Heads Up Health
I met David Korsunsky last year and was instantly a fan of his product, Heads Up Health (HUH). His staff has been tenaciously aggregating all these different medical systems and lab result formats into a single repository that’s really easy to work with. Obviously, as a data fiend, I was immediately interested.
This weekend HUH released a guide that makes it easy to work through my protocol using their system and I’m definitely happy to highlight it. In fact, it’s one of the only ways I know that you could be both tracking your food (say, with MyFitnessPal), while also getting your blood labs (through, say, Quest Diagnostics) and have them all come together in the same place. This would also make it easier if you wished to share your data back to us here (which I hope you do, as always) as it will be in a standardized format, thus making Craig’s life easier.
Full disclosure: Like the keto shake companies, HUH offers support for my research in the form of products and service, but in no way do I have any financial interest or relationship of any kind. I’m funded by individuals like you via Patreon or direct donation only.
I find it laughable that I was so reluctant to start the Patreon page before now. Mainly, I didn’t want any of my research to be pay-to-see, so I kept putting it off. But I got a lot of good advice from others on simply having patrons have access to the behind-the-scenes and a lot of my casual process. A lot of it is rough and incomplete. At times just stream of thoughts like the Vlog.
Yet this is what makes it work so well. Patrons are kind of like the crew that’s on the set of the movies before they come out.
Moreover, I’m finding some other content to slip in — like my Davehead pizza making. 🙂
I’ve mentioned several times that I’ve had “mysteriously high Ferritin” in the 550s. Indeed, I’ve ran the gambit checking iron levels, oxidative stress, etc. to no avail — everything appears normal. But in my most recent labs, my Ferritin dropped to a 303 ng/ml (ref range 30-400).
Why? I have no idea.
But if my coming labs have me back in the 550s again, you can be sure I’ll be doing a forensic deep dive on everything I ate and did in the days leading up to that original 303 test.
There seems to be more noise than usual with Ferritin readings. Specifically, the higher it reads the less reliable it tends to be. A 200 point difference in consecutive readings is not unusual. A couple points of note in this regard. I wonder if its only a coincidence that the lab method accuracy is a function of its relative importance to conventional medicine. Most doctors think elevated Ferritin is a big nothing if all your other iron blood work is ok. I also wonder if they would continue to think this if pharma had a pill that could reduce it? I further wonder what other labs conventional doctors tend to not worry about would fall into this category? Note to self: if pharma doesn’t have a pill for it, that doesn’t mean it isn’t important.
In the meantime, anyone who knows about the chemistry/biochemistry of iron as a supreme oxidizing agent will donate to get it down to 50. The last data I’ve seen indicates blood donation benefits those who donate more than those who receive it.
I definitely agree with much of what you said — particularly with regard to whether a medicine exists to treat the marker.
I’ve given blood once this year to experiment with how much or would or wouldn’t change my Ferritin and iron levels. But to be sure, I already think I give quite a lot of blood right now — to science! Heh! (Did I mention they take four to six tubes out of me every time?)
I’ve been on low carb, high fat since the end of 2009. I’m not a LDL hyper-responder but it did go up near 200 so I had a CAC score – zero. I could hear the shock in my doctors voice when he read me the result. It was only 2 years ago I got a ferritin out of range; almost 800. After donating, it dropped to under 400. Its more likely the original reading was an over-estimate than it actually dropped that much from removing one pint of blood.
Btw, your work on the inversion is terrific. You know that long before LCHF became as popular as it is now, there were and are still many persons with elevated LDL while their other labs are just fine and they are in good health. That segment would make an interesting addition to your studies.
That’s what I find endlessly fascinating about this. LDLp is literally the fat-based energy (TG) delivery vehicle. Yes, we likewise break down fatty acids to ketones, but direct delivery via LDLp and NEFAs are still the plurality, particularly in muscle and cardiac tissue. So if anything, the LCHF/Keto movement should’ve been on top of cholesterol’s link in this regard all along.
With regard to Ferritin, I’ve actually found at least a half-dozen other low carbers with high levels as well who also haven’t had any other markers to suggest problems thus far. Still early to say, but interesting nonetheless.
