Jul 17

Ketofest Cholesterol Experiment – Preliminary Results

While there is still more analysis to collect and unpack, here are the preliminary results from the Ketofest Cholesterol Experiment.

Did it meet the hypothesis? You be the judge:

I can’t possibly express enough appreciation for PTS Diagnostics, the great 2 Keto Dudes and the truly generous volunteers who took this journey through the experiment with me. Thank you so much for your participation!

Jul 12

Ketofest Cholesterol Experiment – Updates/Progress

This post will be continually amended each day until this coming Monday, July 17th.

In the interest of transparency, I’ll be reporting my notes as the experiment progresses. The exception to this rule are any notes that might impact the outcome of the experiment, such as something I report that could influence the participants significantly.

Day 1

As of this morning, there are 46 who have signed up for the experiment. However, I expect a drop off as many have not checked the box for being present on the Monday following Ketofest. As this is a requirement for the experiment, I sent out emails requesting confirmation, but have gotten back little response thus far.

There were 5 who had signed up who let me know they’d need to drop out.

Overall, there are about 6-8 participants who are now engaged in the Facebook group we are using for active communication. Most have posted photo of their food and drink and are doing an excellent job.

I’ve intend to likewise participate in the experiment, but want to note one possible confounder with the day. I’ve been a bit spread thin lately and haven’t been sleeping very well. I ended up napping for a total of three hours off and on in the afternoon. I then only slept three and a half hours in the evening. While I’m doubtful circadian rhythm will have a meaningful impact on my lipids, it is still worth noting.

Day 2

A couple more participants became active in the FB group. Current active participants were again sharing photos, myself included.

My day was a bit tricky. But to set the context, I need to explain my own diet choice…

I had determined before starting Day 1 that I’d keep my diet simple by only having one keto shake portion and two hard boiled eggs for the first phase of the experiment. Then for the second phase I’d ramp it up to four or five times this amount (depending on what I could handle). I made this decision mainly out of efficiency of time as I won’t have to put much extra work in tracking my diet given the simplicity of this system, thus allowing me more bandwidth for the bigger responsibilities I have in the next several days (conducting the experiment, prepping the presentation, etc).

Of course the downside is that I’ll be missing out on the fantastic food of Ketofest. And believe me, I’m not at all happy about that. But like so many other things in the last couple years, I’m choosing science first. (grumble, grumble)

Which brings me back to the conundrum of Day 2. I’m only allowing to eat one meal in the morning before my series of planes, trains, and automobiles (no really, LAS>PHL, PHL>RI, Uber to Amtrack, Amtrack to NL). The obvious choice was the shake since I definitely won’t find 0 carb heavy cream on the layover in the airport. But perhaps I could find two hardboiled eggs. And indeed I did, just before my connecting flight. Whew! (To be sure, the eggs I found were small, so I got three and tossed half of one to make the correct 110g from the day before. Because accuracy.)

After Carl picked me up from the station, we got to check out his studio downtown where we will be staging for the blood draws.

The building has a very mid-20th century feel to it that showed a little wear, yet lots of charm. Walking through the room, I starting taking stock of where we’d be set up and how the process would go.

I couldn’t help but find his sign outside the door “RECORDING” a bit amusing. This Friday it will have a very different meaning. ūüėÄ

Day 3

General progress with participants was steady, nothing unusually new to report.

Things were definitely getting busy for me to the point where I missed two of the electrolyte drinks in my usual diet plan day, but otherwise stayed steady with the shake and eggs.

As an interesting aside, Evelyn (Carbsane) was in town and I offered to “reach across the isle” to grab lunch. We chatted about life, personal stories, and a little science. But of course, I could only have the shake and water at the restaurant.

Day 4

I was extremely happy we got a total of 24 confirmed volunteers. As mentioned earlier, I knew it would be less than that 44 who signed up, I just didn’t know by how many.

Things definitely got a bit frantic for me and I now realize I should’ve recruited one or more volunteers to help me with logistics. I was handling all volunteer entry, processing, waiver signing/collection, and trying to fit in Q&A where possible.

To make matters worse, I had a creeping feeling of illness come over me that seemed very odd. I was getting shaky and oddly sensitive to cold, not sure if this was due to being low on blood sugar or what. In a gap between entries I went to get my blood drawn and the phlebotomist (who was a real veteran) had enormous trouble getting my blood flowing. She ultimately tried in three different sites on both arms, but to our surprise, it just wasn’t coming out. We agreed I’d drink more water as I appeared dehydrated before trying again.

Unfortunately, I got concerned enough about how I felt that I decided I’d just go ahead and eat, thus disqualifying myself from the experiment. The phlebotomist happened to have brought bananas, and ultimately I decided to have one in case this was indeed a low blood sugar issue. “This is the only banana I’ve eaten since staring keto.” I laughed.

Eventually after having to make some more water and electrolytes, I felt a little better, or at least enough to finish out the experiment. I then took an Uber to GNC and bought some magnesium and potassium supplements, which I started downing of the next several hours with water spiked in pink salt. This had a very significant effect and I felt a lot better by the evening’s VIP party. I wasn’t yet 100%, but most of the way back.

Moral of the story: ELECTROLYTES!!!

Jul 11

Ketofest Cholesterol Experiment – The Hypothesis

As detailed previously, participants of this experiment will consume food in two stages:

  1. Low Days РLow calorie consumption or fasting for three days, while still at a low-carb, high-fat ratio (LCFH diet) : July 11th, 12th, and 13th
  2. High Days –¬†High calorie consumption for three days, while still at a low-carb, high-fat ratio (LCFH diet) :¬†July 14th, 15th, and 16th

Cholesterol tests will be taken on the morning of the day following each stage.

