I was incredibly honored to be invited by Annelise E. Barron, Associate Professor, Dept. of Bioengineering, to present my research to her class and discuss the Lipid Energy Model in depth. Originally, I was going to be flying to the campus to give the talk directly, but with the current Covid-19 crisis all speakers were presenting via Zoom.
This proved to be an excellent opportunity provide an overview for general (not low carb) audience. Overall, the presentation was well received, maintained strong retention, and there was quite a bit of discussion afterward. (Discussion not included in the video)
Hi, I like your post really I have read first-time Thanks for sharing keep up the good work.
What were the hardest questions in the follow-up discussion?
Actually, the discussion afterward was more fun than hard. Perhaps the hardest question was when someone asked me about statins — to which I’d refer you to my lengthy discussion with Ethan Weiss on the topic.
Dave:
I just stumbled onto your site, after frantic search following a half remembered comment or description from a Peter Attia presentation, trying to rapidly digest the available information before urgent Cardiologist appointment and treadmill testing tomorrow morning.
Quick summary — I am 72 yr old retired Physician retired at 64. Had been running since age 50, and decided on retiring to learn to swim and bike (how hard could that be) and compete in Triathlon. After a brutal and humbling learning curve finally completed an IronMan in 2018 (lots of 1/2 IronMan events over the years). Along the way I learned so many strange things I didn’t expect. I was the usual lipid- ignorant Family Doctor during my years of practice, so I was really offended when my coach suggested I try lowering my Carbohydrate Intake to boost my fat burning, because I knew that ketosis was dangerous etc. etc. Long story short, I was astounded to find during a Treadmill Respiratory Gas Analysis in 2015 that my fat burning at Zone 1 intensity was only 11%. I tentatively went on a restricted Carb diet (I was totally uncontrolled full-on CHO consumer prior to that) and 12 weeks later repeat testing showed fat burning at Zone 1 was 62%. I continued on restricted carbohydrate intake, and got increasingly knowledgable and consistent in my diet; for the past 3 years have been in dietary ketosis (confirmed by regular blood glucose and beta-hydroxybutyrate testing, and more recently by breath acetone sampling device). I was actually already quite lean before, possibly 53-53.5kg (height 162 cm) and am now 50-51 kg, >> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 14 mg/dL >>> 0.15 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 244 | Iranian LDL-C: 207
TC/HDL Ratio in mg/dL: 3.41
TG/HDL Ratio in mg/dL: 0.64 | TG/HDL Ratio in mmol/L: 0.28
AND SHE JUST ABOUT HAD A FIT!! Hence the urgent Cardiology consultation. The cardiologist has already suggested I should be on a Statin aiming for a target of LDL-C of 2.0 mmol/l. I’m in a bit of a dilemma. I know where he’s coming from, and I used to be in that camp, but I’ve seen the light, and I think the lipid hypothesis is deeply flawed. My wife thinks I’m arrogantly over inflating my self-expertise and that I’m the typical Internet Patient taking my life in my own hands in a bad way.
I’m really trapped. It doesn’t help that my family history is positive for maternal premature death by stroke and hypertension, and hypercholesterolemia and hypertension in a sibling (but he’s obese!) Oh, yeah, in 2014 I got a pelvic CT scan to reveal an avulsion fracture on my femur after being hit by a car while biking — but the CT showed “Atherosclerotic Streaks” (no quantification specified) in my Aorta and Iliac vessels, so, as far as the cardiologist is concerned, it’s established that I have evidence of arterial plaque already.
An interesting tid-bit is that I had a blood test at age 32 in 1980 showing normal cholesterol and lipid ranges including an HDL-C of 41mg/dl (we were using US units then). In 2015 HDL-C had risen to 1.66 mmol/l, and in 2018 HDL-C was 2.12 mmol/l.
But if I can decipher the Feldman Code as precisely as you describe it to be, perhaps I can drop my serum LDL without Statins and keep everyone happy. I don’t mind taking low dose ASA though, and have started that.
Sorry to go in so much detail, but I wanted to establish that I’m a genuine flaming LMHR, and I want to join the team, and I’d do anything you ask me to do. But I’m in crisis mode right now, and anxious lest I piss the Cardiologist off, uppity ex-Doctor patient and all.
Follow up — it was even worse than I feared. The Exercise Treadmill Test was trivial. I got up to Level 5 with no issues at all, and they cut off the test as my HR got up to 153, way higher than their calculated Max HR of (220 – age), which for me was 148, even though I had carefully explained that I regularly achieve 175 bpm at my top exertion levels without issue, and I have actually measured as high as 182. My 2014 CT was reviewed and shows a small calcification at the aortic bifurcation that I would guess represents an occlusion of 2% of the luminal area. I was given a prescription for Crestor 20mg, no discussion at all, I guess LDL of 6.32mmol/l is cut and dried to her meaning I have familial hypercholesterolemia and I am in immediate danger until I treat with Crestor to lower LDL to 2.0 mmol/l.
