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Nov 29

Lowering Cholesterol as a LMHR

Introduction

As our resident Lean Mass Hyper-Responder (LMHR) on the site, I have been an outlier so far with my Lipids. Despite an additional 200g/day of fat, my LDL was effectively unchanged in the Ketofest experiment. I knew exercise was potentially a confounder given Dave’s experiments with distance running, but I had a full training schedule this year leading up to my first marathon earlier this month.  Now, with a fat-fueled, goo-free, finish in the books, I decided to overlap some science with a forced period of rest.

Background

The Inversion Pattern is a theory about the impact of short-term diet on blood lipids (TC, LDL, HDL, Triglycerides). For LDL cholesterol, the supposed “bad” kind, it can be simply stated as:

All else being equal, LDL-C is inversely related to the dietary fat consumed in the 3-days prior to the blood draw

The implications of this pattern are profound. If blood lipids are not static, but instead highly dynamic from short-term factors, all conclusions based on a single sample are suspect. It would be like concluding you lived in a desert from a single sunny day.

Here’s the complete set of relationships from the Inversion Pattern:

  • Total Cholesterol tracks with inverse of dietary fat for the 1-3 days before the blood draw. (87% inverted correlation)
  • LDL-C tracks with the inverse of dietary fat for the 1-3 days before the blood draw. (90% inverted correlation)
  • LDL-P tracks with the inverse of dietary fat for the 3-5 days before the blood draw. (80% correlation)
  • HDL-C tracks with dietary fat for the 1-3 days before the blood draw. (74% correlation)
  • HDL-P tracks with dietary fat for the 3-5 days before the blood draw. (correlation not calculated)
  • TG tracks with the inverse of dietary fat for the 1-3 days before the blood draw. (61% inverted correlation)

Note: Correlation numbers are based on Dave’s data through 4/8/16 and don’t include subsequent experiments where additional variables were introduced.

Goals

The goal of this experiment was to replicate the Inversion Pattern using the Feldman protocol.  If that held, I would use this data as a baseline to compare against my earlier tests that included exercise. And, just for fun, I would be able to see the short-term variability of a number of other metrics in a controlled setting.

Experiment Design

I adapted the 4-test version into a 2-week schedule following my race. The first two days were a washout period with ad lib food. That was followed by a 5-day low-calorie phase and a 5-day high-calorie phase. Throughout, I refrained from all exercise. I even switched to riding the subway instead of my normal bike commute.

For measuring cholesterol, I got both a Nuclear Magnetic Resonance test (NMR) for particle counts, and the standard lipid panel (for redundancy).  I followed my own advice on testing and also got hsCRP, Insulin, Metabolic panel, and WBC.

Predictions

To evaluate the performance of the Inversion Pattern, we’ll score it based on how it does predicting which test shows the highest and lowest values for each of the metrics.

Here are the predictions:

Lipid Score Highest Test Lowest Test
Total Cholesterol (TC) Test 2

From days 5-7 (Low Cal x2, Fast)

Test 3

From days 8-10 (High Cal x3)

LDL-C Test 2

From days 5-7 (Low Cal x2, Fast)

Test 3

From days 8-10 (High Cal x3)

LDL-P Test 2

From days 3-5 (Low Cal x3)

Test 4

From days 8-10 (High Cal x3)

HDL-C Test 2

From days 5-7 (Low Cal x2, Fast)

Test 3

From days 8-10 (High Cal x3)

HDL-P Test 4

From days 8-10 (High Cal x3)

Test 2

From days 3-5 (Low Cal x3)

TG Test 2

From days 5-7 (Low Cal x2, Fast)

Test 3

From days 8-10 (High Cal x3)

 

The Experiment

Food Journal

Overall, I managed to stick to the schedule pretty well.  I managed a 40-hour fast on Day 7 during the low-calorie phase (calories: a coffee with cream and a spoonful of fish oil). On Day 11, I had some unexpected family travel, so it ended up being a Medium Calorie day. Fortunately, there were enough blood draws to still get a sample after three High Calorie days in a row.

 

 

My go-to meals during the experiment, easy to vary the quantity.

  • Breakfast: Bacon and Eggs (with HWC, butter)
  • Lunch: Bunless Burger salad (with Olive Oil)

Results

Total Cholesterol (TC)

First, let’s look at Total Cholesterol.

