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Apr 20

The Fasting Disaster

fasting_macros

Fasting has been all the rage lately. Jimmy Moore and Jason Fung released a book on it that quickly shot up the New York Times Best Sellers list. In fact, it has been so popular that they launched a podcast on it at the beginning of this year. Oh, I did I mention the episode featuring Jason Fung and fasting is still the most downloaded of the 2 Keto Dudes podcast?

Yet other high profile low carbers such as Dr. Stephen Phinney are not part of the fan club. My personal favorite article on the subject was Not So… Fast… (A Rant) from the prolific Amy Berger.

While on low carb myself, I’ve only ever intentionally fasted for 14 hours at a time, which was only done to meet the requirements of a blood draw. But while I don’t feel hungry when fasting, I don’t feel… right.

To be sure, I’ve wondered if I want to eat all the time so that I either maintain or gain weight, given I’m underweight right now. And therefore my feeling odd when not eating is perhaps entirely mental manifestation. Regardless, a fast of a few days probably wouldn’t be that bad anyway, right?

The Experiment

The plan was pretty simple:

  1. I’d take a blood draw in the morning at the beginning of the fast.
  2. Fast for three days while both supplementing and keeping electrolytes high, but otherwise drinking only water.
  3. Take a final blood draw for comparison on the morning 72 hours after the first blood draw. So in all, 86 hours will have passed since my last meal, making it a total of 3.5 days.

Execution

Day One: I was surprised to find I wasn’t hungry at all. This seemed to back up my theory that if I had already made the commitment to myself to forgo eating, my brain wouldn’t send me subconscious “shouldn’t we be eating?” signals.

As happens with me when I’ve lowered my total calories for an experiment (but while still being keto), I feel run down and puny. I have an overall feeling of lower energy. I also feel a little dispirited in this state, but its hard to tell how much of that is annoyance of that phase of the experiment vs it being an actual physical response.

However, that not-feeling-right sensation I mentioned above?… I was certainly getting that signal. But I had hoped I’d only feel it on the first day.

Day Two: I still wasn’t feeling hungry. And while I did continue to feel low in energy, it wasn’t notably better or worse.

However, the not-feeling-right sensation was definitely much, much higher. It was like nothing I’ve experienced before this point. In my imagination it was as though my body found a red phone line and called some special center of my brain to say, “ABORT! ABORT!” No physical pain, no odd changes in the senses, nothing other than a feeling… a feeling this was terribly wrong.

By the evening I decided to go ahead and cut the experiment short. I’d take my blood on the morning of Day Three as opposed to Day Four. Heck, at least it was a 2.5 day fast in the Data Can. I just knew I’d feel annoyed if my numbers had hardly changed. (Just writing that last sentence makes me laugh out loud now…)

General Bloodwork

In every blood draw now, I get a slate of general panels like a CMP and CBC. The latter is known as a Complete Blood Count and has 14 markers. These numbers always been in range… until this time.

 

Ref Range 3/21/17 3/23/17
RBC 4.10-5.70 5.02 5.85
Hemoglobin 13.0-17.0 15.3 18.1
Hematocrit 37.0-49.0 44.6 52

All of these markers have to do with red blood cells and their functionality, which I won’t cover here. What I really wanted to see is if I had fallen off on my electrolytes, which would explain both the run down feeling and my general sense of malaise.

 

Ref Range 3/21/17 3/23/17
Sodium, Serum 134-144 137 136
Potassium, Serum 3.5-5.2 5.1 5.8
Calcium, Serum 8.7-10.2 9.6 10.5

Interesting — instead of being under, I was over on K and Ca.

Cholesterol

Of course the big one is the lipid profile. And if you follow me, you already know what I’d predict after fasting for the very first time given the Inversion Pattern –> a record increase in LDL cholesterol.

So what happened? I hope you’re sitting down for this….

 

Ref Range 3/21/17 3/23/17 Difference
Cholesterol, Total 100-199 371 479 +108
HDL-C >39 72 70 -2
LDL-C 0-99 284 368 +84
LDL-P <1000 2068 3348 +1280
Small LDL-P <=527 <90 546 +546
Triglycerides 0-149 76 205 +129

Indeed it was a record!

Let’s unpack a few things:

  • Like the Extreme Drop Experiment from last year, this one had a heavy shift in dietary energy, as in a sudden drop off. And likewise this huge degree of change broke the Inversion Pattern with LDL-P, while still demonstrating its general direction (lower fat = higher cholesterol).
    • Given the pattern up to this point, we’d have expected LDL-P to land around 2200, but it instead landed much further upward at 3348. This is strikingly consistent with with the drop experiment that likewise overshot in the other direction (from 2597 to 1487 in three days!).
    • Yet LDL-C would be expected to land around 355 +/- 22 and sure enough it landed at 368.
  • While I don’t like doing these huge shift experiments, I am glad they continue to reinforce the general mechanics of the Inversion Pattern and further establish its nature.
  • Once again Small LDL-P pops up in a low dietary energy context.

Final Thoughts

  • While the experience wasn’t great, the data from this experiment was golden! As predicted, the Inversion Pattern kicked in and demonstrated just how fast cholesterol can rise while fasting, particularly for a hyper-responder like myself. I guess that last bit doesn’t actually sound like good news, but don’t worry, the blood test taken just 4 days later (not shown) had my Total and LDL cholesterol drop down near where they were on 3/21.
  • I already didn’t enjoy fasting for even a half day before this experiment… now I’m very sure I don’t want to fast for longer either. This might be something I’d consider if I weighed more, but probably not. The incredibly alarming feeling I experienced was something I’d prefer to leave in the past.