I just reviewed my original comment, and noticed there is a large chunk missing in the middle section, most of which probably doesn’t matter, except maybe my lipid profile drawn on April 30, 2020, which I’ll paste below.
No, wait, I must have originally included the values for my lipid profile because there are comments and conclusions based specifically and precisely on my results — so the values were stripped by the moderator, I’m not sure why, but I’m sure there’s a good reason, so I’m ok with that.
Now to figure out what to do. I’m not filling the Crestor prescription, but I have to come up with a response. I filled the Nitroglycerine prescription, but I can’t imagine needing to use it. I’ve got an Echocardiogram booked tomorrow and a Thallium Stress test sometime in the future.
Hi – thanks so much for providing the details! It can help a lot to establish some context for your concern and where you’re coming from.
Regarding your results – it just looks like they didn’t copy/paste properly, we didn’t remove anything. The only things we remove from the comments are spam, or personal information (e.g. email, or phone numbers) and in the case of the latter we insert a note that personal information has been removed by an admin.
No worries though! Based off what you said, and that you’re a LMHR I can guess what the results would have been anyway (but it would also be great if you could re-post the number – just plain numbers is fine like LDL, HDL, triglycerides, total cholesterol).
Although I’m not a doctor, so can’t give medical advice, from what you said it seems as though the calcification was already there prior to going low carb, correct? From what Ivor Cummins has stated after looking into the research of CACs (coronary artery calcium scoring) he found that if calcification was already present, then the next best thing would be to follow up after two years or so to get another score and check the rate of progression. Progression under 15% (if I remember right) was comparative to a low score from the start. He has a couple different videos on this that might be worth looking into, I’ve linked one with the relevant information timestamped.
Regarding Familial Hypercholesterolemia, as far as I know if earlier in life you had expected values, and cholesterol increased from diet, then this would suggest it’s not genetic – although I’ve heard from a couple people that high levels alone are assumed to be genetic. If it were me, if I were to make diet changes and it went back down to “normal” levels I’d presume it were the diet resulting in the profile (as we’ve seen in quite a few lean mass hyper-responders). But that’s just my own interpretation – perhaps you could discuss with your doctor for clarification given your prior numbers?
If you’re not comfortable with your LDL levels as is, then one thing that people in the Lean Mass Hyper-responder facebook group have noted seems to work pretty consistently is to increase carbohydrates and (this is super important) proportionally decrease fat. This is a diet change that seems to work over the longer term for people who would like to move away from the profile, and fits with the general idea of the lipid energy model.
Some others in the group (which you might want to join if you haven’t already) opt instead for thorough testing over time – including not only CAC, but other blood markers to look at inflammation, metabolic health, etc, CIMT (looks at thickness of the artery in the neck), carotid doppler (visually checks for plaque and measures bloodflow), etc. This is for people who want to monitor their health fairly frequently to see the trend and verify nothing outside lipid numbers is going sideways (or if it does, to alter diet however they feel most comfortable).
If wanting resources for discussion, you could also check out this presentation from Dave about a cautiously optimistic perspective on risk, and this post by Dr. Nadolsky showing a cautiously pessimistic view. This way you can read up on both sides and see which is more compelling to you based on the evidence, and use the studies discussed to talk to your doctor about where your viewpoint is coming from, if you wish.
However, it’s also worth noting that your doctor’s job is to give you advice they think will help you reach better health, but it’s ultimately it’s up to you to decide if their suggestions will help you reach your personal health goals, and help you achieve what you’re wanting to. Although it does get infinitely more complicated when spouses or family is involved, it is you who has to live with whatever decision you ultimately make (or the path you decide to follow to experiment and find what works for you – a decision doesn’t have to be permanent if you later change your mind). So, hopefully you can find something that you feel comfortable with, and work as a team with your doctor to make sure what you’re doing is working for you.
Obviously, because it depends on what you’re comfortable with, your interpretation of the data, etc, I can’t say what you should or shouldn’t do. Only point you to resources which may help you decide for yourself with your healthcare team.
Apologies for my own reply being very long, but hopefully this provides a little something you can use to help orient yourself as you continue to learn and decide what you feel you should do. If you have any further questions please do feel free to check back, and if you’d like to discuss with other lean mass hyper-responders the facebook group is a place worth checking out to hear from others in similar positions (and with similar cholesterol profiles) as your own.
