Apr 24

Discovery Progress, Break Nutrition Podcast, Justice for Noakes

The Discovery Update

I know I’ve been extra coy for the last few days and generally off social media. Yes, I’ve come into new ground with my research and it’s required intense attention and planning for the last few days. As mentioned earlier, I suspect I’ll be able to do a first report on it in about one to two weeks. But in the mean time, I will be a lot less active on the interwebs than usual. The best two places to reach me are here in the comments and on twitter (@DaveKeto).

Breaking it Down with Break Nutrition

I had a great time chatting it up with Raphi Sirt on the Break Nutrition podcast. We covered extreme N=1, the cholesterol / lipid system and my recent fasting experiment.

These guys at Break Nutrition have more good content about high-fat diets such as low carb and ketogenic diets. They tell you how to kick-start your ketogenic diet, how to measure your level of ketosis and what the benefits of ketogenic diets are on inflammation.

I’ve actually been following Raphi’s twitter account for a long time. His story is similar to mine where he found a sudden course correction into biochemistry and ramping up his education on the subject. He is likewise very interested in some of the deeper meanings to the metabolic engine and has a keen eye on his own metabolic data.

Justice is Served!

Professor Tim Noakes is found innocent of misconduct by a 4-1 decision of the Health Professions Counsel of South Africa (HPCSA). This was a large victory on multiple fronts. Obviously making an entire case on a tweet is already problematic given the hard limitations of the medium. Moreover, assigning doctor-patient relationships via public social media contact is likewise as silly as it reads.

Most of all, “the Prof” got to take evidence of the low carb high fat diet to court and weigh it directly in the light of day. I can’t imagine the hardship this has put Tim and his family through. But for as hard as this closing chapter has been for his family and his team, the next one will be much brighter for everyone else from their dedication to this case.

A sincere thank you from my family to yours.

Apr 22

A New Possibility

 

 

Sorry to be so cryptic, but I’m in an unusual situation. I need to let everyone know I’ve had a sudden turning point with my research, but I can’t explain what it is just yet (which will be made obvious later). This is of a level that I need to put extraordinary focus on it, so I’ll be less active with social media.

I can’t talk any further about it until I’ve reached a certain threshold of certainty, which will take some time. My best guess is that I’ll be able to give a preliminary report about in about a week or two.

Thank you for your patience!

Apr 20

The Fasting Disaster

fasting_macros

Fasting has been all the rage lately. Jimmy Moore and Jason Fung released a book on it that quickly shot up the New York Times Best Sellers list. In fact, it has been so popular that they launched a podcast on it at the beginning of this year. Oh, I did I mention the episode featuring Jason Fung and fasting is still the most downloaded of the 2 Keto Dudes podcast?

Yet other high profile low carbers such as Dr. Stephen Phinney are not part of the fan club. My personal favorite article on the subject was Not So… Fast… (A Rant) from the prolific Amy Berger.

While on low carb myself, I’ve only ever intentionally fasted for 14 hours at a time, which was only done to meet the requirements of a blood draw. But while I don’t feel hungry when fasting, I don’t feel… right.

To be sure, I’ve wondered if I want to eat all the time so that I either maintain or gain weight, given I’m underweight right now. And therefore my feeling odd when not eating is perhaps entirely mental manifestation. Regardless, a fast of a few days probably wouldn’t be that bad anyway, right?

The Experiment

The plan was pretty simple:

  1. I’d take a blood draw in the morning at the beginning of the fast.
  2. Fast for three days while both supplementing and keeping electrolytes high, but otherwise drinking only water.
  3. Take a final blood draw for comparison on the morning 72 hours after the first blood draw. So in all, 86 hours will have passed since my last meal, making it a total of 3.5 days.

Execution

Day One: I was surprised to find I wasn’t hungry at all. This seemed to back up my theory that if I had already made the commitment to myself to forgo eating, my brain wouldn’t send me subconscious “shouldn’t we be eating?” signals.

As happens with me when I’ve lowered my total calories for an experiment (but while still being keto), I feel run down and puny. I have an overall feeling of lower energy. I also feel a little dispirited in this state, but its hard to tell how much of that is annoyance of that phase of the experiment vs it being an actual physical response.

However, that not-feeling-right sensation I mentioned above?… I was certainly getting that signal. But I had hoped I’d only feel it on the first day.

Day Two: I still wasn’t feeling hungry. And while I did continue to feel low in energy, it wasn’t notably better or worse.

