Adventures in Ketosis (long)

[RAE]

3) Doc clearly still feels that LDL is a risk factor, but also subscribed to the current knowledge that one of the four forms of LDL is not a risk factor.]

On the subject of LDL-C, here is a paper that came out last year that may be of interest. It's a comprehensive review of all available studies on LDL-C and cardiovascular disease. Their key findings:

• The hypothesis that high TC or LDL-C causes atherosclerosis and CVD has been shown to be false by numerous observations and experiments.
• The fact that high LDL-C is beneficial in terms of overall lifespan has been ignored by researchers who support the lipid hypothesis.
• The assertion that statin treatment is beneficial has been kept alive by individuals who have ignored the results from trials with negative outcomes and by using deceptive statistics.
• That statin treatment has many serious side effects has been minimized by individuals who have used a misleading trial design and have ignored reports from independent researchers.
• That high LDL-C is the cause of CVD in FH is questionable because LDL-C does not differ between untreated FH individuals with and without CVD.
• Millions of people all over the world, including many with no history of heart disease, are taking statins, and PCSK-9 inhibitors to lower LDL-C further are now being promoted, despite unproven benefits and serious side effects.
• We suggest that clinicians should abandon the use of statins and PCSK-9 inhibitors and instead identify and target the actual causes of CVD.

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391?scroll=top&needAccess=true

 

[Golden sunsets]

Thanks for the info Rae. I was aware of most of this from reading I have been consuming over the past 2 months. I had a stent placed in an artery because of a significant blockage back in 2016. This despite abnormally high HDL and moderate to low Trigs throughout my adult life. I wouldn't feel comfortable insisting that I be taken off a statin completely, based on that coronary event and the implications of CAD. Although my arteries other than the one blockage were declared super good, something caused that one blockage. I'm pretty sure that my Cardiologist and PCP would discharge me as a patient, if I insisted on dropping the statin altogether.

 

[Golden sunsets]

A bit of an update. We went into our PCP's office this afternoon, spur of the moment, to get a monthly Vitamin B shot for DH, and low and behold, our PCP was sitting at the reception desk, filling in for his vacationing Nurse/Receptionist, so I hit him with a barage of questions and comments.

1) Told him I'd been on keto and noticed that my lipid panel taken after cutting my statin in half showed decreased trig's, decreased LDL and increased HDL. I told him my theory was that the diet had more than compensated for the cut in statin. He agreed that the diet was responsible on the trig's and LDL but not do much HDL. My HDL always hovers just below or above 100.

2) Shared my concern about DH, based on my recent education on Trig's/HDL and healthy and non healthy ratios. As noted above, his ratios are bad. He said that low HDL has always been a concern for heart disease, and high Trig's has always been a concern for heart disease, but the two numbers are independent of each other. One could have low Trig's and low HDL, have a ratio of less than 2 or lower, but due to low HDL, still be at risk for heart disease. Likewise, the reverse, high Trig's and high HDL might give a low ratio, but still indicative of risk. At any rate, I asked him to run the lipids on DH again, after being on Keto for 11 weeks and he agreed to do that. Will report back results. I'm interested to see if his LDL goes up. He is on a statin.

3) Doc clearly still feels that LDL is a risk factor, but also subscribed to the current knowledge that one of the four forms of LDL is not a risk factor.

4) He has been on Keto himself, understands the value LCHF, but is currently back on carbs, not as a nonbeliever, but due to his love of certain carbs. [emoji19] Neither he nor DH and I have glucose levels issues, so no discussion on that.

And all of this without a visit fee. And he administered the shot to DH himself. There are benefits to seeing a one doc shop.[emoji1]

Received pretty eye popping results on DH's lipids drawn last week. Here is a side by side analysis after being on a ketogenic diet since 5/28/19:

4/24/19 8/16/19

Weight: 185 168
TC 189 142
Trigs 174 124
HDL 48 67
LDL 112 50

Trig/Hdl 3.6 1.9

The increase in HDL is so surprising as he has always had very low HDL. The drop in LDL indicates that if his lipids are similar at the time of his next Annual, perhaps he should drop the 20mg of Lovastatin. We will discuss. The trigs although showing a drop of 29% still seem high, however the blood test was not a fasting blood test. Next time we will make sure that it is. We are very happy and it seems like both my numbers and DH's represent ample anecdotal evidence that this diet is very effective at improving lipids. Whether or not lipids affect heart health is of course a huge debate at this point.

