«

»

May 11

Cholesterol Research Breakthrough

A few important caveats before getting started:

  • This is very preliminary. While it’s true I’ve both produced and reproduced these results, it’s still very early to draw significant conclusions, which I detail further below.
  • This does not constitute medical advice. I realize many may read this and act on it, but I urge you to consult with your doctor and/or trusted medical professional — particularly if you are diabetic or insulin resistant.

Going Low Carb / Keto

Before I started the ketogenic diet, my carb intake was probably north of 250g a day and my fat intake was likely around 75g. After going keto, I brought my carbs down to around 20g with my fat shooting up to around 220g. (My protein remained relatively constant at 25% of my calories.)

To illustrate this, I’ll be using this simple graphic to show a sliding scale from left to right as 100% carbs & 0% fat to 0% carbs & 100% fat.

carbs_to_fat_percent

So let’s overlay the quantities of my carbs and fat both before and during the diet.

carbs_to_fat_quanitites

Sure enough, after adopting this lifestyle, I felt better than I ever have before it.

But then I got my cholesterol scores seven months after starting which showed an extraordinary jump in both total (TC) and LDL cholesterol (LDL-C). And this is where I learned I was one of the fraction of those going low carb who see a dramatic rise in total and LDL cholesterol known as a hyper-responder.

cholesterol_before_vs_after

To be sure, my HDL going higher is presumed good and my triglycerides going lower is presumed good. But the doctors care much more about LDL-C and will insist my higher levels on a low carb diet should be of great concern.

The Assumed Solution

Up to this point I’ve given the same advice to fellow hyper-responders as I’ve read from doctors and researchers: If you want the one surefire method for reducing your cholesterol, you will likely have to give up being low carb.

Let’s look at that graphic again and apply this to myself:

carbs_to_fat_target

If we assume at least a rough linear relationship with fat and cholesterol, then I’d pretty much have to go almost entirely back to where I was before starting keto. By some basic calculations, I could estimate a total cholesterol of around 200, LDL of 140, HDL of 42, and TG of 130 if I get back to about a 50/50 mix of carbs and fat (as shown by the “Best Goal?” overlay above).

This makes perfect mechanistic sense, given how the lipid system works. If eating more fat means my body is trafficking more fatty acids for energy, then necessarily it must traffic more cholesterol in these same lipoproteins.

Weighing the Choice

Let me illustrate this another way to get across the relationship:

scale_even

As fat rises, so does Total, LDL and HDL, with Triglycerides falling. Total and LDL-C going up is supposedly bad (red), HDL going up and Triglycerides going down is supposedly good (green).

scale_fat

Reversed, we see Total, LDL and HDL drop with Triglycerides rising. Total and LDL-C going down is supposedly good (green), HDL going down and Triglycerides going up is supposedly bad (red).

scale_carbs

Three Clues

So given this assumption, I expected my own data would likewise reveal this as well. When taking my blood tests, I’ll always have some variations of carbs, even if they are generally low. Moreover, I’ve had some variation in the ratio of carbs-to-fat. Yet while these were tiny shifts, there wasn’t a linear relationship appearing.

I didn’t put too much thought into it until a series of recent experiments and what it revealed to me. Let’s revisit everything I’ve done to date, excluding only the “extreme” experiments (such as the Extreme Drop I did that spawned the protocol).

markers_to_date_positive

As usual, I’ll be flipping the left axis so you can better see the inverse relationship between three day dietary fat and LDL-C. Past this point, all graphs will have this same inversion with the left axis.

markers_to_date

Above, the darkened lines of orange and blue lines show where I did the distance running and thus lowered my LDL-C marginally. Just after that, I’m going to take the blue highlighted area at the far right and break it down further.

markers_zoomed_in

From here, I’ll highlight each of the experiments I did over this period of time. This is further detailed on my Experiments List page.

markers_with_notes

During first major experiment I had eaten only eggs and cheese for 10 days, changing the quantity in the middle. But unlike other experiments, I had moved it from a moderate quantity to a low quantity. This yielded a sustained gap like I hadn’t ever seen before in my series. I also felt general malaise; didn’t enjoy it much for the second half. But the big first clue came in the form of my fasting blood glucose being unusually correlative with my mood. Lower FBG = worse mood.

The second major experiment was with fasting, which I posted on recently. This too yielded a major clue given it coupled tightly as would otherwise be expected with LDL-C.

The third clue came from the two experiments to follow. In the first, I had one cup (250 ml) of whole milk with each meal, in the second it was a single slice of bread. What astonished me was how tightly the Inversion Pattern held even going up to 78g of carbs / day. This proved the biggest clue of all as I’d have expected the gap between between the three day average and LDL-C to have widened.

teaser_full

The Calculation

There’s a big part of this story I can’t fill in yet. It’s how each of these clues along with a theory I’ve been working on for a long time led me to the next major experiment. I’ll detail it in a future post once it has been tested against, which will take several more experiments to achieve.

I’ll just say that the theory + these clues led me to calculate a range of 90 to 130g of carbs needed to hit this mythical “Sweet Spot”.

The Shakes and Bread Experiment

With this calculation in hand, I wanted to devise an extremely controlled experiment. Indeed, this would be one of the most intensive I’ve ever done.

I wanted to:

  1. Have a keto ratio of food that was nutritionally complete, yet somehow very consistent and quantifiable
  2. Have a common carbohydrate food as the intervention variable, but likewise as simple as reasonably possible

I figured out I could achieve (1) by having a ketogenic meal replacement drink, and for (2) I would just have simple slices of bread. I managed to find one that was both 100 calories a slice and allowed me to get within the net carb range I was looking for at 5 slices a day.

I would do five days of the shakes alone, then five days replacing 500 calories of the shakes with 500 calories of the bread. The first five days I’d be at around 30g of net carbs, with the second five at around 95g. This way I could really hit that target range while being extremely controlled on exactly what I ate.

To further ensure control, I ate to a very specific schedule of 11am, 3pm, and 8am in all but the first two days.

swap_graphic

A Striking Result

Before getting to what happened, it’s worth noting the data advantage I enjoy coming into this experiment. If you’ve been following my work for a while, you are already aware. But if you’re just joining us, you should know I’ve done 63 blood draws in 18 months and effectively have my own Inversion Pattern mapped now. So unlike anyone else I’m aware of, I’ll know when one or more variables are having an impact on my lipid system given the anticipated coupling you see in my graphs. Even in the outliers, there is little significant deviation from the mean, and until this graph below, no repeating patterns of a gap.

Below I highlight the blood test I took following the 5 days of keto shakes, which couples as we’d expect to the Inversion Pattern. Then, a clear gap forms between the higher expected LDL-C and the actual resulting LDL-C.

shake_and_bread

In other words, swapping out 500 calories of the keto shake for 500 calories of the whole wheat bread resulted in a lower LDL cholesterol than we’d expect.

Best of Both Worlds?!?

