The Prediction
“This is the very first public presentation of my data,” I began, “and I’m excited because I get to start it off with a bang.”
I was standing before the Ketogains Seminar audience on October 9th, 2016 in Las Vegas, and I planned to make that day just a little extra special. The first slide I showed included a picture of me smiling as my blood was taken, with the heading, “October 7th, 2016 – Two days ago”. I then explained I expect my cholesterol on that day will be very high.
I follow with a second slide. It has the same picture but I’m a silhouette with a question mark inside. The heading reads, “October 10th, 2016 – Tomorrow”
Finally, I present a third slide that includes both images and my predictions together, the second reading plainly, “Cholesterol Plummets in 3 Days”.
“How am I doing this?” I asked. “A super powerful statin? High dose of Niacin? Some new, special exercise?… No… just food.”
I’d be lying if I didn’t confess at this point that my heart was pounding. I’m no stranger to public speaking, with one of my very first jobs being the M.C. of a dive show and working my way through college as a D.J. No, my nervousness stemmed from the fact that I was trusting all my research to date and taking this to the next level of publicly predicting an outcome. And not just any outcome… the outcome a thirty billion dollar prescription industry tries to provide.
The Results
So what happened? Quite a lot actually. Let me break it down into small pieces…
Sure enough, my Total Cholesterol dropped 66 points. But the real star of the show is LDL-C, the so called “Bad Cholesterol” which dropped a whopping 73 points in just three days — that’s nearly a 30% drop!!!
If I could put these results in a drug, I’d be a multibillionaire right now. Bayer and Pfizer would be pounding down my door offering a slice of the world to package this magic in a bottle.
But what about the actual LDL particles which show on the NMR labs as LDL-P? Or for that matter, the “Small” LDL-P that gets the credit as being the most dangerous of all?
Incredible!
LDL-P is nearly cut in half! This was even more impact than I had predicted. While it is true my LDL-P continued to drop into the 5th day (to be covered in an upcoming post), the shift in just 72 hours was really impressive.
Even more strikingly, Small LDL-P drops from 442 into the unreadably small “<90” range. Like LDL-P above, this runs very counter to the endless articles I’ve read about clearance with LDL receptors, which has been one of the chief suspects as to why LDL gets “backed up” in the bloodstream. Over and over, my data keeps providing a very different story.
HDL-C and Triglycerides both shifted in different directions, each one considered more favorable.
HDL-C bumped up 18 to 68, which is likewise consistent with my data.
Triglycerides are still a little more mysterious to me as they have the lowest correlation of the bunch over my research span, but are still negatively correlated with dietary fat. In this case, I was excited to see it dropped to nearly half of its earlier reading.
Food. Just Food
Unless you’re just now joining us, you already know how I pulled this off. More fat.
On one hand, if this is the first blog post of mine you’ve ever read, you might think I mistyped the above sentence. I most certainly didn’t. As with the last eleven months of my life, I carefully logged my food in MyFitnessPal to track it closely. I likewise took pictures of everything I ate. Everything.
On the five days prior to the Oct 7th blood test that gave me the high cholesterol, I had brought my total diet down to an average of 748 calories per day. This wasn’t pleasant given I’m a 6’3 male who gets semi-regular exercise. (Not to be confused with “athletic”)
Moreover, I didn’t want to stay too low on the calories for very long given I’m also very lean and would actually prefer to weigh a little more. I know this has me on the other side of most people in a low carb lifestyle, but actually aligned well with many at Ketogains.
By the time Friday was rolling around, I was excited to finally move to the next phase and ramp up the total food to full throttle. But unlike my Intentional Outlier experiment that I describe in Part I, I planned to exceed everything and shoot for the gold: 5,000 calories per day for five days.
The first day was pretty easy, most likely due to having been so low cal for the previous five. Each meal I had to double or even triple my portions. But eventually I figured out it was just better to spread it out over the day. By the last day I could barely stand it. It’s incredibly difficult to eat very high calories on such a satiating diet. I kept telling my wife, “ugh, I can’t ever do this again,” to which she rolled her eyes knowing my variety of experiments before it and said, “yeah, we’ll see.”
Thus, many at the Ketogains Seminar noticed I was constantly pulling food out of my backpack in various forms: Adapt bars, peanut butter, and hot dogs I kept in a small cooler to name a few. This was especially annoying given the conference was catered with several amazing Keto-friendly buffet delights. But I couldn’t partake, given I needed to be certain of the exact macros and general ingredients I was consuming.