However, the not-feeling-right sensation was definitely much, much higher. It was like nothing I’ve experienced before this point. In my imagination it was as though my body found a red phone line and called some special center of my brain to say, “ABORT! ABORT!” No physical pain, no odd changes in the senses, nothing other than a feeling… a feeling this was terribly wrong.

By the evening I decided to go ahead and cut the experiment short. I’d take my blood on the morning of Day Three as opposed to Day Four. Heck, at least it was a 2.5 day fast in the Data Can. I just knew I’d feel annoyed if my numbers had hardly changed. (Just writing that last sentence makes me laugh out loud now…)

General Bloodwork

In every blood draw now, I get a slate of general panels like a CMP and CBC. The latter is known as a Complete Blood Count and has 14 markers. These numbers always been in range… until this time.

 

Ref Range 3/21/17 3/23/17
RBC 4.10-5.70 5.02 5.85
Hemoglobin 13.0-17.0 15.3 18.1
Hematocrit 37.0-49.0 44.6 52

All of these markers have to do with red blood cells and their functionality, which I won’t cover here. What I really wanted to see is if I had fallen off on my electrolytes, which would explain both the run down feeling and my general sense of malaise.

 

Ref Range 3/21/17 3/23/17
Sodium, Serum 134-144 137 136
Potassium, Serum 3.5-5.2 5.1 5.8
Calcium, Serum 8.7-10.2 9.6 10.5

Interesting — instead of being under, I was over on K and Ca.

Cholesterol

Of course the big one is the lipid profile. And if you follow me, you already know what I’d predict after fasting for the very first time given the Inversion Pattern –> a record increase in LDL cholesterol.

So what happened? I hope you’re sitting down for this….

 

Ref Range 3/21/17 3/23/17 Difference
Cholesterol, Total 100-199 371 479 +108
HDL-C >39 72 70 -2
LDL-C 0-99 284 368 +84
LDL-P <1000 2068 3348 +1280
Small LDL-P <=527 <90 546 +546
Triglycerides 0-149 76 205 +129

Indeed it was a record!

Let’s unpack a few things:

  • Like the Extreme Drop Experiment from last year, this one had a heavy shift in dietary energy, as in a sudden drop off. And likewise this huge degree of change broke the Inversion Pattern with LDL-P, while still demonstrating its general direction (lower fat = higher cholesterol).
    • Given the pattern up to this point, we’d have expected LDL-P to land around 2200, but it instead landed much further upward at 3348. This is strikingly consistent with with the drop experiment that likewise overshot in the other direction (from 2597 to 1487 in three days!).
    • Yet LDL-C would be expected to land around 355 +/- 22 and sure enough it landed at 368.
  • While I don’t like doing these huge shift experiments, I am glad they continue to reinforce the general mechanics of the Inversion Pattern and further establish its nature.
  • Once again Small LDL-P pops up in a low dietary energy context.

Final Thoughts

  • While the experience wasn’t great, the data from this experiment was golden! As predicted, the Inversion Pattern kicked in and demonstrated just how fast cholesterol can rise while fasting, particularly for a hyper-responder like myself. I guess that last bit doesn’t actually sound like good news, but don’t worry, the blood test taken just 4 days later (not shown) had my Total and LDL cholesterol drop down near where they were on 3/21.
  • I already didn’t enjoy fasting for even a half day before this experiment… now I’m very sure I don’t want to fast for longer either. This might be something I’d consider if I weighed more, but probably not. The incredibly alarming feeling I experienced was something I’d prefer to leave in the past.

[UPDATE]

Hat tip to James DiNicolantonio who pointed out my Uric Acid likely had likely risen and I sure enough it proved to be true:

Ref Range 3/21/17 3/23/17
Uric Acid, Serum 3.7-8.6 5.8 8.2

I run a script that captures every marker outside its reference range and (unfortunately) mostly noticed those that did. Technically, Uric Acid was still inside, but obviously moving upward fast. Would it have gone above range had I been fasting another day? Alas, I’m now unwilling to find out anyway.

Apr 10

Impact of Endurance Running on Cholesterol

Exercise Impact Infographic

Exercise Impact Infographic

(Huff) (huff) (huff)… “I’d better be right about this…” I thought.

I was on the fifth mile of a seven mile training run, and was not love’n it. It wouldn’t have been so bad had I been following the training schedule, but I wasn’t. I was woefully undertrained. I was holding off endurance exercise as long as possible for my research because I had speculated all along that it would impact my lipid numbers.

Indeed, it was my plan all along to have a long Low Exercise Phase followed by long High Exercise Phase. This way each group of blood tests could be distinct from each other to compare.

