Jan 20

START HERE (Pinned)

Please consider supporting my Patreon. All funding for my research and this site come solely from individuals like you. Thank you!

  • If you know little to nothing about cholesterol->
    • And you want to learn the basics->
      • You can check out my Simple Guide to Cholesterol series. It’s full of illustrations and is written for laypeople. Enjoy!
      • Likewise, I have this video that goes over the basic markers for cholesterol while on a low carb diet. (Pictured to the right)
    • You can enter your cholesterol numbers into our popular Report tool to check them against many risk calculations at the same time.
  • If you’re wanting to know about my research->
    • You want an overview->
    • You want the most recent breakthroughs->
      • 1/2/2018: In this latest video, I demonstrate massive changes to my LDL Cholesterol over 5 stages in a matter of days. LDL 207 to 103 mg/dL in seven days with high carb, up again to 146 on mixed, down again to 113 on high fat. (Pictured to the right)
  • 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.

Nov 15

Submit your questions for Dr. Spencer Nadolsky on our first #CholesterolScience Show

Dr. Spencer Nadolsky – Board certified family and obesity physician taking his lipid boards this spring. Former division 1 NCAA heavy weight wrestler.

New Series

Next week Tuesday (November 20th), I’ll be interviewing Dr. Spencer Nadolsky on the first #CholesterolScience series. This show is meant to incorporate many different viewpoints on cholesterol and lipids. (See his page here: drspencer.com)

As many of you know, I’m a bit more cautiously optimistic with regard to higher LDL cholesterol and particle count where I believe there is insulin sensitivity and metabolic health, often reflected in low fasting insulin, low triglycerides, and high HDL.

This is why I’m extremely excited to have Spencer as our first guest as he will be giving a different opinion — you could say, a cautiously pessimistic point of view. In fact, he’s currently working on an article to be published right here on CC in the coming future on this very topic.

I’d particularly like to laud Spencer for being the most curious of those outside the low carb community with regard to the lipid energy model, prominent studies cited in favor of cholesterol, and the general opinion of low carbers in general to best construct a rebuttal. If you all know me well by now, you know how seriously I take moving this conversation forward and truly welcome serious discussion and constructive feedback.

General Format

This will not be a formal debate with Spencer and myself. Rather, I’ll be collecting questions here and on social media that we’ll curate and let him know about in advance. I want this to be generally relaxed and productive. I want any/all who have great information to share, whatever their viewpoint, to feel they can come on the show and express their ideas and research.

With this in mind, I want to ask everyone to be sure they are especially respectful of differing opinions on this show. Please don’t personalize. Feel free to attack their ideas (constructively), not the people themselves.

Rebuttal Rule

Naturally, if this series gets legs, more and more guests may remark on prior guest appearances. As with a more formal debate, if one guest references a previous one specifically and their position, I’ll do my best to allow the targeted guest to have a rebuttal response in a separate video, blog post, etc.

How to Ask Your Question

You can ask questions of Dr. Spencer Nadolsky in advance of the broadcast one of two ways:

  1. Comment to this blog post down below
  2. Comment on twitter using the hastag: #CholesterolScience

Again, keep it respectful and fun.


 

Nov 09

The Tandem Drop Experiment – Part 2 – Carbs

A Very Different Path

If you haven’t already, be sure to first read Part 1 of this experiment by Siobhan Huggins.

Originally, Siobhan and I were going to simply do the same protocol at the same time, perhaps something similar to the one I did with my sister two years ago. But it occurred to me that it might be much more interesting if we tested both directions in lowering LDL that would lend further evidence to the Lipid Energy Model.

I began exploring the idea of going carb-centric in order to showcase this shift in energy metabolism having a likewise effect on my cholesterol. But while I’m at it, why not go big? Why not choose foods that would achieve the task yet from a category no one would associate with “healthy” or “whole food”? I settled on white bread and processed meat.

And heck, while I’m at it, I should exceed my prior levels of carb intake to drop below my previous fasting record LDL of 103 mg/dL, courtesy of the Capstone Experiment. In fact, I predicted this outcome and shot a video in advance of the experiment.

Whereas Siobhan was invoking the Inversion Pattern on her end of the experiment, I was straight up changing my metabolic pathway. As mentioned in the video above, I was moving from a fat-based metabolism to a glucose-based metabolism.

