100 thoughts on “Dr. Paul Mason – ‘Blood tests on a ketogenic diet – what your cholesterol results mean’

  1. Ultimately just a different selection of surrogate markers. ApoB, ldl vs hdl vs trig, CRP, CAC scores… All of these are well and good but they aren't the outcomes that matter. Until there is compelling patient oriented outcome based evidence it is potentially risky to be overly confident in the significance of one surrogate vs another.

    Also regarding his patient, while I agree that looking solely at the lipid profile is fraught with error, I would also say that looking primarily at his body fat composition is also misleading. Ultramarathoners, for example, can have very very low body fat contents but can show fibrotic changes in their myocardium.

    Regarding statins I feel they are often over/misprescribed, but they have demonstrated significant impacts on meaningful outcomes for secondary and tertiary prevention. Their function is independent of their impact on ldl levels as they have plaque stabilizing and other impacts a d have been shown to reduce negative outcomes even in those with normal ldl levels.

    Long term patient oriented outcomes are what are needed.

    I say all of this as someone who practices LCHF and works as a physician. I want more/better evidence

  2. So informative. I fasted for 24 hours before my last blood test and had high LDL. Delighted to learn this could be a key factor. I will retest without fasting. Brilliant video – wish I understood what to eat now!

  3. I've been on keto 7
    months. I just had blood work done. Can you help me interpret this?

    These are my numbers:

    CHOLESTEROL 262H MG/DL Ref: <=200
    TRIGLYCERIDE 117 MG/DL 0 – 250
    HDL 49 MG/DL Ref: >35
    LDL CHOLESTEROL 189.2H MG/DL Ref: <=130
    EGFR 154.2 –
    Vit D 18.57L ng/mL 30 – 100

    HEMOGLOBIN A1C 5.5 % 4.3 – 6.1

  4. I looked at my recent blood work and have better numbers than the example. Yet beside a few short term low carb diets to lose weight, I've had a high carb diet, high sugar diet and im over 40. Given how bad my diet has been, I actually expected to be pattern B, yet on his example, i look most likely pattern A.

  5. so i would love to get some knowledge on how to reverse the bad ldl. when i start keto, will the broken ldl (and the fat tissue in my vanes) start vanishing?

  6. The most useful explanation of lipoproteins I've seen yet. Thank you for making this available for us non-medical professionals who are trying to understand our own health!

  7. This is an epiphany for me! I just went for a physical with my new PCP and when I told her I was on a Keto diet – she said she is concerned about my cholesterol levels – I'm not. I had 14 vials of blood drawn for my requested FULLl blood work. This information thoroughly explains in layman's terms that I now can go to my follow up appointment informed. KETO has changed my life for the better!

  8. Interesting that you never see any lectures like this from the LFHC camp! Do they even do any proper research before spouting about how their diet is more healthy than LCHF. I have never seen an equivalent lecture from that camp showing the mechanisms of how their diet affects lipids, insulin etc. All we ever see is quotes from associative and epidemiological studies.

  9. My neighbor looked just like that guy who was denied insurance. He was an avid bike rider and he had a massive heart attack and had to have bypass surgery. He was in his 50's and was always in good physical condition with a lean body.

  10. He says statins increase the receptors but statins are said to inhibit the enzyme HMG-CoA reductase which plays a central role in the production of cholesterol so that's a huge difference. The problem with these videos is there's no one knowledgeable reading and responding to the comments.

  11. Can't wrap my head around the last part about insulin increasing the LDL receptors. Did he say insulin levels will be raised as long as you're on high calorie diet? Even if those calories do not include carbs/sugar? That would be good. And let's say there's a lot of undamaged LDL in circulation (someone on keto diet), is there a problem? What happens to the "excess" LDL in circulation?

  12. Very interesting stuff! I'm only a bit over half way through watching but I have a question and was afraid I'd forget it. I did 30 day Carnivore lifestyle back in October to kind of start with a clean slate food wise. After that month, I slowly started added some keto type foods in so I could continue to eliminate foods that don't seem to agree with me but add back in some variety. (Sure is easier than eliminating one or two at a time.) My thyroid (integrative physician) is so super supportive of my choices for carnivore/keto which is rare in most doctors these days. That all being said, my question has to do with the CRP test vs the Hba1c test for heart disease risk. My CRP is ALWAYS off the charts high (current is 44.99mg/L with the range being 0.00-3.00) and it scares the hell out of me way more than the cholesterol numbers. This doctor in the video says that the HbA1c test is the better one for detecting heart disease risk. My lab value is 5.1% with a lab range of 4.8-5.6 which seems pretty darn good to me. My glucose is 72mg/dL with a lab range of 65-99. So why is my CRP so insanely high and how do I reduce it? Why is that test seemingly also so important to my doctor?