[UPDATE]

Hat tip to James DiNicolantonio who pointed out my Uric Acid likely had likely risen and I sure enough it proved to be true:

Ref Range 3/21/17 3/23/17
Uric Acid, Serum 3.7-8.6 5.8 8.2

I run a script that captures every marker outside its reference range and (unfortunately) mostly noticed those that did. Technically, Uric Acid was still inside, but obviously moving upward fast. Would it have gone above range had I been fasting another day? Alas, I’m now unwilling to find out anyway.

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Alejandro
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Alejandro

Very similar experience for me.
1. Ketogenic diet for several month
2. fasted for 4 days (96hs) before blood work
3. blood work 14 days later (eating “normally” and not being in ketosis)

Resutls
Fasted 4 days ===>>> eating “normally” + not in ketosis
Tot Col 434 ====>> 338
Trig 109 =======>> 92
LDL-C 337 ====>> 259
HDL 75 ========>>61

Theresa F.
Guest
Theresa F.

For some reason, I’m not concerned with my cholesterol going up while fasting, nor does the ‘hunger’ that lasts maybe a minute bother me. I feel it’s merely psychological since anyone burning fat has plenty to ‘eat’ in their fat stores. My energy is good, I feel fit and my HA1C went down from 6.7 to a steady 5.4. The effortless weight loss and almost total lack of carb cravings is a real relief, as well, but to each their own. 🙂

Nicole recine
Guest
Nicole recine

The electrolytes likely reflect dehydratation. I hope you rechecked them since. Those being abnormal can cause heart arrhythmias

Bryn
Guest
Bryn

Do you think dehydration contributed to the changes? Particularly in light of the CBC changes?

Herbie
Guest
Herbie

Brilliant article

Charles
Guest
Charles

Why is a TC of 371, DL-C of 284 and LDL-P >2000 GOOD??

Sj
Guest
Sj

I’m wondering what this would look like on a non hyper responder Dave. Any hypothesis on whether it might have something to do with the results?

Joe
Guest
Joe

I wonder if what you saw here was actually a good thing (if done in the short term, not chronically?!

If in fact fasting stimulates autophagy, then perhaps we are seeing blood cell turnover where you made lots more and then the old ones get broken down.

Similarly, since cholesterol is involved in so many repair and production processes such as hormone precursors.

Julie Gregory
Guest

Hi Dave,

Another fascinating experiment! The folks at ApoE4.Info (www.apoe4.info) have been closely following your work with admiration. We applaud your citizen scientist approach to understanding the role of cholesterol. We’d like to invite you to speak with us at the LowCarb San Diego event in August. We’re especially eager to hear more about what you’ve learned about being a hyper-responder of dietary fat. I suspect your work may have implications for our population. Please contact me at: [hidden] for details. Thanks for your consideration.

Best-
Julie

Chris
Guest
Chris

Dave,

Fascinating as usual! I’ve asked you think on Twitter but to reiterate, what I really want to know is: based on lipid response to fasting, when is the ideal time to measure lipids to give the absolute *best” insight into future CHD risk? Is it best to do one in the middle of a normal day, one 12-14 hours fasting, and perhaps one just after a meal?

-Chris

Macro Four
Guest

Interesting that you found fasting uncomfortable. I have done two three day fasts always breaking them for social reasons rather than for feeling unwell. The difference is I am chowing down mostly on my own on body fat as I am overweight. My understanding via the 2ketodudes protein episode is that there is an upper % limit to the body fat you can convert so It makes sense that if fasting when not overweight your body would signal discomfort at eating too much body protein.

Thanks for putting up with your pain mistress called science!

Macro Four

ReneeAnn
Guest
ReneeAnn

I’m not interested in fasting at all, but am always about 14 or 15 hours fasted when I have my cholesterol checked and I have high total (around 300), high HDL, low trigs, high LDL and high particle count. I wonder if I tried getting tested after breakfast if I would have a better reading? I have not heard of a hyper responder to fasting before.

Nadir
Guest
Nadir

you should get it checked normally like you do after a 14 hour fast but eat high fat for the three days before like Dave Feldman has done. That will work better.

Rob
Guest
Rob

Is it known if the ratio of cholesterol to other “passengers” in LDL and VLDL stays constant? Or could it be that when the body needs more fat due to e.g. Fasting, the relative amount of cholesterol in LDL and VLDL goes down.

So you see a rise in VLDL and LDL but there might not be a change in the bodies’ total circulating cholesterol?

Charles
Guest
Charles

Incredible short term changes, what do you think the long term effects would have been, for people doing 10+ day fasts? Gene changes would kick in?

Emmanuel
Guest
Emmanuel

(Minor typo with small LDL-P: +564 -> +546)

Manu
Guest
Manu

I see exactly the same effect in my tests. So the implication is to stop fasting because it drives LDL to unhealthy levels?

Leigh Yaxley
Guest
Leigh Yaxley

Why assume that the LDL levels are unhealthy? That’s just the old paradigm with which we have all been brainwashed.
Some people in this world are short and some people are very tall. Is it dangerous for them to be so different to the average height of the human population.
I think the same applies to cholesterol.