One particularly funny moment happened near the end of Sunday where I was sitting with other presenters at a Q&A and I realized I was still 1,200 calories short for my 5k goal which I had to meet by 7PM in order to have the proper 14 hour gap for the blood test at 9PM the following morning. I left my chair to go get a block of cheese and munched on it for the remaining 15 minutes of discussion.
Having said all that, let’s revisit our final version of the chart where we’ll include the food as well:
Final Thoughts
I’ll concede I’m still pretty awestruck. Even as I write these words and post this data, I keep rereading the labs and checking back over my logs. But there’s no doubting it now – the experiment delivered. The Dietary Inversion is very much real and yet almost no one knows about it.
Maybe this will move that needle just a little more.
This Part I is meant to be more layman, less geeky. In Part II I’ll be expanding on the data including the test before Oct 7 and after Oct 10th and how all of it compares to my current correlation timeline.
Thanks for sharing, Dave! This is really cool and I can’t wait for Part II!
Thanks, Carol. I hope to have it up next week.
Thanks for the update! Did you gain weight during the experiment?
I lost weight during the first part with low total calories, then gained weight in the second with high total calories. I’ll chart that in Part II
Awesome results, Dave! I’ve been waiting for these results and it absolutely didn’t disappoint. Glad we met at the KG conference. I’m still curious to know about your liver panel results. We need to have some discussions about that because I know we briefly touched on it back then. But keep up the great work and I hope you can continue your daunting task of experiments! Lol.
Likewise, Bryan, thank you. I take my AST, ALT, and hsCRP with each blood draw. Is there another panel you’re suggesting? Or where you curious about that results in particular?
Dave,
Thanks a lot for sharing your results. This is very cool and encouraging.
With respect to liver markers, have you measured your Gamma Glutamyl Transferase (GGT) levels? GGT has been found to be involved in the development of cardiovascular disease, according to the following paper:
Jiang S, Jiang D, Tao Y. Role of gamma-glutamyltransferase in cardiovascular diseases. Experimental & Clinical Cardiology. 2013;18(1):53-56.
GGT levels could be elevated despite having normal AST and ALT levels. Something to consider if you have not already done so.
I look forward to reading Part II, and thanks again for sharing.
Hi Julio-
No, I haven’t done much studying into GGT as of yet. But I’ll be doing so soon as I’m now slowly getting around to the periphery markers for CVD and what their weight of evidence appears to be (at least for my own risk modeling).
Great experiment Dave. Probably opens up more questions and answers. So with the results you have now do you expect to eat 5000 calories a day, day in and day out to maintain those numbers and I suppose I wonder what would those numbers do if you ate your nornal regular fat intake.
Not at all, Hason. At this time I take no steps (other than experimental) to lower my cholesterol intentionally as I’m I’m not fully convinced it will improve risk of all cause mortality.
I’ll have a forthcoming post about risk in the near future, but the general outline of problems I have can be found on my Risk of High Cholesterol on Low Carb page.
This is fantastic. What unique insights we are gaining via your experiences. Can’t wait for part two!!
Thanks, Chad — I should hopefully have it up very soon.
What are your thoughts on the effects of protein?
Ah yes — I know protein is the latest and most talked about subject inside the low carb community.
I don’t really have much to add to that just yet as I try to keep my macros generally consistent for the research consistency.
That said, I’m probably more on the Ted Naiman side of the fence and would more likely up my protein than drop it.
Interesting and agreed. I saw a talk by Ron Rosedale where he recommends 1g/kg protein as a minimum. I’ve personally tried that, but with any exercise added I felt like recovery took way longer than on a ketogains protein recommendation. Also kinda off topic but, how could one acquire enough micronutrients on such little meat?! for me that would be like 2 cans of sardines a day for all my protein! Seems way low.
I genuinely *love* meat! I really believe giving up meat would be ten times harder than giving up carbs for me.
One of the experiments I did was over 11 days back in February where I tried to reduce my saturated fat and up my mono and polyunsaturated fat. This basically knocked me out of a lot of meat selections, of course, and I was replacing it with mainly avocados. Generally I felt pretty miserable. I still wonder how much of that was possibly psychosomatic. But once I did my blood draw and the experiment was over, I was able to go back to sat fat, I did so with a vengeance and felt an immediate rush of energy and… well… joy. To me, it felt like a clear biological signal where I was switching from what wasn’t working to what was.