The Macros

I had originally wanted to hold out on the “Peak Levels” until I saw that plateau I mention in the video above. But honestly, the massive levels of glucose throughout this experiment being indicated by my Continuous Glucose Monitor (CGM) was making me very uncomfortable. Thus, once below 100, I found myself ramping down soon (starting at 9/25).

For some perspective, here’s my CGM before this experiment (while keto):

Very steady, well controlled glucose levels

You see that slight rise about 2/3rds of the way in? That’s when my glucose was just 105 mg/dL. Yes, that’s how steady this graph is when I’m fully keto — you can’t even tell when I’ve eaten.

Conversely:

Highly variable glucose levels with very high peaks throughout

You see that vertical line on the left side? That’s marking that peak at 183 mg/dL (shown in upper left). In other words, I’m clearly riding massive waves of high glucose throughout this experiment. While I expected this going in, it sure doesn’t help the ol’ psyche to see it in real time… although it does make for some good data.

The CardioChek Data

Let’s combine all three cholesterol markers into a single graph:

During the Ramp Up period where my carbs were slowly being increased, we don’t see a big drop in LDL, nor an increase in triglycerides (TG). Yet once entering into the Peak Levels portion, this changes and we observe LDL dropping dramatically while TG rises in kind.

The Lab Data

I took a total of three lab draws. One on the 17th right before the ramp up, one on the 24th which was midway in, and one on the 28th at the very end of the experiment. Ideally, I’d have had even one more at the end of the Peak Levels period, but I just didn’t know for certain when that would be and if I could get into the lab in time.

I actually got quite a bit of data, but I’m going to highlight the most notable ones here:

Certainly the two that most stood out to me were the Ferritin and Glucagon.

The Ferritin dropping to 11 seems like a legit lab error. For context, note that I’m quite experienced with Ferritin as it is the one marker I’ve most worried about. Before Keto it was in the 500s and remained as such into the diet. However, in recent times it was in the 200s (as shown above). I’ve never seen it below 200, much less lower than 20. Thus, lab error is my my top suspect. (But hey, if it wasn’t, that would be quite a find!)

I blame Ben Bikman for the money I’ve been putting out to test Glucagon <shaking fist>. That said, I think I may be getting the value of Glucagon a lot more this time around. Rather than share my own thoughts on this (for now), I’ll let commenters pontificate down below as to why my fasting Glucagon did go down correspondingly with the rise of fasting insulin and why that last score of 80 pg/mL was actually the highest number I’ve gotten to date.

Brain Change

Of all the experiments I’ve done to date, this one was the most mood-altering, hands down. While I’d like to think I’m usually optimistic, fun-loving, and easy-going in most situations, instead I was much more irritable, temperamental, and chronically anxious. I just flat out complained several fold more, even though a lot of it was repetitive. Even more frustrating was that I was self aware of it but couldn’t seem to help myself.

I actually have several anecdotes from that period that are a bit embarrassing to reflect on. But surely the worst was my wanting to post a complaint I had with a company on Twitter. I didn’t ultimately do this, but it’s quite weird that I ever even considered it in the first place. It’s so not me.

I should emphasize that I don’t think this was strictly a carb thing by any means. I’ve done other carb-based experiments that brought me some issues but didn’t always alter my mood appreciably. I don’t think even the most avid high carb low fat advocate would push for an all white bread and lean meat diet.

Yes, while I mainly focus on cholesterol and lipids, I’ve become very aware that certain combinations of diet in these experiments will have profound impacts on my mood in many ways: temperament, irritability, contentment, and even the axis of outlook on life.

(Not So) Final Thoughts

There’s actually a lot more to unpack with this experiment than I’ve laid out here. The key goal was achieved in making for a record change in my LDL cholesterol over seven days. It came at a cost, of course, and I’d never settle for the resulting HDL and triglyceride levels I was observing during the experiment.

 

Oct 30

News, Comments, Asides — October 2018 Edition

Siobhan Launches Her Patreon

Yes, our own Siobhan has finally launched a Patreon after months and months of our prodding her to do so. This is super important as she (like me) puts out a lot of cheddar for lab tests. If you appreciate the excellent data she’s brought us (particularly lately), please note it costs a very large amount with each experiment.

