Originally Posted by
SteveinMN
As many of you know, low-carbohydrate/ketogenic diets replace the calories you're not getting from carbohydrates and from copious amounts of protein with ... fat. Oftentimes saturated fat. It sends the dietitians into a swoon.
But it's great for blood glucose levels and it can be good for lowering future cholesterol-related cardiac issues.
LDL in the typical lipid profile is not measured directly; it is estimated from the HDL and triglycerides levels. Lower triglycerides levels -- ordinarily a good thing -- mess up the calculation, yielding an estimate of LDL level that is falsely high. Add in modern medicine's penchant for protocols and you can be handed a prescription for a statin (or some other cholesterol-reducing drug) even though you don't need it.
It's turning out that a better predictor of coronary artery disease is the ratio between triglycerides and HDL; the lower the better. A ratio over 4 has shown to be a strong indicator of future coronary artery disease regardless of the patient's LDL level. In addition, there is more than one kind of cholesterol -- a smaller, harder particle that infiltrates cell walls easily and a larger, fluffier particle that does not. A beneficial tri/HDL ratio strongly correlates with having the larger cholesterol particles.
My care provider gave me the corporate line on statins; I was borderline with my numbers but "if you're over 50 and diabetic, you get a statin" (and you get a statin, and YOU get a statin...). I knew that, on a high-fat diet, my LDL was not going to look great. But I also had learned that LDL was not the only consideration. I told her I wanted a particle test and that the results of that test and my next lipid panel would determine if I started taking a statin or if we dropped the topic for the foreseeable future. I got the test; big fluffy cholesterol particles and a tri/HDL ratio well under 2. I don't hear any more about taking statins.