Cholesterol Code

#KetoAF Talk of the Town on Twitter

Around March of this year I began to hear the term “#KetoAF” being used on Twitter. Not just from one person, but from several. The people using the hashtag weren’t using it to mean “very keto” or to exclaim that something was keto in a cool way. Instead, they were using it as a shorthand for “Keto Animal Foods”, or a carnivorous diet where fat was prioritized.

The people discussing KetoAF were also talking about how it helped kickstart weight loss after long stalls, or helped to resolve persisting issues that were lingering even with a more protein heavy carnivorous diet. I was intrigued, especially as I had heard the Paleolithic Ketogenic diet (PKD) discussed at CarnivoryCon earlier that same month.

By April, I was making plans and coordinating with Amber O’Hearn (who coined the term KetoAF) and Josh Blackburn (a fellow KetoAFer) to set up the experiment. This would turn out to be one of the longer experiments in my history, as I wanted to give it enough time to do something – if it did anything at all.

Testing Hiccups

Over the course of the experiment, I ran into a few problems with testing. You can read about the details below, but to summarize:

• I needed to re-test my baseline, I did so by extending my baseline 1 day and re-testing the following morning.
• The baseline microbiome results were lost
• The post-intervention PEG400 data was lost
• The two final tests were confounded by a cold and by a sunburn

Prior Diet and Baseline

Prior to the experiment I had been following a predominantly carnivorous diet (barring experiments, etc) as of October 2017 (a little under a year and a half). I had lost an additional 25 pounds from switching to carnivore from omnivorous keto, bringing me down to 140 lbs. For around a year I had been at 143 lbs without additional weight loss. To note, this still left me “overweight” (and overfat, according to a DEXA). Throughout ad libitum carnivore I averaged around 30% protein, 70% fat and negligible carb from seafood and dairy.

The baseline diet was originally intended to be 10 days, starting at May 17th, but was ultimately 7 days, starting at May 20th to May 26th. The first three days of the original baseline had unusually high glucose readings, and I also realized I was eating too fatty for my intended 1:1 target, so these three days were excluded.

During the 7 day baseline I tracked morning glucose, ketones, and weight. I ate ad libitum, and logged all items consumed via pictures.

During this period I consumed:

• Trimmed ribeye
• Coffee
• Water
• Vitamin supplements (vitamin D, and methylated B vitamins)
• Electrolytes as needed

After the baseline was completed I tested intestinal permeability with a PEG400 from ICMNI, as well as a slew of bloodwork which was repeated at the end of the intervention.

I ended up having to re-test the bloodwork the next day, as discussed, thus on the 29th I did another set of blood tests which we will consider the official baseline bloodwork, here.

Intervention Design

The intervention diet was set up to be ad libitum, eating when hungry until full and avoiding fasting beyond 24 hours if possible (to ensure any weight loss was not due to the fasting/ensuring I didn’t confound any lab results). I wanted to make sure I gave it sufficient time to show positives or negatives so ultimately decided on 26 days. The goal was not protein restriction, but rather fat prioritization so meals generally followed this pattern:

1. Eat raw beef trimming until no more was desired (satiety)
2. Eat raw beef liver (75g) next – this was included as I had stopped B vitamin supplementation, raw liver was best tolerated compared to other preparation methods.
3. Eat trimmed ribeye (main protein source) until satiated.

The “goal” would be 2:1 fat:protein by macronutrient gram, but if I got full before I reached this, it wouldn’t be forced, and if I ate above the ratio (more fat) this would also be fine. All food was weighed and logged via pictures. Supplements and coffee were discontinued during the intervention period. Weight was taken each day, along with glucose and ketones (BHB).

I had two check-in labs, mostly to verify my folate levels were remaining stable with the removal of supplementation and addition of liver. On June 24th, the end of the experiment I tested the following:

• Microbiome test
• Blood work

Late Game Change to Intervention Diet

Originally, the intervention diet was supposed to include 75g~ of raw beef liver per day. However, after a couple weeks, I began to feel averse to eating it. I continued eating it, as part of the experiment design, however this rapidly turned into nausea after consuming it at meals.

On 6/17 the reaction to eating the liver escalated into becoming physically ill after eating it. In order to make sure I could continue the experiment, I decided to discontinue liver consumption for the duration of the experiment.

I’m not sure why this happened, exactly, as the reaction was disimilar to food poisoning, especially as the reaction increased over time. Some I’ve spoken to have speculated the aversion may have been due to being “topped off” on a certain nutrient (or nutrients) found in liver, but I have no way of verifying this.

Results

Weight

During the baseline (5/22-5/28) I remained weight stable, fluctuating between my normal weight of 145-147 lbs. After the KetoAF intervention, I remained weight stable for four days, after which my weight began to decline. My weight continued to decline at a steady rate, with the exception of a period where I had a cold (6/9-6/14) during which I was weight stable. The week after the cold cleared (6/14-6/18) I was also stable at a slightly lower weight, but it is unclear if this is related.