Dropping the Bomb in Houston Texas

Yes, I revealed seven days of my half of the Tandem Drop Experiment to a live audience. I’ll have a write up on it soon.

For now, you can watch the presentation yourself here:

When You Have One Twin Who is Keto, One Twin Who is Not

Just watch…

Siobhan on CarnivoreCast

Siobhan had a recent appearance on CarnivoreCast, a podcast centering around the science, and people, behind carnivorous diets. For those of you who don’t know, Siobhan has been eating carnivorously for over a year now, so if you’d like to hear more about her experiences (as well as other topics covered – including lipid metabolism, of course) you can listen to it here.

Final Stretch

I’ve nearly completed my long winding journey. I have just one jaunt this weekend to San Francisco for Low Carb USA and then on to Seattle to record a podcast before coming back home again to the Mrs. Then I’m staying put until Thanksgiving!

Oct 18

The Tandem Drop Experiment – Part 1 – Fat

Two Experiments in One

On the plane to #NLANashville!

As soon as we started to discuss possibly attending #NLANashville Dave and I began to toy around with the idea of trying out a dual experiment, similar to the identical diet experiment, with a twist. Instead of doing the same experiment the two of us would be doing two different experiments – but both of us would be manipulating our cholesterol numbers intentionally. All while attending a lipid conference and trying to soak up all the knowledge there (because who doesn’t want to add more work on top of an already busy working weekend? Never doubt our masochistic nature).

Originally, two possibilities were floated for my experiment “track”: option 1) fasting for five days or option 2) high calorie ketogenic for five days. I ultimately decided on high calorie, as it would be more interesting to do, and I wanted to be able to concentrate on the presentations while at the conference (fasting longer term often makes me restless). As a result of this choice, I needed something I could easily prepare and eat 1) while traveling to Nashville and 2) while actually at the conference. Luckily, Chris Bair of Ketochow stepped in and offered to sponsor the experiment. This was helpful in a few ways as I would already have most of what I needed before I even left for the conference, it wouldn’t require any cooking, and I could prepare everything for the following day the night before and not have to think about it after that. With that out of the way, the experiment began!

Setup

Instead of starting out with fasting, as I did with my Feldman Protocol experiment I instead decided to start with Ketochow intake with baseline calories in the 4 days prior, with some added whey protein powder after day 1 as I had been craving lean meat after a full day of Ketochow only. Calorie intake ended up being around 1500 calories with the added whey. The fat source used was heavy whipping cream – 99 ml per shake, 3 shakes a day. The flavors used were banana and orange cream for baseline, and pumpkin spice caramel and strawberry for intervention (noted here, as some of them have slightly different nutrient info – all Ketochow used was version 2.1).

Intervention

A bag full of heavy cream for the conference weekend.

Since I was aiming to drop my cholesterol over the course of the following five days, the intervention was to increase the amount of fat while keeping all else the same. Unfortunately, I forgot to bring my whey protein powder with me, so I just went without it after day 1 of intervention. I also found that trying to cram 550~ ml of cream into a bottle for the shake ended up making the texture very…. unfortunate. In order to avoid this problem, I kept the amount of powder the same, but split it up into 6 shakes per day for a goal of 6000 calories (with 4000~ calories achieved on days 1-3, and 6000~ calories achieved on days 4 and 5). For those curious this involved 297 ml of cream for baseline, and 1.6 liters of heavy cream for the highest calorie portion of the experiment. The liquid nature of the fat this time definitely made this possible!

The results

All results include data from my 12 1/2 day Feldman Protocol attempt in the shaded area for comparison – new results are highlighted. The correlations listed are for all data points between 8/20 and 9/24.

Total Cholesterol

As expected, Total Cholesterol dropped from the baseline of 313 mg/dL to a new low of 171 mg/dL after 5 days of high fat feeding. This leaves me with a total drop of 142 mg/dL and a correlation of -0.967684 with the 3 day average of dietary fat before the blood draw.