Right about now you’re probably thinking, “Sure, but isn’t this what you took so much time to explain at the beginning? That increasing carbs will result in better cholesterol numbers?”

Actually, there’s a huge number of differences here between the assumption above and this outcome. Let’s start with a closer look at the other lipid numbers.

lab

Not only was my total and LDL cholesterol the lowest I’ve ever had while on keto at 220 and 140, respectively — but my triglycerides were an impressively low 46, and my HDL was an extremely high at 71. Which is to say, this is the best looking cholesterol lab I’ve ever had.

(As an aside, I’m extremely thankful I did three full tests inside this five day intervention period to help rule out a lab error. Indeed, had this been the only test I performed, I’d have had a hard time reconciling it.)

Reproduction Test

After getting this final lab test four days later on 4/21, I immediately had a blood draw and attempted to reproduce it. However, I ate my “normal” keto diet instead of the shakes, but while likewise adding the bread with each meal to target nearly the same macros as I had on the shake-based diet.

Sure enough, the reproduction appeared to work as well.

markers_all

LDL-P

I ended up getting the particle count data late from the lab. There’s some analysis I’d have covered here regarding 3/23 and 4/7, but I’ll have to save that for a future post.

Like LDL-C above, LDL-P clearly shows the same divergence on its own inversion pattern (three days, with a two day gap).

discovery_ldlp

Revisiting the Assumption

Let’s look to the relationship graphic we had above, but with the new results added.

sweet_spot

Clearly we can see only a small change in total dietary carbs got me the “Sweet Spot” I highlight above. But again — and this is important to emphasize — it didn’t appear until I passed a certain threshold. Remember, just before this experiment I had done another (“One Slice of Bread”) experiment where I averaged 78g of carbs with no diversion in the Inversion Pattern.

In other words, this strongly suggests there is a threshold, a tipping point, a drop off with regard to my lipid numbers. That’s the reason I wanted to illustrate this analog relationship as I do above, because this strongly suggests it may be wrong.

With this in mind, let’s revise the concept.cliff

Here I’m illustrating how the shape of this cholesterol relationship appears different. With a sudden drop off point, it implies I can get the best looking lipid numbers by getting to the other side of this threshold.

Again, this is still very preliminary, but the testing so far supports it.

Other Observations

Naturally there’s much more to share about what happened than my changing lipid numbers. These are just the highlight while at 95-97g of carbs:

  • No Ketosis (of course). Ketone levels (BHB) were around 0.1-0.2 throughout, including morning (Keto average 1.2)
  • Very high postprandial glucose often 110-150 MG/DL two hours following a meal
  • Higher fasting glucose at 102 MG/DL (Keto average 92)
  • Slightly more tired following meals
  • Insulin averaged 5 UIU/ML (Keto average 3.8)

None of these came as a surprise to me given the higher carbs save the fasting insulin, which I expected to be higher.

What This Means

This may be the start of a solution for hyper-responders who seek a better lipid profile, while still staying low carb.

Instead of adding back hundred of daily carbs, I was able to stay just under 100g even if I was giving up ketosis. But again, I have a more distinct advantage than most due to knowing my own lipid patterns so well, so I can more easily identify where this carb threshold is and isolate it.

As far as the theory that led me here, that will have to wait for a later post.

However, while I’m happy if this may ultimately provide hyper-responders like myself with a new choice, not much has changed for me personally with regard to the risk assessment. I don’t know for sure that this lipid profile is a lower risk for all cause mortality today anymore than I would have a month ago. In short, I’m more interested in what this means on a system-wide level for the body’s regulation and control than I am for its personal impact on my life… at least, for now.

Next Steps

  • I’ll be pausing for a little while as I ramp up some contract work to rebuild my research funds. Up to this point I’ve been paying for the last 18 months of blood, medical, and technology expenses from my savings — save a few generous contributions from individuals through my donate button on the site. Thanks for the support!
  • I’m currently back to my “normal” keto ratio and expect to do another blood test following the pause to confirm my numbers have returned to the original Inversion Pattern. If so, we’ll know these changes were indeed transient.
  • Following that, I plan to experiment with other sources of carbs (fructose, lactose again, etc) to determine if the ratios hold regardless of the type of sugar.
  • I’m also tempted to do more lopsided intake of carbs where the same general macros are hit, but with a single meal being carb-heavy where the others are generally keto.

178
Leave a Reply

avatar
 
Photo and Image Files
 
 
 
Audio and Video Files
 
 
 
Other File Types
 
 
 
68 Comment threads
110 Thread replies
2 Followers
 
Most reacted comment
Hottest comment thread
57 Comment authors
Danni SeligerDaveJak MangMatthew SolbergSolid Recent comment authors

  Subscribe  
newest oldest most voted
Notify of
Michael Babcock
Guest

This is fascinating stuff, however . . . The assumption here has to do with having a total cholesterol and a LDL-C that is lower is better and that the standard cholesterol lab result targets are a good thing. Do we know this? Given that pretty much every other marker improves on a ketogenic diet, just maybe that rising total cholesterol and rising LDL-C is actually an improvement as well. Is there actually any research that shows anything detrimental about higher cholesterol and LDL-C numbers? Can we say with authority that raised LDL-C is definitely bad? Back to the other question: is it possible that those raised LDL-C numbers while you were on keto are a good result?

I’d have to ask “the best looking cholesterol lab” according to who? Conventional medicine? If it turns out raised LDL-C is actually good, they don’t look like such a good set of results.

What are the small, dense LDL particles are doing?.If they go up with a keto diet, that would be a concern.

I’m curious: why the effort to make your lipid profile fit western medicine’s ideal? Are you certain it is the best thing for your health and longevity?

Danni Seliger
Guest
Danni Seliger

According to Peter Attia it is the LDL-p that is the problem, not LDL- C . He lays out his entire argument in his blog series on cholesterol. Especially post no. IV. He has a few cited articles in there but it shouldn’t be a problem finding more. Dave’s finding here is super interesting because it lowers both C and P 🙂 https://peterattiamd.com/the-straight-dope-on-cholesterol-part-iv/

Sergi
Guest
Sergi

As another hiper-responder, this is really interesting. I will have to test this out (my latest numbers are 2400 LDL-p and 1100 small LDL-p).

Have you consider fiber as one of the reasons why increasing carbs using 500 cal of whole wheat toast reduces LDL-P so drastically?

Bob Niland
Guest

I only recently began following your blog, so might have missed some key details in the back traffic, but did do some searching.

Overall, you appear to be rediscovering material that is known to the community of Dr. William Davis (cardiologist), and compiled in his former Track Your Plaque program (now named Cureality, and soon to be Undoctored).

Knowing your ApoE status is part of the puzzle. Another couple of tests I don’t see discussed are Lp(a) status, and any calcium [Agatston] score (CT or EBT calcium scan; not a CT angiogram).