Wonderful, Dave. I would also be very interested in your ALT and AST measurements, thank you.
Sure — here are my last 9 going up to the beginning of August:
Date ALT AST
7/15/16 16 21
8/1/16 37 44
9/19/16 22 24
10/5/16 16 22
10/7/16 16 22
10/10/16 18 20
10/12/16 28 27
10/21/16 41 40
10/24/16 30 25
(In full disclosure, I’m omitting one which would spoil the surprise of an upcoming post, but it has no bearing on this data as it is within reference range anyway)
I have read all of your blog posts. I am confused about the diet soda. Can you explain more? My real question is can I drink it ? yes or no?
For me, the jury is still out on diet soda. I was averaging a Coke Zero a day for a while, but have recently sworn it off as I had a few head ache/weirdness issues I wanted to confirm were or were not related to the Aspartame.
But overall, I find this guide to be pretty helpful on general glycemic impact of the various aftificial sweeteners: http://ketodietapp.com/Blog/post/2013/06/10/Top-10-Natural-Low-carb-Sweeteners
Many thanks for your lifesaving blog for it has given me hope on that I can take control over my life. Right now, I want to join a team of those who are like us on learning how to take care of ourselves without the need to resort to medicine. I might just have to but I want to try several things to find what tinkers best for me.
I don’t have full panel in front of me because I gave blood work readings to the last doctor that I saw. He simply told me outright that he treats my symptoms;therefore, he gives me medicine based on the symptoms. I’ve begged him to find out why I have such high readings. He’s not interested in that.
Prior to week one, I was on LCHF for about three years and my weight stalled at 160. Moreover, I tried to keep up with my online biking peloton on Zwift (www.zwift.com) that I had to quit to start all over by focusing on losing more weights. I re-read more about LCHF and learned that I did not take in enough fats. So, I added more fats in May – mostly HWC in coffee, some red meat, and bacon. My wieight started to drop slowly and my biking performance improved! Then, I had the blood drawn for annual checkup.
Week one : total cholesterol 546. Most of them LDL….HDL and Trig were in the healthy range,
Of course, the world crashed on me. I stopped saturated fats and had cold water fish along with avocados, olive oil. I started 16:8 fasting Wednesday and Friday,
Week two: total cholesterol 618!!!! You can imagine my horror. I started just a bit of saturated fats but continued to eat other type of fats and was on 16:8 fasting Monday’s, Wednesdays, and Fridays for three weeks.
This week, I’m fasting 16:8 Mondays through Fridays. I find it to be very doable for I don’t get hungry at all. I have not gotten dizzy or sick. Nada at all. My current weight is 144… very slowly going down, I am going to have my blood drawn on Friday to see what the result is like.
I feel lonely here in Washington for I have not been able to find a cardiologist who is willing to work with me. I have a hunch that my total cholesterol will be down at least 10%. I’m willing to get medicine just as long as I know why I have high reading. I need hard evidence not, ” Oh, your level is too high…it is very common with FH .” I don’t buy it because I want to see hard evidence.
Anyway, your blogging is assuring in that I am not alone on this. The medicine is being shipped to me but I will not take it until I get more readings to see if fasting and eating saturated fats are the way to go…..but, I’m in the dark for no one is willing to explore this new area….
Christine
Hi Christine—
My heart goes out to you in this difficult time. I remember very vividly when I first saw my skyrocketing cholesterol numbers and I too had a period of intense depression. The irony is that my drop off in appetite resulted in the second datapoint of my series after I got another blood test two weeks later and my cholesterol spiked higher. That ended up comforting me because I speculated then (and it has since been confirmed) that there’s an inverse relationship between my incoming energy from fat and the corresponding result in my blood test.
—
I want to point you to two recent, massive studies that show all cause mortality for women in particular is completely inverted. As in, the higher your cholesterol, the longer you live.
Key lines from the Japan study: (N=91,219)
“Overall, an inverse trend is found between all-cause mortality and total (or low density lipoprotein [LDL]) cholesterol levels: mortality is highest in the lowest cholesterol group without exception. If limited to elderly people, this trend is universal. As discussed in Section 2, elderly people with the highest cholesterol levels have the highest survival rates irrespective of where they live in the world.”
http://www.karger.com/Article/Pdf/381654
Key lines from Norwegian study: (N=52,087)
“Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95%”
https://www.ncbi.nlm.nih.gov/pubmed/21951982
But wait — it gets better. While researching atherosclerosis which they induce by a balloon catheter, I found this incredible reveal on lab animal selection.