LDL-C

Baseline LDL-C on the 4 days of Ketochow came out to 252 mg/dL and after 5 days of the high calorie protocol it dropped to 105 mg/dL for a total drop of 147 mg/dL. The correlation between 3 day average dietary fat remained high at -0.97497754. To note, this is the lowest LDL-C I have on record, regardless of diet (Standard American Diet, keto, or carnivore). It’s also worth noting that during the highest calorie days I was consuming 554g of total fat, 387g of which were saturated fat.

LDL-P

LDL-P did exactly as expected and dropped during the high fat/high calorie phase – from 3068 nmol/L to 929 nmol/L for a total drop of 2139 nmol/L. This is pretty much what I would expect from the drop in LDL-C but I was still pretty surprised it had dropped so low. I suppose I won’t complain! The correlation for this one was between LDL-P and the 3 day average of dietary fat plus a two day gap and resulted in -0.919329629.

HDL-C

HDL-C surprised me by starting out higher than is typical for me when at baseline calorie/fat intake – especially as fat was a bit lower than my norm during baseline. I have had a few cases of HDL around the upper 40s on record with a baseline diet, but it’s not the usual case for me. Even more surprising was that upon high fat feeding I got the highest level I have on record – suggesting that my baseline HDL-C may have shifted up during the protocol. I suspect this may be due to something that’s in the Ketochow, and I have my suspicions as to what, but I’ll save investigation into that for another time.

Regardless of the slightly higher baseline at 48 mg/dL HDL-C still did as expected and went higher during the high calorie ketogenic phase all the way up to 57 mg/dL. This is a total increase of 9 mg/dL which is about what I would expect. The correlation with the 3 day average of dietary fat was positive, at 0.815920699.

HDL-P

HDL-P, like HDL-C, went up during the protocol from 21.6 umol/L to 35.7 umol/L for a total increase of 14.1 umol/L and a positive correlation between the 3 day average of dietary fat (plus a two day gap) of 0.922353315.

Triglycerides

Triglycerides were around normal baseline levels at 63 mg/dL which dropped further upon the high fat/high calorie feeding all the way down to 45 mg/dL – the lowest I have on record. Apparently, despite the high fat intake, I was able to use or store the fat-based energy quite efficiently! This was a total drop of 18 mg/dL and a correlation of -0.857910104.

Lipoprotein(a)

Out of all the markers I had been looking at, I was most curious about what lipoprotein(a) would do. During my Feldman Protocol attempt in August, I was surprised to find that it seemed to be following the inversion pattern. As dietary fat intake went higher, lipoprotein(a) dropped lower. But, there were some questions as to why this could be – was it perhaps that having the high calorie phase immediately after a 7 day fast influenced it? Was it something else? Obviously, testing with Ketochow helped isolate out most other possible influences and once again lipoprotein(a) dropped like a rock upon the high calorie ketogenic phase. It also started off a bit higher than my typical 130-140 nmol/L range, but this could be due to the macro composition I was consuming due to using Ketochow + whey protein isolate (resulting in slightly higher protein via whey, and slightly lower fat than usual).

Regardless – despite starting out at 171 nmol/L lipoprotein(a) quickly dropped to an astounding 58 nmol/L after the high fat/high calorie phase of the experiment. Not only was this 7 nmol/L lower than the previous low from August, but it resulted in a 113 nmol/L drop in 5 days of high fat/high calorie feeding (a 66% decrease). Wow! Lipoprotein(a) can move!

Not only that, but the correlation between dietary fat stayed strong here, at -0.93368339.

It will definitely be worth exploring how energy status impacts lipoprotein(a) in the future, along with other possible influences on its levels day-to-day. This experiment (especially back to back with the other protocol) confirms that just like other lipid markers lipoprotein(a) appears to be slightly more dynamic than anticipated.

 

Final Thoughts

On the Locals

Although I didn’t get to do much (any) sightseeing while in Nashville, except to walk to the conference area from where I was staying, I did get to interact with some of the locals. I had several long conversations with my AirBnB hostess, Meredith, for example, who was surprisingly delighted to hear about what I did for work and what I was in town for. Within about five minutes of me arriving at the AirBnB we were discussing lipidology, and she even pulled up a recent lipid panel she’d had so I could discuss what the markers were referring to. Funnily enough, she’d also had a CAC (a test I’m fairly interested in) recently, citing that she wanted to see any signs of actual disease (I brought up Ivor Cummins after this, of course!). She’d often ask how the conference was going, and said she could discuss lipidology with me for hours as it was all so fascinating (something I would have, of course, been happy to accommodate if I’d had more free time!) and over all was one of the highlights of my time in Nashville.

