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Mar 14

Thoughts on Shawn Baker’s Labs

This week, Robb Wolf had Dr. Shawn Baker on his podcast, The Paleo Solution.

Baker has been a controversial figure for his embracing a meat-only diet (no plants). Naturally, this has made him a favorite target of vegans, particularly youtubers. What makes him especially interesting is that he’s not just an athlete, but he’s actually setting a number of world records for his age class (over 50!) in athletic benchmarks.

Full disclosure: I now know a number of “carnivore” dieters like Amber O’Hearn who I consider friends. But I likewise have a number of vegan friends as well, many of whom I have worked with to improve their lipid numbers.

Throughout his time on this diet, Baker didn’t take any blood tests until just a couple months ago. This first round of tests were then revealed on the podcast and proved to be quite interesting. While there are a number of them that would be worth commenting on, those I want to focus on were about the energy metabolism (no surprise).

The Glucose and Insulin Labs

  • HbA1c: 6.3
  • Fasting Glucose: 126 mg/dL
  • Fasting Insulin: 2.6 mIU/L

The A1c and fasting glucose are certainly consistent with someone who is prediabetic and likely on their way to full-blown Type 2. Well — that is — until you look at the fasting insulin. In what circumstance would you expect a high fasting glucose with a low fasting insulin?

I see them all the time: low carb athletes.

Ironically, I just got done talking about this on Ketoconnect’s podcast (airing in a couple months). In fact, Lean Mass Hyper-responders (LMHR) are actually the most likely to have a fasting glucose in the 90s or even over 100s while also sporting a fasting insulin below 3. Moreover, this profile typically has lower blood ketones (BHB) when testing compared to their more sedentary cohorts. (I’ll have a blog post on this soon)

I myself tend to be on the borderline of a LMHR or just past the line when fully keto. In that context, I often have fasting glucose in the 90s or lower 100s and an A1c of between 5.5 and 5.7. And that’s bad, right? Creeping back toward risk of Type 2 diabetes? I certainly don’t think so given my average fasting insulin of 3 or less.

But wait — Baker is much, much higher, right? Almost 20% higher in both fasting glucose and A1c. Surely he’ll be piling up the insulin resistance as we don’t see these numbers in any other low carbers, yes?

Energy Demand Leading to Higher Glucose Sparing?

This is where I part ways with so many people in and out of LCHF. What got me into cholesterol in the first place was seeing how it was really just “ridesharing” in a larger energy metabolism. So energy delivery and homeostasis on a greater network-level scale is what I continue to find endlessly fascinating. I’ll let the Benjamin Bikmans and Michael Eades of this world tackle the finer details of the mitochondria, I want to know how the Human OS manages to traffic that energy to our cells so effectively in the first place.

Which brings us back to Baker. This isn’t any ordinary guy. He isn’t just working out for recreation, he’s an athlete’s athlete. He’s training to break these various world records in addition to a variety of other workout regimes. So if you observe (as I do) a degree of adaptive glucose sparing as being more common with low carb athletes, what do you suppose it would be like for this human cyclone?

It’s not enough to just think of where his cells are getting their energy, you have to think of how timely it needs to be at a systemic level. Is Baker more of a slow jog in the morning kinda guy? No. Is he more of an exploding HIIT adventurer that is probably keeping high muscle confusion? Yes. The latter suggests more need for glycogen stores in the muscle with a strong rotation of glucose via the liver.

This is why I asked Baker and many other low carb athletes to please do more testing for us if they (heaven forbid) get injured or for some reason can’t exercise intensively for a period of time. I suspect in such cases if all other things were equal, their fasting glucose would drop. This is what happened to me when comparing my morning glucose in and out of marathon season.

The Cholesterol Labs

Baker had the following lipids:

Total Cholesterol: 192

LDL-C: 141

HDL-C: 40

Triglycerides: 54

For these I had the following notes:

  • LDL-C and LDL-P are both on the lower end for a low carber who is as lean and fit as Dr Baker is. I suspect this is due to his emphasis on resistance training, which can reduce LDL scores due to a higher rate of use for muscle repair.
  • Small LDL-P is low at 283, and clearly very Pattern A.
  • HDL-C — 40 mg/dL is low for a zero carber. However, as he discussed with me, he apparently has low HDL running in the family as well as a prior history of it running closer to 30. At some point, he may what to check into his SNPs and see if there’s some pushdown there.
  • HDL-P was highlighted as being low (out of range) at 28. However, I see this frequently with low carbers across the board.
  • Triglycerides — 54 is certainly very correlative with a very athletic, insulin sensitive metabolism.
  • Lipoprotein (a) — 2 nmol/L is one of the lowest scores I’ve ever seen (maybe THE lowest).
  • The score I most care about is Remnant Cholesterol which is calculated by subtracting both HDL-C and LDL-C from Total Cholesterol. His score of just 11 mg/dL is extremely low risk and suggests he has a very efficient fat metabolism. (You can use our reporting tool here if you’d like to calculate your own)

Again, I’m not surprised by the lower LDL-C and LDL-P as I’ve covered this before with my own data. As the theory goes, on one end he’s being powered by fat, necessitating more VLDL secretion. On the other, he’s engulfing LDL-P at a rapid rate for tissue repair, particularly for all that resistance training.

Final Thoughts

Baker, O’Hearn, and the many other “carnivores” are certainly conducting a very interesting, real-time experiment. I’m excited to see how this new data will manifest and what positives and/or negatives will be revealed.

At some point, I plan to do an experiment of my own going meat-only for a month, just as I plan to do likewise with a plant-based diet. I’ll be very curious as to what happens to my blood markers when comparing to my many, many labs before it.

