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Jan 01

Shooting for #TheCCDoc is About to Begin

Happy New Year!

I dropped a series of tweets this morning that I’ll just repost here to keep it short and sweet…

This will either be a single feature length documentary (90-120m) or a series of topic episodes (40-55m each)

I’ll be interviewing experts across the opinion spectrum. Pro lipid hypothesis, moderate, skeptic, liberal on statins vs conservative, etc.

We’ll explore:

  1. History of cholesterol discovery
  2. The #LowCarb movement and high “diet induced” #LDL
  3. The science and data of risk: intervention, genetic, and observational
  4. The two Triads, atherogenic dyslipidemia and ⬆️LDL+⬆️HDL+⬇️Triglycerides

And of course, we’ll be talking to many “Lean Mass Hyper-responders” (#LMHRs) across the world. Those who have gone low carb and have seen extremely high LDL and HDL, yet very low triglycerides.

Some are cautious, some confident, and some have taken steps to change.

I know many documentaries these days often tell one side of the story. When I say I hope to have experts across the opinion spectrum, I mean it! If you’ve followed my process for a while, you know I’m sincere in this endeavor. Each major position should be represented.

So if you’re a Lipidologist, Cardiologist, or other expert in this field and we’re visiting your city in January or February, please consider reaching out to us here: https://docs.google.com/forms/d/e/1FAIpQLSdFrcQVQPg-XFKfG-Su1qO_BTn8-JQJVR1gCNz2im0zl-4WFA/viewform

(U.S. schedule for March and later coming soon…)

Questions will include:

  • If a #LowCarb diet high in #SaturatedFat increases one’s cholesterol, even if it lowers many of their other heart disease risk factors, should it be avoided?
  • Do people with low #LDL live longer than those with high #LDL?
  • What can genetics tell us about the role of #LDL causality with heart disease? Are there any limitations in this form of science?
  • Do #LDL particles serve any benefit to the human body?
  • Is there any known context where high #LDL associates with low heart disease risk?

I can’t wait to ask these and many other questions on this journey of discovery. What better year to get a new perspective than 2020?

Lastly — I’ll be posting many updates on social media along the way. Use the hashtag #TheCCDoc to ping us.

Wish us good variance! 🙂

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paul mSiobhan HugginsNancyKirkRaymond Recent comment authors

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Jimmy Vespe
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Jimmy Vespe

Hi Dave,

Reading about your inversion pattern, which matches my observations regarding cholesterol and fat intake. I have a question, understanding that both of us are engineers and not doctors, so not taking any of this as medical advice:

Question : is high fat low carb necessary for longevity and bodily health? I have been able to have very low triglycerides and kind of high LDL high HDL while eating a high carb high protein low fat diet.

When i add in more fat, as expected my LDL drops quite a bit, but my triglycerides also tripled from 60 to almost 170.

HDL wasn’t affected much.

I like Carbohydrates and am a bodybuilder so I like high glycogen stores in the muscle. If I want to maintain that eating lifestyle (high carb, high protein, low fat) is that safe? Of if I went to more of a zone type diet and got my fat from fish, beef, and nuts is that ok?

I think it depends on my triglycerides in the blood stream (for longevity), as long as they are low things seem to be ok ??? thoughts?

Regardless of diet composition, i’m 54 years old, 6’3”, 225lbs, and 8-10% body fat, low serum glucose all the time, ie no metabolic syndrome. Also a IT guy, Director of Engineering at Ticketmaster.

Siobhan Huggins
Admin

Hi Jimmy,

Question : is high fat low carb necessary for longevity and bodily health? I have been able to have very low triglycerides and kind of high LDL high HDL while eating a high carb high protein low fat diet.

I don’t think we know the answer this question, but I’m sure many would argue no – there are indigenous populations that ascribe to high carb low fat eating patterns for example and appear to be quite healthy. Same for the opposite (low carb high fat). From anecdotes, some may fare better with a high fat low carb diet if they’ve developed something like diabetes (or at least we know this appears to work as a treatment), or other conditions, but whether it’s required for everyone? I’d be surprised if that were the case, although it’s hard to say definitively.

When i add in more fat, as expected my LDL drops quite a bit, but my triglycerides also tripled from 60 to almost 170. HDL wasn’t affected much.

To note, the two protocols that are commonly used for short term drops in LDL include the original ‘protocol’ (fat loading in a low carb context), and swapping fat for carbs if already in a high fat context. It’s *not* advised to add fat on top of a carb heavy diet as it can cause an increase in triglycerides, perhaps related to what you saw. It’d certainly not be ideal for a longer term dietary strategy either.