Fleur Brown
Guest

How about repeating the experiment but trying a 16/8 fast for a few weeks by skipping breakfast….you may lose some weight though.
Dr Mark Hyman who says he needs to keep his weight up as he is very slim, eats some starches like sweet potato to ensure he doesn’t lose weight so when you eat after the 16 hour fast you may need to add in some low GI starchy carbs perhaps.if you start losing weight.
Dr Terence Kealey has written a very illuminating and interesting book on skipping breakfast ” Breakfast Is A Dangerous Meal “….

Philip
Guest
Philip

Just got lab results today which flabbergasted me. I have been on the extreme LCHF version of my diet needed to actually lose weight (I shoot for 500-1000 cal, 90% from fat and most of that saturated fat).

BTW, doing LCHF for over 5 yrs.

Cholesterol numbers are through the roof for me:
LDL-P 2260
LDL-C 227

HDL-C went down from my usual range and is at 53.

What interests me about my results are the high Triglycerides (168) and high glucose for me (104). Any speculation about what would drive these numbers up due to my near-fasting? If I need to get myself up to speed science-wise here, any resources to understand this mechansim?

Marie
Guest
Marie

I wonder if the rise in your numbers with fasting is a type of stress response. I am a hyper responder and recently noticed a huge rise with acute stress – in a nutshell, I was admitted to hospital and very worried, cholesterol on admission 250, then sent home next day thinking all was ok, relaxed, then 3 days later got the results I wasn’t ok and spent the next 4 days in hyper stressed mode worrying myself sick. Cholesterol was 350 at next appointment! 10 days later in reduced state of stress, cholesterol was 227. This was all psychological stress not physical. So, do you think raised cholesterol is a response to cortisol – hard to do an experiment on this though!?

stephane
Guest
stephane

Hi dave

Thanks for providing such a useful information. I’m an hype-responder too and never tried longer than 14 hours fasts. Maybe one day I’ll try it with your experiment in mind to see if I can stand it.

Apart from that, I’m wondering why Lipid tests don’t include NEFAS (Non Esterified Fatty Acids). If I’m not mistaken they take some part in the Lipid trafficking in the blood stream the difference being that they don’t come bundled in Lipoproteins but are bound to Albumin. Isn’t this a missing data point in any study about Lipid levels ? To my knowledge, they can be elevated in a series of conditions like Insulin resistance, uncontrolled Type 1 Diabetes and prolonged fasting.

Thanks

Nils Hoernle, MD
Guest
Nils Hoernle, MD

Hi Dave; These are curious results (speaking as a doctor who looks at lab results all day every day). The high potassium is surprising, and could be from hemolysis during the blood draw (the needle tip not being exactly in the vein slices the passing red cells open, releasing potassium). Or from the electrolytes?

Also, it’s unusual to see a true bump in Hct from one day to the next unless it’s from vascular volume loss (so the increase is relative to the decrease in blood serum). Fasting, we know, causes insulin to drop and Glucagon to rise, thus mobilizing our fat stores for fuel. But because Insulin causes sodium retention, it raises intravascular volume, and by fasting and thus dropping Insulin, there is a diuretic effect as sodium is dumped via the kidneys, and water follows it. (Hence the quick wt loss seen w a ketogenic diet, and the drop in BP). So you are probably not “dehydrated” as such, and probably don’t need to take electrolytes for such a short fast.

A couple more points;
– it’s hard to draw real conclusions from an “n of 1”, so please, please, repeat this and see if you get the same results (I’m guessing not)!
– a lot of us (and likely you as well) are starting to conclude that chol and lipids made by the body naturally are normal healthy components of energy distribution, and their quantity (as opposed to quality) does not directly cause atherosclerosis. Plaque seems more the result of corruption of the particles from things like oxidation (smoking, artificial Trans and Oxidized fat (polyunsaturated seed oils), HTN (vessel wall stress), inflammation (immune response to damage from AGE’s from excess sugar, processed foods, additives, toxins, allergens, invaders, etc), calcium buildup from under-carboxylated Matrix GLA Protein due to Vit K2 (menaquinone-7) deficiency, and direct negative effects of Insulin on the endothelium (DM2 and Insulin-resistant DM1’s).
– I have been reviewing CAC scores for my patients for almost a year now, (n=40), and have found no relation between high LDL and high calcium scores. There is a strong relationship between the Trig/HDL ratio, however (marker of Insulin resistance), as well as the ALT and AST (marker of hepatic inflammation and cell death, over about 20), cardiac CRP over 2 (inflammation of vessels), fasting Insulin over about 10, and A1c over 5.5 (3 mo avg blood sugar).

PS – I love your inquisitiveness, and your inversion theory of cholesterol, and hope you keep pushing the envelope!! Below is a link to a really great article on Intermittent Fasting and it’s benefits. (I fast 16 – 23 hrs a day, and absolutely LOVE the way it makes me feel! My brain is sharper and more focused, and by exercising while fasting I have built much more muscle mass (and skiing agility) from the elevated Growth Hormone and BDNF (Brain-Derived Neurotrophic Factor). Note that it does take most folks about 2-3 weeks to switch to this form of metabolism)

