high cholesterol

[Holly]

Hello,

I am 73 years old, my mother died of Alzheimer’s Disease and I discovered about three years ago that I have both ApoE4 alleles. I have been trying to follow the Bredesen protocol since then - eating a keto diet, exercising regularly, sleeping regularly and staying mentally active. My brain function has improved significantly since I began but my cholesterol has been climbing. Many of my numbers are now well out of Dr. Bredesen’s target ranges.

STANDARD LIPID PANEL
Total cholesterol 241
HDL cholesterol 75
Triglycerides 49
LDL cholesterol 151
Cholesterol/HDCL ratio 3.2
Non HDL cholesterol 166

LIPOPROTEIN FRACTIONATION ION MOBILITY
LDL partial number 2040
LDL small 258
LDL medium 326
HDL large 9407
LDL pattern A
LDL peak size 226.1 Angstrom

How can I get my cholesterol under control without losing the benefits of the keto diet? Is that possible? If it isn’t how do I weigh the risk of heart disease against the risk of dementia? I am otherwise healthy.

Any help you can provide would be much appreciated. Holly

[Tincup]

Hi Holly,

You have lower LDL than my 62 year old 4/4 wife (by 40 or 50 points). Our doc, Steven Gundry, thinks she's just fine. Her redacted labs as well as consult transcript are here. All our 10 prior labs & transcripts are here.

Oxidized LDL might be something to look at.

This is controversial, I realize. Not saying you should do what we do and ignore it. Gundry hasn't had us pull advanced lipid tests for a while, but we have in the past.

To minimize, LDL, you need to minimize saturated fat. Even (our doc, Gundry's favorite) EVOO has sat fat. From memory, sesame and perilla oil have very little (but verify my memory).

I think Dayan Goodenowe goes into how 4's deal with cholesterol differently than others in one of these two podcasts with Julie G: one and/or two

[grommet]

Hi Holly - I agree with Tincup…if your objective is to lower LDL, then dramatically reduce your saturated fat intake and test again in a few months. I suggesting focusing on getting your LDL-P (particle count) below 1000. You’ll also find that your LDL-C will also go down which is typical for most but not all people.

I cut saturated fat almost completely from my diet as an experiment and I was able to get my LDL-P down below 800 from 2000…after only 3 months. You can do it too!

[TheresaB]

How can I get my cholesterol under control without losing the benefits of the keto diet? Is that possible? If it isn’t how do I weigh the risk of heart disease against the risk of dementia? I am otherwise healthy.

It is possible to maintain a keto diet with reduced saturated fat. It's a little more challenging because nearly all websites that have keto recipes aren't sensitive to our needs for limiting saturated fat, but it can be done. We do have some recipes in our wiki: Recipes from our members

Are you familiar with the Ketoflex pyramid of Dr Bredesen, that's a good visual as to how I guide my diet. You can see it here from our wiki: Bredesen Protocol and a more indepth discussion from the Apollo Health website that Dr Bredesen is associated with: KetoFlex 12/3. Although it's called KetoFlex 12/3, for us 4/4s, 16/3 is better for us. Additionally, of course, there's also Dr Bredesen's book, "The End of Alzheimer's Program" that goes into detail on dietary recommendations.

Regarding your comment of heart disease vs dementia, they are not at crossed purposes, there is a connection of high blood sugar to both, there is a connection of inflammation to both.

ApoE4s tend to run higher levels of LDL. As I remember Dr Goodenowe explain it, we hold on to our cholesterol better than ApoE3s or 2s. Since we're holding on to what we need, we don't absorb it, so we have more floating in our bloodstream. That alone isn't necessarily bad, it's when the LDL particles become small and dense (sdLDL) and become inflammatory and oxidized (oxLDL) that it becomes an issue.

My LDL has always been high (in the yellow range) but my doctor doesn’t care because my HDL, triglycerides, ApoB to ApoA1 ratio, oxidized LDL, Lp(a), Coronary Artery Calcium (CAC) score and PULS cardiac test score are good. In my humble opinion, Total Cholesterol is a meaningless marker and LDL in isolation says nothing. I’ve heard it pondered that if we didn’t have a drug that lowered LDL would we even pay any attention to LDL. For years Dave Feldman, founder of the website CholesterolCode, has been offering a bounty for every non-drug/non-gene study showing that high LDL equals a high risk for cardiovascular disease or coronary heart disease when triglycerides are low and HDL is high. Last I heard he has yet to pay out.

[Holly]

Theresa,

Many thanks for this very helpful reply! I will read the resources you refer to and share this information with my doctor.

Happy New Year!

[grommet]

For years Dave Feldman, founder of the website CholesterolCode, has been offering a bounty for every non-drug/non-gene study showing that high LDL equals a high risk for cardiovascular disease or coronary heart disease when triglycerides are low and HDL is high. Last I heard he has yet to pay out.

A hardcore keto coworker of mine showed me his numbers recently. Trigs: 54, HDL-C: 100, LDL-C: 356 but his LDL-P was so high it was off the charts. Calcium score was also > 0 and rising. I know that’s a N=1 study but a LDL-P that high is guaranteed to lead to something terrible. He did feel great and lost a ton of weight so at least there was that.

[Quantifier]

What we really need to be measuring is ApoB, as it measures the number of apolipoprotein particles per volume of serum, whereas LDL-C is just a proxy measurement (can be discordant with ApoB if particles are small).

As for Dave's challenge, see this thread by Deirdre Tobias, work done using the data from the Women's Health Study cohort. She later added another table using a cutoff of HbA1c under 5.5 for metabolically healthy (not sure how to link to it specifically). This is still not officially published, but the data are available.