Siobhan:
Thanks for reply, and for your very helpful opinions. Rest assured, after weighing all the evidence I will take full responsibility for my own decisions, whatever they will be. However, there will be no further discussion with the cardiologist — she is as cut and dried and literal minded as they come regarding high LDL is fixed in stone as being synonymous with established high cardiac risk until it is lowered, almost certainly with a Statin tried first, or if not tolerated, with some other pharmaceutical. (She had no patience with any idea that dietary intervention or fasting might have had any effect on the lipid results, even though I had explained to her that the week prior to testing was extremely chaotic and stressful from me, I had not slept well and had not eaten regularly prior to the test, then had occasional binge meal to compensate, then fasted for the test.) That is why my plan is not to fill the Crestor prescription, and to do an end run and repeat the lipid panel, hopefully after thoroughly understanding, then emulating the Feldman Protocol.
Regarding my age, the calcification is not just in my aorta, but also in my internet and computer competence. Given that the Admin had nothing to do with the lost part of my first comment, I’m sure that what actually happened was that I tried to edit, unknowingly highlighted some already inputted text and just as unwittingly deleted that block of text.
Firstly I will try and remember what I had said and deleted. — In March this year I was one day aware of an odd discomfort in my chest while running uphill into a cold winter wind with slippery snow underfoot during the first mile of starting a run that felt like a very mild pressure in my sternum and left 3rd-4th adjacent rib. There was no radiation of the discomfort to anywhere, but being a doctor in my prior life, I was sensitized to the idea that heart disease was common in my age group, notwithstanding the fact that at other times I was capable of much greater exertion and heart rate. The circumstances were suspicious, too, although the discomfort, such as it was, was very mild, almost trivial, and may even have been aggravated by deeper breathing, which was not typical of angina. Then the discomfort went away as I reached the top of the hill, and I sprinted the rest of the run, as usual. I reached the swimming pool, did my swim, then ran home again with no further incident.
On thinking about it, I thought that perhaps I had experienced something similar perhaps on 2-3 occasions in the the prior 4 months or so (with hundreds of other extreme exertional sessions with no discomfort at all), but had forgotten about it. I was undergoing a lot of stress, and shortly after this episode the COVID 19 lockdown started in Calgary, Alberta, Canada where I live, and while still under further stress, I experienced another single mild recurrence of this vague chest discomfort running uphill early in a run one day in cold weather. I was inclined to write this off as a stress phenomenon, but with an abundance of caution, I thought I should run this by my own doctor (an ex-colleague in my old practice).
She ordered a lipid panel which was drawn on April 30. (I will paste what I saved onto my clipboard after filling in the data from your beta testing report tool.)
–===== CholesterolCode.com/Report v0.9.5.15 =====–
• Male • 72 • Coffee: 1 cups/day •
• 4 on years on Keto (less than 20g carbs) •
• 18h water fasted • Cholesterol Rx: false •
Total Cholesterol: 365 mg/dL 9.43 mmol/L
LDL Cholesterol: 244 mg/dL 6.32mmol/L
HDL Cholesterol: 107 mg/dL 2.76mmol/L
TG Cholesterol: 68 mg/dL 0.77mmol/L
———RISK REPORT———
Atherogenic Index of Plasma: -0.554 mg/dL >>> Lowest Risk Third
—-> Go to https://tinyurl.com/ycccmmnx for more on AIP
Framingham Offspring: 0.7 Odds Ratio >>> Low Risk
—-> Go to https://tinyurl.com/y5fc5adl for more on this Framingham study
Jeppesen: >>> Lowest Risk Third
—-> Go to https://tinyurl.com/y63xp7lj for more on the Jeppesen study
Cholesterol Remnants: 14 mg/dL >>> 0.15 mmol/L >>> Low Risk
—-> Go to https://tinyurl.com/y84u92wm for more on Cholesterol Remnants
——CONVENTIONAL MARKERS AND RATIOS——
Friedewald LDL-C: 244 | Iranian LDL-C: 207
TC/HDL Ratio in mg/dL: 3.41
TG/HDL Ratio in mg/dL: 0.64 | TG/HDL Ratio in mmol/L: 0.28
THIS IS WHERE MY DOCTOR PANICKED REGARDING MY LDL-C AND REFERRED ME URGENTLY TO THE CARDIOLOGIST.
By the way, I just had an echocardiogram today (ordered by the cardiologist because of a mild outlier feature in my EKG, that is, slightly increased voltage in the anterior leads, that is, the electrical sensors on the front wall of the chest, which is sometimes an indicator of Left Ventricular Hypertrophy ( a thickening of the heart muscle due to hypertension, which I don’t have, or sometime unexplained). In my case I am a bit of an age group high performance runner, so I might have slightly more developed heart muscular than average, but particularly, I have very diminished body fat all over, including my chest wall, which will allow more electrical voltage to show on the EKG. (I know these things because I used to read EKG’s for other doctors).