authoritynutrition.com/10-health-benefits-of-intermittent-fasting/

Leigh Yaxley
Guest
Leigh Yaxley

Dave,
I have a simple explanation to offer. Here goes:
1) Since you are well adapted to LCHF your metabolism is primarily utilizing fat for energy.
2) During the 3-days of low fat consumption (and especially low fat + calorie deficit – the extreme drop) you are effectively ‘starving’ your metabolism and it will compensate by cranking up lipolysis of adipose tissue and greatly increasing your level of circulating free fatty acids (FFA) – akin to fasting.
3) Most people think of adipose tissue as just ‘fat storage’, i.e triglyceride (TG) storage but it is also a large reservoir of stored cholesterol.
4) The size of the cholesterol reservoir is proportional to the TG content, which suggests that homeostasis of cholesterol within adipose tissue might well be tightly coupled to TG metabolism. If so, any cranking up of TG lipolysis will likely be accompanied by an increased efflux of cholesterol out of adipose tissue along with the FFA.
5) During fasting/semi starvation the rate of fatty acid cycling is much greater than actual oxidative demands – probably by a factor of two to three times. Therefore if cholesterol and TG metabolism from adipose tissue are indeed coupled there is a good chance it will get manifested as an increase in serum cholesterol.
6) I will avoid trying to theorise a detailed mechanism for how the different lipoproteins participate in all of this except to say that it probably begins with an increase of HDL in order to reverse transport the increased cholesterol efflux and increased HDL is one of your observations.
7) Now during the 3-days of high fat (and hypercaloric) re-feeding I think the opposite of the above happens. Adipose tissue lipolysis is cranked down and probably stops as chylomicrons and FFA flood in. Again if the ‘coupling’ assumption is correct the cholesterol efflux from adipose will also be cranked down and get manifested as a decrease in serum cholesterol.

Bert mellinger
Guest
Bert mellinger

Occums Razer. Dave what if you redrew your charts with the following formula: Fat= Calories burned – dietary carb – dietary protein. So fat is 100% while fasting. And while in a calorie deficit, fat is dietary fat plus deficit fat burned.
This would explain the continued increase in ldl p while fasting.

beags
Guest
beags

Hi Dave – are all your blood tests done, fasted (e.g. overnight if not ‘fasting’) and at the same time?

I’ve been in and out of keto for a few years and generally just supplement carb for intensive cycle rides. I’ve stopped counting macros but my last (overnight fasted) bloods where not so ‘good’:

HDL 82
LDL 432
TRIG 122
TC: ??!!

Audrey
Guest
Audrey

Interested in why you think your RBC etc increased?

Lorraine
Guest
Lorraine

Hi Dave ,
Thank you for sharing your findings, they are fascinating! I have been lchf for 10 years. I started out on Atkins and over the years have slid off here and there but for the most part have kept to it. Since hitting post menopause I have gone to Keto and IF. I am post trauma after being hit by a car last February so somewhat sedentary since then. I am about 20 lbs overweight and working on losing it. It’s slow going!
I recently moved and on gaining a new family doctor, he ordered a lipid panel. I have never had one done before, I am 59 yrs old. So I took the test and the results were not stellar! Here are a few,things I think might skew them…I was fasted water only at 40 hrs at time of test . The fast was in response to some high carb indulgences especially a dinner that was 2 days before the test…..and was on a steroid inhaler to reduce a cold induced bronchospasm.
Cholesterol 339.9 , Trigs 132.8, HDL 64, LDL 250, Non HDL 128.7

My doctor who claims he approves of the Banting diet ( he is from South Africa and didn’t recognize the word Keto) quickly recommended statins and a vegetarian diet! I refused both much to his horror!

I wouldn’t say I was lean but do you think this is still a hyper response?

Dennis Shumaker
Guest
Dennis Shumaker

I recently completed a 3 day 19 hour water only fast from Oct 19 430pm to Oct 23 1130am
I took the blood test 45 minutes just before breaking by fast Oct 23 1043am.
I do have a blood test from Oct 17, a few days prior to starting my fast.

Too bad I cant post a pic of my metabolic panel and cholesterol.
I too see very elevated levels of Bilirubin, AST, Total Cholesterol, Triglycerides, LDL and VLDL

Before/After
Bilirubin 0.5 -> 1.6
AST 46 -> 60
Total Cholesterol 183 -> 222
Triglycerides 86 -> 175
VLDL 17 -> 35
LDL 78 -> 112

Im not nervous about it, yet.

I think this may be more of a matter of going keto and body destroying cells to feed itself.
The idea being was to replace bone marrow, white blood cells with healthier new cells.
That said, its more important to check and possible recheck the same test possibly a week or two later.
Maybe even upto a month later.

So the original post of this thread didnt include the blood test to show recovery – that would then be a more complete picture in my opinion.

Philippa
Guest
Philippa

Hi Dennis,
Just wondering if you could share the white blood cell count and absolute lymphocyte count from your blood tests at baseline and after the fast? I am wondering if the lymphocyte count is the key to the renewal of white blood cells that you refer to.

Kathleen
Guest
Kathleen

I am a 55 year old woman, quite thin. I have always had reasonably low cholesterol (total around 160). But the past three months, I’ve been doing intermittent daily fasting (with a few 24 hour fasts here and there) of 19 hours (eating only between 2 and 7 pm). My most recent total cholesterol came back as 297! HDL was 91, and tryglicerides 60. As those last numbers were okay, my doctor did not recommend statins (which I wouldn’t take anyway).

I do have a heart disease in my family (father died at age 55 of heart failure; not overweight nor a smoker, fairly active). So I would like to see lower cholesterol numbers. On the other hand, my father had normal cholesterol levels (though autopsy revealed extensive heart disease).

Anyway, I offer this to show that even intermittent fasting can drive cholesterol way up. So I’m back to three meals a day and will retests within a few months to see if that changes things.

Thanks!

Kathleen

Craig
Admin

Kathleen,

Based on all the research documented on here, I would expect LDL-C to increase with IF.

