As some of you may know, I got the opportunity to present on the topic of Lipoprotein(a) for Low Carb Houston 2019. Just this past week the video was released, and is now available to view!
This can basically be thought of as an improved, fleshed out update of my Big Deal About Lipoprotein(a) post, so if you’re curious about my thoughts on lipoprotein(a) I’d recommend giving it a watch!
I also provide some data from some of my own experiments, including my pork versus beef experiment, and experiments showing lipoprotein(a) following LDL-C e.g. during the protocol.
As always, discussion is welcome especially as this is a topic that’s far from closed – there’s still plenty to learn and I look forward to doing so as more work is done to understand – the still quite mysterious – lipoprotein(a).
Lately I’ve been experiencing an urge to fast for longer than the 36 hours per week I’ve been doing over the last month or so, thus I decided to fast for as long as I can (safely and comfortably). Of course, I couldn’t possibly do this without gathering at least a little data, so it will be a bit of a loose experiment as it stands.
The experiment will have multiple stages, that – except for the beginning and end phase – are not at a set length. They are as follows:
During the baseline, from September 1st to September 7th I’ll be consuming an ad libitum diet of 73/27 burgers (pre-formed), butter, and commercial pemmican. Beverages will include tea, herbal tea, and flavored sparkling water (no sweeteners). Supplements will include my normal fare of a methylated B vitamin complex, and vitamin D. Electrolytes will be consumed as needed.
1 mile of walking will be done every morning as is my usual.
During water fasting, no calorie containing beverages or food will be consumed. Supplements, electrolytes, and beverages will be consumed as outlined in the baseline, and exercise will also continue as normal.
This phase will continue as long as I can comfortably maintain it, I suspect around one or two weeks.
If I reach a point where water fasting becomes uncomfortable I’ll be adding fat (via homemade broth made from marrow bones, and fat [e.g. cocoa butter and/or butter] added to hot beverages, according to hunger. I’ll continue this phase as long as I can comfortably do so.
Exercise, supplements, and beverages will continue as previously outlined.
After I can no longer comfortably fast, or fat fast, I’ll return to eating by slowly breaking my fast and then returning to the baseline diet. After a week of re-feeding I’ll conclude the experiment. Exercise, supplements, and beverages will all follow the baseline, as well.
I’ll be recording the following over all phases of the experiment:
Glucose (daily, morning)
Ketones/BHB (daily, morning)
Acetone (daily, morning)
Weight (daily, morning)
Measurements (waist, hip, thigh, arm; after baseline, weekly during fasting phases, after one week re-feed)
Blood testing (after baseline, weekly during fasting phases, after one week re-feed)
Food/Beverages/Supplements consumed (picture logging; constant throughout all phases).
Fasting time (via free fasting app, delineated between water and fat fasting)
I’ll be getting 12 tests total during each blood draw. This is pared down from what I’d usually get, but covers many metabolic markers.
Comprehensive Metabolic Panel (14)
Insulin and C-Peptide, Serum
Fatty Acids, Free (Nonester)
Complete Blood Count (CBC) With Differential
Uric Acid, Serum
Oxidized Low-density Lipoprotein (OxLDL)
Over the course of the fasting portions I expect the bolded items to decrease and the italicized items to increase. Non-marked items are unknown, or contain multiple tests.
As a side note, I don’t expect GlycA to significantly change over the course of the fast. I expect triglycerides to initially increase and then fall back to normal over the course of the fast. I expect ketones to increase and glucose to decrease over the course of the fasting periods, and weight and measurements will decline. By one week post re-feed I expect blood markers to return closer to baseline levels, with some (although not total) regain in weight and inches.
I’ll be checking in frequently with Dave on how I feel throughout the fast, and in contact with my primary care doctor. If I ever feel unwell, especially any nausea or abdominal cramping, I’ll immediately abandon the experiment and eat. If I ever feel “off” or feel like I should call off the experiment due to any health/safety concerns I will do so without hesitation.
Overall I am very curious to see how things will change over a longer term fast. I’ve previously done a 7 day water fast, outlined here, but this will (hopefully!) extend even beyond that. Adaptions to longer term fasting is definitely something I’m interested in, especially given some studies I’ve been reading recently, and as I’m currently “overweight” I feel I can comfortably take it on. I’m also curious to see what changes may occur comparing water fasting to fat fasting especially in regards to weight, and blood markers.
Given the longer fasting time I’ll definitely be overly cautious about safety and being sure I call off the experiment if I feel it’s necessary for my own health. Other than that, I feel pretty confident overall, especially given I have access to a doctor who has other patients who fast regularly, and am looking forward to sharing back the data.
Eat baseline diet for five days (maintenance calories)
Eat 1/2 baseline diet for five days (hypocaloric)
Eat high calorie keto for five days (hypercaloric)
In the original experiment I sought to have 2x baseline diet but found it untenable and thus made an adjustment. This experiment will attempt to replicate that adjustment as well to keep all food the same.
My current sleep schedule has me waking up a bit earlier in the morning than last year. Thus I’ll be adjusting both the eating and blood draw windows. (See below)
As with the original, I’ll be eating at three time periods a day, each five hours apart. One difference is that my scheduled times will be about 1 hour earlier at 9am, 2pm, and 7pm.
Given the earlier eating times, I’ll be likewise getting my blood drawn at approximately one hour earlier as well.