The echocardiogram was very enlightening because I ran into the cardiologist who was to read it, and we recognized each other’s names from when I used to practice medicine, and she very graciously invited me into her office and carefully stepped through the interpretation with me. So it turns out that I have a very efficient heart with a high ejection fraction but no ventricular hypertrophy. I may have an aortic diameter at the upper limit of normal or possibly at early stage of dilatation, and very mild regurgitation (leakage) of the aortic valve (seen quite commonly in the normal population). A reasonably cautious recommendation would be to repeat the echocardiogram in 1 year. I would call that essentially normal.
Without coercing her to contradict or support another cardiologist’s opinion, I asked her point blank at the significance of some very mild (non-encroaching on the lumen) calcification in the lower aorta and iliac vessels revealed in an incidental CT of the pelvis obtained in May 2014, long before the low carbohydrate diet was started, and she said almost every 70 year old would have some, so it didn’t mean much.
BTW, the other Cardiologist’s “familial hypercholesterolemia” idea comes from my reported Family History of Mother having hypertension and a stroke at age 72, and my 73+ year old brother reporting hypertension since age 30, and treatment with statins for elevated cholesterol. But both my mother and brother were/are your typical sedentary chubby Chinese lard-asses, with a lifelong high carb diet. I really doubt we all carry the familial hypercholesterolemia gene. Although, it’s reasonable to get my children tested, I suppose.
But the Cardiologist’s intransigence from the get go is a bad prognostic indicator for any flexibility in treatment options. It’s gonna be the Crestor way or the highway. She doesn’t even want a repeat of this single testing given above. She wasn’t impressed with my diet history, nor, apparently of my High HDL, low TG, so the Jepessen study would be seen as irrelevant, I guess, because the Pharma sponsored group consensus would not have considered this a credible study, because, well, that’s how it works.
2021Jan20: Just to update the sad saga.
In early June I had a Myocardial Perfusion Scan which showed decreased anterior and anterolateral perfusion. I was referred urgently for coronary angiography and meanwhile the Cardiologist insisted I start on Crestor 20mg (which I had not yet started).
On June08 I underwent coronary angiography, which demonstrated calcium in the walls of the Left Anterior Descending Artery, but no blockage until after the first bifurcation of the first diagonal branch of the LAD, where there was a 90% stenosis of this first diagonal after the bifurcation, and also a 90% blockage of the other (2nd diagonal) branch close to the bifurcation.
The angiography team decided not to intervene, i.e. no angioplasty due to the fact of minimal, if any symptoms, and high exercise performance, and also for technical reasons due to the proximity to the junction of the stenosis in the 2nd diagonal.
With the Crestor 20mg daily my LDL-C level came down to 3.44mmol/l on July03 (HDL-C stayed high at 2.33mmol/l and TG at 0.52mmol/l), which was allegedly insufficiently low, so I was referred to an Endocrinologist to be placed on Ezetrol 10mg daily, which was expected to fail, so that I could qualify for Repatha injection treatment.
Surprisingly, on the added Ezetrol 10mg therapy, my LDL-C came down to 0.82mmol/l on Nov03 (HDL-C and TG remained essentially unchanged). I was allowed to reduce Crestor to 10mg daily and on 2021Jan18 my LDL was measured at 0.93mmol/l. I’m one of the rare people in whom Ezetrol 10mg markedly reduced LDL-C after only modest reduction on Crestor 20mg.
I anticipate that in future I will be “allowed” by the Endocrinologists to taper Crestor dosage further to see if the Ezetrol benefit still holds up.
The burning question that I have is whether the 90% LAD diagonal branch coronary blockages built up over the prior decades of indiscriminate High Carbohydrate eating (which is what I suspect with my current understanding of the pathochemistry of Carbohydrate induced cellular inflammation), or whether it was the rapid and direct result of the high dietary fat load accompanying my highly visible switch to low carbohydrate ketogenic diet in 2015, which is what my family and running colleagues (who just don’t get it) assume, despite the persistence of my resulting high HDL-C and low TG. I am under a lot of pressure from them to quit the diet, and listen to the real experts to take the Cholesterol levels seriously and reduce my dietary fat intake which is obviously damaging my coronary blood vessels, contributing to my ongoing risk of sudden death.
It is very distressing, and I’m getting no help anywhere from the local medical community.