  13. So, I have an Agatston score of 237 (calcium in the arteries) however, I've been strict keto for 20 months. I assume the buildup in the arteries was from how I was eating prior to keto, and the fact that I WAS a diabetic (now have normal A1C levels). Can I also assume that continuing to eat keto will eliminate any FURTHER buildup in my arteries?

  14. Extremely valuable info. I watched this for the second time today and noticed the obvious:

    1) Healthy LDL do not cause atherosclerosis but oxidized LDL particles on the other hand do cause atherosclerosis
    2)LDL receptors are taking LDL particles out of the bloodstream, but only the Healthy LDL not the oxidized ones
    3) one of the mechanism of statin is to increase the LDL receptors
    4) More LDL receptors result in more Healthy LDL taken out of the bloodstream while the real cultprit (oxidized LDL) is left in the bloodstream to eventually cause damage and CVD.

    I cannot think of a biggest scam. This is disgusting.

  15. I was morbidly obese, developed type-2 diabetes and as a result had a cholesterol problem. I struggled with every other diet and exercise routine and nothing worked. I heard about the Ketogenic diet and decided to try it. After being on it for 3 months I had lost 68lbs and then started to add intermittent fasting to it. Fast forward a year I'm down 134lbs and I'm not longer type-2 diabetic requiring medication, my cholesterol problem has fixed itself while eating dietary fats in abundance and I feel great. I'm not fasting all week and eating only on weekends to accelerate weight loss. Never could I have done this without the Keto diet as the catalyst for it all. Dr. Berg, Dr. Jason Fung have excellent channels on the subject on YouTube.

  16. Has a cholesterol score 3x over safe limit
    Calls himself healthy
    Wants to be taken seriously
    Lmao come on, you are a joke.

  17. I do not understand entirely what phenotype means

    If I'm phenotype B and I think I'am.
    Is it possible to become type A with a keto diet ?
    or condemned to stay B by inheritance ?

    Being keto for a year (0.4 to 0.8 keton), I'm baffled by my triglycerides.

    Trigly 1.84
    LDL 1.91
    HDL 0.60

    Total 2.88

    I must have a very bad phenotype, may be type 3.

    Thank you for your fantastic video.

  18. If fasting stops the re-uptake of LDL, is the LDL used as fuel during fasting?

    HOW can the bad LDL be removed from the system if nothing takes it out other than the bad route of swelling under the epithelial calls of arteries and veins? Would fasting do it? Meaning they would be used as a source of fuel during autophage?

  19. https://www.arivale.com/blog/keto-diet-carbohydrates-mortality?fbclid=IwAR2amiHQGcKHUg1447wKOo1hrgZJ0P7zezQsG3o4p6Hz66SiTqnhH44EpoQ

  20. Trying to confim what my apob/apoa1 ratio is but don't have an apob #, but do have ldl particle number, so is apob and the ldl particle # the same thing?

  21. If one is on a keto diet and has a piece of Nan’s birthday cake, because it’s Nan’s 90th birthday and Great Auntie Doris made that cake, will this cause the oxidation process or is a more prolonged exposure needed. Is the keto diet an absolute all or nothing way of eating? I’m not talking hitting Tim Hortons every Friday, I’m meaning sugar once or twice per year.

  22. Great video. Thanks. A small point – the units on the slide @20:20 are wrong. Should be mmol/L and mg/dL. You say it correctly, it is just written wrongly.
    Altogether a fantastic explanation of LDL, particles and atherosclerosis mechanism, together with good info on the importance of triglyceride/HDL ratio.
    Sadly, I am still struggling to understand why my CAC is pushing upward over the last 6 years (580 to 785) even though I am a naturally slim, fairly fit 65 year old with LOW Trig/HDL ratio, low BP, who discovered keto 5 years back and don't smoke or drink! BUT I have sporadic body-wide joint pain/inflammation (not a conventional arthritis), which may be relevant. I am coming to the conclusion it may be Omega 6 oils and am now going totally on a 'I only eat what I cook' regime, to see if that does anything.

  23. Imagine the number of patients who got Pattern A but with high cholestrol, and taking the medicine prescribed by their doctors. Imagine the side effects of those unnecasary medicines.. Gosh!