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116 Comments on "Thoughts on Shawn Baker’s Labs"

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M. GARDYASZ
Guest

APPRECIATE ALL YOUR AWESOME WORK AND THE TIP ON LEAN HYPER-RESPONDERS. I HAVE BEEN LOW CARB FOR 3 YEARS AND MY TC=294; HDL =102 AND LDL=180 WITH REMNANT VALUE OF 12. I AM 58 AND WEIGH 163 AND HAVE HIGH WORK OUT ENERGY BUT MY A1C HAS BEEN BETWEEN 6-6.2 FOR THE LAST 3 YRS. THANKS, WILL FOLLOW ALONG.

Stephanie Holbrook
Guest

Thank you Dave for all of your amazing work. I coach low carb/keto/carnivore endurance athletes. We see similar results in regards to triglycerides, insulin and A1C’s.

I enjoy reading our test results. I look forward to seeing your carnivore compared to vegan results.

Simon Hunter
Guest

This makes me feel better about my fasting glucose. I’m LCHF but not super low carb (4 years or so). I still eat potatoes and get probably around 150g a day. I’m 45 male 5’10 142lbs. I’ve been chasing a high fasting glucose for a couple of years now. It is always in the 90-110 range (I’ve taken probably a 100 readings). I work out at least 3-4 times a week mostly resistance training. However my post prandial numbers seem pretty decent and my fasting insulin is 2.4. I can’t trust my A1C number because I have to donote blood monthly for hereditary hemochromatosis.

Shane O
Guest

I, like you, find human energy metabolism endlessly fascinating. I just listened to his podcast the other day where his blood tests were revealed. I love Dr Bakers attitude in the face of a lot of back lash he receives. Man, could you be on to another paradigm shifting idea??? High glucose no longer means diabetes?? Of course everything has to be taken in context(diet, exercise, overall health):) As always, great blog post and thanks again for sharing your thoughts.

Ross
Guest

Nice tight analysis.

A1C likely high due to Extended lifetime of RBC due, in turn, to low sugar damage

As a patreon was hoping you’d hit this and even more so that you try meat only. But I think 4 weeks might be on the borderline: for really locking definitive contrast you might want six…..

Terry Ritter
Guest

I have seen studies that show that the standard assumption of 120 days for a RBC in the calculation of A1C can be off as much as +/- 20% in healthy individuals, and even a shorter lifespan for those with diabetic level BG. Doesn’t this kinda cause one pause when worrying about A1C? I am also curious Dave to how you think the “glucose sparing” works. IOW, why does the liver keep BG, and especially FBG, high?

Bert
Guest

It seems like no matter how bad the reading, you’re finding a way to justify it because people are low carb.

High blood glucose leads to glycation and increases risk of atherosclerosis. Zero carb has no historical precedence and makes absolutely no sense from any viewpoint other than orthorexia.

What would happen to Shawn if he ate an olive? Would he die? If this guy accidentally had a cup of coffee or some MCT powder (both come from plants) – would he lose strength?

Why are all plants bad?

We’re opportunistic eaters. Carnivore is dumber than vegan because we in the Keto community should know better and aspire to be more than the mirror opposite of vegans.

Here’s another theory – this guy lives on Wendy’s and garbage meats and his gut microbiome isn’t what it should be which is impairing insulin signaling.

He should look into his post prandial glucose responses – anything > 140 and this guy is vastly increasing his risk for heart disease.

But of course I guess that can all be waved away because the scientific community hasn’t taken the time to explore the long term health effects of stupid diets like this.

Right?

Messner
Guest

I tend to agree with you –although I’m following a LCHF/Ketogenic/High Protein diet (varies over time) along with intermittent fasting and time-restricted feeding. I have lost 66 pounds with this approach. My A1c was 5.7 last time I check but before entering this eating approach I had all the symptoms of metabolic syndrome and (at least) pre diabetes. Most notably, persistent blurry vision which reverted and resolved completely since going keto (and following the other approaches).

However, although I have a great deal of “confidence” in that my glucose was out of control I cannot tell for sure because I have no relevant recent measures of glucose to refer too (I have very old ones, of many many years ago when I was much younger, leaner and athletic).

This is what I think. Baker has said that he was overweight in spite of rigorous training before adopting his carnivore style. We know that that, coupled with the fact of this long-term training, may be and indication of insulin resistance and elevated blood glucose. I may very well be that his A1c was higher then than it is now. However, we don’t know.

And that’s the point. We dont know. Baker has said that he did not tested. I personally think that that was a very silly approach. There is no baseline to which compare (and even then, it would be only argumentative as no proper control interventions is available).

I could be that his A1c had increase since going carnivore or it could be the other way around. We don´t know.

However, there is one thing that we know: 6.4 is a number you have to take seriously. I would not jump out of the window just because of one measurement, but I would make a point of tracking nutrition, exercise and outcomes (a la Dave) to understand the dynamics behind that number.

The main problem is that Baker made a mistake (considering he is a doctor) –namely, not establishing his baseline and not tracking behaviour and outcomes.

I also agree with you in that and A1c of 6.4 cannot be dismissed simply because your are eating this or that.

I myself observe this number with caution in the sense of acknowledging the possibility that this eating pattern has a negative consequence on blood glucose levels. That being said, I still need more data. If you happen to have references (good references, with well-define controls groups and interventions) showing that very high protein / carnivore diets induce elevated glucose and insulin resistance, please do share it.

Messner

Colleen
Guest

Re the post prandial, Shawn mentioned that much of the time his glucose was lower, even 80s, and that meals he stayed the same or had minimal increase. His fasting BG was his highest reading of the day, and he mentioned basically being subject to the dawn phenomenon.

However, I agree may high BG may still be of concern despite the atheltics.

Jay
Guest

Where are you getting he eats Wendy’s? He eats ribeyes most of the time, with a little cheese and seafood. You are clearly vegan by your venomous response. Open that closed, pathetic mind of yours. Look up Owsley Stanley, he ate a carnivore diet for over 50 years. Died at age 76, in a car crash. Plenty of people have been doing this diet for 10+ years with amazing results.