 

[Doc0]

A lot of the abba dabba of fat biochemistry is being rewritten. It turns out lipoprotein's main function in the blood has nothing to do with cholesterol. It has to do with hydrophobic energy transfer. Cholesterol is just a passenger in the protein. In a ketogenic diet you are in catabolism. That is the whole point. Your source of energy is fat in the form of free fatty acid and glycerol. If energy need is high FFA goes high and lipoproteins needed to transport FFA goes high. This makes lipoproteins a marker of energy transfer not heart disease. In my opinion heart disease at least in fat people is an inflammatory process due to glucose poisoning. Maybe not directly but as a secondary consequence. Many systems are afflicted by glucose poisoning, heart vasculature brain muscles kidney eyes it's just heart is the most critical. When Eisenhower had his heart attack in 55 the country freaked out and we got sent down a lot of rabbit holes. IMHO control of glucose poisoning is what is critical and not eating seed oils. Seed oils are also poison. They were NEVER part of the ancient human diet and have only encroached into the diet since the last half of the last century. In my opinion it's seed oils and glucose poisoning sold to us a "healthy fats" and "tons of fruits, vegetables and whole grains" that have made America sick.

 

[audreyh1]

Received pretty eye popping results on DH's lipids drawn last week. Here is a side by side analysis after being on a ketogenic diet since 5/28/19:

4/24/19 8/16/19

Weight: 185 168
TC 189 142
Trigs 174 124
HDL 48 67
LDL 112 50

Trig/Hdl 3.6 1.9

The increase in HDL is so surprising as he has always had very low HDL. The drop in LDL indicates that if his lipids are similar at the time of his next Annual, perhaps he should drop the 20mg of Lovastatin. We will discuss. The trigs although showing a drop of 29% still seem high, however the blood test was not a fasting blood test. Next time we will make sure that it is. We are very happy and it seems like both my numbers and DH's represent ample anecdotal evidence that this diet is very effective at improving lipids. Whether or not lipids affect heart health is of course a huge debate at this point.

Wow, fantastic!

It could be simply that the higher fat diet is raising his HDL?

Definitely need the trig test to be fasting AFAIK.

 

[audreyh1]

A lot of the abba dabba of fat biochemistry is being rewritten. It turns out lipoprotein's main function in the blood has nothing to do with cholesterol. It has to do with hydrophobic energy transfer. Cholesterol is just a passenger in the protein. In a ketogenic diet you are in catabolism. That is the whole point. Your source of energy is fat in the form of free fatty acid and glycerol. If energy need is high FFA goes high and lipoproteins needed to transport FFA goes high. This makes lipoproteins a marker of energy transfer not heart disease. In my opinion heart disease at least in fat people is an inflammatory process due to glucose poisoning. Maybe not directly but as a secondary consequence. Many systems are afflicted by glucose poisoning, heart vasculature brain muscles kidney eyes it's just heart is the most critical. When Eisenhower had his heart attack in 55 the country freaked out and we got sent down a lot of rabbit holes. IMHO control of glucose poisoning is what is critical and not eating seed oils. Seed oils are also poison. They were NEVER part of the ancient human diet and have only encroached into the diet since the last half of the last century. In my opinion it's seed oils and glucose poisoning sold to us a "healthy fats" and "tons of fruits, vegetables and whole grains" that have made America sick.

Thanks, interesting.

I have seen some videos by David Feldman talking about blood lipids driven by energy transfer. Do you have any other references that might shine more light on it?

Glucose poisoning - isn’t that ultimately hyperinsulinemia causing all the horrific body damage?