The decline in weight continued until the end of the experiment (6/24). The total weight lost from the lowest weight of the baseline (145 lbs) compared to the lowest weight of the intervention (138 lbs) was 7 pounds. At 5’2″, and considering this is the lowest weight I’ve achieved during my adult life, I would consider this weight loss significant.

Macronutrient and Energy Intake

During the baseline, I averaged 1855 calories per day. During the first two weeks of the intervention, calories dropped to about 1750 calories per day – resulting in about a 100 calorie decrease from baseline. Average fat grams increased from 122g per day to 164g per day, and protein decreased from a daily average of 148g to an average of 51g per day.

On the last day of my cold (6/13) I did not eat as I was not feeling well. This resulted in week 3 having a low average calorie intake. Unfortunately, week 3 is also missing data for one day (6/18). I know I didn’t fast that day, but can’t find picture logs of what I ate. In order to not artificially depress the average, this day has been excluded from all calculations of averages.

Finally, the average calories for week 3.5 was slightly lower than weeks 1 and 2 at an average of 1683 calories per day – on average, 67 calories less per day.

Over all it appears as though eating a carnivorous diet with a high fat content did not result in an increase in energy intake, and indeed seemed to result in a general decrease (100-200 kcal/d). Despite being very energy dense, appetite appeared to be properly regulated. It’s also interesting to note that although week 3 was the lowest calorie week, this did not correlate to more weight loss – in fact, I did not lose weight during this time period.

Ketones and Glucose

Over the course of the experiment, a significant difference in average ketone level was recorded. During the baseline, average ketone level was 1.5~ mmol/L and over the course of the intervention average ketone level was 2.8~ mmol/L.

Glucose levels were not significantly different during the duration of the experiment, with an average of 89.8 mg/dL during baseline and 90.0 mg/dL during the intervention.

Labs

At baseline, my Total Cholesterol and LDL Cholesterol were 312 mg/dL and 251 mg/dL respectively. By the end of the experiment these had decreased by 88 mg/dL and 83 mg/dL respectively, to 224 mg/dL and 168 mg/dL.

HDL remained within my normal range throughout the experiment at 45 mg/dL, while my triglycerides decreased by 26 mg/dL from 82 mg/dL to 56 mg/dL.

It’s possible that these results were confounded by the cold and sunburn at points 6/13 and 6/24, however a follow-up lab on 8/2 showed Total Cholesterol of 231 and LDL-C of 155 mg/dL, as well as triglycerides of 45 mg/dL so I find it likely these are representative. HDL at follow-up was 67 mg/dL but it is unclear if this is a one-off or a new normal. Further testing on all of these points will be beneficial.

Vitamin B12 and folate both increased during supplement cessation and liver inclusion and dropped somewhat post liver exclusion. A longer time trial without liver would be needed to see where they settled longer term.

Throughout the experiment Vitamin C levels remained steady with a small decrease in Vitamin A and a decrease in Iodine. It’s unclear if the decrease in Vitamin A was impacted by cessation of liver consumption.

Glucagon increased from baseline and insulin generally decreased (excluding one datapoint on 6/13 from when I was sick; not shown). They appeared to mirror each other over the course of the experiment.

Free T3, and IGF-1 both decreased over the experiment. Longer term tracking of Free T3 would be needed to gauge relevance versus fluctuation. Low T3 is not entirely surprising due to a very high fat, low carb diet as mentioned in this post. No hypothyroid symptoms were noted during the course of the experiment, and energy levels remained stable.

Uric acid, interestingly, increased over the course of the experiment. Further testing would be required to gauge whether the increase in Uric Acid was temporary due to a deeper level of ketosis (as evidenced by higher ketones) as noted by Westman Et Al that this can cause a temporary increase in Uric Acid during keto adaption. The follow-up test from 8/02 showed uric acid was back to 6.2 (data not shown), so this is suspected in this case. Further testing over a longer time period is warranted.

Finally, although possibly confounded by the circumstances of the last two data points, lipoprotein(a) levels generally decreased during the experiment, just as LDL-C did. This is consistent with Lp(a) following LDL levels over the course of various experiments, with its role as an acute phase reactant in mind given the cold and sunburn of the last two tests (possibly elevating it above what it might have been otherwise). Longer term tracking would be interesting to see if this is sustained over a longer time period.

Final Comments

Ultimately I greatly enjoyed ketoAF as a way of eating over the course of the experiment, minus the liver incident. Since the experiment, I’ve been using ketoAF as my baseline diet including at conferences (e.g. at Low Carb Houston I ordered moist brisket with a side of butter). I find it easy to do even when away from home, and my food enjoyment has increased.

I’ve found it to be a helpful tool post-High Carb Experiment (post on this one coming soon), to help come back from the weight gain and adverse side effects that lasted long after the experiment. I find I will likely continue it longterm as long as I continue to enjoy it. Longterm data will certainly be interesting, especially if it allows me to come down to a normal/lean weight/bodytype given enough time.