BobM
Guest

Not to mention entire groups of people. The Comanches, for instance, basically ate 100% buffalo. Would they eat anything else? Sure, if they were starving.

I’ve personally found eating more meat, fewer vegetables better even while on a keto/very low carb diet. I still eat a few vegetables, though. I used to eat vegetables at every meal, now I can go days without eating them.

Dave, I have a low carb doctor whose theory about HDL (HDL-C, though I find this confusing since HDL is not cholesterol) is that it varies based on the amount of good fats you’re eating. (I assume she means animal fats, but I’ll have to ask her next time I see her.) This does seem reasonable. If I fast (no fats), HDL does down. I started testing eating higher protein and lower fat, and HDL went down relative to eating more fat (i.e., higher fat meats). What are your thoughts on this hypothesis, and how could one go about testing this?

Ross
Guest

Oops, didn’t see the rest of your thoughtful comment, Bert.

This guy’s post prandial response is steady or negative. In the Robb Wolf interview, i think he said the most it ever rose was 5-10 points.

Ross
Guest

Bert – concern of mine, too, until i checked out the underpinnings of the HbAic test. Upshot: if your red blood cells live longer than 120 days on average…your values will be pushed incorrectly higher. If your red blood cells live less (say, due to glycation damage) than 120 on average your HbA1c will be pushed incorrectly lower. Diabetics, therefore, have insufficiently revealing A1c scores. And contrariwise, those with very low/no red blood cell sugar damage will have long-lived RBC and incorrectly high A1c.

That’s why a secondary test like HOMA or fasting Insulin or is needed.

A final note: if Doc Baker regularly donated blood, his ferritin would be lower (this would make PD Mangan happy) and his average RBC lifetime would be shorter — and his HbAic more accurate.

Hope this helps….

chris c
Guest

Yes anecdotally/observationally some diabetics have HbA1c which differs significantly from their spot readings – the low carbers tend towards higher A1c, suggesting a longer life for the red cells. Interestingly some of them had fructosamine tested and that came in more in line with the spot BG readings.

A1c was always regarded as too inaccurate to be used for diagnosis until a few years back.

Rob
Guest

This sets off bells for me! 6 months ago I switched from LCHF to VLCD >95% of my diet is meat and eggs, bit of cheese. I might grab some cucumber or celery sticks here and there (mimicking random foraging). Only refined glucose is for treating my hypos (I am T1D) but usually less than 10g-15g carbs per day as needed. Workouts are short and intense, Ted Naiman style which has added significant muscle tone and strength to my 47 year old body. Before switching I was putting up AIC’s around 5.0-5.4. Since going almost all meat, I’ve bumped up to 5.7 on my last two blood drawn A1C’s. This last test there appeared a discrepancy between my interstitial CGM A1C ‘estimate’ of 5.0, photo recorded the same time as my last blood draw, and the blood result of 5.7! I accept a normal range of variance but the previous 4 comparisons between my CGM and the blood draw A1C was virtually no error range. This leads me to believe there is truth in the idea that red blood cells are hanging in there just a little bit longer and throwing the blood drawn A1C up while the CGM estimate of real time data is showing something else (blood versus interstitial)! I have to say, this is a totally new rabbit hole I need to dive down. Loving this!

Dominik
Guest

Hi Dave,
as always… great post!!
one question on HDL: to my knowledge it primarily serves as an transport molecule for gonads and adrenals and additionally delivers cholesterol to VLDL and LDL. Is this correct?
And is that all it does or do you see different purposes as well?
And btw, if its correct that it supplies to gonads and adrenals, why does not LDL do this? (as it does for the rest of the body)

Colleen
Guest

Dave: great post and I applaud Dr. Baker for sharing this data knowing that it would be the subject for widespread discussion. My limited understanding is that despite his athletic status, the fact of the higher BG levels themselves cause damage to tissue despite the low insulin. Of course all the research I see in this area is in the typical diabetic population and I don’t see research in a carnivore or low carb population happening soon. What are your thoughts on what is causing damage, the BG or the insulin? Both? Is this a case where the body is doing a great job of fuel management but there is a cost to long-term health via the higher BG levels? Is this BG level a red herring with respect to athletics and simply a manifestation of the dawn phenomenon and genetics?

Dutchy74
Guest

I’m a low carber myself and am very sympathetic towards the carnivore diet, but for a second I’d like to put diet aside in the case of Dr Baker.

It seems to me that a lot of the assumptions here are predicated on the idea that this guy is a peak level athlete, so whatever his markers are they must be healthy. I’m not so certain.

While it seems obvious that exercise is good for our health, is it possible that being an ‘athlete’s athlete’ is just another way to put an unnatural amount of stress on our bodies, just like obesity or psychological stress? From a risk perspective, I’d obviously rather be the high level athlete than the diabetic couch potato, but does this mean that pushing yourself to your absolute limits day in and day out is inherently healthy?

It’s tough to set aside the idea ingrained in us by our culture that the athlete is the absolute peak of physical health, but, in a not insignificant number of cases, these guys wind up just flat out dying young.

While I see no flaws in your logic regarding WHY fasting glucose and a1c would be elevated in this example, as far as I’m concerned, it still can’t be said that these markers should be considered by any means desirable until proven otherwise. Particularly not based on the peak athlete/ perfect health assumption I’ve outlined.

phillip kalasz
Guest

Thanks Dave! Love your work!

Nan
Guest

I’m a healthy (no pills) long time low carber, now very low carb higher fat diet; I’m officially an old lady, 70yo, who exercises an average amount, walking 1-2miles 4-5x a week, with once a week weight training; Since I got past 50yo I always have the “Dawn Effect” with my BG up around 100, and it goes higher if I cut calories. Yet, it drops to normal 70-80 as soon as I have any food, and stays there. My very nice (who will never look beyond his training) doctor tries to get me on statins every annual exam, and I tell him I don’t believe in them, but am going to try your protocol to see if I can lower the numbers and flummox him. Will report my results.

