Help to understand blood test results...

[Nico]

Thank you, I find recommendation level here too :
http://cassiopaea.org/forum/index.php/topic,8037.msg57383.html#msg57383

I will wait for the multi-mineral before zincing and coppering, and try little potassium and continue magnesium. I definitely experienced heavy metal reallocation, so replenishing slowly will be good I hope. Thanks again !

 

[Gaby]

Here is an important update on the cholesterol panel:

http://<iframe width="560" height="...1M" frameborder="0" allowfullscreen></iframe>

This is something Dr. Cate explains in her book "Deep Nutrition" with more detail in Chapter 7 (Chapter 8 in the original version), entitled Good Fats and Bad. I quoted extensively this book in the thread "Life Without Bread" starting here.

The relevant quotes from chapter 8 can be read here and here.

For those who can't watch the video, here are some highlights:

- Is all LDL inherently bad as mainstream medicine will have us believe?

- What's inside of the LDL is what causes the atherosclerosis.

- What determines if LDL's content is good or bad is not its size or levels, but excessive oxidation (oxidative stress) due to iron, overheated vegetable oils or excess glycation.

- If LDL is made out of "heated and oxidized vegetable oils" (Oxidized polyunsaturated fatty acids -PUFAs), it transforms into "Minimally Modified LDL" enciched with oxidized PUFA fats (MMLDL).

- Modified LDL is no longer recognized by the cell's receptors which allows the cholesterol into tissues. It stays in the blood where it gets attacked by white blood cells, leading to atherosclerosis.

- Eventually the protein coat of LDL degrades overtime. This is when even the healthy PUFAs get oxidized, because they are unprotected.

- When LDL's protein coat degrades, LDL cholesterol levels could be normal or even low because lab tests can't read LDL without its protein coat. Nevertheless, this atherogenic process is still going on.

- Oxidized fat attracts white blood cells which try to get rid of the free circulating cholesterol stuck in the bloodstream. Inflammatory markers get released by the white blood cells when they call for more help. Inflammation weakens the arterial wall which would bleed to death if it was not due to the blood clot formation which eventually leads to heart attacks and strokes.

- In synthesis, it is not the lipoprotein levels or their size, it is what is inside. It's not the trucks, it's the cargo.

- What chemistry can answer:

*Diabetics have less oxidative defense, will get more oxidized PUFAs in their lipoproteins, accelerates the atherosclerotic process.

*Men have higher risk probably due to oxidation reactions. IRON accelerates PUFA oxidation.

*Vegetable oils are bad not due to their omega 6 content. They are no inherently pro-inflammatory. It's when they are oxidized that causes the problem (and they are highly flammable).

*HDL goes down because glycation makes apoproteins disassociate (they lose their protein coat and the laboratory can't read them anymore).

*Oxidized PUFA accelerate glycation reactions, makes glucose more toxic.

- Take home message: Avoid heated vegetable oils like the plague. Your cholesterol panel can be normal and/or with high LDL and high cholesterol. That is really not the issue. The question is, is your cholesterol oxidized?

- This explains why in some studies, polyunsaturated fatty acids increase the risk of heart attacks and strokes. For more information, see:

What everyone should know about Ancel Key's experiments
https://www.sott.net/article/335949-What-everyone-should-know-about-Ancel-Keys-experiments

The study diets contained between 8 and 12% of calories from linoleic acid. Today's average American consumes about 10 % of calories from linoleic acid, which puts us right in the ballpark of the average study participant. In other words, the average American is on a diet very much like Keys' high polyunsaturated fat diet that does lower cholesterol but actually increases a persons risk of heart attack and strokes compared to a diet high in trans fat.

In other words, the American public is trapped in Keys' medical experiment.

And we know what the results will be: more heart attacks and strokes. American doctors who still recommend polyunsaturated fats are unknowingly putting their patients at risk of death or disability. This is why every doctor should learn the truth about Ancel Keys' experiments.