For the rest of your question, we don’t give dietary advice here for longevity (mostly because we don’t know what sort of diet leads to longevity in the first place!), if you wanted to experiment with different diets you could likely do so and keep an eye out for markers of concern as well as how you feel, and your body composition and decide for yourself what feels right for you.
I know what my preferred diet is for me, but that’s going to change depending on your goals and health concerns. I know for me personally, regardless of what diet I was following, I’d want my HDL to be high, triglycerides low, inflammation markers low, and follow a diet that provided me favorable body composition.
Although I’m not a doctor and can’t give medical advice, regarding low serum glucose – this alone does not rule out metabolic syndrome as far as the research I’ve read, as glucose homeostasis abnormalities are pretty late-stage. Just for me personally, I like to double check with other markers (especially fasting insulin) to catch out anything that may not pop up in hba1c or fasting glucose for a while. Just my own opinion, though.

Deb
Guest
Deb

I hope you will continue to stay current on this site for those of us who are boycotting Facebook, Twitter, and Instagram. Thanks

Siobhan Huggins
Admin

Updates will definitely be posted to CC, as it progresses, not to worry. We want everyone to have access to updates, regardless of their preferred information platform! 🙂

paul m
Guest
paul m

thank you

Nancy
Guest
Nancy

Hi, I am 63 year old with type 2 diabetes. After going keto for one year with carbs less than 20 my blood glucose came down with an A1c of 5.8. However my total cholesterol is 8.4 mmol. My doctor is adamant that i start taking Repatha as i am unable to take statins due to muscle pain and brain fog. He does not support keto diet. I am confused as most info says don’t worry about cholesterol. Is that true for those with diabetes? And how high is too high? Thank you for your help.

Siobhan Huggins
Admin

Hi Nancy – we’re not doctors and can’t give medical advice, but we can provide our thoughts – in order to do that would you mind posting the full lipid panel (e.g. HDL, LDL, triglycerides, and total cholesterol)? It’s hard to comment just off of total cholesterol, as this doesn’t provide context. If you could also provide some info regarding your current lifestyle, such as activity level, etc that might also be helpful.
Thank you!

Nancy
Guest
Nancy

Thank you for your reply Siobhan, I am moderately active, i walk fast paced for 1 hour most days, do mini trampline for 15 minutes a few times a day and swimming and dance lessons several times a week. I do not drink or smoke and eat clean whole foods for the most part. Since getting this news I have stopped keto/ high fat diet and now doing low carb, low fat. I do 23:1 fasting every day now. Only lost about 10 lbs on keto. My bmi is 28. My BP is 120/70. I had a carotid artery ultrasound a few months ago which showed minimal narrowing. Normal for a person my age. I feel great. No aches or pains. My lipid profile before keto Trig 4.04, HDL1.14, LDL 3.63 . Did strict keto for a year. Now it is Trig 2.42 , HDL1.16 LDL 6.15. Thank you for your thoughts.

Siobhan Huggins
Admin

Thanks for the additional information, that helps put things into context a bit better. 🙂
Just a quick follow-up question, as your triglycerides are still a bit above what I’ve expect for a low carber – were you 12-14 hours water-only fasted for the test (e.g. no coffee). If not properly fasted, or fasted overly long, sometimes this can result in unexpected results, including higher than expected LDL and lower than expected HDL. If you were, and if it were me (although I’m not a doctor and can’t give medical advice so can only comment on what I would do), I’d likely want to investigate further to try and see what’s causing it.

Beyond that, there are certainly people who go on a ketogenic or low carb diet and see an increase in LDL, called hyper-responders – the extreme of this being Lean Mass Hyper-responders. The running hypothesis is this is due to fat-based energy demands, due to running off of fat. For people who are looking to move away from this profile, they tend to go for a more relaxed low carb approach, e.g. swapping some fat for carbs. In the cases we’ve seen of people doing this, it appears to result in the most reliable lowering of LDL (perhaps reflecting the energy model in action).

Nancy
Guest
Nancy

Thanks Siobhan. Yes i was water only. I don’t drink coffee. I was eating very high fat. My doctor says i have familial hyperlipidemia. I guess the “high cholesterol doesn’t matter” does matter for some people? I am scared now and am taking the Repatha. Heart disease and strokes at a young age runs in my family. I stopped keto, doing 23:1 fasting to try and improve my cholesterol.