“Male Sprague-Dawley rats are the most frequently employed animals for this model. Female rats are not preferred as female hormones are protective against vascular diseases and thus introduce a variation into this procedure.”
– Let that sink in for a moment. They prefer males over females because females have “hormones protective against vascular diseases…” And thus, who can say how much evidence is built on male-only rats for atherosclerosis and the drug therapies that treat them which may not even apply to women at all???
Hopefully by now you’ve heard about the UCLA study that looked at 136,000 hospital admittances for CVD at 541 hospitals nationwide. The majority had LDL below 100 mg/dl — which is the optimum, of course. A great tidbit to that is that less than 10% had an HDL above 60, suggesting how awesomely protective this higher level is.
http://dietheartpublishing.com/Cholesterol/10/09
I post these things not for you to take my doubts as the gospel and assume everything is okay. To be a good scientist, I can’t speak to what I truly don’t know. But I find it very revealing that there is such a level of confidence within the medical community about cholesterol that, at best, should be mixed.
—
You’re not alone.
Since starting this blog, I have had many people (some of them bigger name low carb doctors, in fact) share their high cholesterol numbers with me secretly. Many feel they need to keep it private as they are ashamed. But now many, like yourself, are posting about being a hyperresponder and we need that!
I don’t know for sure that the path we are on won’t lead to a shorter lifespan, because to be a good scientist, I can’t speak to what I don’t have hard evidence of. But I will tell you that I take no steps to lower my cholesterol and actively eat a lot of saturated fat. I’ve never felt better in my life and until my research and biomarkers reveal signs of oncoming atherosclerosis (which I’d blog about if it were to happen), I’ll remain confident I’m on the right path.
Thank you so much for your reassuring notes on what we can do. I continue to monitor myself. I had my blood drawn last week for a direct reading of LDL. the level dropped from 541 to 359 within 3 weeks. I am staying on course.
I’m sitting here feeling depressed because I am going to see that doctor this Thursday. I have the feeling that he’d be upset with me for not taking the medicine despite my LDL level dropping from 541 to 359 within three weeks.
I am so willing to join in to share data so that we can use it for other women in my shoes. Is there anything I can do?
Thank you so much for your time….
Christine
Hi Christine,
I can’t add to the great feedback already given, and it sounds like you’ve already got the exactly the right attitude of understanding the causes and then how to manipulate the inputs, rather than just trying to squash symptoms. I’d say your doctor should be more like that, but he’s just a product of the medical education just now, and I think it’s hard to find anything different (at least that’s been my experience).
Hope you can find time to keep going on Zwift – we can get an LCHF ride going over there! I’m in the UK, but especially over our winter use Zwift a few times a week.
Scott
Zwift is my true life saver. I look forward to seeing you there if you are there!
Hi Christine.
I just wanted to comment and let you know that my numbers are just as high and I am not worried the least bit. I also research this stuff extensively and work in this field an an RN CDE.
Nicole
Thank you, Nicole….it is scary but I need to be around people who are familiar with this type of study and see what we can do about it. Thank you…
Hi, picked up your podcast on SHR.. awesome thanks
I’m definitely in the hyper zone.. about to explore Keto, do you have any thoughts consuming high fat when the gallbladder is removed? can’t seem to find much or any regarding it?
Regards Scott
Hi Scott —
Can’t say I do as I don’t know as much about the absence of the gallbladder and what effect it would have for low carb. You might want to reach out to prominent LC doctors on social media like Adam Nally or Ted Naiman.
Mike Eades has discussed this on his proteinpower blog.
Hey Dave,
I was wondering if, rather than cramming down massive amounts of calories, you could have just taken tablespoons of MCT or Coconut oil and got the same effect (with potentially less weight gain).
Actually — the literature/studies show small and medium chain triglycerides get converted to ketones directly by heading straight to the liver through the portal vein. Thus, unlike their long chain fatty acid cousins found in most our food, MCTs are definitely a confounder given they don’t get converted to trigs to be transported in LDL particles.
That’s interesting- did you avoid Coconut oil for that reason as it contains around 15% MCT? Or, at a certain point, do you just say screw it? Hey- you can only “normalize” so much! It also seems like MCTs may become a good caloric source for hyperresponders looking to stay in ketosis and control their LDL. I remember reading some research on that in fact, I’ll have to see if I can look it up.