  24. We are told by many doctors that fruit will help prevent heart disease. But you say we should avoid fructose. Also I'm confused by your statement at 24:20 about statins. Are you saying statins are helpful, or are they not helpful.

  25. My numbers: TC 12,14; LDL 8,32; HDL 3,49; TG 0,72; my dr is very worried. I am in keto for almost 2 years. Please comment!

  26. hello, on the ow carb denver you talked about how statins gave no diference in days of mortality at the end of the conference. you made a questian if you would take a drug for a tyear if it gave you 1 day o week of life. cpuld ypu tell me where i can find this part since diet doctor no loguer has the videos onlñine and also the articules where ypu gpt this info

  27. I live in the southeastern suburbs of Melbourne Australia. Can anyone recommend a good KETO knowledgeable Doctor?

  28. I have a question! I maintain a keto diet, but if I have a weekend every blue moon or so where I let my hair down and eat sugar, will this have a negative effect on my cholesterol??

  29. There are other doctors stating that the c-reactive protein levels are a better predictor of heart disease than HBA1C and cholesterol.

  30. This helps explains why my LDL was over 200 when I got my blood work done and freaked out my doctor and suggested I take statin. I was already around my 16th hour of my fast that day (I do OMAD majority of the week). I didn’t hear it on the video but is the LDL elevated because your body is using mostly fat for energy thus requiring increased LDL carriers for transport? Ive been on keto and fasting for about 4 months.

  31. WOW.. BLOODY WOW! My Dr wanted to double my statin to 10mg based on my cholesterol results. I refused and advised that I would come back to her once I had done 'my' research. I'm a 52yo who has been morbidly obese for 40 years. I've been eating keto for 4 months and by this video, I surfing close to type A.. winning!!

  32. What an awesome podcast! Thank you! This is the first time anyone explained the meaning (and problems with) excessively low triglycerides and high HDL.

  33. My latest results that made my doc talk statins until I asked for a CAC and got a zero. TC=7.3 Trig=0.9 HDL=2.12 LDL=4.4

  34. I've been keto for over a year. I had an LDL of 137, cholesterol 191, trigs of 98, HDLs 37. I ate high fat for three days and took the test. My LDL stayed almost the same, 134, but everything else when bad… triglycerides and cholesterol more than doubled, HDLs dropped by a third, my small LDLs went way into the thousands. Everything was shockingly bad. I ain't doing that again.

  35. at 22:20 Dr. Mason incorrectly states that a very high-fat diet for 3 to 4 days before a lipid panel the LDL will plummet. He meant to say a very high carb diet. But the lowering of LDL is not a good thing because it is only healthy, not damaged LDL that drops.

    Furthermore, Feldman has shown in his personal blood work that fasting must be between 12 to 14 hours or the triglycerides will elevate. Fasting either more or less than 12 to 14 hours will result in higher plasma triglycerides.

  36. The last few minutes didn't make sense: "if you have high LDL on a keto diet, it's been shown that being on a high fat diet for 3 days reduces LDL". – A keto diet IS a high fat diet.

    "If you have a high calorie diet your insulin goes up and LDL receptors both increase and increase in their affinity for LDL" – i think he meant to say a "high carbohydrate diet"

    [sic] A high fat diet and a low carb diet achieve the same thing because of the "strong insulin response" – surely insulin response is weaker under these two conditions.

    I thought that high fat and low carb-induced reduction of insulin and thus decreased LDL receptor (and LDL receptor affinity) would create higher blood LDL (which isn't bad because it's not glycated/oxidized). BUT he is telling us that LDL us goes down instead. So he obviously made at least one error in his speaking and leaves me wondering if LDL actually goes down under HFLC (which he seemed quite adamant about) and therefore asking WHY it goes down since receptor prevalence and affinity are reduced under HFLC. If receptor affinity and prevalence are not reduced under HFLC then why does LDL drop?

    If he meant to say at the beginning "high LDL on a high carb diet" then why should people on a high fat diet have high LDL (the subject of the talk). If he meant to say that LDL increases with a high fat diet the why did he say it fell?

    Any thoughts are appreciated.

  37. This was unbelievably helpful in understanding that my elevated LDL was not a concern by itself and that using Dr. Mason's calculations I am clearly considered within the Pattern A category! Woo hoo! Keto on!

  38. My doctor said exactly the same thing, blood test was perfect, I'm health and fit buuuuuuut, my cholesterol is slightly higher than normal, couldn't help but point that out.