Animal saturated fat does not have this problem of oxidation because it is a very stable fat. Which is why reducing its intake in the diet is the first path to an increased risk of heart disease. In fact, in the study quoted above, toxic trans fat outperformed oxidized PUFAs. That is, oxidized PUFAs cause more heart attacks than toxic trans fats. That illustrates how bad it is.

In the video, Dr. Cate explains a lipid cholesterol panel and shows how something that could be more and less good, is actually pretty bad. She ordered an advanced lipid panel for comparison. In the end, what really clarified the person's risk was his food menus. More than all the carbs he ate, it was the heated PUFAs that really stood out.

 

[Nico]

Really thanks Gaby, it's been a long time I have tested my blood, and I am not very encline to go for seeking a GOOD doctor right as everything is fine.

It helped nonetheless. The same day I eat potatoes and chicken in a restaurant and when I asked for butter they told me they don't cook with it... So I guess the oil used to cook potatoes was a vegetable oil heated much.

My aim is continue Keto, eat less, eat sun, and not worrying about cholesterol :).

 

[Jefferson]

I went for a check-up last week and had blood tests and an ECG done, and went over the results with the doctor.
I started Paleo April 2011, was in ketosis for a few years 2013-2015/16 approximately, and have been low carb paleo ever since. I haven't completely avoided vegetable oils, but I most certainly do NOT use them nor consume them regularly. Some alcohol has been imbibed over the past few years. I've been completely gluten-free since 2011.

I also did an Omega 6 to Omega 3 ratio blood test (pricked finger) via the Fish Oil company ZinZino, and the ratio was 8.6 to 1 (so not good, but moderate). I'm taking the Norwegian ZinZino oil to test it out.

Blood pressure: good
Resting pulse : 52 beats per min, excellent
ECG: normal
Hemoglobin, Erytrocyes, platelets: normal

Using http://www.hughcalc.org/chol-si.php :

Your Total Cholesterol of 8.40 is HIGH RISK
Your LDL of 6.08 is VERY HIGH RISK
Your HDL of 1.7 is OPTIMAL
Your Triglyceride level of 1.35 is NORMAL

RATIOS:
Your Total Cholesterol/HDL ratio is: 4.94 - (preferably under 5.0, ideally under 3.5) GOOD
Your HDL/LDL ratio is: 0.280 - (preferably over 0.3, ideally over 0.4) AT RISK
Your triglycerides/HDL ratio is: 0.794 - (preferably under 1.74, ideally under 0.87) IDEAL

I did blood work in January 2010, before Paleo/Keto/Gluten-free

Screen shot: table of basic blood tests 2010 - 2018


Outcome with Doctor:
The doctor didn't know much about the chemistry involved, and admitted he needs to read up more and also to look at the more recent research on natural fats such as coconut oil, animal fat, butter, olive oil etc - he called them "bad, hard fats". The doctor would have prescribed statins for me as there has been some history of heart disease on both sides of my family, and the doctor was also alarmed from the increase of cholesterol from 4.3 to 8.4 with LDL going from 2.2 to 6.1 from 2010 to 2018. I gently but firmly discussed the chemistry behind this, as before meeting with the doctor to go over the tests I spent several hours on the forum getting back up to speed on cholesterol and inflammation overall. Thank you Forum! :)

The doctor gave me a printout of how to reduce cholesterol using vegetable oils. I clearly stated that I do not eat any processed food or oils, only natural oils that come from nature, and brought up the concept of oxidation with respect to vegetable oils. I also emphasized I am concerned about inflammation, and flatly stated that cholesterol does not cause inflammation, and is only a transport mechanism of lipoproteins to and from the liver. The doctor somewhat weakly stated that the link between high cholesterol and heard disease is 'fairly' clear.