I currently did a primary-MUFA keto diet in which my LDL-P dipped a little bit, but so did my HDL 🙁
I’ve now moved into a diet that’s mostly vegan with occasional fish. It won’t be ketogenic and, quite frankly, so far it sucks as some lethargy and other SAD problems are returning, but I do expect to see a return to good LDL-P numbers. I plan on measuring every week for 3 weeks so we will see.
Hi Randeep-
– Yes, MCT content of coconut oil was part of the reason I don’t use it as much.
– When you say, “…control their LDL” — it implies as hyperresponders our cholesterol is out of control, which is the current assumption in the general medical opinion. But I don’t necessarily share that view. Indeed, if there’s anything my data is showing (over and over again), it’s that my body has very tight control of my LDL.
This isn’t to say being a hyperresponder isn’t a greater net risk, it may well be, But in both my research and personal data, I find the case for LDL concentration being atherogenic to be surprisingly weak. (See my page, “Risk of High Cholesterol on Low Carb” in the menu above)
– I speculate that I too would have lower LDL cholesterol (both -C and -P) if I pulled away from fats and moved more in the direction of carbs. But so what? (see above)
– And I too did a trial run of high MUFA with lower SFA for 11 days between data points 6 and 7, but it was miserable. I felt generally lower in energy and had an overall feeling of malaise.
Bottom line is that I’ve never felt better than I have on this diet, and the data backs up that I’ve never been so low on inflammation and a host of other issues (such as GI). Which is why I’m so fascinated by the Cholesterol puzzle in particular.
Dave:
Total C = 241
LDL-C 181
HDL-C 61
Triglycerides 73
Non HDL-C 180
LDL-P 2401 by NMR
Small LDL-P 981 by NMR
Lp-PLA2 >600
I’ve been on keto diet for six months or so. My doctor is concerned about the Lp-PLA2. Indicates high risk.
Have you any information on that? I was particularly discouraged because the Keto diet has proven to prevent bonking and makes me feel great. I’m 72 and very active…daily hiking 1200 ft elevation mountain behind our house, interval train on staitionary cycle 3x a week & hunting in very rough terrain once a month. Just a little bummed out over the >600 and 2401 numbers.
Any suggestions?
Thank you,
Randy Weir
Kapaa, Hawaii
Your lipid numbers are very similar to mine, and I’m not that concerned about mine. I’m much more concerned about inflammation and oxidative stress.
The Lp-PLA2 of >600 does appear concerning. Mine has been just a little north of 200 (209-215ish).
But I don’t actually know too much about the test other than it being a bit new (relatively speaking) to other surrigates. You’re obviously insanely active for a normal man — much less a 72 year old! Well done! This may play a part in that outcome or it may not.
If I were in your well-worn shoes, my next step would be to get a CIMT and CAC test. Both will have a higher likelihood of having some signs of atherosclerosis due to your age alone, but what you care about is if surpasses what the expected baseline is for your cohort.
Also consider getting a bigger workup with your liver markers, especially hsCRP (high sensitivity C-Reactive Protein).
Man, you are quick…much appreciated!
I started running, weight training etc. at age 17 and pretty much kept at it ever since.
Will follow up with those tests.
Thank you,
Randy
Please do! If there’s anything I hope to encourage, it’s more data sharing among our community.
What happens is the lipid cycle starts to function again improving ldl clearance (out bound nutrients) and HDL increases (on the return side of the cycle). HbA1c will also improve and is a reasonable surrogate for sugar damage to LDL receptors. I have some refs in a .pdf downoad on this link http://bit.ly/1fkGYgb
Interesting concept, Glyn. Obviously I’ll be reporting here if my baseline changes, so we’ll see if it comes to be true for me.
Hi Dear Dave , I am 26,male,doctor(moderate activity) following lchf diet for 60 days and lost 14.2 Kgs.current BMI is 30.2 I think I am a hyper responder.
Before. Lchf. 20days of cutting saturated fat replacing with MUFA/PUFA and ain’t fasting
T.Chol 178. 198. 158
TGL. 65. 69. 60
Ldl. 147. 158. 124
HDL. 25. 26. 22
We don’t have NMR lipid profile in India
Problem is my HDL is not rising even after starting Lchf diet. I am desperate. Shud I start heavy workouts or any diet modification??Pls help
Hi Bala–
You’re numbers are indeed unusual for an LCHF diet. While LDL can rise (and does so a lot for HRs), HDL does indeed rise as well.