Dr. Davis used to have specific advice for ApoE4 (and E2) clients, but it rather looks as if the diet and lifestyle program he now recommends for everyone brings things under control for all but the most intractable lipidemias: grain-free, very low net carb, ad-lib specific fats, remediate and maintain microbiome, 3 grams or more per day of Omega 3 DHA+EPA, no added Omega 6 Linoleic Acid, supplement Vitamin D and magnesium to titer target, plus some other strategies.

In his program, TC is deprecated, LDL-C is a bad joke, TG target is below 60, HDL target is above 60. LDL Particle Number matters (600 to 800), and there are other markers to consider. You can get a sense of them at: https://www.cureality.com/forum/topics.aspx?ID=18881

Disclosure: I’m a contributor on Dr. Davis’ Wheat Belly Blog (where the topic of lipidemias, curiously, seldom arises).

Charles
Guest
Charles

http://www.cureality.com/blog/post/2006/11/06/the-track-your-plaque-rule-of-60.html

The Track Your Plaque recommended targets for conventional lipids (i.e., LDL, HDL, triglycerides) are LDL 60 mg/dl, HDL 60 mg/dl, and triglycerides 60 mg/dl: 60-60-60.

Not only is this set of values easy to remember—60-60-60—but is grounded in science and the results of clinical trials.

LDL 60 mg/dl
The LDL target is based on experiences such as that of the Reversal Trial, the PROVE-IT Trial, and the Asteroid Trial, all of which showed that LDL cholesterol values in the range of 60 mg/dl dramatically enhance the likelihood of stopping plaque growth or achieving regression, reducing risk of heart attack more than more lenient LDL targets.

Michael Babcock
Guest

I had another thought after sending the previous post. I do see that your trig/HDL ratio is significantly better at your “sweet spot.” I’d love to see you discuss the balancing of different health markers. Yes, your “sweet spot” might improve the lipid markers but your insulin and glucose not so much. Which set of markers do you seek to optimize or how do you balance the various markers?

eric25001
Guest
eric25001

P!ease read cell metabolism DEC 2014 Time RESTRICTED FEEDING

What hours did you eat?
Seems time is an important factor
Eric

Jorn Vikse
Guest

You are doing a fantastic job with these experiments, and the documentation. I haven’t read all of your post, but I will. Have you discovered the reason for this «hyperesponder» fenomena. I understand that apoE is involved. But the fat you eat is shuttled in chylomicrons, and surely this is not measured in your lipid tests ?
The standard answer to why ldl-c raises in respons to fat is downregulating of the receptors. Can this really account for these big differences you observe ?

Thanks again for your work.

Solomon
Guest
Solomon

Great Job Dave is doing. Jorn, the summary of Dave’s work is this: For the Keto adapted person, the Lipoproteins are in the main, energy distribution particles. The more fat you consume the less of it that you need. And the important factor is the body uses the sum of the last 3 day’s fat consumption to determine how much particles it should produce. For particle numbers, there is a two day delay for the three days used. More fat, less LDL is what the data is bearing out so far.

This new insight says, you can still get ‘great lipid numbers’ for you Insurance Company by doing less fat and a little more carbs. Just that the Glucose starts coming up. Metformin?

Eric
Guest
Eric

Look at my circadian clock. Org
Eating keto in a time restricted feeding seems the logical evidence based way.
Salk institution has the data and evidence
Eric

Rob
Guest
Rob

“This does not constitute medical advice. I realize many may read this and act on it, but I urge you to consult with your doctor and/or trusted medical professional — particularly if you are diabetic or insulin resistant.”

I wonder if all nutritionists will have to put that caveat on their blogs from now on after the Noakes trial

Latife
Guest
Latife

I appreciate your work and feel lucky having you, thanks a lot.
I am hyper-responder too. But I was doing intermittent fasting, like 20/4, 22/2 and have done 46-8 hours fasting few times. I was fast when had test and my cholesterol was really high ( 10.6= about 429). I was on low carb, high fat diet at the that time. So intermittent fasting and HFLC!
I should have another test without being fast and see how fasting effects on my cholesterol.
I am not worried about having high cholesterol after reading and watching your work.
I would like to know how much fasting shot my cholesterol. My understanding from you is, when we eat fat or our body fat is used for energy it is normal if we have high cholesterol and LDL.:)
I have T2D.
Thanks again.

DrDan
Guest
DrDan

Insulin represses the expression of the orexigenic peptides NPY and AGrP. By going into ketosis, I guess that the arcuate nucleus no longer gets the message via insulin that you’ve just eaten. You’d therefore produce more NPY than expected … and NPY increases VLDL-TG secretion by the liver. Taking some CHO would increase insulin, reduce NPY and reduce increases VLDL-TG secretion.

Seth
Guest
Seth

I think this might be interesting, but I didn’t understand the acronyms. Can you say what is: NPY, VLDL-TG and CHO?

Thanks.

Craig
Admin

CHO – Carbohydrates.
TG – Triglycerides.
VLDL – Very Low Density Lipoproteins (from the Liver)
NPY – Neuropeptide Y
AGrP – Agouti-related peptide

eric25001
Guest
eric25001

Not what 9 hour period during the 5 to 10 day window but do you eat in 9 hour windows now?
Does 3000 calories mean 1000 excess? What about maintenance?
135 grams of protein? Too much for me to maintain be and ketone levels.

What about six months or more? Years?

My day average is 180 fat and protein is 3 days of 66.25 grams and one of 12.5 grams along with 3 days of 30 grams carbs and one day of 50 grams.

Two eating styles that might be interesting to compare all meat diet for years and or every other day eating.
What are the blood results after years? Better worse same? How?
Eric

Alberto
Guest
Alberto

Why not forget entirely about cholesterol and focus on your Calcium (CAC) Score, that is scientifically proven to have a much more accurate correlation with cardiovascular disease? I’m a hiper responder who chose to go all in in keto, without looking back. CAC score: zero!

Kanel
Guest
Kanel

Because this research is not only important for Dave, but for all of us. Finding out the truth about the lipid system and its connection (or lack of connection) to heart health is vital if we want to see a change in the current dietary advice and health care.

Peter Bastian
Guest
Peter Bastian

Dave…I just watched Ivor Cummins video on cholesterol and CAC testing. I am pleased to see you have done a CAC in conjunction with your research on the lipid system. For us regular folk, Ivor seems to suggest what Alberto says. Bypass all this lipid panel stuff, and go straight to CAC for CVD risk assessment. To our surprise and joy, the concept of “walk-in” CAC clinics already exists. We have been KETO for 5.5 months, but we’re otherwise healthy adults prior…we were on the low-fat bandwagon. Due to other issues, I have had a number of tests done, including carotid artery sonograms and a esophageal heart sonogram. No red flags, but they said I had some plaque. Here is my question – do you believe low-carb/KETO can reverse a non-zero CAC scan? Or, does KETO arrest a CAC score? In all likelihood, we will be doing multiple CAC scans in the forthcoming months, to see if there is a trend. Seems to me the CAC scan approach to CVD risk assessment and carb v. KETO dieting is begging for a study!!