 

[RAE]

Received pretty eye popping results on DH's lipids drawn last week. Here is a side by side analysis after being on a ketogenic diet since 5/28/19:

4/24/19 8/16/19

Weight: 185 168
TC 189 142
Trigs 174 124
HDL 48 67
LDL 112 50

Trig/Hdl 3.6 1.9

The increase in HDL is so surprising as he has always had very low HDL. The drop in LDL indicates that if his lipids are similar at the time of his next Annual, perhaps he should drop the 20mg of Lovastatin. We will discuss. The trigs although showing a drop of 29% still seem high, however the blood test was not a fasting blood test. Next time we will make sure that it is. We are very happy and it seems like both my numbers and DH's represent ample anecdotal evidence that this diet is very effective at improving lipids. Whether or not lipids affect heart health is of course a huge debate at this point.

Wonderful! Getting that TG/HDL ratio below 2.0 is a very good thing. Looks like the low carb diet is really working.

 

[RonBoyd]

More than a third of adults in the United States are obese. This statistic is often attributed to a confluence of unhealthy dietary practices, sedentary lifestyles, and genetics. But we may be missing the bigger picture.

 

[audreyh1]

So a month after my results I finally saw the doc. He was pleased with my lipid and sugar/insulin numbers - reversed any insulin resistance.

I had also done the annual female hormones test. Here’s where it got weird. My estrogen (post-menopausal) went from low to way high and it alarmed the doctor because high estrogen is not healthy. All he could tell me was to cut back on some of the dietary fat and he increased my progesterone.

So great news but another problem shows up!

 

[6miths]

My estrogen (post-menopausal) went from low to way high and it alarmed the doctor because high estrogen is not healthy.

Why are high estrogen levels unhealthy? And why did they feel the need to test it? Just curious but please do not feel that you have to respond to the questions.

 

[harley]

So a month after my results I finally saw the doc. He was pleased with my lipid and sugar/insulin numbers - reversed any insulin resistance.

I had also done the annual female hormones test. Here’s where it got weird. My estrogen (post-menopausal) went from low to way high and it alarmed the doctor because high estrogen is not healthy. All he could tell me was to cut back on some of the dietary fat and he increased my progesterone.

So great news but another problem shows up!

Congratulations on the mostly good results. Hopefully the estrogen situation will normalize too. I'm convinced most doctors would tell you to cut dietary fat if you went in with a broken bone.

 

[audreyh1]

Why are high estrogen levels unhealthy? And why did they feel the need to test it? Just curious but please do not feel that you have to respond to the questions.

Estrogen is a growth hormone. Excess estrogen encourages growths in reproductive tissues. Not good for post menopause. There are other health risks as well like cardiovascular.

Testing hormones - because I’m on hormone supplementation. Good idea to test during peri-menopause anyway as problems in unbalanced hormones are common leading to all sorts of symptoms which reduce quality of life as well as some diseases.

 

[audreyh1]

Congratulations on the mostly good results. Hopefully the estrogen situation will normalize too. I'm convinced most doctors would tell you to cut dietary fat if you went in with a broken bone.

Not this one, he had told me to go on a high-fat low-carb diet in the first place.

He felt the estrogen situation should have normalized already, and that weight loss makes estrogen levels drop, not rise.

 

[audreyh1]

[I'm catching up with a few posts]

One issue I raised early in this thread was my high blood ketone readings, many of which were above 3, some above 4, and even had one as high as 4.9! These were still in the “therapeutic ketosis” range. I asked the doc about it and he said I probably still wasn’t fully fat-adapted, even though it had been 4 months keto.

Over the next month the readings were all in the 2s, so I did settle into “optimal” ketone zone of 1 to 3 mmol/L.

Shortly after that doctors visit I had to travel for medical reasons (family member) and so I decided it was time to experiment going without the careful tracking and logging I had been doing. I didn’t change too much food wise, although I did allow myself larger cooked vegetable servings occasionally, and when I did eat berries, I ate a larger portion. So my carbs would have increased slightly. I also cut back on cheese and butter a bit, and used more oils.

After a couple of weeks of this, my blood ketones dropped to around 1. My weight had already stabilized. I was within a couple of pounds of goal. Given the crazy repeated traveling lately due to DD’s health issues, was pretty happy.

 

[Golden sunsets]

Glad to hear this Audrey. I've been following your journey.

Were you able to do part of your fall trip to Europe?

 

[audreyh1]

[I was just getting to that ]

The big challenge then was our subsequent trip to Europe. I had already resolved to not eat bread/grains/starches nor sweets/desserts*. And I really didn't have trouble sticking to that. But given the locations (Spain, France) I was not going to skimp on wine and the occasional liqueur. Fortunately dry wine is fairly low carb, but it does add up after a few glasses!