Blood tests for mornings of September 4th, 9th, and 14th
One exciting change is that I’ll be getting much, much more expansive blood tests than last time:
As with the first experiment, I predict my OxLDL levels will track with LDL particle count (LDL-P).
However — of much greater importance are the results of the Oxidized Phospholipid test (OxPL). If the assay is truly quantitative to this metric, it stands to reason OxPL will not quantitatively track with OxLDL, even if there were a correlation at a smaller magnitude. On the other hand, if it did track in magnitude, this would open up a lot more questions (that I won’t cover here), particularly if OxPL rises substantially in the hypocaloric phase and drops substantially in the hypercaloric phase.
Although involving a lot of unpleasantness, the last three days have been interesting, to say the least. To explain why, we should start from the beginning…
Inspiration for the EVOOvsButter Experiment
Before this experiment, there have been a number of others that used a ketogenic meal replacement mix with different sources of fat. These were mainly carried out by Keto Chow owner, Chris Bair — often in collaboration with yours truly.
I mention all this because my considering the meal replacement shake with a refined fat source actually has a lot of precedent and appears safe enough, at least in the short term.
Extra Virgin Olive Oil vs Butter – First Attempt
I laid out the design for the original experiment here and got started Tuesday, June 30th, with the Extra Virgin Olive Oil (EVOO) phase. The first three and a half days went okay overall without any substantial symptoms, save some lethargy and and lower appetite (the last shake of each evening took me a while to finally finish off).
However, on the evening of the fourth day I seemed to be feeling a hightened sense of anxiety that I’d describe as comparable to what you get with nausea — but without the nausea. It was mild, but did increase my anxiety and made it difficult to sleep.
On the morning of the fifth day (4th of July), I had a collection of mild symptoms that included less energy, an odd sensation in my feet and calves, and further anxiety that seem to carry over from the night before. Given the leg problems, I was inclined to assume these may be electrolyte issues — something I’ve struggled with before while keto.
The revised version of this experiment began three days ago with a much stronger electrolyte regime. I also added in a direct source of protein through consumption of a lean burger patty with every shake. Another key change was a lower quantity of the fat source (i.e. EVOO at 12 tbsp/day vs the original 15)
While the initial Thursday went by without incident, I was feeling symptoms in the morning of the Friday after with both low energy and very mild nausea that appeared to dissipate after a couple hours.
My first scheduled exercise of the day is a 2.3 mile walk at around 7am, where I was especially rundown. Following this I typically do some maintenance strength training ad libitum (such as pushups) which I had no energy for and simply skipped.
For the first scheduled meal at 9am I found I had no appetite, something very unusual. I managed to slowly get through my burger patty but kept eyeing my EVOO shake suspiciously. I was getting more doubtful I could consume it without forcing it down and between this and the collection of symptoms, I reluctantly decided to pause the experiment — for a second time.
While I was optimistic this momentary second pause would snap me back into place, I was wrong. The nausea and lack of energy both increased marginally into the evening and I fell asleep for two hours from 6pm to 8pm on the couch. I then had trouble getting to sleep and kept moving in and out of a state of insomnia (also very unusual).
After getting up on Day 3 (yesterday), I realized I wasn’t anywhere close to normal. While the nausea was gone, my energy levels were even lower and I had no appetite until the afternoon. I felt like one does after having been sick for a while and was now coming out of it — being “on the mend” as it were.
Why So Different This Time?
Much of the reason I’m giving the full accounting of everything before this point is to emphasize the unusual nature of this last attempt. Sure, a clear common denominator is the EVOO and perhaps even the 1/3 dose on my coming revision is still too much, I don’t know yet. But I can’t help but wonder if there’s something different about this time compared to the last.
One thought that occurred to me is that it might have been a bad batch of EVOO. While all of them came from the same Kirkland bottles, the current shakes I made were from a newly opened one in the batch. Is it possible they could be different from one bottle to the next in a material way when consumed at scale?
The Next and Last Attempt
As mentioned above, I’m going to attempt to do this experiment one more time, but with 1/3rd the quantity for each intervention (just 4 tbsp / 57g). I’ll be filling the remaining calories with “neutral foods” that try to hit a 50/50 balance between SFA vs MUFA/PUFA.
I had hoped to be on track with that experiment right away, but clearly I should take a little more time to get re-centered first.
The Toll of Setbacks
One aspect to these ambitious n=1 experiments I don’t talk about is the mental preparation. Kind of like gearing up for a marathon-like competition, I’m spending weeks to months getting my headspace aligned for a long haul of a very structured days. It’s a lot of anticipation and planning depending on the scope of the project — and my experiments rarely get larger than this.
Thus, these kinds of developments that actually disrupt a 4-week planned initiative are very emotionally taxing, particularly given all the meetings, podcasts, etc that I schedule around them. Often my wife will plan meals and experiences for immediately following the completion of these experiments as she knows it can’t happen during, so this news is very disappointing to her as well. (Have I mentioned my wife is a saint for putting up with all this?)
Data is Data
While I have outlined a lot of negatives above, let’s not lose sight of the silver lining — even disappointing results can be valuable data in their own regard. I have some new hypotheses regarding what may have happened that may potentially show up in the coming bloodwork once I have this experiment back underway. But I’ll save those thoughts for a later time.
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