Peter
Guest
Peter

Have you measured your CIMT Carotid Intima Media Thickness?

Also, have you measured your sterol absorption? http://www.bostonheartdiagnostics.com/science_portfolio_cholesterol_balance_test.php
Sitosterolemia was one possible diagnosis given for high plant sterol absorption leading to very high cholesterol numbers.

Lary Beck
Guest
Lary Beck

Thank you, Dave for being there to curtail the stress of a newly discovered hyper-responder, although the data is clouded by quitting atorvastatin after 15 years at the same time. (I wonder about a rebound effect.)
Been in ketosis for 3 months with average noon blood ketones at 2.0
Numbers :
TC from 147 to 407 and LDL(C) from 73 to 317. I am also intermittent fasting in order to lose weight. I have not read all the blogs, but combined with your Breckenridge video, I have a basic understanding of the interactions. Btw, 13 years ago at age 57 I had a CAC score of zero and last month it was at 55 which puts me in the 14th percentile, so with a family history of atherosclerosis, I feel I am not doing too bad.
Next up, I will be looking to get an NMR lipids test.

Karl Schmidt
Guest

Several points –

1 – I don’t think that the arrow of causation has been proven for LDL — Could be that damaged arteries alert the immune system and one of the responses to injury is cholesterol recruitment – via LDL. The LDL=bad narrative is failing – several drugs that lower LDL fail to improve CAD-mortality nor all-cause-mortality. Statins provide a very small benefit – and lowering LDL may only be a side effect. NNT for statins is 83 after taking for 5 years – no benefit if you don’t have CAD. http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/

2 -There is no study that has shown that LDL is an independent risk factor if oxLDL is held constant.

3 – There are several forms of LDL – often classified as dense vs fluffy – the only way we know to change the type to the assumed more healthy form is to eat less carbs.

4- People losing weight will have higher LDL (transport out of adipose tissue). So having high LDL on low carb may only be temporary and represent a ‘good thing’.

5- The latest Repatha paper showed lower LDL – yet increases in heart deaths and all-cause mortality. http://www.nejm.org/doi/full/10.1056/NEJMoa1615664

https://xtronics.com/wiki/Cardiac_Disease_Carbohydrates_and_Weight_Loss.html

Peter H
Guest

Great post. An experiment eating ‘gluten free’ would be very interesting. I am high fat low carb without gluten. My LDL was 190 at the last count. I have cut down to one egg for breakfast instead of two. And using less meat fat. To try and bring this down. Though 190 doesn’t look too bad, compared with your 270. I should add that I am 65, nearly 6foot tall and weigh only 70.2 kilos. I am HFLC without gluten to keep my brain working.

Richard Nikoley
Guest

Very, very interesting. I’ll be citing it in a post soon.

Neville
Guest
Neville

Hey Dave, Just wanted to post my test results on a whole foods plant based diet (HCLF). Again, i haven’t been as precise as you’ve been in weighing/measuring food but here’s what my diet (kinda) looked like.

– Breakfast: fruit bowl consisting of chia seeds, 4 spoons hemp protein, 1/2 banana, two handfuls of berries, 1/4th cup of granola

– Lunch/Dinner Option 1: Salad Bowl consisting of ~ 80 gms spinach, 1 mango, 3-4 spoons hemp protein, 2 hand-full’s of berries, 1/2 cup granola.

– Lunch/Dinner Option 2: Rice 3/4th cup rice, 2 servings of vegetable stew made up of cauliflower+potatoes

LDL-P 1150 nmol/L
LDL-C 105 mg/dL
HDL-C 46 mg/dL
Trigs 37 mg/dL
Total C 158 mg/dL
HDL-P (total) 27.1 umol/L
Small LDL-P 159 nmol/L
LDL Size 21.3 nm
H1Ac 4.9 %
Insulin 3.9 uIU/mL

This report looks quite good to me(apart from the low HDL). I am surprised to see this (low) value for trigs! I’d also like to add that i think i have lost some muscle mass in the last month. So in that sense, preserving muscle while losing fat and general overall well being, i would put the ketogenic diet as superior to what i am doing right now. However, unfortunately my cholesterol seriously go for a toss on HighFatLowCarb.

Going forward i might try adding fat gradually and see where these numbers go. Since, i am at the other side of the spectrum right now (HCLF) i’ll probably start adding fat gradually while lowering carbs. I did briefly go through your latest post on adding carbs (will read it in more detail soon). I must say, i had tried adding some carbs (maybe around 50gms) while i was doing LCHF but that didn’t seem to bring down the numbers. Maybe adding more carbs would have helped!

Tim Steele
Guest

Hi Dave – New here, but great blog (Thanks, Allan!). Your inversion factor is interesting. I’d love to see similar labwork on people who follow other dietary patterns, SAD, WAPF, Med, etc. I recently did an Indiegogo project to raise money to test resistant starches and I had enough left over to get more people involved in an n=10 blood glucose experiment (see at potato hack.com). Maybe you could raise funds the same way…very easy to do.

My only quibble with some of your experiments is that the gut flora of a keto-adapted dieter vs a carb/fiber eater would be quite different, and a couple days of eating bread would not change the gut flora significantly. Perhaps a future experiment would involve a high-fiber arm with a timeline that allows changes in gut flora, ie. 6-8 weeks on higher carb/fiber.

There’s a long history of studies showing large and lasting reductions in LDL-C without reducing HDL-C or increasing triglycerides over long treatment periods.

If nothing else, your recent experiments show the meaningless-ness of a single blood draw. I’m always disheartened to see doctors who prescribe (statins, bp lowering meds, diabetes meds…) based on just one or two lab results.

Kanel
Guest
Kanel

Thanks Dave! Awesome work!

Have you seen this talk by Sarah? https://youtu.be/w8jUmCe3zDs (around 15 minutes in)
She explains how low insulin level can cause elevated LDL in some people so it could help explain how you hit your “sweet spot” by increasing the insulin a little.

One thought that bothers me about all this is – basically every single marker of metabolic disease improves when going on a ketogenic diet so then why would the body decide to put you at higher risk of heart disease in the process? It does not make any sense to me.

Manu
Guest
Manu

Love your approach, Dave. I also re-added some carbs after hitting a TC of 400 with regular fasts and keto-like carb intake. Some insulin seems to lower LDL. Discoveded it via Chris Masterjohn, who wrote a lot on this topic.

.. in an insulin-sensitive person, carbohydrate stimulation of insulin has a powerful beneficial effect on LDL receptor activity.

This doesnt answer the question if it’s an issue of course.

Neville
Guest
Neville

Hey Manu, curious to know how much have you been able to reduce TC by adding carbs.

Manu
Guest
Manu

About 20%, but I only did it for a short time by now.

