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Sep 12

START HERE (Pinned)

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  • If you’re wanting a video version of my research:
    • The most current presentation is from Breckenridge in this last February.
    • (Coming soon) A new one will be up eventually from the Low-Carb Cruise that brings the research up to the date of this post.
  • If you have seen your cholesterol rise considerably on a low-carb high-fat diet (like myself):
    • You may want to first visit the FAQ.
    • I would strongly encourage you to read through this blog and my own journey revealing the Inversion Pattern. Key moments were the Identical Diet experiment and the Extreme Cholesterol Drop experiment that I wrapped around the first presentation of my data for the Ketogains Seminar.
    • And finally, you may be interested in my recent discovery with regard to controlled carb swapping. (But note it is very preliminary)

36 comments

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  1. Elizabeth

    Hello! I would love to share your presentation with my father, but he is deaf. Do you have a transcript we can access or is it possible to add CC to the you tube video? Thank you!

    1. Dave

      I don’t… but I may be doing a reprisal of that presentation for the coming Ketofest. If I do, I’ll see if I can work up a text for it as well.

  2. Chris

    Hi Dave, thanks for your work. I’ve enjoyed your twitter feed and will be perusing your site here. I tweeted you about a patient of mine who has familial hypergyceridemia with Trg in the thousands. Currently Crestor and Tricor for this. he is motivated and now has a recent dx of DMT2 with a hgb A1C of 6.7. He is seeking dietary intervention. I’ve been a proponent of low carb high fat diets for many of my DMT2 patients and am having success coaching this, but had some pause in this gentleman given his Trg. He is reticent to start metformin and anxious to intervene w diet. I already started talking to him about LCHF. I am new to LCHF and as a intervention. While high Trg has not been implicated in mortality, non-alcoholic pancreatitis can be a serious complication and high saturated fat diet can be concerning for this. I’ve seen anecdotes about LCHF lowering Trg but would like to see some data on this. Thanks. Chris PA-C

    1. Dave

      Hi Chris–

      – I’m not as familiar with hypergyceridemia — do you mean hyper*tri*glyceridemia? (I’m assuming this due to your mention of the TG in the 1000s) Also, you prefixed with “familial” — if genetic, what is the family history with this disease?

      – Certainly, I’d be very concerned about high TG, and yes, low carb is extremely effective in most cases of bringing it down. I’ve likewise seen many labs (some within my own family) where there were high TGs while using statins, even if having lower LDL.

      – The higher TG in combination with higher glucose is even more troublesome as my guess is there is a very high abundance of energy parked in his system. Does the patient have a lot of visceral fat? There’s a decent chance he already has fatty liver and may be hyperinsulinemic.

      – It’s extremely encouraging he is seeking dietary intervention as I definitely think this should be the first choice.

  3. Kaiden

    I have two sets of test results. I did the protocol backwards (5000 calories first, then 500 calories). They weren’t NMR. They do contain some other numbers I found interesting. The high-day test did come back with elevated BUN. Is this common (i.e. because of the high amount of protein)? Either way, I’ll ask my doctor to rerun the test after a week of fasting.

    1. Dave

      Hi Kaiden-

      That’s interesting. But it’s hard to speculate without seeing the labs. Can you post the numbers?

  4. Andrew

    Hi Dave,

    I was recently turned-on to your Biohackers podcast interview & on one hand, am excited to tap into a LCHF / Keto community however am now slightly in panic mode after my first NMR, which is the second cholesterol test since going LCHF. Your thoughts would be wonderful. Below are my NMR results from Monday, June 5 2017:

    – Total Cholesterol: 233, down from 254 on 10/6/16 (first test on LCHF) up from 202 from my last test before going LCHF
    – HDL-C: 67, down from 71 on 10/6/16 (first test on LCHF) up from 55 from my last test before going LCHF
    – LDL-C: 154, down from 166 on 10/6/16 (first test on LCHF) up from 130 from my last test before going LCHF
    – Triglycerides: 60, down from 86 on 10/6/16 (first test on LCHF) & even with my last test before going LCHF
    – LDL-P: 1,724 (no previous record)
    – HDL-P: 28.9 (no previous record)
    – Small LDL-P: 634 (no previous record)
    – LDL Size 20.9
    – LP-IR Score: <25