Siobhan Huggins
Admin

Hi – although I’m not a doctor, what I *have* heard from doctors is that generally when it comes to familial hypercholesterolemia the “familial” part means “genetic” and is present from birth – considering your levels appeared to be more around where you’d expect before the diet change, I’d suspect that first if it were me with the same two profiles. Diet induced changes in cholesterol is something we do see in the community – as I mentioned prior.
I don’t think Dave or I would ever say “high cholesterol doesn’t matter” – rather there’s some evidence that context may be important for risk – but I think there’s much to be explored there. I think it’s fair to hold the opinion that it seems fair that everyone may benefit by reading the research for themselves and work with their doctor to decide what they’re comfortable with until we have a solid answer of whether this or true or not.
FWIW, although I can’t give medical advice, if it is the diet that caused the increase in cholesterol, and you are not comfortable with it, then many people who find that this is the case find that they can lower fat and increase carbs proportionally (e.g. not adding carbs, but swapping them in to replace some fat they’ve removed) and this can cause reductions.
And, just in case you do return to keto at some point you may find this post on high triglycerides in a low carb context helpful for troubleshooting – as if it were me, regardless of what diet I decided on, it’s something I’d want to try and pinpoint and resolve.

Good luck whichever way you decide to go from here, I hope it all works out for you and you find something that makes you feel the best and ensures your comfort about your own health longterm. Something we can all strive for. 🙂

Colleen
Guest
Colleen

How is your health faring on low carb? Improving? Blood pressure? Weight? Fasting insulin? Inflammation? If this is all good, it appears high cholesterol not relevant. Cholesterol also naturally higher in an older population, and as noted elsewhere by Dave, the US NHANES data shows as we age those with the highest longevity have higher cholesterol. Needed for immune function. Does the doctor understand the mechanism of action in the proposed drug? Has he explained what harm the cholesterol is doing to you? Have you had any scans? Most of the doctors are just treating you like a number and have very little understanding of statistics and drug mechanisms. Just pushing guidelines not relevant to YOU. High cholesterol may be bad in a person that has hyperinsulinemia but simply hasn’t been proven in a low carb, low insulin, low trig population. I am so tired of hearing about doctors bullying patients when the doctor does not understand the patient has largely addressed the problem through diet.

Gee Dee
Guest
Gee Dee

When I had my lipids checked after finally getting my weight JUST into the normal range, having lost 19kg, I was mortified to find my cholesterol was over 11mmol/l. Trig was not low but normal. Had cardiac artery calcification score done and it was in the lowish risk category. I loved the low carb, higher fats and normal protein diet I was on. I found it sustainable. But my question to experts would be, is continuing this style of eating detrimental to my artery health? I have never been able to maintain weight loss on low fat diets.

Siobhan Huggins
Admin

Hi, Gee Dee –
We’re not doctors (nor experts, although we are very interested in the topic) and can’t provide medical advice, but would be happy to post our thoughts. However in order to do this, it would be very helpful if you could post your full lipid panel for context (total cholesterol, HDL, triglycerides, LDL) as ‘normal’ or ‘low’ for various markers like triglycerides can vary by lab/etc.) if you’re comfortable doing so. Thank you 🙂

Colleen
Guest
Colleen

And your age. The CAC score could be improving after losing 19kg. Suggest you repeat in 12 months and see if the CAC getting better, worse, or staying the same. If everything is better but cholesterol, how can you be worse? Does not make sense.

Arthur Jones
Guest
Arthur Jones

Malcolm Kendrick discussed this article in his most recent post

https://bmjopen.bmj.com/content/bmjopen/9/12/e028638.full.pdf

it would seem the authors report that those with higher LDL levels did better than those with low LDL levels (but called hyperlipidaemia)

Raymond
Guest

Hi Dave … will you be meeting with Malcolm Kendrick in the U.K.? You could do a whole movie with him poking holes in the fat/cholesterol theory of heart disease. Have you read his series of blogs on what causes heart disease? I guess you saw Ivor’s interview with Malcolm.

Kirk
Guest
Kirk

I’ve been on Keto/LCHF for 11 months and while I’ve seen an increase of HDL(42) LDL(187) but my triglycerides are still @ 225!?! Which is a decrease from 395 when I first started 11 months ago. I’ve lost 85 pounds from 285 to 200. I do take Synthroid from having my thyroid removed but my TSH is 2.83. Also, I was diagnosed type 2 10 years ago. My A1c has gone from 10 to 5.6. I don’t know if I should be concerned or just keep on doing what I’m doing. My doc also has me on Fenofibrate 145 mg. Any comments would be appreciated! Thanks!

Siobhan Huggins
Admin

Hi – if I were in the same situation, that’s something I’d want to follow up on as well.
I can’t comment on the effects of any medication, as I’m not a doctor and don’t have experience with them in my own data anyway, but you might want to check out this post about high triglycerides on a low carb diet, and see if any seem likely to you. In particular verify you were 12-14 hours *water only* fasted, and if not that one of the others. Additionally, if you have any other markers this may help provide some context as to what’s causing it as well.
If you have any further questions about trying to troubleshoot, please do feel free to ask! 🙂