I was certainly all set to find out. In just a five month span my wife and I had several runs scheduled, including four half marathons and one full marathon. So if there were differences to be found, I was pretty confident they would be showing up!

Let’s take a look at the timeline before delving into the results.

My wife and I as Groot and Rocket for the Disney Avengers Half Marathon

My wife and I as Groot and Rocket for the Disney Avengers Half Marathon

  • August 22nd – Training and exercise phase starts
  • Sept 19th – Blood test (followed two days after the 7 mile training run mentioned above)
  • Sept 24th, 25th – 10k and half marathon – Couldn’t do blood tests as we were in Paris
  • ** => October 3rd – 12th – Extreme Drop Experiment and Ketogains Seminar presentation <= **
  • ** => October 5th, 7th, 10th, 12thBlood tests for Extreme Drop Experiment <= **
  • October 21st, 24th – Blood test
  • November 5th-6th – 10k and half marathon
  • November 7th – Blood test
  • November 12th-13th – 10k and half marathon
  • November 14th – Blood test
  • November 21st – Blood test
  • December 20th – Blood test
  • January 4th-8th – 5k, 10k, half marathon (canceled), full marathon
  • January 9th – Blood test
  • January 10th – Restart low exercise / sedentary phase
  • January 26th – Blood test
  • February 9th – Blood test

** NOTE: I had to intentionally remain sedentary throughout Ketogains experiment given I assumed it would impact my lipid numbers and create confounders. Thus, the below graphs exclude the blood tests of October 5th, 7th, 10th, 12th 2016 given they didn’t include the exercise/training within.

Endurance Running Effect on LDL-C

Okay, now let’s get to the graphs. As usual, I present the left and right axis in relative terms so you can see the obvious relationship. Thus, the one of the left starts at the bottom with -10 and goes upward to 490 with the one on the right starting at 120 and going to 400.

exercise_ldlc_positive

And now we’ll flip the left axis to show the inverse correlation, so it will now start with 490 at the bottom and go up to -10.

exercise_ldlc_negative_graph

Voila! You can now see a number of things:

  • In the Low Exercise Phase in the first 2/3rds of the graph you can see the tight inverse correlation between my three day dietary fat (in dashed orange) and the resulting LDL-C score (in solid blue). Of course this is very old news to me now, but if you’re just joining us and you’re finding yourself stunned, you probably haven’t watched my recent presentation at Low Carb Breckenridge or read my series of posts regarding these patterns.
  • Given the pattern on the left, we can see how our expected trend line pattern is as it comes into the High Exercise Phase on the right 1/3rd. And as is immediately apparent, the LDL-C trends comes in generally lower than we would expect on the Low Exercise Phase.
  • The two largest gaps are the first data point at the very beginning phase and the last one at the end.
    • Per my story above, the first one is the blood test following a sudden entry into the running schedule without much conditioning before it. It was miserable and I was especially sore, to no surprise.
    • The last one was a Monday blood test following four days and three races: 5k / Thursday, 10k / Friday, full marathon / Sunday. Naturally I was extremely sore and spent following this as well. (I also did an experiment inside the marathon as well which proved interesting)

My original hypothesis definitely had some considerably evidence behind it now. But before I break it out, let’s look at the other markers…

Endurance Running Effect on LDL-P

exercise_ldlp_positive

Again, LDL-P appears to have a far stronger correlation when applying a two day gap between its three day window of dietary fat and the resulting blood test.

You know the drill, let’s flip that left axis to show the inverse correlation…

exercise_ldlp_negative_graph

Like LDL-C, we see the first and last data points providing the largest gaps from the original Inversion Pattern.

Endurance Running Effect on Triglycerides

Now let’s get to Triglycerides. Note that triglycerides are a lot “noisier” with far less correlation than the above metrics. But you might be surprised to know that this is the marker I was most interested in throughout this phase. More on that in a moment…

exercise_trig_positive

Now let’s flip that axis on the left…

exercise_trig_negative_graph

Even with all that high deviation, we can clearly tell there is a massive pull down of trigs following the major endurance events (half and full marathons) creating huge gaps in the trend lines.

HDL-C Trends as Expected

I genuinely didn’t know what would happen with HDL-C and sure enough, the answer was nothing unusual…

exercise_hdlc_positive_graph

Less LDL-C and LDL-P Suggests Higher Repair

Early on in my research I learned about “receptor mediated endocytosis” which is basically cells engulfing lipoproteins entirely. This is commonly done so cells can use the parts that make up an LDL particle for their own repair, which includes cholesterol and phospholipids. This led me to assume (rightly, as it turns out) that there would be a drop in my lipid measurements if my body were in the process of cellular repair such as from muscle maintenance following a run, removing more of the LDL-P from circulation.