Leigh Yaxley
Guest
Leigh Yaxley

“Second, I think we were already on the same page. My theory behind the Inversion Pattern has always been mobilizing of energy via VLDLs in the absence of available incoming energy from the gut (Chylomicrons)”

Dave,
Maybe we are on the same page but I’m not sure because your theory doesn’t explain where the increased cholesterol has come from or where it goes to when the serum cholesterol decreases.

My own hypothesis does explain this and it is nothing so very surprising. It is simply an effect of cholesterol exchange with adipose tissue, which has been amplified by changing patterns of food intake that have been switching lipolysis on and off, i.e. increasing fat consumption down regulates lipolysis or switches it off whereas decreasing fat consumption or fasting up-regulates or switches it back on. Furthermore I would expect this phenomenon to be further amplified in someone who is LCHF adapted due to their heightened metabolic flexibility.

The connection with lipolysis comes about because adipose tissue is a reservoir of cholesterol as well as fat. The cholesterol is part of the fat cell structure and must get expelled along with free fatty acids during lipolysis.

Your data in the period 21-23 March show serum LDL-C increasing at an average rate of 58mg/dL per day and during the period 23 March to 17April it is decreasing at an average rate of 34 mg/dL per day.

It is instructive to derive corresponding cholesterol fluxes: At 79 kg and 1.9 meters your total blood volume must be around 5.7 liters and serum volume around 3.1 liters = 31 dL. Multiplying the observed rates of change of serum LDL-C concentration by the serum volume gives an estimate of the mass flux of cholesterol in and out of the serum, i.e.

Fasting/low fat intake period: + 1798 mg/d ~ + 1.8 g/d
Re-feeding/high fat intake period: – 1054 mg/d ~ – 1.1 g/d

(Whilst the above is based on LDL-C measurements previous data from your twin diet experiment shows a very tight correlation between total cholesterol and LDL-C (R^2 = 0.991) so the rate of change of LDL-C can be used as a proxy for rates of change of total cholesterol).

My hypothesis is that the ‘fasting’ rate of + 1.8 g/d is a net rate at which cholesterol is being released from adipose storage and that the ‘re-feeding’ rate of -1.1 g/d is a net rate at which cholesterol is transferred back to adipose storage. Note that the ratio of the magnitude of these rates is 1.6, i.e. transfer to storage is slower than release from storage.

These estimates are consistent with measurements of total cholesterol turnover rates that were made around 40 years ago in 54 subjects – see references [1] and [2]. Forward rates (release from storage) can reach 4.0 g/d and reverse rates (return to storage) can reach 2.5 g/d – interestingly the ratio of these rates is 1.6.

There are 5 primary components of cholesterol metabolism, viz
• Dietary intake (typically 0.2 to 0.6 g/d)
• Bile metabolism (~ 0.6 g/d)
• Liver synthesis (~ 1.0 g/d)
• Excretion (~ 0.6 g/d)
• Extra-vascular tissue exchange (up to 4.0 g/d)

With so many components in play it is not really surprising to see serum cholesterol responding dynamically but extra-vascular tissue exchange is the only component that might account for both the direction and magnitude of the dynamic changes, which your data reveal.

[1] Three-pool model of the long-term turnover of plasma cholesterol in man DeWitt S. Goodman, Robert P. Noble, and Ralph B. Dell, Journal of Lipid Research Volume 14, 1973 http://www.jlr.org/content/14/2/178.full.pdf

[2] Prediction of the parameters of whole body cholesterol metabolism in humans DeWitt S. Goodman, Frank Rees Journal of Lipid Research Volume 2 1, 1980 http://www.jlr.org/content/21/6/699.full.pdf

HN Pandey
Guest
HN Pandey

Dave, this is wonderful!!
I have some data to share and understand your perspective. In keto, my Trigs aren’t coming down. How can I share my excel with you?

Thanks
Pandey

ginny51
Guest
ginny51

Thank you, Dave!
I’m particularly appreciative of what you’ve done and are proving, as surely many others are, particularly as “Jill’s Story” hits close to home for so many women. Being a woman is singled out in statistics as a “risk factor”, eg. CHADS VASC score for prescribing anticoagulation therapy.
I was prescribed statins just recently, with LDL 223, “prediabetic numbers” and heart problems. If I change my “numbers” I’m in an entirely different position to listen to whatever else the docs want to get me to do. This is one big, huge, understatement, the real change in the patient/doc relationship with a real drop in those “numbers” is awesome. (Statins interfere with insulin production, etc., and are known to push you over the edge into diabetes, clinching the score for mandatory anticoagulation therapy, for example.)
I’m aware you need experimental data, but you might be interested in the pattern appearing even with rough data.
I’ve logged my food daily in Cronometer since August 2016, steadily, though not even close to your standards, to try out low carb for prediabetes.
A pattern appears along the lines of what you’ve decided to prove.
Nov 5, 6, 7 2016 – Avg Fat 145 grs.
Blood Test Nov 8: Total Cholesterol 325 / LDL 246
Jan 30, 31, Feb 1 – Avg Fat 210 grs.
Blood Test Feb 2: Total C: 218 / LDL 136
Apr 2,3,4 Avg Fat 151 grs.
Blood Test Apr 5 Total C: 319 / LDL 223
This pattern (that thanks to your work I now see) actually happened by chance as I started that second period after Nov 8 trying for lowish Net carbs (60-70 grs) and low cholesterol (max 300 mg) but as I’m way too thin and tall and started to lose weight, about half way through I just decided to ditch the low cholesterol attempt and continued on to my next blood test, eating all the fat I wanted.
Dear Dave, I am at a loss for words as to the marvellous Pandora’s Box you’ve pried open.
Would data from Cronometer and a future Blood Test mid-June be of any use to you?
In the meantime, my sincerest appreciation for what you’ve accomplished.
ginny51

Deb
Guest
Deb

Hi Ginny51,

In regards to your lipid panel of Feb. 2, I’m curious to know how you increased your fat intake from Jan.30-Feb. 1.
Did you use saturated fat like butter and coconut oil? Did you add high fat foods like avocado?

Thanks
Deb

ginny51
Guest
ginny51

Hi Deb,
Sorry I didn’t answer before but I drop by occasionally and didn’t return to this post.
Fat for the 3 days prior to the Feb 2 blood test was
221.4 gr / 221.5 g / and 188.6 g.
I ate what Cronometer calls “Edwards, New York Style Cheesecake on 2 of those 3 days, accounting for 36.7 gr or 32% of the fat, and the other day Olive Oil 42 g, 38%. No coconut oil, and butter only 24 gr, on one day. Other items were for example: Raw Pecans, Macadamia Nuts, Walnuts, Avocado, Greek yogurt, Buffalo hamburgers, Fried eggs (2). Not sure that helps.
Best regards,
ginny

eric25001
Guest
eric25001

Take a look at toomy web site link from diet doctor
Eat low low carb high fat web site
He reports eight years of labs from eating once a day
Hdl is above trig levels
Hmm
Looks like one time a day has potential
Eric

eric25001
Guest
eric25001

Dave
Looking at the labs reported by tommy on his one meal a day and your 3 to 5 day switch on lipid blood levels then it seems reasonable to test five to ten days of one ketogenic meal a day.