A ferritin of 303 is still high, do you have your iron saturation %? Have you checked your genes for hereditary hemochromatosis ?
I’ve checked the SNPs via 23andMe.
I have rs1799945(C;G) — “One copy of H63D, carrier of hemochromatosis, likely unaffected unless also C282Y carrier. You are a carrier for rs1799945(G) H63D Hereditary hemochromatosis. You are unlikely to be affected unless also a carrier of rs1800562(A) C282Y, but others in your family may be. This is a treatable condition.”
But I have rs1800562(G;G), so not an (A) carrier — “Not a C282Y hemochromatosis carrier.”
— Iron Panel:
Iron, Serum 82 (59-158)
Unsaturated IBC 199 (112-347)
Calc Total IBC 281 (250-450)
Calc % Iron Sat 29 (20-50)
Based on your iron panel you are correct you do not have hereditary hemochromatosis or iron overload. I would still consider giving blood once a year. Ferritin is an acute phase reactant so it can kinda go all over the place. Since I do have hereditary hemochromatosis I can confirm that assuming no other factors a blood donation will take ferritin down about 30 ng/mL. I pint of blood removes 200-250 mg of Iron.
I just got back my ferritin and it was at 500. I’ve been carnivore/keto for like 6 months. I am a carrier of h63d as well. I thought heterozygotes were unaffected. Interesting to say the least. Donating blood in a few days. Any updates on your ferritin levels?
Dave, I have been on keto for over a year and a half now (and before that Paleo for a couple of years). Your experiments prompted me to get my first NMR a couple of months ago, and like you I was freaked out by the results. That lead to more and more tests – and even more contradictory results.
I have a CAC score of zero (scanned several weeks ago), but high hs-CRP, high LDL-p, high small LDL-p, high trigs, high oxLDL. Normal LP-PLA2 (I think… there are different reference ranges depending on who you want to listen to – I’m talking about the activity version of the test). And very low fasting insulin and A1C.
I just got blood drawn this weekend for ferritin and GGT, should find out the results later this week.
My doctor doesn’t want to be bothered, because with the zero CAC score and some other blood work that I had being awesome (thyroid panel, comp. metabolic panel, CBC and sedimentation rate) – he says he has bigger fish to fry than me! He says I’m completely healthy, but can’t explain the high CRP and oxLDL.
So I will continue my investigation on my own, and follow your work diligently.
BTW, have you had a blood test for oxLDL? I am wondering if that would also follow your inversion pattern.
FYI I just got my blood test results from this weekend — GGT 8 IU/L, Ferritin 189 ng/mL, and fasting insulin 1.9 uIU/mL, so these aren’t bad numbers. Ferritin on the high side, but not sky high like yours.
I am really confused by my high oxLDL (67 U/L), and hs-CRP (between 3.48 and 6.97 mg/L) numbers. They don’t make sense to me at all.
Thanks for all your research — it has been very enlightening!
Hi C —
It’s hard to give you an opinion when you’re not listing your numbers specifically. When you say high hsCRP, LDLp, etc — what were they? (High to me is different than high to others, and the patterns themselves say a lot more about what is happening)
Also, you should know CRP is highly affected by recent exercise. I demonstrated this when taking it 24 hours following my 3 half and 1 full marathons. (Normally < 1.0, they were 7.27, 52.96, 7.13 for the half, and 32.44 for the full)
Interesting re CRP and exercise. Makes perfect sense to me I wonder time frame for hs-CRP to return to baseline levels after a run of 10 miles or more?
Don’t know how you do all this work AND have a full time job. How many hours of sleep do you get on average?
Thanks for all your work!
Yeah — I’d love to know the CRP return time as well. But of course, that would require frequent blood draws for that specific experiment alone (can’t combine with a different experiment given the confounder).
Technically, I don’t have a full-time job BECAUSE of my research. If I weren’t doing this, I’d be doing contracting 60+ hours a week (and I’d be a heck of a lot better off financially).
