Before starting an LCHF lifestyle, consider having blood tests to find out your existing risk of developing cardiovascular disease, diabetes, and other lifestyle diseases. With that knowledge you can tailor your LCHF lifestyle to get the most health improvements and reduce your risk of future disease.
Test results explained
After you have a blood test you get the results printed in sections under different headings. For example, there’s a section with the heading ‘Full Blood Count’, another is ‘Liver Function’, another ‘Lipid Studies’, and so on, depending on which tests your doctor ordered.
Doctors call each section a panel.
The lipid panel of our blood test results from the laboratory our doctor uses, shows the values of these fractions:
- total cholesterol
- HDL cholesterol
- LDL cholesterol
- ratio of total cholesterol to HDL
Although still given, the total cholesterol is not important like once thought. How much HDL you have, and what type of LDL you have, are the important results now.
In his excellent video talks, the medical-test expert, A/Professor Sikaris, explains how high blood sugars (glucose, and in particular, fructose) cause the liver to make a fat called triglyceride.
To see Prof. Sikaris’ talks, scroll down our YouTube playlist.
When triglyceride rises, it causes the ‘good’ HDL cholesterol to fall, and the number of small dense LDL particles to increase.
In other words, these three values in the lipid panel – not total cholesterol – are the real markers of cardiovascular disease risk:
- triglyceride (often abbreviated to TG or ‘trigs’)
- small dense LDL (usually written as sdLDL)
1.Triglyceride (how high is it?)
The laboratory our doctor uses here in Kuala Lumpur flags a triglyceride level of more than 1.7 mmol/L. In Australia the cut-off is lower, and Dr Sikaris says triglyceride above 1.5 mmol/L is cause for concern.
Ideally, he recommends the fasting triglyceride level for men should be 1.0 mmol/L or less. Women naturally have higher values, so for women he recommends the ideal is below 1.3 mmol/L.
Adopting an LCHF lifestyle is the most effective way of lowering your triglyceride level.
2. HDL (how low is it?)
Rising triglyceride level causes the ‘good’ HDL to fall, so people with a high triglyceride level always have a low HDL value in their lipid panel.
The local laboratory lists a lower limit for HDL of 1.03 mmol/L, but in reality we don’t want to get just over this threshold: the higher the HDL is above 1.03 the better.
That’s because the ratio of how much HDL you’ve got, compared with how much triglyceride you’ve got, is known to predict if your LDL is the dangerous small dense type. The HDL:TG ratio is therefore a strong indicator of future cardiovascular disease.
If your blood test shows you have a low HDL number and a high triglyceride number, it’s time to take a very close look at the amount of carbohydrate and sugar you’re consuming. And for that an online food tracker is very helpful.
3. LDL (what type is it?)
LDL cholesterol is noted in the blood panel, and because the amount was once thought to be an important indicator of future heart disease, LDL was always considered ‘bad’ cholesterol.
It’s now known that LDL is not ‘bad’, and the actual amount of LDL is not important. What is important, is the type of LDL cholesterol you have.
There are several types of LDL particle. Some are larger and fluffy; some are smaller and dense. The fluffy ones are harmless; the small dense ones are harmful.
Small dense cholesterol particles (usually abbreviated to sdLDL) appear to have the ability to squeeze between the tiny spaces in the lining of artery walls.
There they become oxidised, or glucose sticks onto them (a process called glycation), which changes their characteristics even more. They’re no longer normal, harmless LDL particles – they’re smaller and denser and oxidised or glycated.
Cells of the immune system called macrophages detect the abnormal sdLDL particles and attempt to remove them by gobbling them up.
As the process continues, the artery wall accumulates a growing mixture of oxidised small dense LDL and bloated macrophages. The mixture is called plaque, and the developing condition is known as atherosclerosis.
The plaque build-up continues, until the artery lining eventually splits, releasing a sticky mixture of sdLDL cholesterol and swollen macrophages, which blocks the artery. If the blockage is in the heart, it causes a heart attack. If in the brain, a stroke.
Small, dense, and dangerous
Instead of knowing how much LDL I’ve got, I would much rather know how much of it is large, fluffy and harmless, and how much is small, dense and dangerous.
At this juncture, the local laboratory is unable to test for the different types of LDL particles. However, that doesn’t matter too much because it’s possible to predict what proportion of the LDL is large and fluffy, and what proportion is dense and dangerous.
From detailed studies of the biochemical processes going on in the liver, doctors now know there is a relationship between triglyceride, HDL, and the number of small dense LDL particles.
A low triglyceride level accompanied by a high HDL level means there are few of the dangerous small dense LDL particles, and therefore a low risk of atherosclerosis.
The converse is also true.
A high triglyceride level accompanied by a low HDL level means a high proportion of dangerous small dense LDL particles and an increased risk of atherosclerosis.
As you can see, your triglyceride and HDL numbers tell you a lot about your future risk of cardiovascular disease, and whether you need to make any urgent changes to your diet.
If you’ve got the trio, make changes now. After all, there’s no point waiting until you’ve developed atherosclerosis.