  39. I went keto in 2013, my LDL-P spiked & my Dr said I was going to die unless I took statins. 
    But I had Pattern A large & buoyant size, good C-reactive protein, good HbA1-c, and good inflammatory markers.
    I had a blood test NOT fasted and was made to do another one FASTED. The fasted LDL-P was higher and my Dr was confused af.


  41. So, will the sugar damage eventually be reversed, to a degree, once we've gone on ketogenic diets (particularly if autophagy is happening)? Or, do we just have to hope for the best?

  42. I'm from UK
    May triglyceride is 1.8 mmol/L HDL 2.16 mmpl/L so my ratio is 0.8 . My gp wants me to take medication to lower my LDL 6.9. mmol/L. What do you think ?

  43. My buddy was identified as having extremely high cholesterol and had been placed on meds. Seafoods are usually not on his diet program therefore a choice to move in this path is straightforward for him. Getting this cholesterol manual “Hοzantο Axy” (Google it) is the perfect choice for him. Weeks have went by and also the final results are all impressive, He have his cholesterol level to drop. This medicine does not give you a bad taste. .

  44. This was a great talk. Glucose damages the LDL particles but what about rancid oxidized fats like soybean oil? I wonder how rancid plant oils play a role…

  45. @dr mason here is a letter from my Doctor (below)after blood work on 8-9-19. What should I do here? Been on Keto and fasting OMAD strictly since March 14. Was at 260 now 190 = 70lbs lost. Need to loose 20 more pounds without a heart attack:-).

    From doctor:
    Labs show your cholesterol is extremely high worse then previous and most likely due to the keto diet you are doing. Stop this immediately and focus on a low carb and low fat diet. Your LDL levels are almost triple what they are supposed to be and your risk of heart disease is very high. If the levels do not decrease you will need to start medication. Recommend a repeat cholesterol check in 6 months. Please call to schedule a lab appointment please. Thanks

    My results
    Cholesterol 343 mg/dl (High) Range Reference =100 – 199

    Triglyceride 142 mg/dl (in range) Range Reference = 0 – 149

    HDL Cholesterol 40 mg/dl (in range) Range Reference = 40 – 150

    LDL Cholesterol 275 mg/dl (High) Range Reference = 0 – 99

    CHOL/HDL 8.6 mg/dl (High) Range Reference =0.0 – 5.0

  46. I have high LDL because of my diet…
    high LDL mixes with sugar and becomes toxic

    So the low carb diet makes it more dangerous for us to eat sugar?!?!?!?!?

  47. Thought Dr. Paul was an actual doctor, not a comedian. Marathon runners are extremely lean and they get heart attacks, what's your point doc. ?

  48. Swartzeneger had three heart surgeries due to high cholesterol. Tell me again how looking lean and muscular on the outside is an indicator of arterial health. FFS, you guys are killing people!! 🙄

  49. I've had never had a high cholesterol or a1c (5.2 a1c last year) at that was even at my heaviest at 278lbs. Last year my total cholesterol was under 180 and all my levels were fine, but now that I've been on Keto for 8 months and lost 81lbs (cw 197lbs, 5'11" female, 35yo) **HOWEVER** I just had a new blood test and my a1c went up to a 5.4 (still not bad, but why did it go up when I eat no sugar at all?). Also my total cholesterol is now 297! My triglycerides are 81, HDL is 61, VLDL is 16, LDL is 220!, Chol/HDL 4.9%. My Glyco Hbg panel was fine and so was my comprehensive metabolic panel – liver and kidney function are optimal. My blood pressure was 100/52, bpm was 65.
    I also test my blood sugar/ketone every day before lunch (I do 18:6 fasting) and my blood sugar is consistently 70-80. My ketones are usually 0.6 – 1.6.
    I am just concerned now about my A1C going up 0.2 points and worried about my LDL being so dang high….uggg! I'm losing so much weight still and want to get to 175lbs and now my doctor is very concerned and says I need to stop keto asap

  50. Thank you for this video. It has helped me put meaning to my results. My doctor had advised that my cholesterol level was 'elevated' and suggested that statins were in order. I resisted and he sent me to see the lipids consultant who suggested I try the teeniest dose of statins to bring my LDL down. I had worked out my ratios before, but I did not know how to evaluate the figures. I know now and I am impressed with my figures, thanks to you.