Meanwhile, on a ketogenic diet (confirmed daily with blood ketone strips) at 72+ years old I can run 10k in 45 minutes, generate and sustain 2.3watts/kg on the bike and sustain a heart rate of 175bpm without any undue distress.
Hi –
This does sound very frustrating – if you were seeking other perspectives from doctors who may have other ideas that may be of interest to you to consider you could always seek the guidance of a low carb/keto friendly doctor and see what they have to say. They may say the same thing as your current doctors, or they may not (or you may end up disagreeing with them) – but it may be of interest, regardless. In addition, there is also the Healing Heart Disease with Keto and Fasting group, you could ask there as well to see if anyone has been in a similar position and how they addressed it. It does sound tricky to navigate so I hope, regardless of what you decide to do, you find something that makes you comfortable over the long/short term. We, of course, can’t say what the correct course of action is as we’re not doctors, but I thought these resources may be of interest to you.
Su Chong
Su-Chong I am having similar experiences from a Cardiologist at the Mazankowski in Edmonton. It’s Statins or the highway I didn’t even bring up how miserable they make me feel. I indicated to him I thought taking Statins was doing more harm than good and there was documented evidence that statins block the production of COQ10 which was vital for normal Heath metabolic functions. He would have none of of it. My LDL was 5.50 mmo/l and I had to go back on Statins. I have resumed Lipitor 10 mg per day but after a week of it I’m going to go every second day and get another lipid panel in another week. I requested a CIMT and Calciium scan from my to see if the statin course but he declined. I had an angiogram done over a year ago and he said my arteries were pristine and that was the gold standard for arterial scanning and if I wanted to prevent future CVD to go back on statins. I asked if there is an alternative to statins and he said there is but they stick a needle in your belly! I asked him to forward info to my GP. End of telephone consultation. See my score at https://cholesterolcode.com/remnant-cholesterol-what-every-low-carber-should-know/#comment-26143
I am a retired engineer and have been struggling to get some viable alternatives to statins within the Alberta health care system
Dave, My husband and I fund research investigating diet and chronic disease. I would like to talk to you about your lean mass hyper responder research. I think I can clarify a piece of the puzzle that you are missing with LMHRs, and would like to discuss supporting your research program. Please contact me at the email below.
Hi Peggy — thanks for your interest. Will contact via email. 🙂
Dave and Siobhan, have you looked up anorexia and high cholesterol before? I found a few interesting papers on the subject. It looks like anorexics often have high LDL, high HDL, and low triglycerides. This goes along with elevated ketones. It’s not a great comparison since anorexia is going to cause a bunch of health challenges too like being malnourished and actually starving, but I thought it was interesting. Here is one paper https://pubmed.ncbi.nlm.nih.gov/16791856/. Have you ever checked your CEPT before?
Hi Reese! Yes, I’m not sure if it’s been brought up in a presentation, etc but it is something Dave has discussed with me in regards to what he’s looked into before. I’ll see if he’s seen the paper you’ve linked in particular, as more info on this is appreciated, regardless with regards to the lipid energy model.
Regarding CETP (if that’s what you meant? If not, please correct me!) I’ve not seen a blood test available to measure it through common resources, so I haven’t.
Oh! Hah! You mentioned anorexia in your presentation. I should have watched the whole thing first. I thought I’d discovered something new. 🙂
Hello Dave, The last year I have been severely sick and suffered from several infections and neurological issues. The only thing that has brought about genuine relief is supplementing with Zinc Sulphate, I have heard that supplementing with zinc if you are relatively healthy and not obese can cause atherosclerosis as it has been shown through several meta analysis that Zinc significant lowers HDL and raises both TC and Triglycerides,
I would love you’re opinion on the impact of Zinc because it has helped me but I don’t want to risk heart disease since relatives have it.
Article below finds different conclusion on the impact of zinc on healthy and non healthy individuals.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523910/#:~:text=The%20present%20meta%2Danalysis%20demonstrates,cholesterol%2C%20LDL%20cholesterol%20and%20triglycerides.
Hi Dave, Hi Everybody!
I am a Senior SW Developer who felt and found out that the mainstream energy model of the “medical science” must be wrong.
As you I started to do blood tests at a private lab to find correlations.
It all started in 2016 with an antibiotic which almost killed my liver.
I was then told not to eat fat and suger, but carbs.
With my own data points I could proove that eating low carb helps my liver (lowers GGT).
I read everything out there about the topic. Back from Otto Warbung, Krebs Cycle until
the metabolic pathways poster and “Metabolism at a glance” from Hallway.
I want to suggest the follwing.