I’m curious why you started IF, since you are already thin? (I’m in the same boat, thin and practicing some IF, CVD in family).

IMO, your lipid panel is enviable, TG/HDL of 0.7. If you are disappointed that you need to give up IF because of a TC score, I’d encourage you to get some better metrics before making a decision. At 55, you might consider a CAC test. Ivor’s talk is a great intro on that.

Jim
Guest
Jim

Dave,

The effect you observed is not uncommon. See this 2014 study: https://www.sciencedaily.com/releases/2014/06/140614150142.htm. Fasting needs to be done over a period of time to see changes. What you probably experienced is your body trying to fight the sudden change by dumping more cholesterol into your blood.The inversion you speak of is probably a temporary self-protection effect, and not a long term phenomena.

Di Smith
Guest
Di Smith

I am female age 61. 173cms ( 5’8’). Currently 63kgs ( 139 lbs) Very active and well (athletic most of my life) I always look slim, but my body fat with calipers has always had me in the obese range! Normal weight and BMI 21. I work full time in my own business and am happy. No medications beside supplements, mg, d3, Omega 3, zinc.

I have followed LCHF since 2013.
3 months ago I stopped drinking completely (was wine about 2 sometimes 3 glasses, every day) I felt it had become a bad habit. I wanted to focus more on my health and well being. Wanted to lose a couple of kgs and get a bit stronger and toned. I was cheating occasionally on lchf and wanted to get back on track. The easiest way for me to do this was to go into ketosis which I did very easily about 3 weeks ago, I increased my exercise to daily 1.30 hour weight training exercise. I walk 4 KMS daily to and from work. I have lost 2.5 kgs in last 2 weeks am feeling great and strong and sleeping like a baby 8 hours. Could not actually feel better!! I go for annual blood tests for my own interest every year.
I was shattered today when I received my labs taken while in ketosis!
Previous/yesterday
TC was 8.8 (340) – now 11.66 (447.87)
HDL was 2.3 (88.9) – now 1.8 (69.6)
LDL was 6 (232) – now 8.1 (313.22)
TRI was 1.7 (151) – now 2.75 (243.57)
HDL Ratio was 3.8 – now 6.4
Non HDL was 6.5 (251) – now 9.8 (378.38)
HbA1C was 5.4 – now 5.4
Fasting Sugar was 5.3 – now 5.1 (91.89)
CRP was 0.5 – now 1.73mg/L

I typically eat 16:8. Time restricted eating.
So my eating has been high in saturated fats this last 3 weeks! I loose my appetite when in ketosis, but not my energy so I thought everything was perfect until I got these results!! I have followed you videos and blog and Twitter for a while so I am aware of your experiences…. If you are a hyper responder I am a super hyper responder! The results that bother me most, all of them, but CRP and triglycerides!! Any comment? Thanks

Traci
Guest
Traci

Hello Di,

Since we sound similar and I’m going to start LCHF soon, your post was of interest to me so I found this that you might be interested in: https://friedmansprout.com/2015/04/01/how-does-a-ketogenic-diet-affect-you-part-3-c-reactive-protein-a-marker-of-inflammation/. Have you thought of doing IV therapy? You can get an inflammation reducing cocktail and that might help these numbers. Just a thought!
Best wishes!

Di
Guest
Di

Hi Traci
Thank you, the article was interesting and happily, I believe I know what was causing the high CRP so will not do an IV therapy. My CRP is usually very good. Best wishes with the LCHF lifestyle:)

Abhishek Anand
Guest

It is interesting to note that your small LDL-P rose that much. My small LDL-P hardly budges: it stays between 1040-1089 even when my LDL-P fluctuates between 1617-2295.

Steve Phinney and others have proposed that during fasting, the body mobilized the cholesterol stores in adipose tissues.
https://www.ncbi.nlm.nih.gov/pubmed/2035468
I never quite understood how this happens. Do the adipose tissues directly store LDL particles which come back to circulation after weight (fat mass) loss? Or fresh LDL particles from the liver visit the adipose tissues and there stuff in more cholesterol from the adipose tissues?

If one’s adipose tissues were formed when they were eating badly (e.g. high sugar diet), could major weight loss unleash damaged (e.g. oxidized) cholesterol or LDL particles into the bloodstream?
In the above article, Phinney cites the following paper:
https://academic.oup.com/aje/article-pdf/129/2/312/200594/129-2-312.pdf
Here is a quote from its abstract:
‘The 25-year crude risk of coronary death was 26% in the “gain and loss” group, 15% in the “gain only” group, 14% in the “no change” group, and 17% in the remaining 1,550 men.’
I am stunned that the risk was greater in the “gain and loss” group than the “gain only” group.

I am especially worried about this possibility because my symptoms (exertional chest pain) of 99% LAD blockage first appeared after I lost 8kg in 5 months.

D
Guest
D

I’ve been doing alternate day fasting for 5 years, and I started that after moving to an all organic diet with essentially no processed foods. Some years before the alternate fasting, my triglycerides were at 100, and in those days I had a sweet tooth. I just got them measured after an eating day (so after ~12 or so hours of fasting) and they were 340.

Another guy on reddit who does intermittent (not alternate) fasting, says his triglycerides are at 52.

I’m not sure what to make of this.

(I’ll add that ADF was very natural for me. It was like discovering what I had been looking for, for years.)