Finally, Feldman drop achieved! As predicted, TC peaked on Test 2 after the 40-hour fast.  Three days later, TC dropped 112 points to its minimum value. Interestingly, the Medium Calorie day allowed a difference in dietary fat between Test 3 and 4, which showed a small increase of TC, as predicted.  

Prediction Score: 2/2

LDL-C

Next, let’s look at LDL-C, the “bad” cholesterol that everyone is worried about.

Similar to TC, LDL-C peaked on Test 2 after the 40-hour fast.  Three days later, LDL-C dropped 100 points to its minimum value for Test 3, as predicted.

For comparison, my normal LDL-C with regular exercise was in the 210-230 range. For those keeping score at home, that’s a 200 point difference from the peak of this experiment.

Prediction Score: 4/4

LDL-P

Next, I was eager to see LDL-P. In Dave’s results, LDL-P has both a higher correlation and a trickier formula.

Boom. Exactly as predicted. From Test 2 to 4, LDL-P dropped by an impressive 1200 in 5 days. I found it particularly interesting how large the change was between Test 3 and 4 in LDL-P, even though the LDL-C went in the other direction in that interval. Clearly, LDL-P is a lagging indicator from LDL-C.

For comparison, my normal LDL-P (from one NMR in August) was 1597.  In this case, the total net difference was 1700. Without medications.

Prediction Score: 6/6

HDL-C

On to HDL-C the “good” cholesterol.

At first glance, HDL-C doesn’t seem to move much. However, since going low-carb, my HDL-C has been in a pretty tight 110-115 range, so 102 was actually a low-outlier, as predicted.  The two highest fell within my normal range and didn’t appear in Test 3 as expected. Maybe it takes a little bit more time to spin up my reverse cholesterol transport to above 110.

Prediction Score: 7/8

HDL-P

After the first prediction miss on HDL-C, my expectations were lower for HDL-P.

Wow. HDL-P moved from 31.3 to 36.9 exactly as predicted by the Inversion Pattern. Even if the cholesterol cargo in HDL has some additional variability, the particle counts (and thus emission and/or clearance rates) clearly have short-term diet as a driver.

For comparison, my one previous NMR in August showed HDL-P of 34.7.

Prediction Score: 9/10

Triglycerides (TG)

Triglycerides also played along and followed the 3-day fat intake as predicted.  At first I thought the higher TG in Test 1 and 2 might have been due to the lingering expectation of energy needed for exercise, due to my sudden drop off in activity. However, their correlation with 3-day fat matches the Inversion Pattern and implies a more responsive dynamic.

For comparison, my TG tests have typically ranged from 50-70, going back to before my low-carb diet.

Prediction Score: 11/12

Insulin

Insulin is a key hormone that I was interesting in following during the protocol.

Here I plotted against 3-Day Fat, but protein was similar. Despite keeping Carbs generally below 40g (except days of 73g and 56g), I still managed to have a 6x change from min to max. Clearly, Insulin is responsive to non-carb nutrients. I wonder how much of the later results were driven by late-night dairy (e.g., 4-oz of half-and-half at 10pm).

For comparison, my Insulin from August was 4.3.

hsCRP

I tracked High Sensitivity C-Reactive Protein to see how inflammation would track as I recovered from my first marathon.

I was extremely sore for several days following the race. I was feeling better by Test 1 on day 6, but still had somewhat higher inflammation. As expected, inflammation declined as I rested and healed.  My previous CRP reading in August was 1.01, so it’s possible that the 0.89 minimum was because I excluding some inflammatory food from my diet. Dairy is the most likely culprit, and it would be interesting to exclude it and check my CRP again.

Summary

This experiment was a clear confirmation of the Inversion Pattern for all lipid scores except HDL-C. Short-term diet was demonstrated as an input factor was able to move LDL-C by 100 points. In previous tests, exercise during the 3-days prior was sufficient to confound a similar change in diet. In addition, infection, injury, and other short-term inputs have known or theoretical impact on these numbers.

One of my takeaways is that the lipid system is much more dynamic than conventionally understood.  For those who are getting advice to change their lifestyle or take medication from someone ignorant of this fact, I would encourage you to learn more first. For those who need a low LDL or TC score to get cheaper insurance or to get their doctor off their back, I would encourage you consider using the protocol yourself.

Another takeaway is that my blood lipids are quickly reacting to serve essential bodily functions. Some of the missing LDL-C from my exercising tests were likely used for muscle repair via endocytosis, reducing my recovery time. In addition, the four hours of marathon running without goo was only possible because of VLDL distribution (and possibly even HDL to some narrower vascular channels after CETP). I’m grateful I have a “hyper-responding” lipid system to get the job done.

