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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.

13 comments

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  1. Annlee

    I listened to that conversation with Raphi – and now I need to listen again. There’s a whole lotta info in there. Thanks to you both!!

    1. Dave

      Thanks, Annlee!

  2. Kevin Mattson

    Thanks for your excellent work. I will make a donation. Three questions.

    Has no one before noticed the lipid inversion effect, or, have you seen or heard of other studies that inadvertently show the effect? Seems incredible that this has not been observed.

    Have you considered how your collected data might inform the results of fasted blood tests of all kinds?

    I will soon have a standard lipid profile done soon. And I have been carefully LCHFing for a several weeks. I won’t be able to afford multiple blood panels, but might a few days of calorie restriction prior to gorging increase the inversion effect in the tests I will have done?

    All the very best!

    1. Dave

      >>>Has no one before noticed the lipid inversion effect, or, have you seen or heard of other studies that inadvertently show the effect? Seems incredible that this has not been observed.

      – No, I haven’t yet found a study that shows this pattern. And YES, it is definitely unbelievable that it would have been missed by this point. However, it makes more sense if you recognize there was already a bias of thought against the lipid system being so responsive.

      >>>Have you considered how your collected data might inform the results of fasted blood tests of all kinds?

      – Definitely! I often joke that cholesterol has been my “gateway drug” the larger topic of energy metabolism. So I believe all blood tests should be looked at in the light of this overarching regulation, particularly its influence of the past few days on the blood test outcome.

      >>>I will soon have a standard lipid profile done soon. And I have been carefully LCHFing for a several weeks. I won’t be able to afford multiple blood panels, but might a few days of calorie restriction prior to gorging increase the inversion effect in the tests I will have done?

      – Until you’ve had one “normal” lipid test while being LCHF, I’d advise waiting on doing the protocol. It’s better to first know what your baseline average would be so you know already if you are a hyperresponder in the first place. Plus, having been on it only a few weeks could be a further confounder. Myself and many others who have tried this have been on LCHF for typically over 6 months at least.

      1. Karl Schmidt

        Actually, Dr. William Davis mentioned peoples LDL going up as they lose weight many years ago. Not in a paper – not something your MD knows about. (These days he seems more interested in selling books ).

        Makes sense – if you are burning fat – the trygly have to be transported by Lipoprotiens from adipose tissue to where the calories are needed – and so the body makes more of them.

        What is funny, is that for all the narratives about cholesterol, a lot of the basic research was never done. Thus a lot of health advise is based on ungrounded narratives rather than hard science.

        Fer instance, the science existed from the Apollo project that fructose spikes trygly – yet never made it to the mind of your family doctor. Or that consuming PUFA changes the insulin sensitivity of adipose tissue – producing weight gain.

        Most of research is directed to keep the money flowing – not to further science.

        1. Dave

          – Yes, the theory of weight loss leading to heightened LDL is speculated in many places (I think Volek & Phinney were one of the first). Logistically, I too think it is a component. But that said, I think it is probably a fraction of the regulatory mechanism behind the Inversion Pattern (whatever that turns out to be).

          – You’re absolutely right about core assumptions being made and yet without testing. I’m still amazed myself at how many things I’m finding that didn’t take much work to investigate.

  3. ad

    I came across this website a few months ago and didn’t think much of it, sorry. Came back out of curiosity again a few days ago and felt compelled to post.

    Because I would simply like to urge all readers to beware of wannabee researchers, especially when the research is n=1. the web is littered with them, and I am one of them although I do not share, precisely because there is enough publication medical or not to explain exactly what is going on.

    The so-called inversion theory is nothing new and documented as being down to the exceptional ability of chylomicrons to hoover up cholesterol in blood. This was pointed by another poster at the end of last year and linked (to a medical publication) on this very website.

    I fear a lot of you will be trawling blogs and publications to try to figure out why your cholesterol has risen on high fat diets.

    Well rest assured of one thing, LCHF raises cholesterol period, unless you were unhealthy/overweight to begin with (so unless you had problems of some sort), in which case there is no trend, it depends on your medical condition and past diet, it may go up or down, but it will end up higher than if you were eating healthily but weren’t on high fat.

    It is “mechanical”, if your body has adapted to running on fat, more fat is transported through the blood constantly, post-meal and between meals, which inevitably raises IDL and LDL, whether from liver LDL production or chylos conversion to LDL. Total Cholesterol below 300 if you otherwise have low blood pressure, low TG, low BG and high HDL is probably not a big deal. Above 300 it is up to you to decide;

    There are a number of well documented research (most of which has actually already been linked to this site by other contributors, so please look back through this site or pubmed.

