10+ TOP MEDICAL

TESTS TO FOLLOW
ON THE LCHF DIET

DR. BRET SCHER

INTRODUCTION

Are you interested in trying a LCHF diet but afraid you might be harming yourself?
Or have you been told by your doctor/nutritionist/trainer/favorite celebrity that it is
a dangerous diet? Here’s the good news: it’s not dangerous! And the best news,
you don’t have to guess if it is helping you or not. There are simple tests you can
follow to see if your overall health is improving. Objective data without guessing!
Celebrity trends can’t promise that, can they?

Of course, following a LCHF diet has many benefits which are not measured in the
lab, such as:
• Increased Energy
• Weight Loss
• Mental Clarity
• Lack of hunger
And more…

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

•

Despite these benefits, the medical community still fears avoiding carbohydrates
and eating more fat. They base this fear on decades of poor quality science and
unchallenged dogma. But here is the secret (hopefully not really a secret), their fear
is misguided and generally wrong.

Fortunately, you can measure your progress on the diet and prove to yourself (and
your doctor) that your health is objectively improving. You just have to know what
to follow, and most importantly, what to ask your doctor to follow.

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 Why do I have to ask my doctor? Shouldn’t she/he already know what to follow?

Great question. (that’s why I asked it).

Many physicians practice within traditional norms and established guidelines.

Unfortunately, these norms and guidelines were developed from people eating
either the standard American diet (SAD) or a low-fat diet, and thus these norms are
ill-equipped to adequately monitor a LCHF diet.

Your doctor, therefore, may need a little nudge to check blood tests that are out of
the norm. You may hear, “I have never checked those before.” Or “Those tests
aren’t part of our usual workup.” That’s OK. Just smile, acknowledge their
statement, and say “I understand that. And here is what is so interesting. I read that
a LCHF diet is very different from the standard diets, and therefore may benefit from
different monitoring tests.” Then dive right into my list of the 10+ most important
markers to follow when you are on a LCHF diet.

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

Below is a list of the tests and the expected results on the LCHF diet. The second
section has a more detailed description. Please note that the basic tests are easily
ordered in almost all labs. The bonus tests, however, may require special labs or
special protocols to measure.

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BASIC TESTS
HgbA1c- should go down
Fasting glucose and fasting insulin (HOMA-IR)- should go down
hsCRP- should go down
LDL- usually unchanged, but could go up or down
HDL- should go up
TG- should go down
TC:HDL ratio- should go down
TG:HDL ratio- should go down
Apo B or LDL-P- usually unchanged, but could go up or down

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

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BONUS TESTS
OGTT or Kraft test- glucose and insulin should go down
Fibrinogen- should go down
sdLDL- should go down
oxLDL- should go down
LDL phenotype- should be pattern A

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

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MORE IN-DEPTH DESCRIPTION
OF THE TESTS
1. Measures of glucose control AND insulin sensitivity- Most doctors
frequently follow just the glucose level and assume that is adequate. The
problem is that by the time the glucose is out of control, we have had years if
not decades of hyperinsulinemia trying to keep the glucose in check. We can
be much more proactive by detecting abnormal insulin levels, and thus fixing
the problem long before it effects our glucose level.

a. Fasting glucose AND fasting insulin- This allows you to calculate what is
called a HOMA-IR, which is essentially an equation using both glucose and
insulin levels. This is a great marker for insulin sensitivity. Here is an example.
A fasting glucose of 90 (normal) with a fasting insulin of 20 (high) suggests
that your body is working hard producing a very high level of insulin in
order to maintain a normal blood glucose (thus an elevated HOMA-IR). This
is an unhealthy state, with potential damage from years of elevated insulin

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

levels, and definitely on the road to metabolic disease and diabetes. On
the other hand, a glucose of 90 (normal) with an insulin of 2 (normal)
represents a very healthy state with a normal blood glucose at a low insulin
level (a low HOMA-IR). That tells us you are sensitive to insulin, and your
pancreas does not have to work overtime to maintain a healthy blood
glucose level.

b. HgbA1c- This is a marker of your 3-month average blood glucose. If this is

elevated, you know you have both a glucose and an insulin problem. This
may be inaccurate if you have disorders of your red blood cells (i.e. they
do not last 3-months like a normal red blood cell), but otherwise it is a
reliable test for a long-term glucose average.