I presented one extensive research article to the doctor (https://cassiopaea.org/forum/index.php/topic,26327.msg679356.html#msg679356) as I had my abovementioned ratios and abstract of this article printed in advance, and the doctor seemed interested and open for more. I will send a few more links to the doctor.
The doctor is sending me to a specialist to do a clinical stress test (exercise ECG) to further investigate my heart.
The doctor wants me to do a thyroid test and the cholesterol tests again in May.

Although the doctor was polite, there was definitely pressure to take statin medication as the doctor brought it up 3 times during the visit ONLY because of the "high" cholesterol levels!
As otherwise with blood pressure very good, resting pulse excellent, ECG just fine, and no other definite heart-related symptoms, why would a doctor prescribe evil statins! (maybe a medical requirement, understandably).


My thoughts and questions:
My liver is ok, but it could be better, it is good to see some improvement over 8 years from 20 U/L to 17 U/L. That 35 U/L of glutamyl-transferase bugs me.
Good to see kidneys seem ok.
Glucose drop from 5.3 to 4.8 over 8 years is good, but I thought it would be better since being low carb.
The white blood cells might be up because of smoking, but I'm wondering if this could indicate some inflammation.
The Omega 6 to Omega 3 ratio is 8.6 to 1, so my body may be at risk of some of inflammation in that respect.

I am not concerned about the high LDL 6.1 / 236, or the overall high cholesterol 8.4 /324 , but I am wondering why HDL is slow low at 1.7 / 66, with a very small increase from 1.6 / 62 in 2010 before knowing anything about the diet? The knowledge from this Forum has shown that cholesterol levels don't mean much, but there could be some indication of an underlying inflammation.

The question I ask, and have asked myself over the years, is how to reduce inflammation. There have been on and off sleeping problems, partially that has to do with a neck pain problem that has persisted for over a year. Some stress, being surrounded by wireless technologies daily, a fairly hectic family life which due to being fairly high in personality trait neuroticism, can get to me at times. Over the years, with the help of EE and the knowledge from this Forum, my stress levels have tended to decrease. I'm not exercising that much either, mainly walks once a week, along with once a week with a medium intensity cardio-type circuit training (that I miss time to time).

I will see a traditional 'healer' / traditional medicine practitioner who has an excellent reputation. We'll see what he can do with my neck pain, overall inflammation reduction, and deep tissue (emotional) work. I plan to work with this practitioner over the next several months starting hopefully at the end of March (he has a long waiting list).

 

[Gaby]

Hello Jefferson,

There is a possibility of you having a polymorphism that doesn't make you the ideal subject for a ketogenic diet or a low carb/high fat diet.

Your cholesterol levels don't look right for me and my thinking is that you either have familial hypercholesterolemia and/or a polymorphism.

At what ages did your family members had their cardiovascular problems and/or did they ever had high cholesterol?

Do you have any blood tests from the 2010-2018 period? Any blood tests since starting the paleo or keto diet?

Next time, other than checking thyroid function, you'll need vitamin D levels and ferritin, TIBC, transferrin, iron and transferring saturation to check for iron overload markers.

 

[Gaby]

Also, what do you eat on a typical day for breakfast, lunch, dinner, and/or snacks?

 

[Keyhole]

My thoughts were similar to Gaby's when seeing the cholesterol.

I'd also opt to get your homocysteine checked, as that can be helpful in conjunction with glutamyl-transferase and is a great marker for CVD risk. Definitely looks like there is something going on that is undetected in that blood panel.

You could try persuade him to do an organic acids panel with a private lab, as this could point to where some of the inflammation may be stemming from.

Aside from what your eating, what time are you eating each meal specifically? And which meal is largest?

 

[Jefferson]

Thanks Gaby and Keyhole for your replies and questions.
I am really keen on getting to the bottom of this.

Ancestry
My father: 53 years old, heart attack, angioplasty done, one blockage of a bend in an artery
- apparently cholesterol not very high, not sure (got cancer, had a bunch of chemo, died at age 59)

My mother's father: final heart attack caused death at age 61 but apparently he had heart attacks for years before that but he didn't do anything about. No info on cholesterol levels.