On the Conference

There were many interesting presentations throughout the weekend, ranging from lipoprotein(a), to lipid disorders (I find that understanding how things look when they’re going wrong can help me figure out how they should work when they’re going right), and intermittent fasting was even mentioned during a presentation regarding dietary habits! There was also a section of vendors at the conference, including ones that offered genetic testing, and more in-depth lipid testing which I found intriguing. I’ll definitely have to do a little more research into those sometime in the future.

It was honestly a bit surreal to walk past people having a conversation and hear them discussing LDL, particle counts, and other lipid-y things in passing – it’s not often I get to experience that in person! I also got the opportunity to meet some interesting people, from clinicians, to nurses, and dietitians. I was also delighted to see that one of the complimentary goodies the conference was offering its attendees was the most recent volume of The Journal of Clinical Lipidology. I got to have a bit of a study session with Dave before the conference day started in earnest as we both read through the studies it contained. It ended up being pretty productive and (dare I say it) fun.

Over all, it was a great learning experience, and I’m glad I decided to go.

On the Experiment

Chow time at Clinical Lipid Update

I’d say, in this case, the inconvenience of having to drink 6 shakes a day was far outweighed by the data I got in the process. Lipoprotein(a) coming from a baseline diet to a high calorie/high fat phase provided some useful information that – of course – leaves me with even more questions, and possible future experiments in mind, for sure. Plus, it wasn’t too bad, as the very kind staff at the hotel where the conference was taking place offered to store my shakes in the front office fridge so they could stay refrigerated until I needed them. I’m extremely grateful, as this made the whole process much less of a hassle, and allowed it to go as smoothly as it did. The food served at the conference actually did look quite appetizing, but in this case the sacrifices of citizen science won out over the freshly carved meat they were serving.

Even with that said, I must say that my diet over the conference weekend was definitely more appetizing than what Dave was eating – as he expressed multiple times! I’m sure he’ll be mentioning that himself, however, in part 2….

To be Continued in Part 2 – Stay tuned!

Oct 17

Attending #NLANashville and the Secret Tandem Experiment

Siobhan and I flew to Nashville to attend the Clinical Lipid Update put on by the National Lipid Association. We were both very excited to be hanging with like-minded lipid geeks, even if our perspectives might vary a little. We managed to make some new friends, get interesting perspectives and learned a few new things in the lectures that have us looking into some research we might not have come across otherwise.

The Organization and Staff Were Super Friendly

My one biggest worry was that NLA staff might not receive me well given I might be considered a more controversial figure with regard to cholesterol (certainly I get that feeling in social media). But nothing could have been further from the truth. Before registering, I worked closely with Brandi Rawls, the NLA Membership Manager to get the details settled. And upon arriving, I had a number of questions for their Project Coordinator,  Chealsea Schroeder, who was all too happy to answer. All in all, it was a lot of smiles and well-wishing.

Project Coordinator Chealsea Schroeder

Meeting the Luminaries of Lipidology

We got to meet quite a few Big Names in the field.

While not all are fans of the Low Carb / Ketogenic lifestyle, one particular figure Sarah Hallberg wanted me to meet was Greg Pokrywka of the Baltimore Lipid Center. He had some great suggestions on next steps for us in our research and I was quite honored to have the chat.

I had a number of questions for many who gave presentations, but I decided to forego the public Q&A to instead approach them with my query privately following the session.

I was especially interested in the blood and non-blood tests taken for patient cases. How much do they focus on Lp(a), free fatty acids, and CTs like CAC? Overall, quite a bit, actually. I also asked about fasting insulin and C-Peptide, but hadn’t found anyone who actively used it before.

Final Thoughts

Overall, Siobhan and I had a positive experience and especially enjoyed the last day which had a focus on CAC’s value and a couple things we didn’t know about like Lipoprotein X.

We also wrapped an experiment around the event: the Tandem Drop Experiment. But more on that in the next post…

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