I average 5.5 to 6 hours of sleep on average except when doing an experiment involving carb increases, then (surprise!) I need a little another half hour to an hour more.
Here are the results of the 3 NMRs I had:
6/17/2017: LDL-P 1627, LDL-C 115, HDL-C 41, Trigs 203, Small LDL-P 1168, LDL Size 19.7
6/21/2017: LDL-P 1730, LDL-C 129, HDL-C 40, Trigs 182, Small LDL-P 1036, LDL Size 20.1
8/25/2017: LDL-P 1737, LDL-C 119, HDL-C 44, Trigs 122, Small LDL-P 1084, LDL Size 20.3
The first two NMRs are only a few days apart because I couldn’t believe the results of the first! The only carbs I eat are the cruciferous or leafy green variety, I don’t eat anything with omega 6 vegetable oils, never smoked, eat twice a day keto — bacon, eggs, fatty steaks, bulletproof coffee, salmon, pork ribs… stuff like that. I occasionally blood test my A1C (usually around 4.8), ketones and blood glucose… they are all good.
The results from the first two NMRs prompted me to get a CAC scan and test additional markers. Here are some of the results:
6/21/2017: hsCRP 6.95
6/21/2017: Fasting insulin 3.8
6/21/2017: Thyroid panel with TSH – all readings within normal range
6/21/2017: Omega-6/Omega-3 ratio – 5.0
6/30/2017: CBC w/ differential/platelet – all readings within normal range
6/30/2017: Comp. Metabolic Panel – all readings within normal range
6/30/2017: Sedimentation rate 5 (ref range 0-40 mm/hr)
7/3/2017: LP PLA2 Activity 114 (ref range 50-133 nmol/min/mL according to Quest)
7/5/2017: CAC scan – ZERO score
8/25/2017: hsCRP 3.48
9/2/2017: OxLDL 67 (ref range <60 U/L)
9/2/2017: hsCRP 4.33
9/16/2017: GGT 8 (ref range 0-60 IU/L)
9/16/2017: Ferritin 189 (ref range 15-150 ng/mL)
9/16/2017: Fasting insulin 1.9 (ref range 2.6-24.9 uIU/mL)
Very interesting about the recent exercise point — I thought about this, and I found this paper: http://www.sciencedirect.com/science/article/pii/S0735109705004705
Your experience is consistent with this. They don't tell you not to exercise in the days leading up to the hsCRP test! If exercise has that big of an impact, why is it considered such an important biomarker of CVD?
However, I don't do long distance races, so wasn't sure if this was my case. I do hike twice a week on hilly terrain (usually 4-8 miles brisk pace), and more importantly do heavy resistance training twice a week to failure. As a result of the resistance training, my muscles are almost always a little sore somewhere. Could this be jacking up my hsCRP numbers? I don't know, I'm not aware of any studies of CRP with resistance training.
Regarding OxLDL, I just found this one associational study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777541/
Quote: "OxLDL, oxLDL/HDL and oxLDL/LDL were significantly associated with CRP." — so I don't know if there is a causal relationship here at all.
Thanks for your response, and for all you do!!! It is very enlightening.
– Not sure on what degree your exercise would impact hsCRP, but I suspect resistance to failure would be a good candidate for it. Naturally, you could simply take a full week break and then take another hsCRP to see for comparison.
– Of course, your smLDLp is higher than I typically see in proportionality. However, when I *do* see a higher relative % of smLDLp in hyper-responders, it is usually in muscle-building athletes. Thus, this too you might see a difference on if you took a break and retested.
Again, in a LCHF context, it’s worth noting two things in particular:
1) You’re relying on LDLp for TG delivery. This is why a smLDLp might not be as surprising given you are literally depleting them at potentially a higher degree. Until we can see more studies on metabolically healthy low carbers and their per-particle usage, it’s hard to disentangle this aspect pre-clearance.
2) You are likewise relying on LDLp for tissue repair, of course.
Not that I’m dismissive of your data or suggesting you should be — just that it’s worth knowing the counter perspectives you’re likely getting from the literature. It’s fascinating just how much is presumed causal where there is an association (and, for that matter, a compelling alternative explanation).