After surveying other relatives (aunts etc) nobody seems to have any particular problems with high cholesterol (certainly familial hypercholesterolemia has never been diagnosed).

Blood tests
No blood tests for me except for January 2010 and last week February 2018 as posted.

Eating
Breakfast: from 7:30AM to 10:30AM depending what time I go to work, or if it is a weekend - 2 or 3 organic egg yolks and organic bacon with organic butter every morning.

Lunch: I very rarely eat lunch, may take some gluten free cafeteria meal swimming in olive oil at work, but that might only be a few times a month but that will be usually after 13:30 or closer to 14:00. Sometimes over the years I've warmed up bone broth at work around midday, but I haven't done that since Spring 2017.

Throughout day: organic black tea or organic dark coffee with coconut oil. Staves off hunger, a good way to get some MCTs in me.

Supper: between 4pm and 6pm - pork or beef, sometimes chicken, sometimes with olive oil but mostly with lots of butter. I'll eat this with bone broth (moose, beef, sometimes pork bones) sauerkraut, beets, sweet potato, powdered mash potatoes that don't have any vegetable oil, lettuce, sometimes steamed broccoli. The beef is grass-fed organic, but the other meats are not grass-fed, but sometimes organic. I don't really get a chance or feel like warming up the bone broth at work in the microwave during the day so I will eat that with supper.

The largest meal is usually supper between 4pm and 6pm.

I cook everything in leaf lard that I render myself.

Snacks: I don't snack alot but during birthdays or some event with family, I'll reach my daily carb limit with those "baddies" but they are always gluten free (yeah, sometimes with the other gunk in them). But this is just once in awhile. Dark chocolate every once in awhile, sometimes I eat snacks that the kids eat (some gluten-free bread, rarely chips but a bit at kids birthdays, gluten free cheesecake with Mascarpone cheese once in awhile). This is where I've been cheating a bit along with sometimes alcoholic apple cider when having sauna. I don't experience much suffering when I cheat a bit (no obvious inflammation).


Question on the polymorphism: I had the DNA tests done at Family Tree DNA (the Family Finder and Y-DNA), I wonder if the potential polymorphism can be determined via Family Tree DNA?

I have a body type that does not gain weight, and it hasn't gained weight in all of my 47 years on this earth: not before diet changes I made at 40 years of age, and not after diet changes. I have the same waist size as I had when I was 18-19 years of age (32 inches). So maybe some mutation?

Other observation: I have felt a weird (not painful), but weird and disconcerting 'squeezing' feeling in my torso over the past year or so, maybe more, that comes and goes, and it tends to concentrate on the left side of my chest. This seems to come when I'm relaxing and seldom, if ever, comes when I am exerting myself (and I seldom if ever feel shortness of breath or dizziness when exerting myself). I don't know if this weird chest feeling is muscular, skeletal, tissue, indigestion, lung/heart. Well, according to my check-up, there's nothing wrong there. One hypothesis of mine is my heavy mobile smartphone use, laptop WiFi use which I can only get away from for short periods.

 

[Gaby]

And no blood tests between 2010 and 2018? It is always a good idea to check on your cholesterol panel and thyroid function after 3-6 months on the keto diet.

The polymorphisms that I was referring to was based on research quoted by Rhonda Patrick from foundmyfitness.com This podcast that I listened was from the last 6 months, and she said that no lab was doing them commercially, for now. So no luck with Family DNA tree. The polymorphisms got checked in study participants in a highly specialized lab. I searched for the study and sure enough, I didn't found any widespread information on the specific polymorphisms. It doesn't mean that you would not be able to find other clues with other genetic tests though.

This is why D'Agostino says that if your blood biochemistry looks the opposite of what it should look after months on the keto diet, then you know keto (low carb/high fat) is not for you. A certain percentage of the population has polymorphisms that make them unable to metabolize fat effectively. I probably eat as much fat or slightly more fat than you and my total cholesterol is half your levels. My HDL is over 100. I work at my best in the keto diet though.