Following the second phase of higher dietary fat, I predict the resulting LDL cholesterol for the majority of participants will show a decrease when compared to the first.

Jul 09

Doubters, Haters, Colleagues, and Friends

One of my favorite quotes of all time happens to be from Mahatma Ghandi:

First they ignore you, then they laugh at you, then they fight you, then you win.

I’ve certainly felt the first and second of these stages, and I now believe I’m entering into the third. But don’t confuse my motivation from the above quotes as originating from hate or anger — I genuinely want to change the minds of even my biggest detractors.

No matter how strong or compelling my data is, it will take much more to open minds to it. I need to put in the effort to communicate to the biggest doubters out there. And yes, I know the vast majority won’t change their minds. But a few will, and in the end, I believe it will be worth it.

And with that, I’ll close with another favorite from Ghandi:

Whenever you are confronted with an opponent. Conquer him with love.

Jul 03

Are you a Lean Mass Hyper-responder?

One of the benefits of establishing this niche in Low Carb Cholesterol Research is that I get people sending me their labs constantly. Naturally, I obsess over possible patterns with hyper-responders.There’s one pattern that is clearly emerging that I’m calling a Lean Mass Hyper-responder. (LMHR)

General Hyper-responder vs Lean Mass Hyper-responder

I consider a hyper-responder (like myself) as anyone who sees a dramatic rise in their LDL cholesterol after adopting a low carb diet. Usually, this is 50% or more. As is typical for a low carb diet, most people see their HDL go up and their triglycerides go down.

However, a Lean Mass Hyper-responder takes this to a new level. I consider the cut points as follows:

  • LDL-C 200 mg/dl (5.2 mmol/l) or higher
  • HDL-C 80 mg/dl (2.1 mmol/l) or higher
  • Triglycerides 70 mg/dl (0.79 mmol/l) or lower

Note these are just the starting ranges. Typically I see both LDL-C and HDL-C hit levels no one else has, while likewise having very low Triglycerides. Here are some examples:

431 147 46
226 98 52
342 110 61
263 89 55
277 102 67

This is only the first five I found to plug into this post. I suspect I probably have at least another half dozen or more that I’ve responded to on Twitter, email, or comments here at the site.

In fact, the very first LMHR I encountered was Nicole Recine here on the comments of a blog post. I’ve since collaborated with her quite a bit and consider her a damn awesome resource for low carb. (See her site at NicoleRecine.com) She’s sub-10% fat mass, very energetic/althletic, and much more comfortable standing than sitting. She holds at an extremely high LDL-C of 558¬†with an¬†HDL-C of 140 (Total Cholesterol of 721). Yet, like me, she gets frequent checkups such as the CIMT that continue to show normal results.

Characteristics of a Lean Mass Hyper-responder

As the name suggests, LMHRs tend to be on a very low carb diet while also lean and/or athletic. Some are ultra-athletes and have taken strongly to the low carb way of life with great appreciation. And of course, all of them are shocked to see their cholesterol scores at these levels. Yet there’s clearly a mechanistic reason for this…

A Simple Theory

For me, this certainly has an¬†Occam’s Razor-level explanation. Before reading below, be sure you at least know your basics with my Simple Guide to Cholesterol on Low Carb series.

Lean and/or athletic low carbers have three things in common:

  1. Lower adipose stores (less body fat energy) relative to the average peer.
  2. Lower glycogen stores (less incoming dietary carbs) relative to a carb-centric diet.
  3. Higher energy demands.

Our body seeks to keep our glycogen stores in our liver and muscles reasonably stocked, even on a low carb diet. But obviously, this is more of a challenge when you are both lowering dietary carbs and burning through it at a faster rate than most. Per Volek and Phinney, the body gets better at sparring (and I have my own data that confirms this), but the demands are still relevant for available fuel.

So think about it — (1) lower adipose fuel tank, (2) lower glycogen fuel tank, yet (3) higher energy demands. It makes perfect sense for the body to want to mobilize more fat-based energy to meet the need. And yes, that will ultimately mean more LDL particles (LDL-P) delivering more triglycerides to the cells. Likewise, this means more of the cholesterol in those boats (LDL-C) being circulated along with them.

This explains why both LDL-P and LDL-C would be higher, while TGs would be remarkably low, relatively. The¬†TGs are getting depleted from use, yet there’s no denying that more “boats” (LDL-P) are needed to provide them.

Likelihood for Children on a Low Carb Diet

This needs to get talked about as soon as possible. If this mechanism is indeed true, I’d hypothesize many children going on a low carb diet would likewise exhibit signs of a LMHR given higher metabolic rates relative to adults. Indeed, there have been three cases I’ve been made aware of in the last couple months. One privately shared via email, one in the comments of this site, and one on the forums of another. In all three cases, the child fits the pattern of an LMHR.

Naturally, this means many children could be incorrectly diagnosed as having Familial Hypercholesterolemia. Again, FH is, in fact, a genetic disease. That it often gets diagnosed on cholesterol scores alone is a modern tragedy. My fear is that this will happen more often as low carb diets become more popular and GPs don’t know enough about cholesterol and the lipid system to understand what is happening in this context.


Final Thoughts

All things considered, I hope the theory proves true given it makes a lot of sense. Before this particular pattern emerged from having lots of labs to compare to each other, I often speculated a higher mobilization of LDL-P could be used by the body as an “alternative glycogen store”. This profile adds some weight to this possibility.

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