D
Guest
D

Ok, so I’ve just watched one of your talks. Here’s more data on my lipids, and this is from a person who has been doing ADF for 5 years, loves it, and has a steady weight. This was measured the day after an eating day, and so on 12 or 13 hours of fasting:

Total cholesterol: 184 mg/dL
HDL: 53
LDL: 63
Trig: 340

So my Trig’s are high, but my LDL’s are low. Hm. Do I understand correctly that it’s the LDL’s shuttling around Trigs? If one’s high, shouldn’t the other be?

D
Guest
D

Thanks for your reply. They seem curious to everyone else involved, too. To answer your question, no, I am not doing a ketogenic diet on my eating days. I did try a higher fat low carb diet at one point, prior to doing ADF, and found it didn’t work for me. It made me tired and foggy. Presently, my diet consists of basically: veggies, fruit, eggs, chicken, a little rice, a little fermented, gluten free bread, a small amount of nuts & seeds along with some coconut.

I have just made a modification due to a UTI: I have removed all fruit. I will replace that with more veggies and … well, we’ll see what feels right. I plan to retest after the UTI is resolved, and see what happens.

D
Guest
D

I don’t know if it’s useful, but I do have some other lipids results from some years before, when I was doing nothing special for diet, other than whole, organic, foods. I was also a long-time, 28 yr, vegetarian. I would have to say that at that time, I had a bit of a craving for both sugars and fats.

Total cholesterol: 189 mg/dL
HDL: 50
LDL: 119
VLDL: 20
Trig: 100

So while my total cholesterol and HDL are similar to my recent test, my Trigs are more than three times lower and in the (supposedly) normal range, but my LDL is almost twice as high.

Dawson Oliver
Guest
Dawson Oliver

Your “inversion” is nothing more than dehydration. Anytime you fast you must be more hydrated than usual. When you are dehydrated everything in your blood in more concentrated so you are going to see increases in CBC, CMP, Lipids, and decreases in electrolytes. This article is utterly useless.

Douglas Hoover
Guest

My Name is Douglas Hoover- In the spring of 1975, I read 2 books by Dr. Paul Bragg, Water, The Shocking Truth, and The Miracle of Fasting. I fasted for 19 days to get rid of gout and get off the Zyloprim…Gout disappeared after 6 days. Continued fasting every year for 21 days (distilled water only) and every 5th year fasted for 40 (while working the entire time in my construction company. Fast forward 34 years, I performed 26 21-day fasts and 8 40 days fast. I know very little about biology, medicine or science! However, I do know this for sure, for 43 years I eat meat, dairy, bread, butter, eggs, and bacon etc. along with drinking a minimum of 1 gal. distilled water daily. I started my 9th 40 day fast at 70 yrs. of age January 15 and will be drinking 1.5 gallons of distilled daily and working out at LA Fitness 1 hour three days a week. I had complete blood work and physical at Scripps Clinic in LaJolla CA prior to starting. I’m documenting this fast and will be publishing a book, “Diary of a 40- Day Fast”. First Fast I ever started and finished with medical monitoring. My faith in MDs, ND, and PhDs is not so very strong. If you Google ” “drinking distilled water can bring early death” you will find this exact statement has been quoted by 1,300,000 times. I do, and I have not been to a doctor for 34 years for sickness and never took any drugs! My wife is in the same program! We are on the 6th day. The book will be available on FastingAuthority.com when it is finished. Get a free copy of my last best seller sold on Amazon/ Kindle at DistilledWaterAndHealth.com A man with an experience is not at the mercy of a man with an argument. Dave, you more than likely will delete this but I shared it primarily with you for your own benefit.

Derrick
Guest
Derrick

Just last week i finished a 12 day water( smart water ) fast. Some himalayan salt on several days only was added. Ht 6’2″ and 210 at the start. End day 12 at still 6’2″ : ), and 187. Mild fatigue yet energy for everything. Wish I did Pre labs but results are …Chol 210, Tri 91, Hdl 40, Ldl 152, Glu 63……4 years ago last results and only major change was Tri from 59 to 91 also Small particle number was quite high “” . 2 years ago I did a 22 day water only and felt fantastic from day 4 to 22…..No change in work schedule through out ….i daily intermittent fast as well…..

Greg Mueller
Guest
Greg Mueller

My question is, why would an alarming feeling dissuade you from fasting? It’s a stressor, it’s not supposed to feel amazing. Also, the first 2 days are the worst, so if you stop there you’ll never really feel the “good” part people talk about (good in a way that is hard to describe).
Would you not work out because it made you out of breath, gave you a burning in your muscles, or made you dizzy/lightheaded? Of course you do, b/c you know it’s the recovery from that stressor that makes you stronger. It’s the recovery from the fasting that makes you stronger at the cellular level, that increases mitochondrial density/efficiency, insulin sensitivity, etc.

trackback

[…] The high LDL is likely due to the fasting.  I was tipped off to this phenomena by the self-experimentations performed by David Feldman, a software engineer by trade, but someone who has made a name for himself in the world of Ketogenic diets.  Normally, people on ketogenic diets report excellent improvements in lipid blood panel numbers.  But David is an exception.  He is what is called a hyper responder.  While on a ketogenic diet, his blood cholesterol skyrocketed and remains high.   That lead him to undertake a series of experiments accompanied by an epic level of blood testing.  What he found is worth reading about at www.cholesterolcode.com.  One of his experiments was with a 3 day fast to see what effect, if any, a fast had on cholesterol levels.  Sure enough, after the fast, his LDL cholesterol (aka LDL-C) shot up 84 points.  It returned to pre-fast levels after refeeding.  His HDL cholesterol was unaffected.  You can read about it here: cholesterolcode.com/the-fasting-disaster/ […]

Erica
Guest
Erica

This was really fascinating. I had an abnormally high cholesterol reading (also after losing 25 lbs) after fasting for 24 hours before because I thought I might get better numbers. I was also taking Red yeast rice supplement which is a TERRIBLE idea. My numbers were through the roof which was crazy because I had gone Vegan etc. New test tomorrow but I will definitely eat tonight to see if there is a difference. Although my HDL is crazy high at 85 the LDL was off the charts bad which was really confusing.