In the future, this data should prove valuable if I decide to continue with further experiments. They might have to study the impact of exercise, though, since the prolonged rest was difficult for me.

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36 Comments on "Lowering Cholesterol as a LMHR"

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bill
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Great. Thanks.

Mike
Guest

Good article! Very informative.

bonnie lee
Guest
Craig, thank you for doing this and then sharing the info! I am on day 4 of the Feldman Protocol and trying to get all the fats/calories in. I had my first set of blood work checked yesterday after 3 days of near fasting. I’m alarmed at how high the TC and LDL are! So is my doctor who called me this morning. My TC was 12.53 (484), LDL 9.61 (371), HDL 2.35 (91) and TG 1.26 (111) I am 64 years old, 136 lbs. and although not an athletic by any stretch I am in pretty good physical shape… Read more »
Dave
Admin

Hi Bonnie–

I’m excited to see your forthcoming results from doing the protocol.

As always, I caveat that I’m not certain of higher LDL-C/-P given a healthy keto lifestyle is safe, only that it makes perfect mechanistic sense. Give you’ve watched all my media, I’m sure you’ve seen me explain it quite a number of times. 🙂

You may be interested in a few of my upcoming articles and my current series of experiments, which I hope to have completed by the end of the year. So stay tuned!

Bonnie
Guest
Hi Craig and Dave. As noted Nov.29, “ I had my first set of blood work checked yesterday after 3 days of near fasting. I’m alarmed at how high the TC and LDL are! So is my doctor who called me this morning. My TC was 12.53 (484), LDL 9.61 (371), HDL 2.35 (91) and TG 1.26 (111) Now I have both sets of results. My average fat intake for the first 3 days was 46 gm (83% of total daily calories) and the results are as above. My average fat intake for the next 2.5 days was 275 gm.… Read more »
Dave
Admin
Hi Bonnie– – Sorry you didn’t get more traction from the protocol. I’m sure you were looking forward to a much larger drop in LDL than you had. Two side questions: —– 1. You did water fast (no coffee) before each lipid test for at least 12-14 hours, yes? —– 2. You avoided coconut and/or MCT oil per the instructions…? – The slightly higher C-reactive protein may have been activated by the stress of the protocol, which I have seen before (particularly if you were actively concerned about doing it right + the outcome = likely higher cortisol, etc). –… Read more »
BobM
Guest
Bonnie, you have to pay for the first test yourself — don’t give it to your doctor! 😉 The second test, after the high fat period, that’s the one you give to your doctor. Although if your doctor gets both, and sees what a dramatic change there is, he or she will completely change his or her mind about cholesterol. Just kidding! There’s a snowball’s chance in heck of that happening. Personally, I wouldn’t be worried. Many studies indicate that HIGHER cholesterol is good for women. Also, an HDL of 91 is impressive. Did you know that HDL became the… Read more »
Dave
Admin

It’s comments such as yours, Bob, that really give me extra strength every day. I’m so happy this site and our work has helped you to understand what was happening and how to change it.

I feel genuinely sad knowing there are so many out there who are dropping their dietary fat or multi-day fasting before a test because they presume it will give them the lowest cholesterol scores… not realizing they are actually spiking them!

Ingrid
Guest
Craig or Dave, Help me to understand base on my lab test results what Pattern I am A or B, the more I read the more confuse I get. Also, what is the best approach to lower the LDl-P it’s my understanding this is a key marker that contributes to cardiovascular disease given the fact that my father had two heart attacks one in his late forties and the other one at 80 years old. He got to live 40 more years after his first one.. Ever since I went low carb my numbers have crippled; could it be that… Read more »
Annie Q
Guest
According to the lipids panel report I just got, an LDL particle size of 20.6 or greater is Pattern A. Yours seem to have been Pattern A throughout with your best score being the most recent. Also, the reference range on my report shows that a Small LDL-P of below 117 is considered very low (low is desirable) so your Small LDL-P scores of 90 are very good. My LDL-P has skyrocketed also, and I don’t know whether to worry about it or not. I have been losing weight pretty steadily for the last six months, but I have reached… Read more »
Ingrid
Guest

Thank you so much Annie Q for your input!

George Henderson (@puddleg)
Guest

(and possibly even HDL to some narrower vascular channels after CETP)

Almost certainly one of the functions of HDL is its ability to redistribute TGs from larger species in this way.