Dave, I *am* starting to be dismissive of all the LDL markers, and even CRP. In my personal experience and following your work, I now believe that these mean almost nothing in relation to atheroschlerosis! Not even oxLDL.
It would be a great experiment to lay off the training for at least a week and get another NMR. I just have to find a week to do it. I rarely take off any gym days…
My take from all of this is that the CAC is really the last word. Doctors push colonoscopies once you reach middle age, why not CAC scans too, from say 40? And perhaps even earlier if someone does not appear to be metabolically healthy?
Excellent points, C!
Without question, I do find there’s a lot of core assumptions many of these reference ranges are built on and many markers are treated as static (or even 90% genetic) where they turn out to be mutable and contextual.
Great paper! That puts my latest hsCRP in context, too.
I agree CAC is the last word on ~10 year risk. However, it measures the cumulative amount of atheroschlerosis (above a pretty high threshold) not the rate of change. It’s also an expensive test in terms of radiation and convenience.
There’s a lot more to be learned about what cheap tests are best for measuring its progress. LDL (in its many flavors) is likely a red herring. oxLDL, hsCRP, 2-hour insulin, TG/HDL all might be reasonable candidates. If Tucker Goodrich is right, I also want to find the best Omega-6 imbalance marker, too.
But yeah, exercise is a big confounder. It’s good for you in a lot of ways, but you need to burn (oxidize) fuel to do the work – which causes oxidative stress.
Just how fast does atheroschlerosis show up on a CAC scan? From my understanding, 10 years is the zero to high risk estimate. I would expect that if a person is suddenly doing something that is not so heart healthy it would show up much sooner than that. In my area a CAC is not that inconvenient – only in the respect that my state requires a prescription for one. The time to take one and monetary cost is the same as a NMR. Radiation, yeah that could be a different story, I don’t know.
Nevertheless, I have been doing hard resistance training now for about 35 years, and intermittently other forms of exercise during that period to, like running. If that was a factor, wouldn’t it have shown up in the CAC by now? BTW I am a 52-year old female.
Unfortunately, I never did any NMRs before this summer. I have been keto for over a year and a half – getting most of my calories from animal fats. Before that I was paleo for a couple of years, again probably most calories from animal fats, just not as high a proportion as keto. And before that SAD but mostly whole foods with some grains thrown in.
If keto and / or paleo were atherosclerotic, wouldn’t *something* have shown up on the CAC scan by now?
It is often mentioned that people with these high numbers should eat less SFAs and substitute MUFAs. But why should anyone swap out nutrient-dense grass-fed beef fat and dairy with olive oil which much less heart-protective nutrients by contrast? Just to chase some lipoprotein numbers that probably don’t mean squat?
Did it ever occur to anyone that removing things like CoQ10 and K2 from our diets by not eating saturated animal fats might exacerbate atherosclerosis?
How long? Years, probably. Most everyone agrees that SAD is the worst possible diet, and it takes till age ~40 to show up there. Here’s a link: http://onlinelibrary.wiley.com/doi/10.1002/clc.22539/pdf
Why would anyone swap out nutrient dense animal foods? Seems unhelpful to me, too. They certainly don’t appear to be the root cause of atherosclerotic. IMO, any advice that is chasing intermediate bio markers and ignorant of the root cause is probably not worth listening to.
Serum ferritin may be a marker of cellular damage.
Please refer to this document.
Thanks — I’ll have to check into this.
One of the challenging things with ferritin is how many systems touch it.
I was diagnosed with high cholesterol for the first time this July 2017 with the following numbers:
After eating a high carb, low fat diet for about one month (Aug 2017):
I’ve been on a low-carb(<25 net carbs per day), high-fat diet for the past 8 weeks and my LDL skyrocketed!!! Here are the results from my most recent labs from October 2017. I am 33, 5'6", and 148 lbs.
From my research it seems like hyper-responders are usually athletes, which is not my case….is there a possibility I am a hyper-responder?
It seems like I should find out my LDL-p levels…?