My LDL is High During Fasts
Guest
My LDL is High During Fasts

I went to get blood work done after my 5th day of water-only fasting. The LDL results alarmed my doctor, but not me.

https://www.ncbi.nlm.nih.gov/pubmed/10539776

Vasu
Guest
Vasu

I have been on 16-8 Fast 7 days a week for around 8 months now. I am a vegetarian. I quit milk and egg as well. Except for LDL and Total Cholesterol, all other markers improved remarkably. I lost around 15 lbs, now I weigh156 lbs and feel better than I have ever been. I am in my late 40’s.Exercise/gym 5 days a week. Cardio includes Running outside 7.5 miles on Sundays and around 3 miles on Treadmill. Should I be worried?
A1C – 6.5 to 5.7
Fasting Sugar – 117 to 95
Testosterone – 290 to 472
Triglyceride – 129 to 107
HDL – 45 to 52
CRP – 0.93 to 0.7
Homocyst(e)ine – 7.6 to 9.7

TC – 205 to 227
LDL – 130 to 153

Siobhan Huggins
Admin

Hi Vasu,
First off – congrats on your weight loss! I am glad you are feeling better.
One question before commenting – are you following a low carb, high fat diet? Just curious.
While I can’t really comment on whether or not you should worry (we’re not doctors after all 🙂 ) I can comment on a few things.
For one, I would agree that even by conventional standards all other markers do appear to be trending in a good direction. While I personally prefer to see triglycerides below 100 mg/dL if it continues to go down from the studies I’ve read on various risk markers that would be considered a good thing.
As for LDL and total cholesterol, I do tend to see people who get closer to the leaner side have increased levels, especially if they’re more active, although it’s also worth mentioning that LDL and total cholesterol can fluctuate based off of what you’ve eaten in the past 3 days. Dave talks about this here…
If you are following a high fat low carb diet it could also be contributing, because LDL particles are used to carry fat that we use for energy and based on what I’ve read increased reliance on fat for energy can increase LDL as a result, although it’s worth mentioning that based off of #4 on this list, if you combine low triglycerides, with high HDL, LDL doesn’t seem to have much impact on risk.

Grace Lee
Guest
Grace Lee

Do you take electrolytes prior to a blood draw?

khin Hong ho
Guest
khin Hong ho

Hi, very interesting read… I just want to know if I should be alarmed over heightened levels of LDL due to intermittent fasting?

Last year from Sept to November I tried IF to various levels… sometimes 16 hours, sometimes 24. I lost 6kg from these, pretty happy but quite shocked over LDL results… both me and my doctor. He wants to put me on satins.

It seems to suggest that the body is using fats for energy during fasting thats why there are so much LDL floating around in the blood stream. But would it cause heart problems in the future?

Michael Shparber
Guest
Michael Shparber

Thanks for this article! I’ve done a blood test today and my doctor wants me in the morgue immediately. I am on keto and I did 4 days fast last week. (I’ve ended the fast 4 days prior to the test and ate keto during these 4 days).
LDL from 241 to 324 (!!!)
HDL from 59 to 68
Trig from 94 to 169
Total ch from 319.6 to 426
My doctor is going NUTS 🙂 Actually, I am a bit worried, too.
When can I expect the numbers to go down?
Thanks!

Siobhan Huggins
Admin

I actually don’t think fasting four days prior to the test would have a major impact like that unless you were under-eating before the test.
I’m not sure how long you’ve been low carb, but I don’t usually see triglycerides going up on a normal 12-14 hour fasted blood test.
So, one thing you might want to try is to re-test… also here’s some common things people run into that might confound their trigs in particular:
* Not water-fasting 12-14 hours before the blood draw
* Some people experience higher trigs if they drink coffee on the morning of the test, or frequently in the days leading up
* Some people experience higher trigs if they consume MCT or coconut oil in the days leading up

Do you perhaps do any of those that might have impacted the results besides the 4 day fast a few days before?

Michael
Guest
Michael

But Dave’s trigs also skyrocketed from 76 to 205….
And mine are even lower. I have done a full 4 days zero calories fast.
After that I was eating normal keto food for 4 days, then took a test. Probably, the fasting influence lasts longer…
Now I MUST show much more lower numbers in the next test or my doctor will die from a heart attack!
What do you recommend: to do a three days of Feldman protocol or to exercise as hard as hell. And how long before the test (including in the morning of the test?) ? Thank you!

Siobhan Huggins
Admin

Yes, but his bloodwork was done *directly after* (technically during) the fast. Definitely possible that the fasting numbers may have impacted several days after, so you can avoid that for the next test just to make sure it doesn’t influence anything in the next one.
You could definitely try the protocol (5 days of high calorie, as much extra calories from fat as possible, e.g. fatty meats/cheeses/etc), no coffee during this time period (in case it impacted before) only water would be ideal if possible, no MCT or coconut oil if possible, 12-14 hours fasted before the blood draw.