Let’s put the energy model into a program:
Simple rules define the behavior of
organs and their interaction. Entities are “Glycogen Store”, “Liver” …
Liver: “if (!gylcogen.isEmpty():
release steady blood sugar from gylcogen store
else
if (in fight and flight)
trade body tissue for sugar
else
access fat for ketons
”
Cells: “if (Vit B1 around and Floride not present)
do gylcolysis”
“if ( flight and fight OR !oxygen)
burn pyruvate into lactate
else
burn pyruvate in krebs cycle”
Then we define some Test-Cases which reflect different energy demanding scenarios
for the body and are backed up by empiric science
“Steady state, 24h walking” -> Expected result: “glycogen empties, afterwards ketons get burned. Uses krebs cycle for pyruvate”
“Emergceny, 24h running” -> Expected result: “glycogen empties, afterwards body tissue traded for energy. uses pyruvate to lactate (until ….tissue if full with lactate then die)”
Another test case would of course be the feldman protocol. We tune the rules until the
model can quantitavely and qualitatvely fullfill your obeservations.
Out “program” would be then be the Unit-under-Test.
A correct energy model would just satisfy all test cases.
In the end we can more and moe finetune parameters and rules.
Finally we get the get the nobel price.
BR
Matthias
Interesting idea, Matthias. I’ll concede I’d be skeptical as to the degree of accuracy — but wouldn’t be opposed to seeing how well it matched up to my own data when written up.
Hi. I went Keto and my LDL P doubled and triglycerides lowered. I’m afraid, what to do?
Hi Mari – could you post your actual numbers (total cholesterol, LDL cholesterol, HDL, triglycerides, and any other relevant info)? It’s hard to comment without the details.
Hi Dave, Siobhan,
Thank you for this talk and the graphic presentation of your energy model, it makes a lot of sense.
I am signing up as a LMHR with significant CVD. Female, 56 y.o., keto since November 2014, 52.4 kg, height 164 cm.
My last lipid profile 9th July, 2020 was:
Cholesterol – 7.9 mmol/L
Triglycerides – 0.4 mmol/L
HDL Cholesterol – 2.5 mmol/L
Non – HDL Cholesterol – 5.4 mmol/L
LDL Cholesterol – 5.2 mmol/L
All LFTs – normal (incl ALT)
Inflammation markers – normal
Coronary artery Calcium score 492
Tolbutamide Stress test (Better Covid safety)- normal cardiac function, low risk for next couple of years.
Statin recommended – declined
Aspirin 100 mg/ d
I have one cafe shot of coffee each day, midday. One meal a day (evening) with 18 hour fast. Total carbs <20g/d
Thanks for sharing back your info! Does indeed look like the profile of a LMHR. For further context, if you don’t mind sharing, when did you get your CAC score done in relation to when you went keto?
Hi Siobhan,
I began my keto lifestyle in November 2014. My cardiac calcium score was done in March of this year.
Can you explain what might be going on for me please?
My brother (2 years younger) and my father have 3 and 2 stents respectively.
Should I try the Feldmen strategy ahead of my next blood test to see if that will change my LDL?
What information is there on the saturated/unsaturated fat in the diet with regard to LDL? I have been told to eat more unsaturated fat to decrease my LDL.
Thanks for your interest and research into this critical area?
Cheers
Pauline
Hi Pauline, thanks for the extra info. Unfortunately, without a baseline from before you started keto I don’t know of a way to tell if the CAC score is from before you started and has just remained the same over the years, or whether it has developed since 2014, or any other combination of other possibilities – it’s why I try to mention getting baselines when people first start a big dietary change so they can know for sure if it’s pre-existing or not.
Usually, what I see people do who are uncertain what is contributing to a high CAC result is to re-test in a year or two and see what the progression is – less than 15% progression per year is apparently almost as low risk as having a low score to start according to Ivor Cummins (who has looked a lot into the research on CAC and risk).
But, in the mean time as for what to do – I can’t give medical advice as I’m not a doctor, but you may want to check out the healing heart disease with keto and fasting group as there are plenty of people there in similar situations who may be able to share what they’re doing, resources to look into, etc.
If possible, if I were in the same situation I’d also want to look into finding a doctor who’s familiar with similar situations who may be able to also guide you in what else to test/keep an eye on/etc.
As for LDL, if you are uncomfortable with your current levels given your situation, then the most reliable method we’ve come across so far is to decrease fat and increase carbs proportionally. Usually to a level of 50-100g of carbs per day will result in a decrease if the person was originally on a low carb/ketogenic diet (being sure to decrease fat proportionally, so it’s a carb swap and not an add). There has also been other talk in the CholesterolCode facebook group discussing experiments with fiber, or switching saturated fat with unsaturated fats, but these results seem to be on a lesser scale and less reliable between individuals as well.
