extrapolated your cardiac risk from that.
Alternatively, many people trying Keto are sick and unhealthy with the obesity and diabetes that
accompanies marked insulin resistance ... and they really do need help and ARE at
SIGNIFICANT cardiovascular risk. With this in mind, from the doctor's view, a statin is probably a
good idea, and this isn't erroneous thinking. Statins themselves carry risks of worsening insulin
resistance, don't seem to reduce the calcification of cardiac arteries, and cause frank diabetes
(1% or so). For these reasons and others statins themselves are a bit at odds with the
fundamental principle of Keto: reducing insulin resistance.
A more advanced approach to blood lipids is to interpret your cholesterol results in a broader
context of your actual health (age, weight, blood pressure, etc) and your other lab tests. Note:
LDL cholesterol can be bad for you depending on your body's metabolic health environment.
Well, what blood tests reflect a healthy environment that keeps LDL cholesterol from becoming a
problem ? A low HbA1c, a low hsCRP, low ferritin, low C-peptide, low fasting insulin are key
metrics for sure. This post will focus on using triglycerides, HDL and the triglyceride/HDL ratio to
"rule out" atherogenic dyslipidemia in the majority of cases.
This graphic and post was inspired by Dr. Paul Mason (@DrPaulMason on Twitter) and a
Youtube talk he gave a few years back.
--------------------
Edit - here's the image that somehow didnt get posted :(
This image helps you Rule in non-atherogenic dyslipidemia
Using Standard Lab tests to rule in or rule out atherogenic
dyslipidemia
https://imgur.com/QuHG9tc
--------------------------------

Dr. Paul Mason - 'Blood tests on a ketogenic diet - what your cholesterol results mean'
https://www.youtube.com/watch?v=DXKJaQeteE0 (Tri/HDL ratio - starts at 20min 45sec).

Please view the image I created that summarizes everything in one image. :) I used an actual
slide from Dr. Mason's talk to give him credit where credit is due.

tl;dr
If your Triglyceride/HDL ratio is :
< 1.8 in USA (mg/dl) or
< 0.8 in SI units (mmol/L)
your chance of Pattern B (atherogenic dyslipidemia) is low. SI units = (UK/AUS/CAN/World -
mmol/L)

Note that many people who don't quite pass but are close are likely fine. I believe Dr. Mason
uses this approach to help avoid (aka triage) the expensive NMR Lipoprofile testing. The
idea is that if you pass this tough test you'll very likely pass the NMR Lipoprofile test.

At the other end of the spectrum if your

Tri/HDL ratio isUSA: > 4.0
Rest of world: > 1.8
You are very likely have atherogenic dyslipidemia and need to make changes.

If your Tri/HDL ratio falls in between these cutoffs (I think most will) then you may want to get
an NMR Lipoprofile to assess your risk more accurarely ... or better yet do a better job of Keto.

KetosisMD
Triglycerides (alone, not the ratio) vs Pattern A/B

HDL vs Pattern A/B

3 days ago
trig/hdl = 0.4 ~ 0.5 so I'm good :)
The main point for me is to find markers that indicate risk but it should be clear to people these
are signals of the situation, not the problem in itself. This is often confused when people read risk
marker. It would be senseless to focus on the marker itself to try and get it down. By addressing
the cause, the marker will go down by itself.
HDL may be low naturally through your genetics. Even though Trig/HDL is already an
improvement, trigs change more easily through lifestyle while HDL is much harder (high fat
carnivore works best). I mean addressing indirectly, via handling the cause.

LDL by itself is not a good marker because it can be high for different reasons.
 High because there is continuous (low grade) inflammation
-> this is where the real issue is
 High because FH (fam history)
-> not a problem unless you also have the inflammation
 High because of being lean and eating low/zero carb and high fat
-> not a problem. This diet will take away many causes of inflammation. There is however no
science available on how the CVD disease may progress or reverse when you already have
issues and then switch to this diet.
https://www.youtube.com/watch?v=OyzPEii-wo0

A/Prof. Ken Sikaris - 'Cholesterol - When to

Worry' •Nov 13, 2015
Because it improves outcome, but how does this statin improve outcome?
It reduces LDL, but what it particularly reduces is small, dense LDL [sdLDL].
So the reason why statins work in familial hypercholesterolemia is that they reduce the small dense
LDL [sdLDL]
They don't eliminate it completely, But they reduce it. Remember the risk of chance of death didn't
disappear completely. It was just reduced.
So the way you should think of LDL is normally it's green and good.
If triglycerides are present it will become small and dense.
And if it's small and dense and gets into the blood vessel wall it can be Glycated and
Oxidized and that's where the trouble starts.
Now we can measure small dense LDL.
Studies on LDL And TGL