    I started intermittent fasting at the beginning of 2019 to lose a few pounds after Christmas, however, I was still eating carbs. 3 weeks later I went to have a wellness check-up and everything came back fine except cholesterol, which was 'elevated'. The results were: 25 Jan 2019: Total Cholesterol 7.8, Triglycerides 0.88, LDL 5.6

    Trig/HDL ratio: 0.4889

    I continued intermittent fasting and by June when I took another blood test, I was eating 1.5 meals within a 6-8-hour window. I was still eating carbs. My results frightened my doctor, who called me in for a chat. The results were: 19 Jun 2019: Total Cholesterol 8.4, Triglycerides 0.87, LDL 5.9

    Trig/HDL ratio: 0.4143

    A few days before I saw the Lipids Consultant in September, I came across the Ketogenic diet and began it. I gave myself just over 4 weeks before I took another blood test. The results came back as follows: 18 Oct 2019: Total CHolesterol 8.09, Triglycerides 0.77, LDL 5.86

    Trig/HDL ratio: 0.4096

    From what you explained, and from the calculations, I can safely say that my LDL is healthy. I have to go back in January to see the Lipids consultant, who had given me 4 months to bring my LDL down 1 point. It doesn't look like that's going to happen and I hope by that time, he will have found this information about cholesterol and rethink his ideas about prescribing statins to healthy people.

    The mind boggles!

    Thank you so much for all you do.

  51. Bit left field but I've heard the theory that as my CAC score is 850 and as statins are now thought to have an anti inflammatory effect then I should continue Keto but still take a low dose Statin.Any ideas,folks?
    I was on statins for 15 years,I'm 63 and have only the past 6 months been on Keto.Obviously should have gone Keto 15 years ago.My cardiologist has no interest in Keto.

  52. This is too hard to explain to a gp. They look at you as if to say I have more college than you. Yes but Ive done more research.

  53. Dr Paul Mason! Could I ask you what you make of my cholesterol? I recently had the Lipid Subfractions test done (paid out of my own pocket) when I heard you and some others talking about it. My total cholesterol has been higher for the past few years but I have also been pregnant and breastfeeding for the last 5 years (I've had 3 babies and c-sections in that time also). I ended up with gestational diabetes with my 3rd. I wasn't tested during my second pregnancy but suspect I may have been prediabetic as in this postpartum period (now 6 months postpartum) I haven't really been able to reintroduce many carbs (sticking with low carb) because it seems to spike my blood sugar more than what looks good. I did a follow up GTT and had okay results for the fasting and 2h but spiked to 12.1mmol at the one hour. I had my first HbA1c a few weeks ago but because I have been eating low carb, I suspect it too would be higher if I had resumed my usual diet. The result was 5.3%.
    Anyway, back to my cholesterol: Total 8.43 mmol /L; Triglycerides 0.7 mmol/L; HDL 2.80 mmol. The Trigs/ HDL were looking pretty good despite the total, but then the subfractions: Total LDL 5.24 mmol/L LDL 1 – 2.06 mmol; LDL 2 – 1.35 mmol and LDL 3 – 0.31mmol and LDL 4 – 0.05 mmol. Both LDL 3 and 4 are over the recommended levels of 0.15 and 0.01 respectively. What should I do in this case? Stick with low carb eating for the rest of my life so I don't allow this sdLDL to increase or my blood sugar to become T2 diabetic? Will that just keep me in a safe zone with a bit of sdLDL? I also had a C-Reactive Protein test which came back a bit elevated 5.4 mg/L (not sure though if it's related to the sdLDL or whether I was at the tail end of a virus and it picked that up.) Should I just test everything again in another year or sooner? I've been offered statins from before I took the lipid subfractions test but my current GP wasn't sure what to make of the lipid subfraction results and I wasn't keen on quitting breastfeeding to take a statin… Can low carb help rid the body of sdLDL or does it just help prevent more LDL from being oxidised?

  54. We need more training for our gp’s I love my family doctor but she’s convinced I’m going to drop dead because it looks like I’m in the hyper responder category, I think I’m going to do the Feldman protocol and see what she makes of those results after only having my tests last week 🤦‍♀️

  55. I have a very good friend with the same body type, who works out 4 times a week. Great physical shape. He just had his 4 stent placed in his heart vessels after his second heart attack. So this lecture points out why LDL levels is only part of the story.

  56. Brilliant presentation. Thank you so much for posting. It explains the high LDL level, and its significance vis a vis CVD risk or lack there of, esp. in LMHR’s and IM fasters in a most satisfactory manner.

  57. So either be on Whole Foods Plant Based diet.. or be on high fat low carbs diet … Question is what is sustainable in long time

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