Jake
Guest

I took part in the original carnivore 90 day study and had blood work done at the end of the 90 days. I am a 50 year- old male, 185lbs, 6′ tall, and workout 5-6 times per week. The year prior to the study I ate following the protocol outlined by ketogains.

For what it is worth, my labs were as follows:
HbA1c: 5.5
Fasting Glucose: 93 mg/dL
Fasting Insulin: 2.2 mIU/L
HOMO-IR score: .3

Total Cholesterol: 321
LDL-C: 219
HDL-C: 89
Triglycerides: 39

Antol
Guest

Solve the heart disease question in 1 go with a CAC SCAN. JOB DONE. HE’S RIGHT AGE TO SHOW A HIGH NUMBER. LOW NUMNER LOW RISK..KEEP DOING WHAT UR DOING… u can test all the ldl and hel u want.. CAC SHOWS THE CALCIFICATION
NO HUGH CAC NO INSULIN RESITAMCE NO PRE T2

Micheal Adeyosoye
Guest

Hey Dave. Id like to share some blood results. Im a 23 year old grad student who’s very active in the gym. Ive been on keto since june last year. I wen to do a blood test to see where Im at.

Test 1- January
hdl 56
triglycerides 60
ldl 270
total 338

After this, I decided to go on a cut and make most of my fats monounsaturated for around 2 weeks. I went to the gym and HIIT cardio every day. I decided to get a nmr test as well.

Test 2 – february
hdl 48
trig 109
ldl 299
total 369

the particle number was high as well, which makes me suspicious of how much an nmr can calculate cvd risks.

Then I finally went to experiment the feldman protocol by having my calories up to 5400. I got a CRP and a regular blood test done. This time i didn’t do the HIIT cardio these days.

Test 3
hdl 60
trig 60
ldl 199
total 271

My grandmother, who is a nurse, is still skeptical because the cholesterol I consumed in test 3 was around 300mg less that test 1 and 2. Im going to do another test on monday with the protocol again with a higher amount of cholesterol consumed and get back to you on Tuesday. One question I have is that should I be going to the gym and cardio while doing this experiment? I’m thinking it might make my body require more cholesterol and produce more to fulfil.

Bill+G
Guest

Everyone looks at these high glucose numbers here as a progression to type 2 diabetes (hyperglycemia/hyperinsulinemia/insulin resistance), but what if it’s actually an onset of type 1 diabetes (immune attack on beta cells curbing insulin production)?

Contrary to popular belief, destruction of beta cells comes in waves & not all at once. Is it possible that he has lost beta cell function & becoming a type 1 diabetic?

Tests should be run like C-peptide & antibody to make sure his pancreas is ok. We don’t have knowledge of what exactly CAUSES the autoimmune destruction of beta cells. I suspect world class athletes are still human and are susceptible to becoming a type 1 diabetic.

Vic
Guest

Hey Dave,

Just did a 6 week run of Carnivore with Pre and post blood work. I’m a pretty lean athlete and would love if you would take the time to give hear your input on my numbers.

Units are mmol/L

Pre (roughly 14 hours fasted)
Cholesterol 4.48
Triglycerides 1.07
HDL Cholesterol 1.50
LDL Cholesterol Calc 2.49

Post (11-12 hours fasted)
Cholesterol 7.31
Triglycerides 1.10
HDL Cholesterol 1.62
LDL Cholesterol Calc 5.19

Angelika Ilina
Guest

Thank you, Dave, for this very informative post! I follow Shawn Baker even though I am not a carnivore myself. I’m not sure if I’m a LMHR – my remnant cholesterol is 10; fasting glucose 84; triglycerides 48; LDL 143. Maybe I’m just a low carber 🙂

Johannes
Guest

Hi Dave, as always great thoughts.
When thinking about your work i came to realize that im unable to explain something from your earlier research .. may you help me back on track: –> inverse pattern and LDL-P… why is there this 2 day gap?

Chris Parker
Guest

Dave, I read previously that adipocytes can only release free fatty acids back into the bloodstream at a rate of approximately 31 calories per pound of fat on the body.

I assume that as Volek etc found an up-regulation of fat burning for athletes following substantial carb restriction (Faster study) that the number quoted may be able to move north considerably. That being said, at some point of fat loss, energy demand will outweigh what the adipocytes are willing to give up.

If this is true, then for lean people like yourself and Dr Baker, this would mean that less fat, and therefore calories, are available from adipocytes even if available.
This would make organ/muscle stores of fat extremely important for normal activity. Could it also lead to excessive levels of glucagon leading to excess glucose in the blood and eventually hyperglucagonemia?

Razvan Popescu
Guest

i would also suggest going 1 feed/meal every 2-3 days
as that is probably the closest to maximum efficiency
ps hope you have a demanding sport to play

Dana Beaver
Guest

Hi Dave, I just listened to your podcast with Keto Connect and I’m very interested in your research. I just started moving toward a keto diet about 17 days ago. I’m 48 yrs. old and last year, I was diagnosed with familial hypercholesterolemia. My total cholesterol at that time was 275, and it only dropped minimally when I tried simple diet changes in order to avoid going on statins. My doctor felt that because my father’s side of the family (my father and his only brother) also have/had high cholesterol, in addition to the fact that I’m not overweight and I am active daily, a more disciplined dietary change wouldn’t be likely to bring my numbers down enough either. My cardiologist prescribed Atorvastatin, and later added Zetia. By February, my total cholesterol was down to 153, with a remnant cholesterol of 27. I am very interested to know where this number falls in the severity range. Regardless, after just starting the ketogenic diet and I’m fairly certain, after listening to your podcast, that my numbers are probably sky-high now. I’m writing to inquire about whether you know the effect of statins and Zetia when a person switches to a ketogenic diet? From my understanding, Zetia absorbs fat in the stomach, so what happens when an individual is trying to eat higher amounts of fat for energy? I’m certain my cardiologist is going to tell me I’m so mistaken for doing what I’m doing, and I do have doubts that I’m doing what’s best for someone in my situation. Like you, however, I feel so much better eating a keto diet that it’s hard to imagine it could bad for me. Thanks so much for any input you have.