    A little background: The Saturday & Sunday leading up to Monday, June 5 2017 were very active where I burned probably close to 1,000 calories each day mountain biking in fairly warm weather. I'm wondering (hoping) the high LDL-P is my liver releasing cholesterol for repair / maintenance? Also, this weekend was a little more carby than usual. Finally, high blood pressure is prevalent on my Mom's side of the family with her dad suffering from both stroke & heart attack. I think both parents are taking cholesterol lowering medications. In terms of next steps, I think another NMR is in order, perhaps not after exerting as much energy in the days leading up? At least to rule it out. What are your thoughts?

    1. Dave

      Okay, a few things…
      1) You are possibly a “Lean Mass Hyper-responder” as I’m calling it now. (I’ll be doing a post on this soon, but for now you can reference my comment here: https://www.reddit.com/r/ketogains/comments/6jjpby/deranged_lfts_on_keto_xposted_to_keto_subs/djisdpp/)

      2) Actually, given your intensive exercise, I would speculate that your non-exercise test scores would likely be higher in LDL-C, and marginally higher in LDL-P if my theory/research is consistent on this. (See my blog post on distance running and its impact on my numbers here: http://cholesterolcode.com/impact-of-endurance-running-on-cholesterol/) I tell you this in advance because I want you to be ready for this possibilty if this turns out to be true.

      Moreover, the carbs you had may have actually lowered your LDL-C/-P further given my more recent experments with carb swapping in the attempt to test glycogen store influence on lipids. (See here: http://cholesterolcode.com/cholesterol-research-breakthrough/)

      3) If you’ve read the links above and even a tiny fraction of my research/data, you’ll have noticed I’m exposing how agile the lipid system is. It is far more regulated than current medical literature believes it to be — at least, I can say this confidentally in the context of low carb given others’ reproduction of my protocol as well.

      So with regard to risk, that’s an individual choice. As I often say, when I first learned about my high cholesterol numbers, I was a 9 on a 10 scale of concern. Now I’m more like a 5, but I’m not a 0. I understand why it functions this way with regard to fat-based energy management and how cholesterol is along for the ride. (And on that note, please consider reading my Simple Guide series for laypeople on low carb http://cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/)

      I hope this was helpful. 🙂

      1. Andrew

        Very helpful & thoughtful, thank you. I have read everything you posted & then some. A couple follow up questions. 1. do you have your weekly menu posted somewhere or are you following some other regiment or cookbook? Finally, aside from the normal lipid panel & NMR, do you have your list of recommended blood tests posted somewhere? BTW I submitted an interest form to be in your Ketofest cholesterol study 😀

        1. Dave

          Glad to be of help!

          – I don’t have a weekly menu posted, per se. My primary source of tracking is photographic as I literally take pictures of everything I ingest. However, I get behind on my text-based food logging (currently MyFitnessPal) and mainly have it maintained for all periods just before blood tests. The key is the photos and all the context as I can always catch my text logs up perfectly. (But more importantly, I need all my work to be independently auditable)

          It’s worth noting that my diet is better than most, but not ideal, and I try to point that out. Many assume because I’m so disciplined in recording data that I must likewise be disciplined in quality food selection and strongly Paleo. But my diet is probably around 20-25% “fast food” keto, such as lettuce-wrapped burgers from Carl’s Jr. Probably 40-50% I cook myself, such as cage-free scrambled eggs or my keto pizza. The remainder is restaurant or keto snack-ish such as individually wrapped colby jack from a convenience store (sure it’s cheese, but more processed/preserved, of course).

          – As blood tests go, I won’t bother doing a single one that doesn’t include an NMR, fasting insulin, and high sensitivity C Reactive Protein (hsCRP). Those are the minimums for me.

          But usually, I get the above three and a Comprehensive Metabolic Panel (CMP), a Complete Blood Count (CBC), Cortisol, hbA1C, ApoA1, ApoB, Uric Acid.

          I occasionally add Ferritin, Iron Panel, Homocyst(E)Ine, Vitamin B12 And Folate, Vitamin D, and GGT.