The two biggest gaps above with LDL-C and LDL-P happened to be the first and last data points. And indeed, these were the two toughest periods for me, the first where I jumped right in the middle of the training schedule and the second following the grueling marathon week. Both times I was noticeably sore on my way to the blood draw.

This is also why I’ve held off on resistance training and plan to make it a phase by itself. I suspect more intensive muscle repair will likewise draw down LDL-P and LDL-C from the expected pattern.

I’m sure many will read this and feel it reinforces the reason to get exercise in order to remove these elements from the blood stream. But I don’t necessarily buy into that. I think many other things about exercise are far more relevant to cardiovascular health such as increased sheer stress.

The Critical Triglyceride Connection

So why was I so particularly interested in triglycerides? Because my body is primarily fueled by it, hello!

As I state over and over and over again, the lipid system is first and foremost about “energy distribution”; it’s primary job is to distribute triglycerides. Yes yes yes, it wears many other hats and I know all about them — but it can be easily debated that from an activity, payload, and contact standpoint its most destined of all jobs is distributing energy from fat. (Sure, we have some amount of these fatty acids being broken down for ketones as well, but they are still in second place for cellular usage ATP-to-ATP relative to trigs brought by LDL particles)

And that’s why I speculated that my trig scores would be extremely low following the big races, which is exactly what happened! Bear in mind I would have preferred taking the blood test in the minutes following the race, but had to wait until the following day given the blood labs aren’t open on Sundays when all the long races took place. As such, there was probably an even higher level of trigs in my bloodstream due to the food I ate following the race that afternoon and evening.

To recap:

  • Trigs following 11/6/16 races: 27
  • Trigs following 11/13/16 races: 42
  • Trigs following 1/8/17 races: 31

Unsurprisingly, all three were the lowest triglyceride scores I’ve ever had (my average is 91).

So one more time… if you want to understand cholesterol, start by understanding how your cells get their energy! Otherwise you’ll keep looking at the passengers and not the drivers.

Apr 08

Two Years Later…

before_after

As of today I will have been on a low carb, ketogenic diet for two years.

If you had told me when I started that (A) my cholesterol would skyrocket, (B) I’d become obsessed with researching new patterns around it, and (C) I’d get the data from these patterns by intensive self-experimentation and frequent blood draws (55 so far) — I’d have said you were out of your mind.

In some alternate universe where the Inversion Pattern didn’t exist, I’d have noticed nothing new beyond the research already out there and would have likely found some alternate, middle-ground diet that mitigated my lipid numbers while staying relatively low carb. Hey, I might yet do that anyway.

For now I’m obsessively punching though these experiments to isolate key variables that I hope will get me closer to the data I’m looking for. And yes, I’m a bit behind in reporting them here, but I promise they are on their way. Here’s a running slate of what I’ve already done and will be posting on soon:

  • The Effect of Endurance Running on my Cholesterol – I’ll detail what happened between August of 2016 to January of 2017 when I both trained and ran several races.
  • The Egg and Cheese Only Experiment – Just like it sounds, but even more controlled in that I ate to specific quantities and on a very set time table.
  • The Fasting Experiment – I did it, but I won’t be doing it again. You’ll see why soon…
  • The Egg, Cheese, and Whole Milk Experiment – Intentional addition of lactose to test impact on glucose, insulin and the lipid profile.
  • The Meal Replacement Experiment – 10 days of a keto meal replacement which started yesterday.

And yes, I know I need to wrap up Part III of my Simple Guide to Cholesterol Series as well. But that may still be a bit further down the road given current responsibilities.

Speaking of current responsibilities, I should note my next speaking engagement will be on the Low Carb Cruise sailing for Alaska next month (May 19th).

It should be emphasized once again that I actually don’t make a dime from this life pursuit, my income is from my career in software engineering. Most of the blood testing I’ve done to this point has come out of my own savings and easily qualifies as the most expensive hobby I’ve ever had. (Which is pretty funny when you think about the fact that it involves so many challenging experiments and painful blood draws… there are probably more enjoyable pastimes to blow money on!) The point being, while I’d love to do this 24/7, I still have to take a significant amount of time to add back to the funding I need to move forward. So when I have drop off periods, this is usually the reason why.

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