Dana Beaver
Guest

Dave, Thank you so much for your replies. I really appreciate and value your thoughts on this. Below are my numbers, as generated from the report. I started a ketogenic diet just 2 weeks ago, so I haven’t had my new levels checked yet. I apologize is that is the information you were requesting. Please let me know if that’s the case.

Initial Cholesterol Test (2/9/2017):
..47 years on Standard American ::: 12 hours water fasted…
Total Cholesterol:
275 mg/dL
7.11 mmol/L
LDL Cholesterol:
172 mg/dL
4.45 mmol/L
HDL Cholesterol:
64 mg/dL
1.66 mmol/L
Triglycerides:
197 mg/dL
2.22 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol:
39 mg/dL
1.01 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL:

0.61 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.126 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–

Friedewald LDL-C: 172 | Iranian LDL-C: 239
Total/HDL Ratio: 4.3
TG/HDL Ratio in mg/dL: 3.08 | in mmol/L: 1.34

After 25 days on statins (10/30/17):
–==== CholesterolCode.com/Report v0.9.2 ====–
…47 years on Standard American ::: 12 hours water fasted…
Total Cholesterol:
209 mg/dL
5.4 mmol/L
LDL Cholesterol:
134 mg/dL
3.47 mmol/L
HDL Cholesterol:
62 mg/dL
1.6 mmol/L
Triglycerides:
63 mg/dL
0.71 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol:
13 mg/dL
0.34 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL:

0.21 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.353 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma
–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 134 | Iranian LDL-C: 114
Total/HDL Ratio: 3.37
TG/HDL Ratio in mg/dL: 1.02 | in mmol/L: 0.44

After 3 months of Zetia (Ezetimibe) added to statins (2/8/2018):

–==== CholesterolCode.com/Report v0.9.2 ====–
…48 years on Standard American ::: 13.5 hours water fasted…
Total Cholesterol:
153 mg/dL
3.96 mmol/L
LDL Cholesterol:
62 mg/dL
1.6 mmol/L
HDL Cholesterol:
64 mg/dL
1.66 mmol/L
Triglycerides:
137 mg/dL
1.55 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol:
27 mg/dL
0.7 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL:

0.42 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.03 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 62 | Iranian LDL-C: 104
Total/HDL Ratio: 2.39
TG/HDL Ratio in mg/dL: 2.14 | in mmol/L: 0.93

Dana Beaver
Guest

By the way, I’m in great overall health, no heart conditions, no calcium build-up so far. My father lived into his mid-80’s, despite having high cholesterol and his brother is still alive, healthy and active in his 80’s. My dad used statins, but his brother used diet and exercise (I.e., lifelong marathon runner) and is comfortable with a 240 total cholesterol level. I initially started keto to loose an extra few pounds I had gained, but I’d like to continue because I feel better. I’m 5’7” and 134 lbs.

Matt
Guest

So, for those like myself who aren’t nerdy on this stuff… Does that mean he’s healthy? Does his blood work show he could maintain this long term and be “healthy”?

David
Guest

Hey Dave just wondering when you are going to try the diet and experiment?

Douglas Gilliland
Guest

Makes sense. I did a test of myself (now ketogenic but former T2D) against a triathlete friend who is also ketogenic. His fasting Blood Sugar was relatively high compared to mine at start. We both ate a 50g Whey protein bolus at the same time and measured our blood sugars. His went down and mine went up. Mine took longer to normalize. Put link to results in the website link.

Jeremy
Guest

Hi Dave,

I am hoping if you can help me by giving your opinion about my cholesterol test result.
I just did my first blood test after two months on Keto diet, I did a lot of reading and researched in these two months on the subject cause getting into kept adapted is not as easy as I imagined.
I did a blood test 6 months ago as a general checkup, everything is under the guideline, and I didn’t know I was gonna change my diet to LCHF in four months.
The reason I got into LCHF is because I am an seasonal athlete doing ocean outrigger paddling, long two to three hours paddling across channel between island…etc.
I felt like my recovery time and endurance is getting worse and worse every year after four years of paddling, I just turned 45, and I hate carb loading, but there is no other options till I came across LCHF diet.
The past two months has been GREAT, I feel great, not hungry. full of energy….you know what I am talking about.

SO,I did my FIRST LAB TEST AFYTER TWO MONTHS on LCHF diet, I was expecting the Cholesterol number to changed and it did.
My Cholesterol went from 186 to 254
HDL stayed the same as 66
LDL went from 104 to 149
CHOL/HDL Ration went from 2.82 to 3.85
THE MOST SHOCKING TO ME is my Triglyceride went from 80 tp 197 !!! I am concerned since I don’t know why/how it happened.
My doctor want me to quit the diet (cut back dietary fat and take more grains) or take medication.
Thanks to your research and experiment I now have a better understanding of the lipid system/mechanism but I have no clue why the triglyceride number will jump to 197.

As I said the first blood test was just a regular check up without any purpose of it, at that time, I was pretty healthy, not overweight, no major health problems, I did consume a lot of carb (carb load for paddling), and a lot of it is actually beer !!! and stupidly I didn’t think it’s carb !! overall I just started to feel the inflammation level in my body is getting higher and higher, as you can imagine.