  5. Lars Behme

    Dave, I am going to schedule my next blood test, I find the calorie intake for your protocol challenging :). I am T2D, off meds, but am keeping my carbs below 10g a day – any hint/ suggestion on how to beef it all up while keeping the carbs at that level (if it “has” to be 3%) ?
    thanks for your time.
    \Lars; Ireland

    1. Dave

      Hi Lars-

      The total amount of calories is individual — you just want to find an upper limit. It’s something you find yourself.

      Keeping under 10g of carbs a day while upping total calories would probably be unrealistic. You’d have to use a lot of factory-based oils as the primary fat-sourced, which I wouldn’t recommend. 🙂

  6. Lars Behme

    True, I did a test run, and managed around 1780 cals… natural carbs, even the mascarpone was made from farm made double cream which raw milk was used for – where I actually know the cow it came from… I was truly sick munching away – Let’s see how I will manage that huge amount :), and if the blood sugar is a wee higher (didn’t rise over 5 today) so be it. Factory based oils don’t usually hit my table (The blessings of living in rural Ireland and knowing the farmers, I guess).- Thanks Dave, good words.
    \Lars

    1. Dave

      Yes — please don’t do anything that is making you sick or feel nauseous. I really want to stress that!

      And yes, I’d expect the blood sugar to be higher relative to when you are on a lower caloric load (even fat has small amounts of glycerol backbone that likewise get processed to glucose, so there’s no avoiding some small spike).

  7. Latife

    In relating your calling ‘Lean-Mass-Hyper responders’ and exercise part, I am bit confused and want to ask some questions. Let say I am a lean person and have lower glycogen stores. I regularly do exercises after low carb high fat dinner (about 2 hours after dinner). Also during day I am quite active physically doing kitchen, garden, shopping works etc. (or playing with kids). in this case my body uses fat or glucose? How long takes my body to use glucose or glycogen? If I have lower glycogen stores and think my body uses it during HIIT exercise and after about 12-14 hours fast isn’t it possible my body mobilising energy from triglycerides that increases my LDL? What is the reason my LDL or cholesterol decrease after exercises?
    Thanks in advance!

    1. Dave

      Hi Latife–

      That’s a lot to unpack!

      – First, we are already using some amount of glycogen and some amount of fat at all times — but the ratios change, of course, depending on availability and demand.

      – I’m not an expert on the exact amounts (I refer you to the *real* experts, Volek and Phinney), but I believe it is extremely rare to completely deplete your glycogen stores. That’s usually done at times like marathons where one “hits the wall” at around the 17th mile, for example.

      – The more fat-adapted you are, the more your body appear to have a higher ketone/trig usage relative to a glucose preference when not needed for immediate HIIT or sprint-like activity.

  8. Ian

    Hi Dave
    Thanks you for your blog and the video of your latest research.

    Just a question about the lipid response to fat intake. In your studies (fasting, 5000 calories, etc) were you able to test the ldl subfractions (1 to 6)? Reason for asking is – maybe the LDL overall drops on high fat intake but the profile becomes more atherogenic (or vice versa). Hope that makes some kind of sense.

    regards
    IanA

    1. Dave

      Hi Ian-

      Sorry for the late reply — this one slipped past me.

      Yes, I have always gotten NMRs for subfractions. Your question is probably better answered in my Breck presentation – http://cholesterolcode.com/about/

  9. b. holiday

    Hi Dave. I want to report my results. I ate 4000 calories on Monday, 400 grams of fat. 5000 calories on Tuesday, 500 grams of fat. 5000 calories on Wednesday 500 grams of fat. 5000 calories on Thursday, 500 grams of fat. Tested blood glucose and ketones every night around 8PM. Blood sugar in 70-80’s. Ketones from 4-7.8.

    Last meal around 4pm on Thursday. Blood test 8:15 am Friday.

    LDL-P >3500 High.
    LDL-C >429 High.
    HDL-C 74
    Triglycerides 147
    Cholesterol, Total 532 High.
    HDL-P (Total) 34.3.
    Small LDL-P 219
    LDL Size 22.3
    LP-IR Score: 51 High.

    Do these numbers look good, or very bad? I am getting very mixed messages.