So - I did quite well with this scheme. It was interesting. We had almost all meals included on the tour with a set menu plus hotel breakfast buffet. I simply didn't eat the starches on my plate nor the ubiquitous bread on the table and skipped desserts (one exception - a bittersweet dark chocolate mousse that was just magnificent). Didn't even notice the pastries at breakfast. I was surrounded by carbs at all meals but it didn't bother me at all. I felt way better than I had on other Europe trips - I never felt heavy or stuffed. Some meals I ended up not eating enough and would be hungry in a couple of hours, but no big deal. We were very active - so burning up a lot I guess. Late in the trip I did sample a little bread a couple of times as it's hard to beat crusty European breads. Didn't do much for me. Did not touch a single viennoiserie (croissants, etc.) We had a couple of memorable meals on our own in France before returning, plus two wine day-tours out of Bordeaux. I was quite happy with the whole gastronomy experience even low carb. I did still ate a lot of food, and drank a lot of wine.

According to the urine strips I maintained moderated to light ketosis throughout the trip which was great.

Returning home, I was up only a couple of pounds which disappeared in two days and then even dropped below my lowest weight a couple of days later. My blood ketones were at the same level as right before I left on the trip. I'm glad I didn't restrict the wine in Europe as I wasn't punished for it at all. Now back to my few modest glasses a week.

*BTW - I didn't try to provide dietary restrictions to the tour operator. It's just too complicated. I decided it was simply easier to not eat the heavy carb foods on my plate.

 

[Luck_Club]

In my opinion it's seed oils and glucose poisoning sold to us a "healthy fats" and "tons of fruits, vegetables and whole grains" that have made America sick.

Glucose "Processed carbs" seem to be a really bad thing overall from what I've read.

I've gone keto on and off for about 2 years now. Just starting another cycle.

Few observations I'd like to hear from others about:
1) gum receding (I can feel the base of my teeth at times when reducing carbs)
I think this is related to carb/ glutton inflammation
2) Bloat gut health
I notice within 2-4 days of starting Keto my belly shrinks and gas is gone.
3) After about 4 weeks it is good to take a short 1-3 day break.
The first run on Keto, took me through Thanksgiving, Christmas, etc. I took a 1-3 day break for each holiday, and really pigged out on carbs. This was my most successful weight loss period. Dropping a full 10% body weight during the period. After the carb binge a plateau would be broken and weight loss would begin again.

Oh if only I had the genetic cocktail that offered a fast metabolism and a runners/exercise high.

 

[audreyh1]

Totally belly bloat gone on low carb.what a difference!

I’m not comfortable on the taking a high carb break for several reasons. 1) I am no longer carb adapted and will probably feel bad because I won’t handle high blood sugar well, 2) I don’t have a taste for sweet or starchy foods anymore so they don’t appeal and 3) if I do redevelop such a taste I might feel deprived when returning to low-carb.

 

[Red Badger]

Okay. I've got my one chair in a circle....

Hi. I am RB and have been fighting a ten pound battle for about a year. About 5 years ago, I shed almost 50 pounds the old school way - being hungry. During my weight loss period, I cut out most processed foods and started eating in hotel rooms (road warrior). I stayed in rooms with a kitchen and prepared simple meals. I knew most moderately priced restaurants were merely "sit down fast food" with all the attendant risks of extreme salt, sugar, carbs etc. So, gone they were.

I walked a ton, still do (3-6+ miles/day), but as most know, exercise only incremental WRT weight loss. The secret sauce has to be in the nutrition side of the equation. My suspicion is that I was (completely) unintentionally following a light version of a low carb diet, with a fair amount of carbs from a lot of fruit and multi-grain stuff.

Anyhoo, over the years, I have managed to find about ten of those lost pounds. Lucky me. This year, I've tried to shed them without success. Soooo, here we go. Started the Keto path yesterday. Of course, I won't know anything for a few/several weeks, but I shall be optimistic. Hoping it will also help with my slightly elevated BP. But I can share one update right now. The satiety is amazing. I have had 4 meals so far, and the lack of hunger between meals is powerful. And while I am not eating huge meals, they are very filling. I am having trouble wrapping my head around enjoying a buttery egg, cheese and sausage omelette for breakfast (having been told my whole adult life that such meals were eventually a death sentence). I'm also taking steps to mitigate (as best possible) the Keto flu.