So because I did the second lab test after two months in LCHF diet, I asked my doctor to do the A1C and EAG test also the CRP-HS test, A1C came back 5.2 and EAG is 103, CRP-HS is 1.18
I didn’t do those 6 months ago so there is no comparison to it but I personally feel there is an improvement on my inflammation level even it’s still borderline 1.18 on the CRP-HS number, my recovery from exercise is way better and I have way more energy during training. And I am not hungry !!

My first month of LCHF diet was not easy, luckily I was very willing to try and change, I listened to how I feel and really pay attention to what I eat and be strict about the macro. The second month went a lot better, I checked my blood glucose/ketone several times a day and I can also predict the number now since it’s pretty stable this month, my glucose number is usually up or down around 80 through out the day, my ketone number are mostly over 3, sometimes over 4 through the day. I don’t know why my ketone number are on the high side? Maybe I ate too much FAT? I kind of mainly focus on limiting the carb and protein intake for my diet and not limit the Fat to get to ketone adapted, can this be the cause of the Triglyceride number up high or my ketone number always above 3?

I felt what you said when I saw you telling the story of JILL, I am so lucky to see your lecture online and feel ease on my Cholesterol number being high on LCHF diet.
I need your opinion about my Triglyceride number been high cause I don’t know what to do to change it, my doctor want me to quit the diet or take medication.
From what I understand the high Triglyceride number comes from carb but in these two months, at least the past month I was very strict on my macro, my carb daily is 25gm and protein 50gm, I am 145lbs now, I only lost about 9 lbs in the two month of LCHF diet, I am 5’7” age 45 asian live in Hawaii.

My other thought is maybe this is still temporary as I am only two months on LCHF diet and maybe if I keep doing it and run another lab test next month or wait for another 4 months to do another test?

Siobhan Huggins
Admin

Hi Jeremy,
I’m helping Dave with comments while he catches up on a few things…
First off, there is some variability in triglycerides (it appears to be one of the more variable markers), but I wouldn’t expect to see triglycerides go that high on low carb in general. There are some things you can take a look at to help figure out what’s going on here. It is definitely worth trying to pinpoint where the issue is.
1) Do you track what you eat? Sometimes there can be some unexpected carb creep, in things like sauces or condiments or even heavy whipping cream that says 0 or <1g of carb per tbsp which could actually mean 0.5 or .8g of carb. That can add up pretty quickly, and can be quickly caught out by logging everything and taking a look.
2) How long were you fasting during the second test? Fasting under 12 hours or over 14 hours can skew results, including triglycerides
3) Are you a heavy coffee drinker, or did you have coffee on the morning of the test? There's some possibility (both in viewing other people's data, and some studies that have been done) that show coffee may influence triglyceride numbers
4) Any MCT or coconut oil on the morning of the test? Another possible confounder

I would say start tracking everything for now, and see if you can spot any possible leaks, make sure you fast the proper amount, and be on the lookout for anything that may influence. Once you do that, it may be beneficial to go ahead and get a follow up in a month and see where it's at. Granted your small amount of time on low carb may influence as well, but making sure it's not anything else is important too.

Jeremy
Guest

Hi Siobhan,
Thanks so much for the information.
I do track what I eat but it is possible that I missed something.I was VERY strict of what I ate, I made my meal 90% of the time, mostly fatty meat and cooked green leafy vegetables with animal fat, I don’t usually use any kind of salad dressing. But I only keep tracking the protein and carb though, fat and oil I kind of just go with it cause I was trying to get adapted. I already cut back on fat since my ketone/glucose reading are pretty stable now.
What I don’t understand is, 6 months ago when I did the lab test, I was still drinking bear, most all IPA, at least one a day and sometimes two or three, my triglyceride number was 80. After going into Keto for two months and the number went to 197. It’s totally possible that I missed some carb but my carb intake is definitely way less then before. Just make me wondering if there is anything else I should look into?
I didn’t eat anything the night before test starting 9PM and I did the lab around noon time the next day, I don’t recall drinking coffee, just water with some lemon in it, can that be the problem?
I am not a heavy coffee drinker, one cup a day usually in the morning, I would drink coffee (sometimes with oil sometime without) and usually have my first meal of the day around 1-2PM.

again thanks for the info

Jeremy
Guest

Just did another lab after two months from last one, probably not the right place to post this but did it just so can see the comparison since I posted the questions back then. Definitely caused by early stage of changing diet also not stricly tracking what I eat everyday.
Starting tracking everything after the first lab and two months later, numbers looks pretty good?

–==== CholesterolCode.com/Report v0.9.2 ====–
…2 months on Keto (less than 20g carbs) ::: 15 hours water fasted…
Total Cholesterol: 254 mg/dL 6.57 mmol/L
LDL Cholesterol: 149 mg/dL 3.85 mmol/L
HDL Cholesterol: 66 mg/dL 1.71 mmol/L
Triglycerides: 197 mg/dL 2.22 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 39 mg/dL 1.01 mmol/L >>> Medium-High Risk Quintile
Remnant Chol to HDL: 0.59 >>> Medium-High Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: 0.113 >>> Highest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 149 | Iranian LDL-C: 219
Total/HDL Ratio: 3.85
TG/HDL Ratio in mg/dL: 2.98 | in mmol/L: 1.3

–==== CholesterolCode.com/Report v0.9.2 ====–
…4 months on Keto (less than 20g carbs) ::: 13 hours water fasted…
Total Cholesterol: 267 mg/dL 6.9 mmol/L
LDL Cholesterol: 172 mg/dL 4.45 mmol/L
HDL Cholesterol: 79 mg/dL 2.04 mmol/L
Triglycerides: 78 mg/dL 0.88 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 16 mg/dL 0.41 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.2 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.365 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 172 | Iranian LDL-C: 156
Total/HDL Ratio: 3.38
TG/HDL Ratio in mg/dL: 0.99 | in mmol/L: 0.43

Colin
Guest

LDL cholesterol levels should be less than 100 mg/dL. Levels of 100 to 129 mg/dL are acceptable for people with no health issues but may be of more concern for those with heart disease or heart disease risk factors. A reading of 130 to 159 mg/dL is borderline high and 160 to 189 mg/dL is high. A reading of 190 mg/dL or higher is considered very high.