  10. Dave

    Hi b—

    Your numbers are unusual for the protocol. Can you post your food logs here?

    (I should warn I’m deep in the Ketofest experiment now, so might be spotty on reply…)

  11. Gina

    First, thank you for the blog and all of the information you have been providing to us. I am also a hyper responder. When I started a ketogenic diet, my total cholesterol steadily rose to the 500+ range. After three years of being on the diet and improving all of my health markers, including a 100+ weight loss, my total cholesterol has slowly been going down and it’s currently at 345. I am not concerned over my cholesterol as I don’t believe in the lipid hypothesis but I am very interested in lipids, especially how LDL works.

    Excuse my ignorance but since this subject really is fascinating to me, I want to make sure that I am not missing anything important. I am just not understanding what this protocol is for or what it is showing about cholesterol that we didn’t already know and why the results are meaninful. I have read through the blog and I also have a basic understanding of how lipids work. I am just not understanding what your research is showing.

    If you eat a whole lot of calories, a few days before your blood test and it makes your cholesterol go down, what does that mean? Why would that be of any importance? You normally wouldn’t eat 5000 calories or more a day, so the fact that doing that causes your cholesterol to drop, is almost a fluke result. In other words, it’s not a true, everyday, result that you would get otherwise. I don’t see why anyone would do that unless they are trying to manipulate results for insurance purposes or to get their doctors off their back.

    Most importantly though, I want to know what it means and why it’s meaningful? “Cholesterol” is so dynamic that basically anything can change it. I think that lipidologists know this and it hasn’t changed the country’s obsession on cholesterol so showing this effect on multiple people wouldn’t cause them to think cholesterol is any more harmful.

    1. Craig

      Gina,

      Unfortunately, most doctors aren’t as informed about TC/LDL as they should be regarding both it’s predictive power as a risk factor and its dynamic variability. Instead of educating them, it’s often easiest just to give them a ‘good’ number and move on. If you have a LCHF-friendly doctor who is more interested in measuring insulin resistance, inflammation, and atherosclerosis, you don’t need the protocol.

      The research so far has shown that the lipid system is highly dynamic, and more is going on than the conventional wisdom suggests. There is still a lot more to figure out, and we don’t know for sure if having high LDL-p is causal for disease in-and-of itself. So if you’re interested in learning more, you’re in the right place. 🙂

      Craig.

      1. Gina

        Thank you Craig.

  12. Joe

    Hi Dave,

    Your research is really fascinating- I as well had higher LDL numbers when I started the low-carb/Keto diet. The only thing is when my doctor tests my cholesterol he absolutely insists that I take the test non-fasting. When I look at the numbers with a layman’s eye, the numbers are always outside of the normal reference ranges- I.e: Either the ldl to high or the hdl is too low or both. He never seems concerned an always tells me everything is OK

    Do you take your tests on a full or empty stomach? Do you think there is any clinical value to doing the test on a full stomach?

    Thanks,

    Joe

    1. Dave

      I always take my labs at around 14 hours fasted. I make sure that span of time exists between the meal I ate on the night before and the blood draw the morning of.

      The reason is that one group of the LDL particles that originate from food, called Chylomicrons, will be almost entirely cleared by that point. Thus, I can count my scores to be consistent with the other half of LDL particles that come from storage and originate as VLDLs.

  13. Jan Bardot

    Hi Dave,
    I just met you at San Diego LCHF. My name is, Jan an empath, the retired professional athlete, massage therapist and you read my NMR. I loved your presentation and your passion for getting the true data out about what cholesterol numbers really mean. Thank you very much.

    Please let me know the dates in advanced so I can plan. As I said to you yesterday I am now single with no children which gives me the freedom to travel.

    Looking forward to hearing from you.

    Jan

    1. Dave

      Yes, Jan — it was awesome meeting you!

      I may have some studies coming up. Keep an eye out on this blog in case I post something on it in the near future. 🙂

  14. RS Weir

    Hi Dave:
    Not sure if this is the right place to ask this question…but here goes.
    I’ve been on a keto program for the last five years. Virtually no carbs other than leafy greens, cauliflower etc.. Yet fasting glucose is 96. However, fasting insulin is 2 which gives a very favorable HOMA_IR of .47.
    I am curious as to why the glucose remains in the 90s. I would think that with no carbs I could get it lower.
    Does the low carb, high fat, moderate protein diet produce such low insulin that consequently glucose cannot be driven down below 90 without long periods of fasting?
    Thank you.