However — you’re in uncharted territory due to the time window you’re working with. I only started testing my blood 7.5 months after I started Keto (although I wish I started sooner) and I suspect my baseline numbers didn’t change within weeks, my guess is it probably took months. So it’s difficult to say if your numbers are transitory.
Note that I’ve read plenty that shows saturated fat in particular raises HDL. But with that said, your HDL seems low even for being on lower levels of SFA in favor of MUFA/PUFA.
Please also consider double checking your staple foods. Audit everything you’ve been eating with a glucometer and see if there’s anything that is spiking your blood sugar. I have a couple of Keto friends in India who have complained a lot of spices they enjoy there have turned out to be very carby but they didn’t know until much later.
Hope this helps!
Thanks so much for the quick reply Dave. Sure I ll check on whatever you have told. Shall I go back with adding saturated fat and increasing the workouts or stay with MUFA/PUFA with fish oil supplements and wait for some months to check back ? Is there any specific saturated fat source I should concentrate on for my HDL and what type of workout do you suggest?
Myself, I’d be eating more saturated fats. I’ve done an 11 day “switch” from SFA to more M/PUFAs back in Feb and I didn’t find it altered my HDL that favorably.
But as I discuss on the podcasts and social media, it’s imperative for everyone to know that if they are fat adapted, they are *trafficking* more LDL particles (LDL-P) regardless of your blood test for concentration. You are getting the majority of your energy through triglycerides now (even if many are converted to Ketones) and those same lipoproteins contain the cholesterol that comes up on the test (LDL-C). What you, I, and everyone are *really* caring about is whether it is building up as atherosclerosis. And thus far, I have lots of reason to believe the presence alone is not the cause of concern any more than emergency vehicles casually driving to the grocery store.
Thanks a ton Dave
Dave:
Wow! I’m a little slow. How would I do the same thing to hack a life insurance test? 5 days of 750 calorie/day diet (ketogenic or what) followed by 3 days of 5,000 calories /day (again, whats the macronutirent breakdown?) and then the blood test?
Hi Dave-
No, you don’t have to bring the calories low first. I did that to show that it SPIKES my cholesterol numbers. But bear in mind, I’m on a low carb diet, and the anecdotes coming in that are confirming my results are from others on a low carb diet — I’m not yet sure if that’s a key consideration, but I do want to note it is possible given we don’t have any anecdotes form carb-centric dieters yet.
I’ve had two people write me they have tried a variation of this specifically with life insurance and had success, but as both hadn’t had a blood test in several months, it’s not a complete certainty that it didn’t drop down from other means. (I’m just trying to be a good scientist and acknowledge all confounders)
Macro breakdown for me has been pretty close to standard LCHF ratio of 75% fat / 20% protein / 5% carbs.
As with everyone else who approaches me on trying this, I advise to please (1) record everything you ate (including supplements / drinks) and (2) PLEASE come back and share what happened, good or bad. I’m trying to aggregate together a lot of data of others working with this as well and would appreciate your contribution! Thanks!
Hi Dave! I have lots of personal data that likely will be helpful to you and every morsel of food has been reported to MFP. I have imp blood test this Friday and would love to talk to you ASAP. I have been part of major important research Project since 1998 and Lower LDL Results on Friday would blow them away. Please tell me how we can talk today so I can eat accordingly for next few days! Thanks!
How can we talk today? I have good data to share with you! Thanks!
Hi Dave. How can We talk? I have relevant information for you and want to speak today if possible. I have logged on My Fitness Pal for 6 months and my info will be useful. Thank you.
Hi Dave, I am trying to contact you to no avail. I have important and relevant data for your studies and have kept detailed precise tracking on My Fitness Pal. On Friday I have imp blood test and have been studied since 1998. I need to speak to you asap regarding food intake for next 3 days! Thanks!
Hi Abby — I’ll email you directly. 🙂
Yes!
Hey Dave,
I tried to find a contact for you directly but couldn’t so I will leave this here and hope you respond.
I had the “high LDL so you need statins” talk from my doc. I found your video and did the 3 day high calorie protocol. So I thought. I had a bullet proof coffee about 2 hours before the test. Oops.
I did increase my fat intake up from 200g a day to 500g a day for the three days before however.