HDL levels should be kept higher. A reading of less than 40 mg/dL is considered a major risk factor for heart disease. A reading from 41 mg/dL to 59 mg/dL is considered borderline low. The optimal reading for HDL levels is of 60 mg/dL or higher.

Baker’s numbers aren’t good no matter how you spin it.

Maria Schn
Guest

I’m a 58 years old female. On a strict carnivore diet since mid-February of 2018. Feeling great. Lost more than 42 lbs. (from 189 lbs to currently 146. Eating once a day, when I get hungry. Eating mostly fatty steaks, some butter and a little bit of heavy cream in my morning coffee.
Exercising almost every day mostly with moderate weight kettlebells. My energy level is getting better and I feel better than before starting this way of eating.
I feel more alert and able to focus. I’m an ICU nurse and I feel that I can perform better my work. My chronic joint pain has almost disappeared. I used to have migraines secondary to allergies and I was taking acetaminophen and/or ibuprofen on a daily basis to function. I suffered from anxiety and I have a tendency to get depressed. All the above issues have been gone since I started on the carnivore diet.
My blood pressure is 119/85 and the moderate swelling I experienced during the first weeks of eating just meat has resolved. My allergies are gone and I haven’t needed to use any bronchodilators nor antihistamine drugs. My GI tract is still adapting to this way of eating. Sometimes I get liquid stools but I ‘correct’ this issue having a piece of aged cheddar cheese.
I went to my family doctor and shared with her my decision to change my dietary habits and she recommended some blood tests. To the list she had, I requested to have my fasting insulin and C-peptide levels, which surprised her because in Canada these biomarkers are not investigated regularly.
All my labs are normal except for my cholesterol levels. I’m attaching my results here for your review.
My doctor phoned me to book another appointment to discuss my high cholesterol levels. I want to be prepared to answer to her questions and explain to her why cholesterol is not a meaningful biomarker by itself. I appreciate her concern for my health and I understand she is doing the best she can with the information she has. I feel the professional duty to share with her the evidence-based data available about cholesterol and health within the zero carbs diet as the rationale for my decision to embrace a carnivore diet high in saturated fats from animal sources.
Would you please help me with a short summary recontextualizing cholesterol levels on a low carb high fat diet? Can you guide me to find studies to support this recontextualization?
I thank you beforehand for your help and for all you do to educate the public and by leading with the example.
Sincerely,
Maria Schneider, RN, BScN, ACCN
250 571 9471
canadanahuatl@gmail.com
Suite 140
230-1210 Summit Dr.
Kamloops BC V2C6M1

*Please find attached my lab results on the next page

Maria Schn
Guest

I’m trying to send you my lab results after following your protocol. I have them on PDF or JPG. Thank you fro your help,
Maria

sauman
Guest

I appreciate this post. I have a remnant score of 10 based on TC 249 LDL-C 180, HDL-C 59, TG 51. However my LDL-P was a whopping 2005!! Been Carnivore/LC for over a year now. Any thoughts on the excessively high LDL-P, and any reason for concern there?

Siobhan Huggins
Admin

With concordant LDL (e.g. LDL that is not of the “small dense” type) typically LDL-P is roughly LDL-C times ten.
So 2005 LDL-P within range for an LDL-C of 180.
So, keep in mind that if you are utilizing fat for energy (as you would eating fatty meats) your need for transportation vehicles (LDL-P) goes up, and the emergency life vests stored in these vehicles (LDL-C) also goes up merely as a result of more vehicles being around due to the need to transport fat at a higher rate.
Dave’s presentations from Breckenridge 2017 and 2018 may be some help in imagining how this system is working exactly.

If you’re altogether concerned you could combine your lipid panel with your other markers – signs of insulin resistance, fasting insulin, hs-CRP, etc and see what sort of story that is telling you. Is the context this higher LDL-P in telling you it is a healthy system (low CRP, low insulin, low HOMA-IR, higher HDL, etc), or a sick system?
As mentioned in the Top Ten Studies post, even in those with genetic reasons for high LDL-C (and thus LDL-P) the main difference between those who fared poorly and those who didn’t were signs of insulin resistance.

Rock
Guest

Hey Dave, great work. A couple questions.
I’ve been LCHF for over a year. But my cholesterol or triglycerides kept going up.
So now have been Carnivore 3 months. Weight has stabilised. Been pretty strict, meat and water. Occasionally grab a handful of blue berries. Not very often. I do drink coffee, working midnight shift over 30 years. So I redo my blood liped. Total cholesterol stayed about the same. 368. Always has been high. But I was expecting my tri’s to go down on this WOE. But they have shoot up from 406 in March to 696
As of yesterday. That’s alarming. I am 54 , 6’3″ 215. Started at 250 on LCHF. Lost a few more pounds on Carnivore. But has stopped losing. Workouts have been infrequent. Any help would be appreciated.

Aman
Guest

Hi Dave,

Below is my report from a test that I got yesterday. I have been on the carnivore like diet for the past 2 months and take Lipitor 20 mg (have been taking for 10+ years). My results seem to have freaked my doctor out and he has told me to go see a specialist. I have also posted the report further below from my last year numbers (when I was on SAD). Remnant cholesterol seems to be okay. What do you think about the results?