Before taking the plunge, I read this entire thread, including many of the links, videos, etc. Very powerful stuff. I want to thank Audrey and all the participants on this thread. I'll update in a few weeks.

Best,

rb

 

[Golden sunsets]

Okay. I've got my one chair in a circle....

Hi. I am RB and have been fighting a ten pound battle for about a year. About 5 years ago, I shed almost 50 pounds the old school way - being hungry. During my weight loss period, I cut out most processed foods and started eating in hotel rooms (road warrior). I stayed in rooms with a kitchen and prepared simple meals. I knew most moderately priced restaurants were merely "sit down fast food" with all the attendant risks of extreme salt, sugar, carbs etc. So, gone they were.

I walked a ton, still do (3-6+ miles/day), but as most know, exercise only incremental WRT weight loss. The secret sauce has to be in the nutrition side of the equation. My suspicion is that I was (completely) unintentionally following a light version of a low carb diet, with a fair amount of carbs from a lot of fruit and multi-grain stuff.

Anyhoo, over the years, I have managed to find about ten of those lost pounds. Lucky me. This year, I've tried to shed them without success. Soooo, here we go. Started the Keto path yesterday. Of course, I won't know anything for a few/several weeks, but I shall be optimistic. Hoping it will also help with my slightly elevated BP. But I can share one update right now. The satiety is amazing. I have had 4 meals so far, and the lack of hunger between meals is powerful. And while I am not eating huge meals, they are very filling. I am having trouble wrapping my head around enjoying a buttery egg, cheese and sausage omelette for breakfast (having been told my whole adult life that such meals were eventually a death sentence). I'm also taking steps to mitigate (as best possible) the Keto flu.

Before taking the plunge, I read this entire thread, including many of the links, videos, etc. Very powerful stuff. I want to thank Audrey and all the participants on this thread. I'll update in a few weeks.

Best,

rb

Best of luck. Somewhere, on this thread I think, there is a reference to an online source for keto specific products. It is Netrition.com. You will find some great lo/no carb products on that site. I've ordered from the site a bunch of times.

 

[audreyh1]

Hoping it will also help with my slightly elevated BP. But I can share one update right now. The satiety is amazing. I have had 4 meals so far, and the lack of hunger between meals is powerful. And while I am not eating huge meals, they are very filling. I am having trouble wrapping my head around enjoying a buttery egg, cheese and sausage omelette for breakfast (having been told my whole adult life that such meals were eventually a death sentence). I'm also taking steps to mitigate (as best possible) the Keto flu.

Best,

rb

Congrats!

It should lower your BP - weight loss plus excess water loss should help a lot.

Lots of good free info on dietdoctor.com. And the only thing I bought for keto was some magnesium supplements for nighttime leg cramps, plus melatonin to help sleep, and urine strips plus blood meter to measure ketones. I already had some low carb snacks on hand (e.g. Parmesan crisps and Mac nuts). I’ve generally avoided keto specific foods or substitutes as I prefer minimally processed food.

 

[audreyh1]

Another update

I had another panel done for my annual with my PCP. This was 2 months after the most recent panel and after 5 months in ketosis.

LDL (and thus still total cholesterol) still going up.
HDL - nice jump, my highest ever at 69!
Tryglycerides - still dropping, from 85 to 74.

Thus my Triglycerides/HDL ratio is really looking good now! Over two months it dropped from 1.37 to 1.07. Very pleased.

So I'm interested to see what my PCP says. I think her eyes will pop out at the jump in LDL from a year ago. I'm ready to point out my great HDL, low triglycerides (about which she had mentioned a concern when they were highish) and terrific triglycerides to HDL ratio. I'm ready to explain about the low carb diet and how the higher fat content is raising my both my LDL and HDL and that based on the ratio the additional LDL should be the big fluffy type that is not a heart risk concern. She must have other patients on low-carb diets. Of course I've lost weight, my already normal BP is lower, etc......