In particular, look at the amounts of carbohydrates and sugars you eat and drink, and investigate how the LCHF lifestyle would benefit you.
Other useful tests
4. ALT for Fatty liver
As you know now, when blood sugar is high, the liver converts all the sugar the body can’t use for energy, or store as glycogen, into fat known as triglyceride.
Some of the triglyceride gets deposited around the waist and hips, but some remains in the liver, eventually making it fat – a condition known as non-alcoholic fatty liver disease. It’s often abbreviated to NAFLD.
Fatty liver is a strong indicator of metabolic syndrome, rising body weight, diabetes, and cardiovascular disease.
The liver function panel of your blood test results will tell your doctor if you’ve got something wrong with your liver.
Look down the list and you’ll see ‘alanine transaminase (ALT)’.
Prof. Sikaris recommends paying attention to this test value, because it could indicate you are developing fatty liver, or already have fatty liver, depending on how high the test number is.
Our laboratory gives the number 55 as the upper limit, so anything below that is good, and obviously the lower the better.
If your number is higher than 55, your doctor may check the size of your liver by palpation and ultrasound. A liver engorged with fat is larger than a normal, healthy one and these two simple tests help with the diagnosis.
As you may know, the so-called delicacy, foie gras, is made from the fatty livers of ducks or geese. The poor birds are forced to eat corn until their livers become large and full of triglyceride.
Starchy carbohydrates do the same to our livers. it seems logical therefore, that cutting starches from the diet is the first step to reversing non-alcoholic fatty liver disease.
5. Blood glucose during last 90 days (HbA1c test)
Even if you are not diabetic, it’s good to know your blood glucose level. That’s because glucose is a very sticky substance that tends to adhere to proteins and stop them working properly – a process called glycation.
As I mentioned above, glucose sticks to the protein coating of the small dense LDL particles and alters them further, contributing to the development of plaques in the arteries.
In the blood glucose also sticks to the protein in red blood cells called haemoglobin.
The most common measurement of blood glucose is the fasting blood glucose level, but it only tells you how much sugar you had in your blood at that snapshot in time when your blood was drawn.
And it varies from day to day, so if you repeated the test the next day you’d get a different result.
A more useful assessment of what your blood glucose has been like, is to measure how much sugar is stuck on the haemoglobin of your red blood cells.
They have a lifespan of about three months, so testing them to see how much glucose they have on them will give you a good idea of your blood sugar level during the last three months or so.
The test is called HbA1c.
Dr Sikaris says if your HbA1c level is higher than 5.6%, there is an increased risk of cardiovascular disease. Also, you’re on your way to diabetes.
Adopting an LCHF lifestyle is a very effective way of lowering your blood glucose and therefore your HbA1c, thereby reducing your risk of developing cardiovascular disease and diabetes.
6. Insulin level
In a healthy person, the amount of sugar in the blood is equivalent to about 1 teaspoon.
After eating something, the blood sugar rises. The pancreas gets a signal to release a hormone called insulin, which lowers the blood sugar down to 1 teaspoon again.
Fats cause a very small increase, proteins a greater increase, and carbohydrates a large increase in blood sugar.
Insulin has many functions, and there’s more info about insulin and blood sugar, and why the levels are important for health, in this post.
Here’s a thumb-nail sketch…
Many people, who frequently have refined carbohydrates and sugary drinks for meals and snacks, develop a kind of resistance to the effects of insulin. As Dr Mike Eades puts it, insulin is calling, but the cells are not listening.
High levels of sugar in the blood do a lot of damage, particularly to the very small blood vessels in the eyes, kidneys and feet.
The body’s sensors begin ‘shouting’ at the pancreas to make more and more insulin, in order to get the ‘deaf’ cells to accept more and more sugar, thereby geting it out of the bloodstream.
Eventually, there’s enough insulin to force sugar into the cells and the blood sugar level slowly falls.
At this stage, you and your doctor will be quite happy your blood test shows your sugar level is still within the ‘normal’ range.
After more years of churning out vast quantities of insulin to keep blood sugar down, the body’s cells eventually become really ‘deaf’ to insulin, and blood sugar rises. There’s plenty of insulin, but it’s having no effect.
A diagnosis of diabetes is just around the corner.
The diagnosis could have been foreseen if less emphasis had been placed on the sugar level, and more emphasis on the rising insulin level in the background. Timely dietary interventions could have been recommended and diabetes averted.
Simply put, carbohydrate is digested to glucose. Glucose causes insulin to rise. Reduce carbohydrate – especially processed carbohydrates and sugars – and both blood sugar level and insulin level remain in their healthy ranges.
Ideally, a Kraft Assay would best inform you how far along the road to diabetes you are. Prof Grant Schofield has a good description of the test and its importance in this article on his blog.
Dr Kraft worked in a university hospital and had the facilities to measure a patient’s insulin level over a period of 5 hours, after the patient had been given a known quantity of sugar solution.