Both your father and your mother were young for the standard cardiovascular disease from everyday environmental insult, considering the time they lived. There's got to be something more there. Now it is "normal" to see people in their late 30s or 40s with strokes and heart attacks, but the standard American diet and current environment is unsustainable for the average person. Still, when a person doesn't take care of himself, the "normal" thing would be to have a cardiovascular event in the late 60s or 70s for men, and a decade later for women.

Perhaps others have more suggestions, but for the time being, I would stop adding coconut oil to your food and chunks of butter as well. Stop the high fat intake. How did you eat before, when your cholesterol panel was normal? Perhaps cutting on fatty cuts and the extra fat would be enough, but you'll have to start eating healthy carbs that you can tolerate. You can also get an IgG food intolerance test to get an idea of what you tolerate.

Unfortunately cardiovascular disease is something that you cannot diagnose with the standard tests that you had. I think the suggestion of a stress test is a good one.

Sorry, no extra fat for you for the time being. Try to eat organic fish products (small preferably) from time to time, along some selenium to help chelate the heavy metals. That should help to get your Omega 3s up naturally.

You take any supplements? There are lots of options, but a basic all time favorite cocktail might come in handy. Get your vitamin D levels and iron markers checked. If you have iron overload, the cholesterol is probably getting oxidized and you want to avoid that. Then donating blood would be a priority.

My 2 cents!

 

[Joe]

Hi Jefferson, I have just two things to suggest.

1. For high cholesterol, try taking beberine and niacin once every day and get it tested against after a few months to see if it has helped.

2. Don't challenge doctors on alternative views on cholesterol etc. It's pointless.

 

[Keyhole]

When you say organic butter, what do you mean by this? Is it Kerrygold, or is it just standard butter but an "organic" variety? The reason I ask is because the "organic" varieties of butter usually just mean that the cows have been fed organic grains. Grain-fed beef = high Omega 6, whether it is organic or not.

Similar for the leaf lard, is the lard pastured? Or is it grain fed? These are important questions, because you are eating a whole load of fat.

It seems that if someone is going to do keto, then they need to do it carefully. And I echo what Gaby said... a lot of people just don't seem to be suited for ketosis. A safer option would be to back off on the fat, stick with a paleo diet of whole foods and veggies.

Also, I would switch up the meals completely. Eat the biggest meal at breakfast, and then don't skip lunch, and have a light dinner. Just meat and fat at breakfast, for someone who is poor at metabolising/dealing with fat, can be a recipe for stress. Timing is just as important as food. In fact there are some studies suggesting that the detrimental effects of eating a crap diet can actually be mitigated by eating within an 8-10 hour window, which would suggest that timing is possibly more important than what is eaten.

How are you sleeping aswell? Do you have trouble nodding off/maintaining sleep?

Thinking about it, I would get your doc to run a DUTCH urine test by precision analytical, because it can provide insight into cortisol/DHEA ratio and other hormones. If you can afford it, you could check out the OURA ring. This is a thrifty little device which measures several markers, namely your sleep quality, heart-rate-variability, and body temp etc. It can show you whether your body is effectively entering "recovery mode" or not, and helps you to track what does/does not work in your lifestyle.

 

[Adaryn]

Hi Jefferson,

you could try this supplement: LIMICOL (made in France). Someone I know has been taking it for high cholesterol for almost 3 months. According to the manufacturer, you have to try it out for at least 3 months to see any effect, and then you can do another cholesterol test. See the whole description on their website (you can order the product from anywhere on their online shop): https://www.laboratoire-lescuyer.com/en/about-limicol/more-about-limicol

Limicol

Cholesterol complex

Helps lower total cholesterol and LDL cholesterol without associated discomfort.

The natural, exclusive and patented formula combines a total of 8 beneficial active substances which act synergistically against excess cholesterol!