I am not willing to do the same for junk food once a day or vegan or anything but my keto but what an insight if a switch to one meal per day for 5 days can switch the blood results! Eric

Leigh Yaxley
Guest
Leigh Yaxley

Dave,
I’ve dug up a few more clues from the literature – see references [1] and [2] below.

Your combination of keto shake, bread and fat were probably a close emulation of the ‘casein + oligosaccharides + fatty meal’ experiment of reference [2].

Any idea what type of protein was in your Keto shake?

Key takeaways from these papers:

• “Insulin acutely inhibits VLDL production via its ability to suppress free fatty acid [FFA] mobilisation from peripheral tissues” [i.e. it suppresses lipolysis in adipose tissue]

• “Elevation of plasma FFA levels acutely stimulates VLDL production”

• “The addition of oligosaccharides [i.e. carbohydrate] to a fatty meal suppresses the concentration of FFA due to increase of insulin but in addition chylomicrons and VLDL are delayed by effects of glucose and insulin on gastric emptying.

• Casein [i.e. protein] added to an oligosaccharide-containing fatty meal reduces the chylomicron response. Casein also markedly suppresses FFAs in the presence and absence of oligosaccharides in the fatty meal.

• Because FFAs fuel hepatic triacylglycerol production, a lowering of VLDL may be a long-term consequence when fat-rich meals are regularly combined with arginine-rich proteins such as casein.”

[1] Interaction between Free Fatty Acids and Insulin in the Acute Control of Very Low Density Lipoprotein Production in Humans
Gary F. Lewis, Kristine D. Uffelman, Linda W. Szeto, Barbara Weller, and George Steiner https://www.ncbi.nlm.nih.gov/pmc/articles/PMC295395/pdf/jcinvest00023-0176.pdf

[2] Postprandial Lipid and Carbohydrate Responses after the Ingestion of a Casein-enriched Mixed meal
Sabine Westphal, Stephanie Kästner, Elina Taneva, Andreas Leodolter, Jutta Dierkes, and Claus Luley
http://ajcn.nutrition.org/content/80/2/284.full

Sergi
Guest
Sergi

After reading this I did a similar experiment last week. My last numbers (3 weeks ago) were:

LDL-C: 193
LDL-P: 2475
Small LDL-P: 1252
HDL: 49
Triglycerides: 79

I ate around 2500 calories per day (no shakes or bread, so numbers are not exact), with at least 100gr coming from carbs (up to 200gr one day). My saturated fat consumption was low (<25gr), but plenty of monosaturated fat (nuts, avocado and olive oil). I also took vit D (~5000IU) and fish oil (3gr of https://www.amazon.com/Ascenta-Health-Nutrasea-Omega-3-softgels/dp/B002GP08EK). Ratios in the 30-50-20 (carbs – fats – protein).

Results:

LDL-C: 137
LDL-P: 1725
Small LDL-P: 588
HDL: 50
Triglycerides: 112

So, reduction in both LDL-P and small LDL-P, but increase of triglycerides.

I think I will try again in 2 weeks, but controlling a bit more the carbs around the 100gr mark, and with higher saturated fat consumption. Also doctor appointment, so I will ask for a calcium score.

Deb
Guest
Deb

Hi Dave,
Thanks so much for this website and all you are doing to help all of the hyper-responders out there. I must admit that a lot of what I read is a bit over my head, so I appreciate that you always sum things up!
 
I need some advice in knowing what to do for my next lipid panel. I had one in March, the first one I have had since an NMR in 2013 and once again my LDL is high, 231.  I have a new doctor now and of course he was very alarmed at my LDL. Never mind the fact that my HDL was 114 and my trigs were 81 (a bit higher than my NMR, probably due to the fact that I had been fasting a couple days before my test). I did try to do some explaining but he just prescribed a statin (which I never picked up) and wanted me back in a couple months to re-check.  I asked for a referral for a CT Heart Calcium Score, just had that done a few weeks ago and my
score was 0.
 
I got the call to come back for a re-check so that is in a couple weeks. I plan on asking for an NMR this time and also for more of the tests that you recommend we get done. I was thinking about using your protocol of  increasing my fat consumption for the 3 days prior to my test, but then I saw something on the Diet Doctor site that intrigued me. They have a page of advice for people whose LDL goes up on a Keto or Low carb diet.
Here’s what they started off with;
Stop drinking Bulletproof coffee (butter, coconut fat or MCT oil in coffee). Don’t drink significant amounts of fat at all when you’re not hungry. This alone can often normalize cholesterol levels. https://www.dietdoctor.com/low-carb/side-effects#cholesterol
 
I have been drinking Bulletproof Coffee for years. I use about 2 TBS of grass fed butter and 1 TBS of MCT oil in 2 16 0z cups of coffee, not each cup, but the 2 cups. Is there a difference in the fact that I am drinking that fat rather than getting it from eating food with the fat, like eggs cooked in butter etc. ?   I don’t recall reading or hearing on any podcasts of anyone who just stopped the BP coffee and their LDL was corrected. If I decided to give that a try, how long before my lipid panel should I stop the BP coffee?
 
Right now I’m not sure which option to go with, lots of fat for 3 days, or no BP coffee for some amount of time. I’m not convinced at all that my elevated LDL is a problem, but I’d like to do some experimenting. I’d appreciate any advice from you or the community here.

Steve
Guest

Hey Dave, I’m very new here, but your advice for hyper-responders seems very similar to Chris Masterjohn’s. Have you read (or listened to)this (particularly at 42:00): https://chrismasterjohnphd.com/2017/03/19/what-to-do-about-high-cholesterol/#transcript

I’m fascinated by this subject because…. have a very low insulin score (4), and am lean and insulin-sensitive by all measures. I also have high LDL (200), high total (300), fairly high HDL (78), and low trig (78). My oxidized LDL (measured for the first time recently) is extremely high (116). My LDL particle count is 2400 and my SD-LDL particle count is 949. I’d like to get the unfavorable numbers, particularly the oxidized LDL, down considerably.

If I’m reading the transcript of that Masterjohn episode correctly, and reading your article correctly, someone with those stats should not be eating keto LCHF with sometimes only two meals/day, but rather should be eating three meals/day with lower sat-fat and higher(ish) clean carbs, like lentils or sweet potatoes in the 100g/day range, and loads of antioxidant vegetables and spices. The greater carb load will trigger an insulin response that the insulin-sensitive person can handle, and that insulin response will activate LDL receptor sites which will clear LDL from the bloodstream before it can oxidize.