Here is what happened:
Triglycerides went from 1.5 to 0.71 mmol/L – fantastic
HDL-c went from 1.04 to 1.61 mmol/L – amazing
LDL-c only went from 5.82 to 5.41 mmol/L
Total Cholesterol only dropped from 7.54 down to 7.34 mmol/L
What does all of this mean and could the bulletproof coffee have just made a mess of it all?
Thanks,
Jack
Per our private conversation, I’m just going to recap for those reading this comment:
– Yes — I believe having the bullet proof coffee two hours before the blood test would have a decent chance of throwing it off given you may have added a payload of triglycerides and cholesterol via newly circulating Chylomicrons.
– You pointed out that a doctor suggested that fasting was unnecessary and had no impact on the lipids. While I think this is possible if the Chylomicrons were given the chance to clear, it’s a risk on the chance they hadn’t. Myself, I always fast around 14 hours before each blood draw to be safe.
Saw your video and have been fascinated by your work. I was reading on various aspects of apob100 and came across some literature which mentions the residence time of LDL in blood circulation is only 2-3 days with about 3/4 of particles removed by the liver and the remaining by extrahepatic tissues. In any case I would imagine this is why the 2-3 day fat moving average corresponds the highest with lipid testing. The increase in exogenous fat probably means your gut is providing more than enough chlymicrons, your liver gets a break and as a result the LDL count drops.
The source it cites for the 2-3 day comment is here https://www.ncbi.nlm.nih.gov/pubmed/6309127.
Here’s the journal
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022322/pdf/westjmed00066-0059.pdf
This is a very interesting study. I do question one aspect of it. It is pretty well known that fasting will increase cholesterol levels at least during the fast.. When you begin burning your body fat, isn’t it broken down into triglycerides and cholesterol? Didn’t you artificially increase your cholesterol with your extremely low-calorie diet before your gorging period? This may not apply if you are relatively lean, I am not certain about that. I am a very fat guy who has been on the keto diet around 3 weeks, and I have an appointment with my cardiologist in 2 weeks. I am hoping not to have a spike in my cholesterol levels for that appointment.
Cholesterol rises when losing weight as the free fatty acids released from fat cells make it to the liver and get repackaged as VLDLs, the precursor to LDLs. I personally don’t consider this bad, quite the opposite. As I mentioned in more recent posts, the more powerful metric for risk is HDL-C (the “good” cholesterol) and triglycerides. I advise trying to get HDL-C high (preferably above 50) and triglycerides low (preferably below 100).
I have been LCHF for 4 years. The first year my health greatly improved, no weight loss, but off all my meds. The second year I lost 15lbs (which put me at my goal weight). The third year I regained all the weight while still following LCHF very strictly (I never cheated, hard to believe but I never did). The 4th year I have continued to gain weight. I have 1) Raised my calories, no result in weight loss, 2) Lowered my calories, no change, 3) raised my Protein, no change, 4) Lowered my protein, no change, 5) Raised my Fats (75% and more daily) and lowered my carbs (below 5%), no change, lowered my fats to 60%, no change, all while keeping carbs low (below 25 gms/day.. Now my LDL has exploded to almost 300! Trig are good (46) and HDL is good (80), HgAIC down to 5.0, both fasting Insulin and cortisol levels are low. Total calories that I typically eat do not exceed 1300 cals (can’t seem to eat more than this). I cannot seem to fast as I become weak , light headed, and nauseous about the 14th hour. My hunger actually wakes me up at night most nights. Can’t understand why I am hungry? I’ve gained 20lbs even though I consistently work out 5 days a week and never cheat on LCHF tracking everything with myfitnesspal for 4 consistent years now, with both cardio (2-3x/wk and heavy weights (3x/wk). I am 62 and post menopausal. I am at my wits end with an exploding LDL and no weight loss (actually weight gain!). Help!!
I’ve noticed you haven’t received a reply from Dave. Have you had your thyroid checked?
Hi Melanie — I’m sorry, we’ve been a bit swamped lately and I think your comment fell through the cracks.
Your case is quite unusual. The cutpoints for your lipid levels are that of a Lean Mass Hyper-responder ( CholesterolCode.com/lmhr ), yet it sounds as though you are struggling with your weight, which isn’t typically the case with the LMHR profile.
You’ve said you can’t seem to eat more than 1300 calories, but you also find you are hungry to the point of it waking you up at nights? This is a curious combination.
