Cholesterol and the heart

Triglycerides — fat in the blood that the liver makes from sugar and fructose — fall first and the most. HDL — the “good” cholesterol that removes cholesterol from the blood vessels — rises with dietary fats, especially saturated fats and omega-3s. Total cholesterol may rise — and that means nothing without a breakdown. LDL is unchanged or slightly lower in most people, but rises noticeably in 20-30%, more often in lean people. Analysis — cholesterol on a low-carb diet.

Divide triglycerides by HDL (in mmol/l): below 1 — excellent, 1-2 — good, above 3 — poor. Why this matters more than LDL: the ratio reflects LDL particle size — with low triglycerides and high HDL, particles are large and “fluffy”; they hardly penetrate the vessel wall. With high triglycerides, they are small and dense, and these are the ones that form plaques. The same LDL number with a different ratio means a different risk. Analysis — triglycerides and HDL.

Neither panic nor ignoring it. First, look at triglycerides and HDL: if both are excellent, the particles are large, and most cardiologists consider this a different picture from high LDL with high triglycerides. Second, check ApoB and, if available, particle size. Third, consider family history, blood pressure, blood sugar, and inflammation. Fourth, you can reduce saturated fats in favor of olive oil, avocado, and fish while keeping a low-carb plate: LDL usually falls without losing the other benefits. Make the decision with a doctor based on the full picture. How to read the report — how to read a lipid panel.

Insulin makes the kidneys retain sodium and water — blood pressure rises. When insulin falls, water is released and blood pressure drops by 5-10 mm in the first weeks, and in some people by 15-20 over three months. If you take medication, monitor at home from day one: doses may become excessive, and dizziness when standing is a signal to talk to your doctor, not to stop eating salt. Salt is needed on the method. Analysis — blood pressure on a low-carb diet.

Before menopause, estrogen protects the blood vessels and keeps HDL high, so the risk of a heart attack in women is lower than in men. After menopause, this protection disappears, and over 10 years the risk becomes similar. At the same time, symptoms in women are different: not “chest pain,” but fatigue, shortness of breath, nausea, and jaw pain — and they are more often overlooked. Therefore: a lipid panel, blood pressure, and waist measurement after 45 — once a year, not “when something starts hurting.” The three markers the method improves fastest — triglycerides, HDL, and blood pressure — are exactly the ones that deteriorate first in women after menopause. About perimenopause — after 40: perimenopause.