The complex has been the subject of 3 placebo-controlled clinical trials of high methodological quality conducted in a total of 184 subjects and demonstrating the efficacy of the product.

Unprecedented in Europe: Laboratoire LESCUYER obtained a positive opinion from the EFSA; which was totally unprecedented for a food supplement > consult the press release

Food supplement containing red yeast rice plant extracts and vitamins.

Description

Essential for the body, cholesterol is a lipid that naturally circulates in the blood. The body synthesizes 75%; only 25% are derived from the diet. There are two types of cholesterol: "good" cholesterol, transported by high-density lipoproteins (HDL), and "bad" cholesterol, transported by low-density lipoproteins (LDL).

An excess of "bad cholesterol" (LDL) gives rise to fatty plaque which may adhere to the walls of the arteries and become harmful for cardiovascular equilibrium. "Good" cholesterol (HDL) limits the poor-quality lipid deposits.

LIMICOL contributes to naturally regulating your cholesterol thanks to its exclusive formula:

Artichoke extract, endowed with antioxidant properties, contributes to maintaining normal blood lipid levels and facilitating digestion of the fats by the body.
Red yeast rice, sugar cane policosanol, garlic extract, pine bark PCO and vitamins B2, B3 and E complete the unique formula which has demonstrated its efficacy against cholesterol in 3 clinical trials including a total of 184 subjects (15.3% reduction in total cholesterol ¹, 21.4% reduction in LDL-cholesterol ¹ and 12.2% reduction in triglycerides ²).
The active substances are supplied at rigorously appropriate doses! The efficacy of LIMICOL and the uniqueness of its formula are based on the synergistic action of the 8 active substances selected and the precise doses of each ingredient, which are lower than those recommended for the ingredients taken separately. This particular feature helps avoid the discomfort generally observed.

LIMICOL is to be taken in the context of a varied and balanced diet and a healthy lifestyle.

 

[aragorn]

Fwiw, Jefferson, regarding the neck pain and trouble sleeping. For long I've had similar issues, with neck pain and aches in the hip area making sitting for longer periods painful. Ca a year ago, I stopped eating butter, and that lessened the pain a bit. I've been dairy free for years, but I never stopped using butter until now. The neck pain/tightness in the upper back however remained, and I've always experienced "cracking" noises when I laid my head on the pillow. This tightness in the upper back and neck made the whole falling asleep process quite long. However, a few weeks ago I quit eating eggs, just as an experiment, and in a few days the neck/upper back tightness was almost not noticeable. I don't have any "cracking" noises anymore, which feels weird.

So, you might consider doing the same for a few weeks and see if it makes any difference.

Also, thanks for bringing this up; I had quite similar cholesterol levels as you in 2014, and I haven't get those checked since. I probably should do that asap.

I have a few questions: so, if I've understood correctly, moderately high cholesterol levels aren't dangerous, since cholesterol per se isn't dangerous. However, if the levels get vey high, and stay high for a longer period, that would indicate that there's inflammation and/or other problems. And high levels might mean that you're not able to use fat effectively, because of this polymorphism or other genetic traits? And when the fat isn't effectively "burned" it accumulates in the arteries???, creating problems.

 

[Seppo Ilmarinen]

The polymorphisms that I was referring to was based on research quoted by Rhonda Patrick from foundmyfitness.com This podcast that I listened was from the last 6 months, and she said that no lab was doing them commercially, for now. So no luck with Family DNA tree. The polymorphisms got checked in study participants in a highly specialized lab. I searched for the study and sure enough, I didn't found any widespread information on the specific polymorphisms. It doesn't mean that you would not be able to find other clues with other genetic tests though.