My fasting blood glucose was much higher than 3 months ago where it had dropped way down to 69, the lowest ever. Now it was 96 - on the high side for me even when I was eating much higher carb. I may be starting to see that dawn phenomenon that is fairly common for folks in long-term ketosis. This panel was more limited, so didn't include A1C or insulin. Based on my improving triglycerides, however, I expect continued improvement on the last panel's great numbers.

After my big European trip where I ate more then usual (even though low carb) and drank plenty of wine, a couple of extra pounds came off within just two days of return. And then I continued to drop pounds, now below the best numbers of just over a month ago. Essentially at goal or a bit below (depending on the day, LOL!).

 

[Golden sunsets]

Another update

I had another panel done for my annual with my PCP. This was 2 months after the most recent panel and after 5 months in ketosis.

LDL (and thus still total cholesterol) still going up.
HDL - nice jump, my highest ever at 69!
Tryglycerides - still dropping, from 85 to 74.

Thus my Triglycerides/HDL ratio is really looking good now! Over two months it dropped from 1.37 to 1.07. Very pleased.

So I'm interested to see what my PCP says. I think her eyes will pop out at the jump in LDL from a year ago. I'm ready to point out my great HDL, low triglycerides (about which she had mentioned a concern when they were highish) and terrific triglycerides to HDL ratio. I'm ready to explain about the low carb diet and how the higher fat content is raising my both my LDL and HDL and that based on the ratio the additional LDL should be the big fluffy type that is not a heart risk concern. She must have other patients on low-carb diets. Of course I've lost weight, my already normal BP is lower, etc......

My fasting blood glucose was much higher than 3 months ago where it had dropped way down to 69, the lowest ever. Now it was 96 - on the high side for me even when I was eating much higher carb. I may be starting to see that dawn phenomenon that is fairly common for folks in long-term ketosis. This panel was more limited, so didn't include A1C or insulin. Based on my improving triglycerides, however, I expect continued improvement on the last panel's great numbers.

After my big European trip where I ate more then usual (even though low carb) and drank plenty of wine, a couple of extra pounds came off within just two days of return. And then I continued to drop pounds, now below the best numbers of just over a month ago. Essentially at goal or a bit below (depending on the day, LOL!).

This is good news for the most part - right? I am unfamiliar with what "dawning" is. Is it some sort of saturation point with ketosis, where numbers begin to reverse (as in higher LDL?).

I visit a new PCP in a couple of hours for my new patient visit. DH's is tomorrow. Our former PCP announced he was retiring a couple of months ago. He is 67. His blanket letter informing us of his decision caught my attention. He said that in addition to the paperwork requirements of Medicare and the ACA, which he complains about every time we see him, he feels that google is making his life difficult. Everyone is now an expert, armed with a medical info from the internet. I couldn't help but think he was referring to me! Based on that comment, I'd say it is time for him to hang it up. I liked him though, He was almost our age and loved to sit around and shoot the bull before doing our annual physical.

So our new PCP is about 9 years old. We'll see what this guy thinks about the Ketogenic diet. All of our docs now seem to be really young, or maybe it's just that we are so old.

 

[Sittinginthesun]

Nice going Audrey! I am down 47 lbs in three months on keto, one meal a day intermittent fasting. Feel fantastic, higher energy and clear thinking, sleeping like a rock, never hungry. I have done 48 hour fasts once every three weeks (in the middle of one now) and find them strangely easy. I am taking supplements like potassium, magnesium, men's multivitamin and calcium/D. Latest blood work excellent and my doctor is a fan of keto and intermittent fasting and is fully supportive.

I'm sticking with this long term. Zero doubt. Dr Jason Fung and Dr Eric Berg have been very helpful explaining the science of how to reduce insulin in your body through low carb and IF. Youtube makes it easy to access this info.

 

[audreyh1]

The dawn phenomenon is having elevated fasting blood glucose (early in the morning). This was traditionally of concern because elevated fasting glucose was the first indication someone might be developing pre-diabetes. But when someone is in ketosis, the body can generate (via gluconeogenesis) blood sugar as preparation for waking up and being active. In that case it is usually the highest level of the day, and not accompanied by elevated insulin.