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 c. Bonus Tests: The above tests are very easy to do and you should get very
little push back from your doctor. The following are a little more logistically
challenging, and may be harder to get ordered.

i. Oral Glucose Tolerance Test OGTT- You start by drinking a 75-gram

carbohydrate sugary drink (not an easy or pleasant thing to do) and
then measure your glucose level at 1-hour and 2-hours. Since the
average person spends more time in the post-prandial state (i.e. having
eaten) rather than the fasting state, it can be very helpful to see how
your body handles a carbohydrate load. This measures your body’s
ability to respond to glucose, and your body’s sensitivity to insulin, and is
much more sensitive than just measuring a fasting glucose.

ii. Kraft test- This test is the same as the OGTT above, but you measure both
glucose and insulin. Adding insulin increases the sensitivity of the test
and will identify issues earlier than if you only measure glucose.

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

2. Measures of inflammation- Acute inflammation, such as with an
infection or injury, is necessary and beneficial. The problem comes when we
have chronically elevated levels of inflammation as this can affect our lipids,
our insulin sensitivity, our hormone levels, and even our weight loss.

a. High sensitivity C-reactive protein (hsCRP)- This is a very sensitive marker of

inflammation, and is most useful to track trends as you change your diet
and lifestyle. Results can vary depending on what is going on at that
moment. It therefore has to be interpreted with caution. You should try to
measure it when you are at your true steady, more than 12 hours after
intense exercise, and preferably when you are at your healthy baseline
(i.e. not sick with a cold or worse).

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 b. Bonus Test: Fibrinogen- This is a protein associated with forming blood clots.
You need elevated fibrinogen if you have a serious cut and need to stop
the bleeding. Chronic elevation, however, signifies chronic systemic
inflammation and thus can be an additive marker to CRP to follow
changes in your inflammatory levels.

3. Lipid Profile- Lipids are likely the most controversial topic regarding LCHF
nutrition. But it doesn’t have to be this way. The key is to evaluate the entire lipid
profile, as detailed below, as opposed to relying on just one marker such as the
total cholesterol or LDL concentration.

a. Apolipoprotein B (Apo B) or LDL particle number (LDL-P)- The traditional

lipid panel measures an LDL-C, or total concentration of your LDL
(described in more detail below). A better marker, however, is measuring
the total number of LDL lipoprotein particles, rather than the total
concentration. The classic analogy is this: what causes traffic? The number

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

of people in the cars (i.e. the concentration of people on the road or
concentration of LDL), or the number of cars on the road (the total number
of lipoproteins)? One lipoprotein particle with an LDL concentration of 100
(i.e. one car with 100 people in it) is thought to be less “dangerous” than
100 lipoproteins each with one LDL. Either way the LDL-C is 100, but they
represent two very different scenarios. Since each LDL lipoprotein has one
Apo B on it, the Apo B is an accurate proxy for measuring the number of
particles. These tests are not included in the standard lipid profile, so they
will need to be ordered additionally. They are very helpful in diabetes and
insulin resistance, as there is frequently a discordance between LDL-C and
LDL-p (i.e. LDL-C is normal but LDL-P is elevated).