I've done foundmyfitness.com comprehensive report (it uses 23andme data), and it shows for example which PPAR-alpha, PPAR-gamma and FTO gene polymorphisms you have. I'm not sure are these the same ones you're referring to, but in this podcast Rhonda Patrick says:

There have been a few important gene polymorphisms that have been identified to play a role in a context of a high-fat diet such as FTO, PPAR-alpha, PPAR-gamma and APOE4. PPAR-alpha is one of the most important genes that I’ll mention because it plays a very important role in the process of ketogenesis. Activation of PPAR-alpha promotes uptake, utilization, and catabolism of fatty acids by activating genes involved in fatty acid transport, fatty binding and activation, and fatty acid oxidation. There is a polymorphism in this gene that has been associated with lower PPAR-alpha activity and a 2-fold higher risk of type 2 diabetes, increased levels of triglycerides, increased total cholesterol, increased LDL cholesterol, and especially important, increased small-dense LDL particles in the context of high saturated fat intake and low polyunsaturated fat intake. Obviously measuring these blood biomarkers will help illuminate whether any type of diet works for you.

Jefferson, maybe doing 23andme analysis and running these other tests (which are quite cheap) would help evaluating what's going on (you can also run the data to check some other relatively common issues, like polymorphisms affecting methylation or hemochromatosis).

 

[Gaby]

I've done foundmyfitness.com comprehensive report (it uses 23andme data), and it shows for example which PPAR-alpha, PPAR-gamma and FTO gene polymorphisms you have. I'm not sure are these the same ones you're referring to, but in this podcast Rhonda Patrick says:

There have been a few important gene polymorphisms that have been identified to play a role in a context of a high-fat diet such as FTO, PPAR-alpha, PPAR-gamma and APOE4. PPAR-alpha is one of the most important genes that I’ll mention because it plays a very important role in the process of ketogenesis. Activation of PPAR-alpha promotes uptake, utilization, and catabolism of fatty acids by activating genes involved in fatty acid transport, fatty binding and activation, and fatty acid oxidation. There is a polymorphism in this gene that has been associated with lower PPAR-alpha activity and a 2-fold higher risk of type 2 diabetes, increased levels of triglycerides, increased total cholesterol, increased LDL cholesterol, and especially important, increased small-dense LDL particles in the context of high saturated fat intake and low polyunsaturated fat intake. Obviously measuring these blood biomarkers will help illuminate whether any type of diet works for you.

Yes! Thank you for the quote! She probably mentioned it in various podcasts and/or interviews. Those are some markers. Others are currently being researched. The cheap and indirect way to test this is to see your blood biochemistry after 3-6 months on the keto diet. "Increased levels of triglycerides, increased total cholesterol, increased LDL cholesterol, and especially important, increased small-dense LDL particles in the context of high saturated fat intake and low polyunsaturated fat intake" should definitely NOT happen with a keto diet. If it happens, it's an indirect marker of some sort of polymorphism.

That kind of cholesterol profile is more common in those with a high carb processed diet rich in vegetable oils. It is very atherogenic (plaque inducing in the arteries). But there you go, due to certain polymorphisms (genetic variants), some in the keto diet get this cholesterol profile.

It is true that LDL and total cholesterol can go up in the keto diet, but triglycerides and small-dense LDL particles would go way down. An indirect way to test this is to see HDL and triglycerides. If triglycerides are very low (often even lower than the low normal range), and HDL very high, then chances are that LDL is mostly made up of big and fluffy (good, anti-inflammatory) LDL particles. In general, a total cholesterol above 300 and LDL above 240 is more than your average increase due to keto diet.

Those right there in the limit of cholesterol levels should look at their HDL and triglycerides, and probably should increase good quality fish product intake and don't go overboard on the fat. Some have had even fatty liver from the extra added fat, a condition that is more typical of metabolic syndrome and/or high carb intake. The niacin and other complementary supplements are probably a good idea as well.

High cholesterol that doesn't get cleared up effectively has a better chance of getting oxidized by iron, heavy metals, oxidants, etc. That is bad.

In short, a certain percentage of the population has polymorphisms that shouldn't be adding extra chunks of fat into their diet.