–==== CholesterolCode.com/Report v0.9.2 ====–
…2 months on Carnivore/Zero Carb/Meat Only ::: 17 hours water fasted…
Total Cholesterol: 506 mg/dL 13.09 mmol/L
LDL Cholesterol: 422 mg/dL 10.91 mmol/L
HDL Cholesterol: 65 mg/dL 1.68 mmol/L
Triglycerides: 95 mg/dL 1.07 mmol/L
(VLDL value is 19 mg/dL)

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 19 mg/dL 0.49 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.29 >>> Medium-Low Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.196 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 422 | Iranian LDL-C: 378
Total/HDL Ratio: 7.78
TG/HDL Ratio in mg/dL: 1.46 | in mmol/L: 0.64

Test from last year (07/28/17):
–==== CholesterolCode.com/Report v0.9.2 ====–
…3 years on Standard American ::: 12 hours water fasted…
Total Cholesterol: 230 mg/dL 5.95 mmol/L
LDL Cholesterol: 143 mg/dL 3.7 mmol/L
HDL Cholesterol: 64 mg/dL 1.66 mmol/L
Triglycerides: 117 mg/dL 1.32 mmol/L

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 23 mg/dL 0.59 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL: 0.36 >>> Medium Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.1 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

–CONVENTIONAL MARKERS AND RATIOS–
Friedewald LDL-C: 143 | Iranian LDL-C: 159
Total/HDL Ratio: 3.59
TG/HDL Ratio in mg/dL: 1.83 | in mmol/L: 0.8

Siobhan Huggins
Admin

Hi Aman,
apologies for the very late reply on this, we had an issue with some accidentally deleted comments and are in the process of addressing these…

As for your results the difference between the two results looks to me like shifting from someone on a lower fat, higher carb diet to a higher fat, lower carb diet. If I, personally, had the most recent result I likely wouldn’t be particularly concerned as – from what I’m aware of – it’s just reflecting someone who is fueled by fat.
However, I do tend to want to take a look at other markers too, to make sure I’m taking the results in context, such as fasting insulin and CRP.
But I’ve yet to come across a study (although I have been looking) in which high HDL and low triglycerides presented a higher risk, regardless of LDL level – for what it’s worth.

Jack
Guest

I would love to know what fat metabolism polymorphisms Dr. Baker has.

Giedrius
Guest

Dave, I was following your experiments for quite a while, thank you very much for the awesome work you are doing!

Don’t you think that Shawn could have early stages of hepatic insulin resistance? His muscles are insulin sensitive, but liver might be not, so it does not stop secreting glucose if insulin levels are low, therefore high fasting blood glucose.

I became interested in low carb diet myself when my fasting glucose and A1C started slowly climbing up about a year ago. I used to eat very low fat, and fairly low protein, mostly fruits, vegetables, grains, fish, some eggs, some meats, etc. I was always moderately active, always around 185lbs, 6.3 tall. My lipids were for many years very good according to conventional standards, fasting glucose OK, roughly about:

Total cholesterol ~175
HDL-C ~50
LDL-C ~115
Trigs ~65
Fasting glucose ~90

Last year in July my results were:

Total cholesterol 209
HDL-C 49
LDL-C 144
Trigs 82
Fasting glucose 104
A1C 5.4

After that, I started eating mostly in 8-10 hour window twice a day low carb for a month and then keto for a month, results after 2 months (that was the first time I did NMR lipoprofile):

Total cholesterol 242
HDL-C 47
LDL-C 177
Small LDL-P 431
LDL-P 2039
Trigs 90
Fasting glucose 77
Fasting insulin 2.7

I was reading Peter Attia’s blog at the time and he was writing that some of his patients who were on keto and had high LDL-P lowered it by cutting saturated fat. So I decided to try to live for a month basically on a green salad with avocados, olives, a lot of olive and avocado oil and sardines or salmon with very little eggs, chicken and dairy. Results after that month were unexpected:

Total cholesterol 248
HDL-C 43
LDL-C 181
Small LDL-P 1267
LDL-P 2260
Trigs 119
Fasting glucose 99

I decided to continue with low carb diet with intermittent fasting without trying to stay in ketosis for a year or so and see what my bloodwork would be after a longer period of time. So last year I ate mostly all kinds of meats with salads, eggs, cheese, butter and olive and avocado oil. I had a cheat day with a burrito or pizza every few weeks or so. Surprisingly during all that year I never had ketones, even after 2 day water fasting. I did bloodwork a month ago:

Total cholesterol 258
HDL-C 53
LDL-C 192
Small LDL-P 507
LDL-P 2158
Trigs 63
Fasting glucose 104
A1C 5.9(!)

I was surprised my A1C was higher than when I was on a high carb diet. A1C 5.9 translates to 123mg/dl average glucose level, so if my fasting glucose was 104, to get 123 average I should have had 150+ postprandial glucose. So I started preparing for glucose and insulin stress test by eating about 200g of carbs every day for 5 days and did the test:

Glucose:

Fasting 105
1 hour after 75g of glucose, 76
2 hours after 95
3 hours after 83
4 hours after 79

Insulin:

Fasting 3.6
1 hour after 27.5
2 hours after 13.6
3 hours after 2.9
4 hours after 1.7

After a year of experimentation, I have worse total and LDL cholesterol, worse blood glucose, worse A1C and more questions then when I started. I decided to try to go back to low fat high carb diet for 3-4 months and see what’s gonna happen. Maybe my fasting glucose and A1C comes down if I eat carbs and will have higher levels of insulin, and my cholesterol becomes “normal” again? Is A1C test not useful? I obviously cannot have an average glucose of 123 unless I have >>150 glucose when I sleep (I hope http://www.gluco-wise.com/ or someone else will release their noninvasive glucose meter soon). Do I have hepatic insulin resistance and the early stage of a metabolic syndrome? If I do have an early stage of metabolic syndrome, is HFLC diet the best diet if I want to maximize long term health even if I get high total cholesterol, high LDL-C and LDL-P? Peter Attia and some other smart guys think that high LDL-P shouldn’t be ignored, but what are the alternatives to HFLC for hyper responders with metabolic syndrome?

I know that’s a lot of questions and no one knows 100 percent right answers, but any insight will help.