Freddy
Guest
Freddy

Hi, thanks for the article and your continuing research into this field. I have a few questions, but first a little context.

Ive been keto for the past year and a half with the exception of a 2 week vacation and a few cheat days here and there. In that time Ive lost 44lbs while maintaining muscle mass along with gaining all the benefits of a keto lifestyle.

I did my first ever lipid profile on June 14th which was the last day of Ramadan (no food or water from sunup to sunset). Ive been intermittent fasting (16 – 20hr fasts) for the better part of the past year and dry fasting (15hr fasts) during the month of Ramadan. I generally drink lots of coffee, more so during Ramadan and I dont consume much coconut oil maybe 20g thrice a week. I had a high calorie keto meal the night before along with a usual amount of coffee. I had blood drawn on hour 10 of a dry fast. I am 6’1, 195lbs, 22% BF.

My results all in mg/dl:

Total serum cholesterol 261
HDL – C 57
LDL – C 181
Triglycerides 164

Ive been researching the health related aspects of keto since I started the lifestyle so Im not worried about the high cholesterol, however I was surprised with the high trig results. My questions:

1) How does caffeine cause high trig numbers?
2) Could the dry fasting throughout the month or on the day of have caused a spike in my trig numbers?
3) I plan on retesting after 3 months, Ive already cut out caffeine with the exception of 16g of 99% chocolate on most nights, any tips on how I can lower my trig numbers?

Thanks again and in advance

Peter
Guest
Peter

A hyper respinder is usually someone who is lean, right?

Can it be that in a hyper responder, dietairy fat goes really quick to storage and then has to come back from storage as well? When you maintain weight and on low carb, fat either has to be used or stored. The more you use the more you eat, the more that has to go to storage.

The more that comes from storage, the higher Cholesterol goes. Multiple day fasts means all your energy comes from storage,… Thus your cholesterol numbers are super high. But what it really means is more boats in the rivers.

Siobhan Huggins
Admin

A very good explanation of what is likely going on – I would describe it similarly.
The only difference being in Lean Mass Hyper-responders, there’s also the addition of having very little fat mass. Adipose tissue can supply some energy to the muscle directly adjacent to it, thus in someone who has a lot of fat mass there may be less reliance on “global transport” (lipoproteins), but in lean mass hyper-responders they have very little fat mass and thus the lipoproteins are perhaps more heavily relied upon. Dave touches on that in his talk on LMHRs that you might find interesting.

AAl
Guest
AAl

Interesting article!
I actually went through similar experience. I had my before Keto blood work done and for 3 months i did 1.5 month keto/IF and 1.5 fasting. LEADING to the blood work the second time i had a 12 day fast and saw my cholesterol all increased! My A1c and other markers went to “green” though especially a1c from 8.ish to 5.2

I read and listened to others that the reason behind the increase in cholesterol is due to in a fasted state, your body is burning fat. So there’s tons of fat particles floating around and your liver is processing all that. So naturally when taken blood test the cholesterol numbers will be wildly distorted.

Siobhan Huggins
Admin

Indeed. The LDL particles carrying the cholesterol have the first job of also transporting fat (triglycerides) from fat tissue to cells that need it.
Hence when you are relying more (or, I suppose, entirely) on fat from storage, LDL skyrockets to meet that demand. 🙂

Claire
Guest
Claire

Thank goodness! I just had my yearly health screening and heavily fasted for the week before and my LDL was triple what it usually is. All other metrics were fine. I’m glad I found this page.
OT: My cousin’s name is Siobhan but it quickly morphed into “Chibby” by her older siblings and her cousins

Thank You, Siobhan and have a great day!

trackback

[…] from NEFA release from fat cells can be observed in leaner individuals who fast for multiple days, as Dave Feldman has demonstrated, where this effect is likely to ensure plenty of fats for hungry cells to […]

rob beaton
Guest
rob beaton

ive been fasting for a few months now round a bout 12-14hrs my waist circumference has dropped by 4.5 inches and a drop of 10lbs body weight ,my current weight is 10st 11lbs ,i train every day walk /run about 25.35 miles weekly ,train and teach karate and also do light weights weekly. my diet consists of mackeral,tuna.sardines walnuts,beans and two eggs every day chicken and lean red meat occasionally ,i try to keep to a low card diet with plenty green veg ,i also have good energy levels my age is 64,my last cholesterol test showed the following ,serum cholesterol 7.2 mmol/l serum triglycerides 0.6 mmol/l ,serum hdl cholesterol 2.9mmol/l serum cholesterol ratio 2.5 se non hdl cholesterol 4.3mmol/l my results were classed as abnormal and im being referred to my doctor , any body have any thoughts on these results .

Siobhan Huggins
Admin

I copied this from our report tool after inputting your numbers:

–CHOLESTEROL REMNANTS–
Remnant Cholesterol: 11 mg/dL 0.28 mmol/L >>> Lowest Risk Quintile
Remnant Chol to HDL: 0.1 >>> Lowest Risk Quintile
Go to https://tinyurl.com/y8hokam2 for more on Cholesterol Remnants

–ATHEROGENIC INDEX OF PLASMA (AIP)–
AIP: -0.684 >>> Lowest Risk Third
Go to https://tinyurl.com/ycccmmnx for more on Atherogenic Index of Plasma

If I had those numbers I’d be pretty pleased 🙂
It looks like you fit into the profile of a Lean Mass Hyper-responder who does endurance/resistance training (hence lower LDL).
You may find this presentation and our facebook group useful.