    1. Craig

      Check out Dave’s comment from today at 11:32 in The Game of Glucose. Your muscles learn to ignore the glucose so that its only used by tissues that require it.

  15. Matt Allington

    Hi Dave.

    Matt here (twitter @exceleratorbi). I would love to work with you to help visualise your data. I am a professional data consultant and made keto guy.

    1. Dave

      Glad we were able to connect, Matt. 🙂

  16. Mary

    Former Reliability Engineer here.
    This stuff is fascinating.
    Would love to see someone decompose dietary “risk factors” and associations into a ranked list of 1st order, 2nd order, 3rd order effects. Does anyone think that’s possible?
    After the 1st order effects, genetics, microbes, frank poisons, (known and unknown exposures), accidents, available calories ( non starvation), exercise levels, even background radiation, a lot of medical science “risks analysis” especially from nutrition, looks pretty specious to me. Presumably the goals are to not die sooner or more painfully than needful and to function well. The first goal is more clear than the last goal
    Many biological deaths are marked by (could be modeled as) cascading failures from the disruption of homeostatic processes ( don’t screw around with electrolytes and oxygen uptake). A. Be careful with your experiments B. We don’t know squat about proteomics, or the microbiome for that matter , and C., the whole science of endocrinology appears to be a bit thin on the subject of nutrition.
    There are differences in phenotypes that affect metabolic efficiency for some compounds. (12 phenotypes for alcohol metabolism) Homeostasis will mask a good bit of variation. Everyone has some organ reserve. You might not realize damage until you’ve lost a good bit of cellular machinery. Then your numbers are going to go seriously south without a good way back. So be careful.

    1. Dave

      Thanks for the thoughts, Mary.

      Indeed, I share some of your concerns and will try to be careful with the experiments as you suggest.

  17. Kathy Kennedy

    Hi Dave,

    Glad to have found your blog. I had suffered for well over 15 years with horrendous digestive problems. After much trial and error, I tried a no starch diet and the results were incredible. It was the first thing that actually helped me. I eventually discovered that eating as close to zero carb as possible has given me the best symptom control to date. I am probably not in ketosis because I eat a fair amount of protein. I do what works for me.

    I read that the body handles saturated fat differently on low carb or keto diets, so I didn’t worry about it, although I have had high cholesterol in the past. But at my physical in June, I got these results:

    Total Cholesterol: 561 mg/dl
    Trigycleride: 97 mg/dl
    HDL: 109 mg/dl

    I retooled my diet to lean meat, 2 eggs per day on average, fish,a little cheese, and monounsaturated fat and fish oil. And that is seriously about it, diet-wise, plus a piece or two of dark chocolate. I can tolerate beer because no fiber. No fruit, no vegetables of any kind, because I can’t digest them and any supposed health gains are canceled out by poor quality of life. I might be one of your lean mass hyper responders because I am 5’5″ and 107 pounds or so. Pretty physically active–lift weights and lots of walking. (15,000-20,000 steps/day)

    Anyway, I don’t really know if it pays to be tested again. I will not take statins under any circumstances, and I simply can’t eat carbs. I figure I am doing the best that I can under the circumstances, but you seem to have studied this way more, so if you have any thoughts, I would be interested in hearing them.

    Thanks,
    Kathy

  18. Ted

    I’m curious if you have considered Dr. Thomas Cowan’s theory on the causes of heart attack. His explanation, while not an explanation of how dietary cholesterol or blood lipids work, it shows that the root cause of heart attacks is not blocked arteries, it’s capillary dysfunction, stress and poor para sympathetic response.

    https://cdn.shopify.com/s/files/1/1021/7291/files/What-Causes-Heart-Attacks-Cowan-reprint.pdf?10079655763935097707

    1. Dave

      While I’ll have to come back around to this paper given available time at the moment — I certainly feel in general agreement with your summary of this as stated. Certainly endothelial damage/dysfunction is an extraordinarily relevant component.

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