Per Stalean’s comment below, you may want to get your thyroid checked. (Get an extensive panel that includes T3, T4, reverse T3, and TSH at a minimum)
I’m wondering right now if this is a micronutrient deficiency of some kind. Perhaps your body is reaching for something it’s lacking. You can help to rule this out by shooting for a wider nutrient profile — such as adding more liver (or even try supplements — though make sure they are good ones).
Another possibility could be the way you’re processing this diet given your genetic profile. For instance, if you have the MTHFR gene, this could have an impact on your methylation and may require supplementation that is now more apparent given the LCHF diet.
Hi Dave
I really enjoyed your talk at Low Carb Denver 2019. Your experiment intrigues me thus my desire to participate. Even though I have not experienced weight loss, I have vastly improved my health markers and for that I am committed to LCHF nutrition.
I thank you for your response. My Thyroid has been tested (these are the tests my PCP has conducted):
TSH .38 mIU/L
T3 free 4.2 pg/ml
I have been on Nature-Throid 65mgs QD.
I do not expect you to spend much time on my case with all you have to do. I am continuing on VLC/HF (70%/25%/5%, total cals: 1300) diet and all my exercise. I want to participate in helping you collect data. I do take supplements:
Fish Oil 1000mgs QD
magnesium 400mgs BID
Potassium 100mgs BID
L-Carnitine 1000mgs QD
Vit D3 5000 IUs QD
Adrenal Support
CoQ 10 200mgs QD
I appreciate your assistance, I know you are busy. How do I participate in your data collection? (I am currently conducting field research myself so want to help your worthwhile effort).
Take Care and Thank you for all you do
Melanie Tidman
Hi Melanie — Thanks, it sounds like you are quite competent in this area. Nothing like being a field researcher when you are a part of the field you’re researching. 🙂
I have some potential experiments upcoming, so sure, keep an eye on the site as it might include a lot of people.
I have been doing LCHF for 2 months (net carbs less then 26) with a 500 calorie deficit plus walking 3 miles day (further deficit). My HgbA1c dropped from 5.8 to 5.2, CRP dropped from 2.4 to 0.9. My HDL dropped from 42 to 26 and is small size 8.5, LDP at 2650, TG: was not on NMR report, TYPE A LDL size 25.9, Insulin resistance score high at 54. I have had 17 pound weight loss in 2 months, waist down almost three inches. For the past five days I have increased my calorie load to 2000 calories (my maintenance), protein at 1g/kg, and net carbs under 26. I have kept exercise relatively the same. I am getting labs tomorrow. Ordering Regular cholesterol panel so I can TG, NMR lipo, BUN/Crt, HgbA1c and blood glucose. My LFTs were in the 20s last time (lowest by far in a year), and CBC perfect so will not recheck. Pertinent med history: Bone Marrow transplant 2 1/2 years ago for AML, Chemo/ Full body radiation many, many times. FULL REMISSION with no graft vs. host disease. On no meds other then Testosterone replacement a week prior to last test. I have no doubt that my cholesterol is high to fix the damage done a couple of years ago from treatments. I would just like to see LDLp and HDL improve. I know that testosterone can mess with results. Any other ideas why HDL would have dropped in both size and number??? Is it possible that the HDL is giving up its apoproteins to repair the increased utilized LDLs that were increased because I was in such a caloric fat burning state??? BTW, I am a medical doc and love your site:))) I am up for suggestions on how to proceed and can send you my data if you want for your data base.
Hi Brad, unlike you I am not a doctor so I can’t give medical advice! However, if I were in the same situation where HDL dropped without a clear reason why, I’d definitely want to do two things, at the same time. One, is I’d want to request a re-test to make sure the result wasn’t lab error – this is something that can happen, and I’d want to rule it out for sure. For the re-test I’d want to make sure I was 12-14 hours water only fasted to limit other confounders as well. Along with this, I’d likely want to test other markers to help double check the bigger picture, especially the tests in the “basics set” listed in this post (which has our personal favorite tests to look at in general or when troubleshooting).
At the same time, I’d want to check in with my doctor so I could get their perspective as well, as they likely have other suggestions for what to follow-up on to rule out other causes I may not think of myself, so I can narrow down the possibilities a bit further.
HDL is one of those markers I try to keep a close eye on and follow-up if it does anything I’m not expecting, as it can be helpful to catch things I might not otherwise. 🙂
I hope that helps!
Couldn’t agree with Siobhan more! Likewise not a doctor and this isn’t medical advice, ofc, but I’d be especially curious regarding the much lower HDL.