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 b. Low density lipoprotein (LDL)- Traditionally called the “bad” cholesterol,
LDL is actually not inherently evil. LDL has a role in our bodies for fighting
infections and inflammation, and also helps with energy delivery. In the
setting of low HDL, high TG and insulin resistance, however, a higher level
of LDL correlates with a higher risk of cardiovascular disease (CVD). In the
opposite situation, high HDL, low TG, insulin sensitivity, LDL does not
correlate as well with risk of CVD. Therefore, context is crucial when
interpreting LDL results. Also, contrary to popular belief, most people on a
LCHF diet see no meaningful change in the LDL. Less than 30% of
individuals (likely closer to 5-10%) may see a 50-100% increase in their LDL.
While we do not know that this is dangerous, it is something of note and
may require further investigation or alterations.

c. High Density Lipoprotein (HDL)- Traditionally called the “good” cholesterol,

it tends to track with insulin sensitivity, going up with improved sensitivity
and down with insulin resistance. In addition, HDL goes up with eating
more fat and greater levels of exercise. Having naturally high HDL levels

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

seems to negate the risk of LDL. Interestingly, drugs that increase HDL do
not lower cardiac risk. The benefit only seems to come from natural
elevations, i.e. through lifestyle!

d. Triglycerides- TGs are elevated in diabetes and states of insulin resistance,

and frequently come from increased carbohydrate ingestion. Triglycerides
are an important source of fuel for the fat adapted individual, and the
main source of fuel when in ketosis. Triglycerides tend to go down on a
LCHF diet as your body is efficiently using them for fuel.

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 e. Total cholesterol to HDL (TC:HDL) ratio- This is not a separate test, but simply
using results you already have to get a ratio. It is a better predictor of CVD
than just LDL alone since it factors in LDL and remnant particles, and
accounts for the protective benefit of naturally elevated HDL. It is easily
calculated from a standard lipid profile, but frequently is overlooked.

f. TG:HDL ratio- Similar to TC:HDL ratio, it is a marker of insulin resistance and is

easily calculated from a standard lipid profile. It is also a better predictor of
cardiovascular risk than LDL alone.

g. Lipoprotein a (Lp(a))- This is a helpful one-time test, but not all that helpful
to follow over time. Higher levels are associated with more atherogenic
lipoproteins, an increased risk of cardiovascular disease, and frequently go
along with a family history of CVD. Studies show that lowering Lp(a) with
medications, however does not decrease clinical risk of CVD. Instead,
when Lp(a) is elevated, more attention should be paid to LDL and other
risk factors.

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

h. Bonus Tests: These are not measured by standard lipid tests and usually will
require sending the blood to special labs.
i. Small, dense LDL (sdLDL)- A higher proportion of small, dense LDL
particles is associated with greater cardiovascular risk. Again, however,
this is highly influenced by insulin resistance and inflammation.

ii. LDL phenotype (Pattern A or B)- This reflects the overall size of the LDL
particles. In a simplistic way, pattern A represents less dense particles
that are less harmful (easy memory device, A is Awesome). Pattern B
reflects the denser, more worrisome particles (B is Bad). A LCHF diet can
help change pattern B to pattern A.

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 iii. Oxidized LDL (oxLDL)- Oxidized LDL particles are “damaged” and easily
taken up by macrophages. This turns the macrophage into foam cells
which leads to unstable plaques and heart attacks. Normal, non-
oxidized LDLs, however, are not taken up very well, and therefore pose
a substantially smaller risk. Anything that reduces inflammation and
oxidation can help reduce the risk of your LDL.

There you have it. 10+ Top Medical Tests to Follow on the LCHF diet. Remember, you
don’t have to guess if things are getting better or not. You can measure them! And
you don’t have to do this alone. Talk to your doctor and join one of them many
online support groups. If you have any questions or concerns, you can always
contact us for more information or to schedule an individual consultation at
www.LowCarbCardiologist.com

Bret Scher, MD FACC

Founder, Boundless Health

10+ TOP MEDICAL TESTS TO FOLLOW ON THE LCHF DIET

www.LowCarbCardiologist.com

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Bret Scher, MD FACC
Founder, Boundless Health
www.LowCarbCardiologist.com