Do I have that right? Do you diverge from Masterjohn at all with respect to this theory? Let me know. I’m highly invested in this issue at the moment.

Mark
Guest

I find it interesting that Chris Masterjohn explains how LDL-C can spike in an insulin sensitive person who goes on a Low Carb diet (this has been my experience on Keto) but how do you explain the many very insulin resistant people who see the same thing ?

Jotham
Guest
Jotham

Dave,
Thank you for taking the time and all the needles to do this. I switched to a LCHF diet back in September from a HC-LF diet I was on for almost two years. I lost around 20lbs since then and I’m currently 165lbs at 5′ 10″. Overall I look and feel better than I ever have but my LDL-C has doubled since the switch which has prompted my doctor to tell me to stop the LCHF diet.

Before —> After
Chol 162 – 262
TG 77 – 57
HDL 43 – 48
VLDL 15 – wasn’t listed this time
LDL-C 104 – 203

From what I’ve read of your experiment your suggesting a moderate amount of carbs has allowed you to drop your LDL levels. I’m thinking about trying this as well to see if I can have the best of both worlds by reaching that sweet spot. My idea is to drop my saturated fat intake from 67 grams per day down to 32 grams per day by switching from coconut oil and grass fed butter to olive oil instead. I’m also going to switch regular sausage for turkey sausage to cut down on sats, but I will keep in cheeses and red meat. To replace the lost calories I plan to add approximately 100 grams of carbs (per your experiment) in the form of mixed fruit, brown rice, and gold potatoes (breads/pastas tend to make me feel sluggish, so I’m avoiding those). Just wanted to check with you if this sounds about right? Also how long do you think I should wait before getting blood work redone?

Ran Naot
Guest
Ran Naot

HI Dave,

Interesting post and very nice comments to follow 🙂
My son is APOE E4/E4, we emailed in the past and I am looking forward for your research.

So I understand your stats are “Better”, but having high fat intake without keto can lead to trouble…
I wonder if you monitor the point where you go to keto, could be that the step in the graph is you system going into keto ?

Since you are keto adapted could be that you remain keto on more than 20g a day…
The question is really what make this step in the graph, as an ENG. myself, it seems like some process is kicking in that before this point it is suppressed…

Craig
Admin

Hi Dave,

Great work! I can’t help but notice that your sweet spot tipping point was right at the keto/no-keto level of carbs. Did you plot LDL v ketones?

Personally, I’m following this even more closely after I got my first blood test after 3 months on Keto. I happened to have had a 36-hour fast in the measurement window – which probably “worsened” these numbers.

Cholesterol – 342
Triglycerides – 176
HDL – 98
VLDL – 35
LDL – 209

I’m strongly considering doing your protocol for a non-fasting retest. Reach out to me if you had any tips or documentation requests. (Though, I realize these reports will be mostly moot after your kickstarted study)

thanks!
Craig.

Anita
Guest
Anita

I am fascinated by your experiments. I am hypothyroid (Hashi’s) and get bloodwork every 4 months. I’ve been eating very low carb for years, and my LDL was too high on my last test (HDL is high;trigs are low). My doctors don’t see a problem but ‘make noises’ about the LDL.

At the time of the last test, I was eating a lot of Kerrygold butter, and I thought that might be the problem. I’ve since reduced intake significantly using olive oil instead. I have a test scheduled for next week, and I was thinking of trying your ‘carb solution.’ But then I wouldn’t know if it had just been the butter.

What interests me about the carb issue is that years ago my endo worried that my low carb eating might be
‘masking’ Type 2 diabetes (all my siblings have it), but she warned me that I needed to prepare for the test by eating at least 150g carbs for 3 days–or results would be inaccurate. I wonder if there’s a similar shift with LDL.

Jim Cesca
Guest
Jim Cesca

Hi Dave,
Fellow hyper-responder here.
I’m trying to decipher the concept of eating LCHF leading to higher utilization of Triglyceride for energy, alongside the typical drop/lowering in Triglycerides on a lipid panel.

Using the cruise ship analogy:
Would it be the equivalent of more people being interested in taking a cruise (Trigs for energy demand), so more cruises are being scheduled more frequently (increased LDL-p), even though each ship is taking fewer total passengers (lower Trig levels)?
So, even with less passengers per ship (low Trigs), the cruise ships just happen to maintain a high level of life boats (LDL-c), just in case those life boats are needed?

Thanks for your input and efforts.
-Jim

Anita
Guest
Anita

Hi Dave–

Yes, the endo thought that my very low carb eating might have been ‘controlling’ Type 2–i.e., I was getting normal blood sugars by restricting carbs (I typically eat <20g). The GTT was negative–i.e., no diabetes.

I definitely plan to do low fat/increase carbs for three days next week prior to my blood draw. I'm aiming for 150g, mainly from rice and beans and some gluten-free bread (I have Hashimoto's and avoid gluten). I'll post my results.

George
Guest
George

Are all the results above, all the testing, with no other changes in stress levels, sleep habits, movement, exercise, social interaction, sunlight?

Thomas
Guest
Thomas

Hi Dave,

I had great success with this protocol.

In April these were my numbers after 4 months of continuous strict keto/IF (I’ve been mostly on keto for almost two years, with a couple month-long moderate carb excursions to test for improved insulin sensitivity):

Total Cholesterol: 289 mg/dl (my previous high had been 204, after my first six months of keto)
Trig: 99
HDL: 54
LDL-C: 215 (the previous high was 148, after first six months of keto)

My doctor took a wait-and-see approach, and gave me two months to try lifestyle changes, then re-test. This time he ordered the NMR lipoprofile. For four days before the blood draw I ate my usual keto food, minus added fat, plus about 100g carbs/day (mostly bread).

Total cholesterol: 168 (the lowest I’ve ever tested, beating the 186 I had 10 years ago following the SAD)
Trig: 90
HDL: 50
LDL-C: 101
LDL-P: 1011 nmol/L
Small LDL-P: 402 nmol/L
HDL-P: 27.6 umol/L
LDL size: 20.8

I don’t know exactly how to interpret the NMR results, but they don’t look bad to me.

Thanks for the inspiration to try this.

Michael
Guest
Michael

I would love to see this experiment done with alcohol instead of carbs. I am curious to know if there might be a similar threshold.