In every day practice, not many people are motivated enough to spend a day in hospital having umpteen blood tests. It’s possible to get a good idea of your insulin status with a simple fasting insulin blood test before breakfast.
Some doctors recommend an additional test 2 hours after your morning meal, to see how high your insulin rises in response to your meal. This will show you if you are needing to make a lot of insulin to get your ‘deaf’ cells to respond.
In the pancreas, insulin molecules are made from two halves, as it were. A substance called c-peptide joins the two halves together to make insulin, which is released into the bloodstream to do its various jobs.
After the insulin parts have been joined, c-peptide is released and is re-used to make more insulin.
Because one molecule of c-peptide is released for every molecule of insulin made, measuring c-peptide in the blood is a good surrogate for insulin and will show you how much insulin you have been producing.
If you don’t want a 2 hour or 5 hour insulin assay, ask your doctor to add a c-peptide test to your standard fasting blood panels. There’s a good description of the test at diabetes.co.uk.
Inflammation is at the root of most disease. Knowing how much inflammation is going on inside your body gives you a heads-up for diseases coming your way in the future, and enables you to take preventive action now.
C-reactive protein is a substance made when inflammation is occurring. Testing for it is easy, so check with your doctor the high sensitivity c-reactive protein test – usually abbreviated to hsCRP – is on the list of to-do tests.
A low carbohydrate, moderate protein, healthy fat way of eating is very effective at reducing inflammation. Converting to a LCHF lifestyle will help reverse, and prevent further progression of the destructive inflammation that is the hallmark of modern lifestyle diseases.
These two tests (urate and troponin) are not essential, but you may find them helpful before starting your LCHF lifestyle.
Urate is useful if you want to know before you start, if LCHF will work for you.
Troponin is useful if you suspect your heart has suffered some damage recently and you’d like to check.
a. Blood urate (to test carbohydrate sensitivity and if LCHF will work for you)
The amount of uric acid building up in your blood is a good indicator of whether you will benefit from the LCHF lifestyle.
That’s because the amount of uric acid in your blood tends to increase as you lose control of your blood sugar and insulin levels on the way to developing metabolic syndrome and later, diabetes and heart disease.
If your blood uric acid level is low, you can deal with carbohydrates well, and could adopt an LCHF lifestyle with a level of carbohydrate around 100 gm a day. That would give you all the health benefits of LCHF while enjoying a reasonable allowance of your favourite carbs.
If your uric acid level is high, you would respond well to a much lower carb intake of 30 gm a day, or less. That low level of carbohydrate intake gives you the health benefits of the LCHF lifestyle, including regaining control of your blood sugar, insulin, and urate levels.
b. Troponin (to test if your heart muscle has been damaged recently)
Troponin is a substance made by certain muscle cells of the heart, which increases if the muscle cells have been damaged by, for example, a heart attack.
The test is not necessary before adopting an LCHF lifestyle. I’ve only mentioned it because Professor Sikaris suggested the test if you have any concerns about your recent heart history and want to check it.
Metabolic syndrome is a group of factors that indicate if you are on the way to so-called lifestyle diseases like obesity, diabetes, cardiovascular disease, cancer, Alzheimer’s, arthritis, and a host of other conditions.
You don’t need your doctor to perform any special tests for metabolic syndrome – you can easily diagnose it yourself.
According to the National Cholesterol Education Program of the National Heart, Blood, and Lung Institute in America, if you have three or more of these five factors, you have metabolic syndrome:
- Waist measurement greater than 102 cm. (Or 88 cm for women)
- HDL cholesterol level more than 1.0 mmol/L. (Or 1.3 mmol/L for women)
- Triglyceride more than 1.7 mmol/L.
- Blood pressure higher than 130/88.
- Glucose level above 6.1
To sum up
Before you start a LCHF lifestyle, find out:
- If you have metabolic syndrome – easily diagnose this yourself (see previous paragraph).
- Your HDL level.
- Your triglyceride level.
- Your LDL particle size. If a specific test is not available where you live, estimate it from your HDL and triglyceride levels.
- Your HbA1c to see your blood sugar level over the last three months.
- Your insulin or c-peptide level to see if you are having to make lots of insulin to keep your blood sugar down.
- Your hsCRP level to see if you have inflammation.
- Your ALT level to see if you have fatty liver.
Consider asking you doctor to repeat the blood tests a month or two after you start LCHF to check you’re on track.
Or get the tests done after you have been LCHF for six months or more, depending on your level of health before you started your new LCHF lifestyle, and the changes you are seeking.
Keeping it short and simple is often the best.
Weight fluctuates a lot, down one day, up the next. Avoid the scales. One day you’ll be elated, the next day depressed.
A really simple way of checking your progress is to measure your waist. If you’re losing centimetres, you have successfully converted to LCHF, and your new lifestyle is benefiting you.
If you are taking medicines, please don’t forget to read the page Medical Cautions before you start your LCHF lifestyle.
And as always, if you need some clarity, please type in the comment box below. I’ll get it and reply to you asap.
Or if you prefer email, my address is on the Contact page.