Hi Siobhan, thanks for your comments. I am going to assume my CAC would have been worse had I not been on a ketogenic diet and will try for a retest in a couple of years. I will also check out the Healing Heart group.
I realised Dave was doing the saturated versus non-saturated with his EVOO and butter experiment. I am sorry he was unable to complete it, but I can understand it would take quite a toll on his body and mind as he says.
Thanks and cheers
Pauline
You’re welcome – yeah I’m a bit sad that it didn’t work out for Dave, I was curious to see the data. But I am glad that he listened to the fact that he wasn’t feeling well and didn’t try to push through it. Safety is always rule number one.
Hi Dave, Hi Siobhan,
I have been reading and watching your videos for the last weeks and it is amazing how much we can learn!!
I am on a keto diet for a year more or less, feeling awesome, honestly, I havent felt like this in decades! I have been fighting against my weight since I can remember ( I have Cushing’s syndrome since I was 12 y.o – not anymore thx god!)
Now I weight, with 34, the same I did when I was 14 – 55kgs. Amazing!!!
The “problem” is that I got my blood test done, and surprise!!! Crazy level of cholesterol. My numbers are
TC 410; TRG 89; HDL 73; LDL 319
Low glucose 61; visceral fat 3
Before the blood test I had a 18 hours fasting, which I suppose is one of the reasons why my LDL was sooo high ( after I read Dave’s fasting speech).
Yesterday I was talking to my doctor and he was sooo scared of my numbers and I tried to explain but doesnt know much of the keto diet related to cholesterol. So he asked me to show him medical studies that support my point of view …
I told him I will repeat my blood test ( i am going to eat as much fat as I can) to show him how things are…
My questions are: how do you see my levels? Do I have to eat more calories than normal as well before the blood test? Whats the best numbers of hours I should fast before the blood test?
Thanks a lot for your time, and sorry for this long message!
Regards from Spain!
Hi Emma, thanks for commenting 🙂
I’m glad to hear of your weight loss (and presumed health gains!), always a great feeling to feel your best. Although we’re not doctors and thus can’t give medical advice, we can offer our opinion and potential resources in case they’re of interest.
Regarding your levels, it looks like you’re pretty close to the Lean Mass Hyper-responder profile, so you may find the Lean Mass Hyper-responder facebook group of interest in order to stay up to date on the latest discussions, research, and other people’s experiences, etc.
It is possible, but from the data I’ve seen (in myself and others) usually the significant increases typically occur around the 18+ fasting point, particularly 24+. To answer a later question, we find that fasting for 12-14 hours usually nets the most consistent results, with the 12 hour minimum being a hard minimum – here’s a post explaining why. I’ve seen generally consistent results up to 16-18 hours fasting, though I personally stick to 12-14 for consistency.
I’m not really sure what your view is, but I’ll link general resources. Of course the stanford talk (the post we’re commenting on!) is a good overview the lipid energy model, as far as risk goes we have two posts which may be of interest. Although you said you were looking for studies that support your view, we find that looking at multiple perspectives can be important. Both of these cover the topic of risk, but from slightly different perspectives – perhaps you’ll find something of interest. The first is a presentation from Dave regarding high LDL in the context of high HDL and low triglycerides from a cautiously optimistic perspective – multiple studies are referenced and discussed if you wanted to read them. On the flipside we also have this guest post from Dr. Nadolsky covering the same topic from a cautiously pessimistic perspective as well. There are additional studies referenced in our open letter to the editor here, and it’s a nice one page text on the topic as well just in general.
The work of Volek and Phinney is likely also relevant here.
If you wanted to do the protocol as an ice breaker to demonstrate and discuss the lipid energy model, we have a handy write up here and here as well as demonstrations of the protocol by me, Dave, and the resident lean mass hyper-responder Craig here.
In short, roughly double baseline calories with ketogenic macros (mostly fat, moderate protein, low carb) usually does the trick. If already ketogenic, doubling your normal meals is what people usually do. For most consistent results, as per usual, fasting for 12-14 hours water-only (no coffee, no tea, no caffeine – just water), avoid coconut oil/MCT oil during the protocol has helped avoid confounding.
As a side note, I’ve also done the protocol to open the discussion of cholesterol metabolism with my prior doctor (prior, only because I moved to a different state), and we ended up having a great discussion as a result.
Dear Siobhan, thank you so much for your great answer, vert helpful!!