Ann
Guest
Ann

Thank you so useful.I’m not alone. I will keep watching and cheering you on.

ginny51
Guest
ginny51

Hi Dave,
Could carb loading upset the fat loading apple cart?
Or could Moderate Net carbs 70 – 85 grs somehow be on the wrong side of the fence, not close enough to keto?
Got my results today. I’ve failed. My Total C and LDL peaked. (Other results fine: HDL 72 Trigs 57)
I did my best and haven’t a clue as to what went wrong.
On this page, May 17, 2017 I mentioned seeing a pattern:
“Nov 5, 6, 7 2016 – Avg Fat 145 grs.
Nov 8: Total Cholesterol 325 / LDL 246
Jan 30, 31, Feb 1 – Avg Fat 210 grs.
Feb 2: Total C: 218 / LDL 136
Apr 2,3,4 Avg Fat 151 grs.
Apr 5 Total C: 319 LDL 223”
I had also seen something of a pattern with carb loading for a better FBG and HbA1C.
I don’t trust FBG, but simple 3 month Cronometer Net Carb averages to HbA1c were:
Net Carbs 86.1 gr – Nov 8: HbA1c 5.7% – FBG 100 mg/dl
Net Carbs 90 gr – Apr 5: HbA1c 6.0% – FBG 144 mg/dl
I decided to Carb load because of that last FBG *and* do your 3 day high fat on the same 3, 4 days.
I doubled Net carbs and Fats for 4 days before the Blood Test.
Prior 3 month Net Carb avg: 85 gr / Fat 180 gr
My results, a failure on both accounts, though I find FBG pointless for this:
June 12, 13, 14, 15 – Avg Fat 236.1 gr / Avg Net Carbs 179.3 gr
June 16: Total C: 314 mg/ml / LDL 230 mg/100 ml
FBG: 140 mg/100 ml – HbA1c: 5.7%
Hope it makes sense and could prove useful.
I really appreciate what you’re doing. A fascinating Pandora’s box, no doubt.
ginny

ginny51
Guest
ginny51

Hi Dave,
My missing data:
Proteins: 111.9 / 89.9 / 95.7 / 141.9
Carbs: 148.8 / 112.8 / 74 / 179.3
HDL: 65 / 71 / 85 / 72
Trigs: 57 / 49 / 54 / 57

I’ve been looking at my Cronometer data since August 2016 checking Macros and Calories, which I paid no attention to before, as I was trying to find a way to keep carbs down to a certain number of grams to see if I could bring my HbA1c out of the prediabetic range.
I have 5 blood tests with data (Sept, Nov, Feb, Apr and June).
I looked at the 6 days prior to each test, and took averages for the first 3 days and the second 3 days of those 6 days, considering Macros (%) and Calories (up or down).
I’ve found that in only 3 series I (unknowingly) kept my ratios relatively similar from the first to the second 3 day periods.
In those 3 series, only 1 shows “decent” numbers: TC 218 and LDL 136, and an increase in calories (+138)
In the other 2, TC 289 and TC 319 and LDL 223, the drop in calories from the first 3 days to the second 3 days prior to blood tests was (-279) and (-271).
Just wondering if at all useful.
All the best,
ginny

Keith Rathbone
Guest

Hi Dave

Great work. You are a typical engineer with such attention to detail and determination to find out WHY.

I have done similar to with extensive testing of BG (including CGM) to achieve low BG readings (especially for yearly tests). Unfortunately the KETO + FASTING + EXERCISE to achieve low FPG has resulted in SUPER HIGH CHOLESTEROL of 538 with LDL of 441 and HDL of 58 at the last yearly test.

GP was shocked and provided my risk score of near 40% chance of heart attack in next 10 years.

From attending recent conference I learned about your incredible work and managed to have stay of execution from statins until after my next cholesterol test on Monday.

Could you please help with a little more advice on menu details for the 5000 calories I will be consuming on Friday to Sunday, for example Breakfast how many eggs and bacon, Diner what weight of steak and veg etc.

Thank you.

Keith

Anita
Guest
Anita

Hi Dave-
It worked! And I was totally shocked because I really didn’t think it would. What’s amazing is that it ONLY affected the LDL and kept my great HDL and trigs as they are.

What I did: I normally eat <20g carbs a day (closer to <10), so for 3 days prior to my blood draw, I ate 150g of carbs, which is what's recommended when preparing for a GTT, so I thought it might be a similar metabolic principle. I ate brown rice, beans, brussels sprouts, and some gluten-free bread and counted my carbs careful.
I made sure to fast between 12-13 hours before the draw, which meant eating later in the evening than I usually do.

LAST numbers: NEW numbers:

HDL 85 HDL 89
LDL 158 LDL 112.8
Trigs 65 Trigs 61
Non-HDL cholesterol 171 Non-HDL cholesterol 125

Not to deceive anyone, when my endo commented on the 'nice' change in LDL, I explained what I'd done and how I thought it might be 'more accurate' because that's why you carb up before a GTT. He agreed that it was likely and
saw no problem with this. So it's possible this isn't a 'hack' but a way to arrive at more accurate numbers.

Justin
Guest
Justin

Hi Dave,

Great work as usual! I’ve been a hyper-responder with my total cholesterol around 260-280 in the past. For those blood draws, I was eating typical keto and trying to gain some weight with weight-lifting. However, I just had a blood draw while now cutting back on fat/calorie intake (still very low carb) to try and lose a little weight and continuing to weight-lift, and it came back with my total cholesterol over 500! I’m going to try having around 100 grams of carbs a day, and I’ll let you know how my results change.

Not that I think high cholesterol is a problem (although 500 is starting to get concerning), but I think it’ll be interesting to see the results even though it’s confounded with exercise.

Mark
Guest

I just tried the experiment for the past month. I calculated 100 carbs per day but just got me latest cholesterol test back and my LDL is still off the charts. Not sure what to do now, increase the carbs more or just go back to eating Keto. What do you suggest?

beags
Guest
beags

HI again – OK so I’ve tried to replicate the LDL drop with upping carbs but no luck yet…

However trigs and HDL have improved markedly!

Where would you go from here – more carbs? Maybe I’ve not hit my ‘sweet spot’ yet?

Rusty
Guest
Rusty

Hi Dave,
I’m a hyper-responder. Starter Keto diet in Sept 2015. Body fat for these labs has been between 10 -13% (currently 12.5%).

Test 11/30/2015 4/21/2016 10/7/2016 7/7/2017
Total Cholesterol 220 253 337 527
LDL Cholesterol 136 141 231 >350
HDL Cholesterol 75 98 95 91
Ratio Total:HDL 2.9 2.6 3.5 5.8
Triglycerides 43 71 54 68

HDL Large 7358
LDL Medium 277
LDL Particle No. 1756
LDL Pattern A
LDL Peak Size 225
LDL Small 218
Total Calcium CT Score was 1.1 (on 10/13/16)

I’m going to try the LDL drop with a followup NMR test soon. I’ve tracked every meal in myfitnesspal for the last 1880 days so if you’d like to take a more detailed look at my meals for data collection purposes or to recommend a target carb level pre test…email me.

Rusty
Guest
Rusty

Well that didn’t work out too well. My LDL increased after the bread drop. Total dropped though.
LDL = 375 (previous was >350)
Total = 475 (previous was 527)
Although I only averaged around 3500 cal for the three days before…couldn’t scarf down anymore. Also, the previous was llisted as >350…apparently unable to calculate it above that…whereas the post bread drop was an NMR so I suppose the 375 could actually have been a drop from the >350.
Rusty