Dave
Admin

Of course, this one is a real biggie for me. I’m pretty confident this is the case, but not confident enough to include it in my presentations just yet.

Anecdotally? It makes 100% sense given what we’re seeing with LMHRs.

Anne
Guest
Hi Craig, Thanks for showing all those diagrams illustrating the inversion pattern, it really shows the relationshiip between high fat and the lipid test clearly. Is there any post that is ‘short’ enough, if you get my meaning, that I can show medical professionals ? My lipids behaved exactly as Dave predicted (I am a lean hyper resonded btw). I told my endo that I had eaten more fat “recently to try and put on wieght” (wink) and was surprised at the lipid result (wink). He wrote in his report what had happened – he was surprised enough to write… Read more »
Yoav
Guest
Hi Craig, Dave. I wanted to write you an email, but could not find your email address. I’ve sent the question below to Ivor Cummins about two weeks ago, but did not get a response yet. I hope you can help me clear up some of this, or maybe point me to someone who can. 3 months ago I learned of the Keto diet. Everything I’ve read and heard about it made perfect sense, so I decided to go ahead and experiment. I have been doing Keto since, and have listened to many (many!) videos, including yours about the subject.… Read more »
Dave
Admin
Hi Yoav– – First, kudos for listening to “the other camp” — as you may have seen in my many comments and tweets (including today, ironically, https://twitter.com/DaveKeto/status/938482570584395776), I encourage EVERYONE to research all major sides of any meaningful subject. Keep it up! – Yes, I’m very familiar with Mic the Vegan. In fact, I’ve watched many of his videos to date. While I can’t unpack everything he’s talking about, I can speak to where the bulk of it comes from (which he concedes early in the video 1:47-ish mark) — that this is mostly lifted from Paleo Mom’s post here:… Read more »
Yoav
Guest
Hi Dave, Thanks for the quick response. Despite agreeing with Raphi’s/Craig’s point 3 below, the thing that bugged me about this reseach’s results is the liver damage that the HF diet showed. Basically, as far as I have been able to understand our physiology, combining High-Carb and High-Fat is a recipe for disaster, as the research does show, although this usually produces the tastiest food 🙂 During my first two months of Keto, I did not consider anything above 5% carbs as LCHF, but as I listened more, I’ve seen that many reasonable people supporting this lifestyle (including Ivor) cross… Read more »
Dave
Admin
Hi Yoav – Yes, combining high carb with high fat. And FWIW, I’m not even sure if you can pull that off without refining the source of carbs or source of fats. Basically, the easier and faster you can get that energy absorbed into your system, the more problematic it can be. And yes, it’s no surprise that the tastiest of the tasty food happens to have BOTH refined carbs AND refined fat (typically oils). – And yes, I have a lot of problems with rodent studies which could be its own series of posts. But I’d rather put more… Read more »
Steve
Guest

I think I fall into the LMHR camp and have had my first ever NMR test at 44 years of age.

Can anyone point me to a good place to learn how to read the test results as best I can? Specifically, I want to understand the LDL-P and particle size portion of the test.

Dave
Admin

I don’t have that video and/or guide up for that yet. You can post your numbers here and we’d be happy to let you know our thoughts.

Dorthe
Guest

Does any of you know, if it is possible to get a NMR test done, anywhere in Europe? And how are you guys doing it, is it a test that you do at home, and then ship it somewhere?

Dorthe

Ade
Guest

Hi Dorthe, the only one I found so far (and not had it done so can’t comment on it really) is : http://www.smartnutrition.co.uk/health-tests/comprehensive-cardiovascular-risk-assessment/cv-health-profile/

Dorthe
Guest

I will be going to Orlando this summer on vacation, I will have the blod test done when I’m there 🙂

Dave
Admin

Not sure on where you can get it done in Europe. But I’m pretty sure there’s no home test for it.

Dorthe
Guest

Well, I found a private doctor here in Denmark, where I live, where I can get a NMR test done, but they ship the blood test to the US. It will cost me around 850$ to get it done. I do unfortunately not have that kind of money for this.

Richard
Guest

Iif you are not a LMHR would this approach still give you the best chance possible to reduce cholesterol numbers for a blood test?

Dave
Admin

The protocol currently had about an 85% success rate, and that appears generally the same whether you are a LMHR or not. http://cholesterolcode.com/extreme-cholesterol-drop-experiment/