Just to let you know, my point of view concerning cholesterol, is the one you also have 🙂 but my doc ( as many docs) dont think the same way. I have sent him many studies, including dave’ stanford one 🙂
Yesterday I had my new blood test after 4 days eating as much fat as I could and double calories I used to, no coffee, no mtc, and 12hours fasting. The result wasnt too different from the first one 🙁
Total cholesterol from 410 to 407
Triglicéridos from 89 to 139
HDL from 73 to 78
LDL from 319 to 301
i suppose trigliceridos are higher due to the almost non-fasting(12h in comparison to 18h). However it is important to tell that in my first test I was taking statins and in the second one ( with lower levels) no statins at all.
What I dont understand is why my numbers arent lower… maybe I didnt eat enough calories? Normally i eat 800/900 calories but before the test I was eating around 1800 ( impossible to eat more)
Now I gotta wait for the results of the lipid profile to see the sdldl, I hope the levels are not high :/
I am gonna have a look at that fb page, I suppose I have the profile of a lean mass hyper responder… why aren’t docs in Spain that know about this?? It really is annoying!!!
Thank you and Dave so much for your fantastic work! It helps a lot to people like me who are totally lost in the “woods”
Everything is sooo confusing
Best regards,
Emma
Hi Emma, thanks for commenting back.
A couple things…
Typically double normal baseline calories is enough to see a drop but it seems there are a couple confounders here. For one, being at least 12 hours fasted is pretty important (as you saw with the triglycerides) as explained here. And since triglycerides are used to calculate LDL that may have played in. This is why it’s generally recommended to fast for 12-14 hours before any blood test (experiment or not). Additionally, it’s possible coming off of statins may played in, though I’ve not seen data on this specifically. But given they’re used to lower cholesterol, if you come off they it may have zero’d out the decrease from doing the protocol resulting in not a big change. Just speculation there.
As a side note, <1000 calories is not a lot for pretty much anyone as far as I'm aware, is there a specific reason you usually eat so few calories, if you don't mind me asking? Would you mind describing what you typically eat in a day to reach these levels? Is it usually all in one meal? Just curious - even in general (especially in people who are already lean) unintentionally undereating is something that's "on my radar", so I'm curious about the context here.
Regarding your doctor not being aware of the profile - it's a fairly niche profile typically found in people who are on low carb diets/ketogenic diets, thus I'm not too surprised. However, I think knowledge is slowly spreading. And of course many doctors learn of the profile from their patients.
Hope that helps, and hope the facebook group proves useful for your needs.
Too complicated for me to understand.
I also like to know what fats he was eating
Hi Virginia, if you had any specific questions we may be able to clarify the points of confusion. Dave does also have other presentations that may be of interest, for example this one, which may be easier to follow. Dave does specify what he eats in individual experiment posts, so you can usually find what he ate for it (it varies by experiment). Here is an example of such a post.
Hi, I am a hyper responder. My total cholesterol was 383, my HDL‘s were 72 my triglycerides were 119 and my LDL‘s were 287 my VLDL was 24. Does anybody have any advice for me? I was placed on a low-dose Staten and all of my values have gone down to a level that my doctor tells me is good. However, I want to get off the Staten. I know you are not a doctor and not giving medical advice. I have been on the Staten now for over five years. I am very healthy otherwise.
I think i am hyper responder how do i join your study
Thanks for your interest! As mentioned here, you can contact the institute to see if you qualify and if they’re still seeking participants.
I’ve been on various health diets and stayed with a Paleo autoimmune diet and eat for your blood type(0)- minus no no’s for autoimmune diet. I also do intermittent fasting at least every other day. I have hashimoto and celiac and gave up gluten, grains, soy, corn, legumes and nightshade veggies. I have no choice but to eat this way and most of my levels are good except for my cholesterol- which is over 315. I don’t eat red meat often. I add olive oil to my diet for fat. I drink almond milk. I’ve been eating grain free cereals- some with seeds, flax and I add collagen protein. I take other supplements and try to maintain a low carbohydrate diet. I’m 10lbs overweight in my mid section. I don’t eat much dairy and sugar. I eat blueberries and mostly homemade foods and soup- with fresh ginger, garlic, leafy greens, mustard, chicken, carrots, celery and onions- mostly organic. This is the highest that my cholesterol ever was. I just added back niacin, red yeast rice and will buy omega 3 today. What are my risk factors. I used to have high inflammation markers- on a pristine diet. I’d like to try something new. I’m reading things regarding low normal thyroid functioning people seem to have high cholesterol- what do you think about this. I feel it’s an innate metabolic dysfunction. There are new drugs on the market that are statins without side effects and more interesting is a new drug that blocks cholesterol absorption-, which I feel may be more beneficial? – with regards to the role of our liver and assimilation of fats. You’re very interesting, thank you for your response.
Hi, I’m Phil … I’m here because of a serious interest in the link between ketogenic diets and some mental illness