    In addition to what can be found already published, most of my “knowledge” comes from a 1300 pages “brick” (ISBN 0-8493-7261-5), that I cannot obviously link, but this book is only a collection of the publications you can find online, so amongst other things, a few facts:

    – LCHF raises cholesterol, unless you were unhealthy to begin with, period. If it makes you uncomfortable then don’t eat high fat, because you will not find a miracle cure;

    – LCHF raises cholesterol in the long term, but not necessarily in the short term. Cholesterol varies hugely from one day to the next and throughout the day (as you will see later);

    – Eating huge amounts of fat does lower TC indeed, it is documented and the mechanism reasonably well understood, the Chylomicron are very good at hoovering up serum C and bringing it back to the liver. So eating waste amounts of fat does lower TC short term, due to the constant presence of Chylos;

    – Similarly, fasting does raise TC short term, again this is well documented both in literature (in normal people as well as anorexic);

    But here is the catch, beware of short term trends and think long term. LCHF raises long term lipid profile. Every boot of excessive fat consumption raises your baseline, your lower threshold around which you can then show some swings fasting or feasting or supplementing. Your baseline will creep up over time. I guess there is an upper limit, but I don’t know.

    I use a Mission 3in1 meter to test almost every day, as well as an Accutrend meter to double check, sometimes several times a day. Every so often I get a lab test to confirm meters are working well.

    The Mission 3in1 is amazingly repeatable within a batch of strips as well as reasonably accurate. So perfect for trends and pretty accurate for absolute measurements too.

    All it measures is TC, HDL and TG from 35uL of blood. It is not cheap but reasonable. LDL can be calculated with the various formulaes out there, you chose, depending on how high or low your TG are. But again, looking at trends the calculation is of no importance.

    In the past year alone I have tested approximately 200+ times. Before and after meals, with various durations of fasting, various intakes of fat, of carbs, of protein, of macros, micros, vitamins etc.

    I have discovered nothing new, neither has this blog with all due respect, I just confirmed on myself the last century of research and the above non-exhaustive list.

    I have tried all sorts of vitamins, supplements, etc. Most of those, supposed to lower TC, do indeed lower TC but short term. Within a few days, despite the supplementation, the body returns to its baseline. Discontinue the supplements and resume later on will produce the same short term shift.

    But the only thing that changes the baseline is abrupt changes in dietary fat (up or down).

    So if you want to lower your cholesterol, don’t follow the “findings” of this website, just follow the literature written in the past century: reduce your fat intake, it is that simple.

    Fat, saturated in particular, and cholesterol are good for you. I eat 2 raw eggs a day and plenty of butter in addition to the rest of my macros. However no-one will convince me that eating 90% is how we evolved, so don’t expect low blood lipids unless your ancestors are masai or innuit.

    By the way, I am 40+, male, 184cm, 74kg, 6% body fat, FBG 90, eating approximately 2500kCal /day when not exercising, resting HR = 55, BP = 100/60 to 110/70.

    For as long as I can recall, my weight has been between 72kg (high carb / low fat – cycling 40hrs / week for several weeks) and 78kg (normal medium carb / medium fat diet). My FBG has always been around 90, and my HR and BP around the values quoted (expect during the intense cycling period where my HR was 42).

    The question as to whether a high cholesterol is a problem, or how high is too high is entirely different and out of scope. But I suspect most of you are here because it makes you uncomfortable!

    For me, I am happy with anything up to 250-260 achieved with approx. 15% protein / 20% carbs / 65% fat. If I eat 80% fat / 10% protein / 10% carbs I get to 300-330 and I am uncomfortable about it. If I eat 20% protein / 30% carbs / 50% fat I get down to 200-220, which is my long term average diet (for as far back I i remember being tested (approx. 15 years of yearly lab tests).

    Baseline changes take 2-4 weeks (what I call long term) for me. Short term changes can take a few hours.

    I do not have time to produce nice plots so I attach my raw data, I hope this will illustrate my point and depict short and long term variations. Pretty much every time there is a sharp daily rise / fall is inversely correlated with high (sat intake, usually butter and/or cream). Long term increases in TC (end of August, October and December) have come from sustained increases in sat fat mainly. Long term reductions in TC (From January and more pronounced from March) correlate with increases in carb, reduction in fat, in the proportion mentioned above.

    Anyone interested should be able to cut and paste directly into excel, otherwise I can email excel file:

    [This is Dave: I replaced the text you pasted here with a link to a text file that contains the same data to keep this comment tighter]
    DATA TEXT FILE

    I hope as many readers will get to see this, as although your “research” is interesting it is equally dangerous, as none of it is controlled, your sample size is minuscule, none of it is new and it will lure many towards precisely the opposite to what they need doing to do long term to put their mind at rest.

    1. Dave

      Hi Ad-

      Interesting comment. Lots to unpack 🙂

      – In many places you discuss rising cholesterol on LCHF as a certainty. I’m assuming you mean serum cholesterol in this regard (proving/disproving overall cholesterol in the body is entirely different). But if so, this hasn’t been shown to be predictive after going LCHF, in either short or long term. Some see their cholesterol fall, some see it rise, and some (like myself) see it rise dramatically. You may find the coming studies from Sarah Hallberg especially interesting given they had several hundred take advanced lipid tests before starting and throughout, showing this same observation.

      – You’re suggesting the Inversion Pattern I’m working with here is “well documented” — I’m very interested in finding where this is the case. You mentioned the book id – [ISBN 0-8493-7261-5] – which looked up is “Fatty Acids in Foods and their Health Implications”. Is this the referenced material you’re speaking of?

      – I’m not familiar with chylomicrons “hoovering” cholesterol in order to yield the same result as the pattern. You mentioned this is linked “on this very website” — can you point me to the comment/page?

      – The Mission 3in1 you mentioned is interesting and something I’ll look into. Like CGMs, I was less interested initially because I had read the accuracy wasn’t as effective, and being an engineer I wanted a much higher bar (part of why all my tests are NMRs). However, I’m reconsidering that now and I’ll be curious how much it will match the NMRs directly when taking blood draws. Glad you brought that up! 🙂

      Ad — Even if we disagree on what the data/research is showing, I’m very glad you are likewise doing N=1 yourself and shared it here on the site. I hope you continue to do more and I welcome any and all ways you can challenge my research as well… it’s the way science gets better. 😀

  4. Alex Weber

    Thanks for all of your hard work Dave. I am in a slightly different demographic of people following high fat ketogenic diets. I am 25 and 5′ 9″, 175 pounds just looking to cut down to around 160 and lower body fat from 13% to around 8-10%. I am around 5 weeks in. My employer does blood tests every 6 months and good results equates to cheaper insurance. Right now I am at the top level (tested while on my eat whatever I want diet) so it will be interesting to try and explain a large LDL increase if it occurs. A topic that I have seen so little on when concerning ketogenic diets and cholesterol is types of fats and their effects on cholesterol levels. I am hoping your new research may have something to do with this but I want some more studies on people following the ketogenic diet who have a huge LDL swing – can they incorporate more unsaturated fats while maintaining the same macros to improve the traditional markers. You linked to a couple studies where this seemed to be the case but I would like some more thought on this. I know our bodies make a good portion of the cholesterol but your protocol does seem to show that our dietary behavior can have a drastic effect on our blood cholesterol levels.
    At this point I am thinking about one meal a day with normal keto foods like maybe ground beef butter and veggies (more dietary cholesterol) and then limiting my second meal of the day to mostly unsaturated fats (vegetables covered in olive oil, and an avocado etc)
    Mostly because I don’t want to even deal with having to bring in references to explain my cholesterol levels… I am sure you are in the middle of an experiment but would love to see what happens if you upped monounsaturated fats for a week and got a test!

    1. Dave

      In my experience so far, the nature of the fat doesn’t appear to have a very high significant difference with LDLc (but saturated fat does appear to boost HDLc).

      For what it’s worth, I’d want you to know your “base” cholesterol first. Which is to say what it would be if you were eating at your average calories while on a ketogenic diet. You might want to consider getting it privately tested through requestatest.com or similar website. This way, you won’t be overly shocked if it’s actually very high in spite of doing the protocol.

      On a final note, stay tuned to this website as I’ll have something new coming out that you’ll likely be very interested in the next week or so.

  5. Jesse Lamsam

    Hi Dave,
    I want to thank you again for the incredible amount of work you have done and the data you are willing to share. It’s an amazing body of research that will help elucidate the complex interactions of our lipid/energy handling system.
    I am eager to participate with a 3 day protocol at this time and will be willing to share my data with you as well. I have just been scheduled for a visit with my cardiologist next week (blood work will be drawn Tues a.m.)

    Although I have been LCHF for about 3.5 yrs and the last 2 have been mostly Keto, I admit being daunted by the huge caloric intake for 3 consecutive days.

    To that end I do have a question for you, being that I’m about 5ft 7in. and weighing only 143 lbs, is it still necessary to get >4000 calories/day? I tried that for 2 days last week and felt like I was going to burst. I could barely look at food on day 3.

    Also, for me to really jack up the calories, I have resorted to drinking heavy whipping cream. I wonder if that might bias the final results – do you have any recommendations on that? Thanks again for taking time with this.

    1. Dave

      Ack! I really need to heavily emphasize that one doesn’t need reach 5000 calories or even close to it on my protocol page.

      Everyone’s upper limit is individual. Try to figure out that limit and shoot for it with each day of the protocol. Ideally it would be 50-100% more than what you typically eat in a day. But if even that is difficult, scale back further.

      And yes, as always, share back what happens. 🙂

  6. Jesse Lamsam

    Wonderful to hear, Dave. Thanks again. I’m excited to see how this pans out. I have learned from experience that no matter what, I cannot tell my cardiologist what I’m really doing. I simply tell him it’s a “lifestyle” change that involves adhering to the Mediterranean Diet. 🙂 He always nods approvingly at that and the appointments are much shorter.

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