Am I part of the 1% - please help

(Matthew) #1

Am I part of the 1%?

Hello all. I have been on the ketogenic diet for just over 100 days and I am in desperate need of help. I fear that I may be one of the rare 1% of people I keep hearing about that cannot tolerate this diet. I have appreciated all of the great support from this community and fantastic content to help me get on - and stay committed to the ketogenic diet. I feel it is equally important for the community to assist those that simply may not be able to use this diet.

Background
I came to this diet because I had noticed an increasing trend in my A1C and my fasting glucose. My A1C had crept up to 5.7 and my fasting glucose was up to 113. I have type 2 diabetes in my family so I wanted to nip this in the bud. I started keto at close to 190lbs (6ft). I complied strictly with all the major “rules” of keto, stuck to my keto calculator numbers (for 20% less/loss),and entered every single food item in myfitnesspal. I had a planned slip up on thanksgiving - but other than that I was under 20 carbs, about 80 protein and about 140-160 fat everyday. I quickly lost weight (down to 167lbs), started feeling great like everyone else, and was getting great kept/glucose numbers on my blood tests.

One bump in the road was a few vicious gout flare ups. I read that they should go away in about 8-12 weeks. I patiently waited. Even when the flare ups were not “hot” - I consistently had a dull gout pain. Now we are over 12 weeks in and I am currently experiencing another BAD flare up.

Worse of all - just after 100 days I went to get an check on my blood numbers. I was ready for the bump in LDL - but had convinced my Dr. to give me an NMR so I could push back. Unfortunately, my numbers were so bad - I am really scared.

Before this diet my numbers averaged:
Total Cholesterol - 220-240
HDL - 41-48
Trigs - 180-200
LDL - 140-160

Here are the results of my NMR taken after 100 days on keto

A1C - 5.2
Fasting Glucose - 97 (87 when I tested that morning with my own monitor)
LDL-P >3500 nmol/L
LDL-C 331 mg/dL
HDL-C 46 mg/dL
Triglycerides 169 mg/dL
Cholesterol, Total 411 mg/dL
HDL-P (Total) 23.3 umol/L
Small LDL-P 1631 nmol/L
LDL Size 21.1 nm
LP-IR Score 45

This put my historical HDL over Trigs ratio at over 7! Typically they have been between 2.5 - 4.0.

I am extremely worried that I am hurting myself. I need some advice.

Few specific questions:

Which of the numbers from the NMR above represent the pattern A & B (small dense / large fluffy particles) that we all talk about so much?

Wish number is my HDL - 46 or 23?

Overall my trigs and LDL are going up and my HDL is going down. Other numbers look dangerous.

I plan on getting a CAC right after I get home from holiday travels.

Please let me know what you thoughts are.

Thank you.

Matt

(Darlene Horsley) #2

Hopefully someone with more knowledge than I will be along soon to help answer your concerns.

(Athena) #3

Cholesterol goes up when you are actively losing weight. It’s okay to have high cholesterol.

(Jo O) #4

Google the list of high purine foods you need to stay away from to lower your gout incidents.
I know shellfish and mushrooms are high on that list.

(matt ) #5

@siobhan and @DaveKeto might have some input

#6

Cannot help on the Cardio question but here is a gout thread that I contributed to when I thought I had gout (may have https://www.ketogenicforums.com/t/keto-with-gout/265

I tried a bunch of OTC remedies and something eventually worked but I am not sure if I had gout in the first place. The ACV made the biggest difference and as long as you do not have Gerd or reflux are probably worth trying

(Siobhan) #7

Hey, we must be twins because I had results that looks exactly like this not too long ago. I’m no doctor, but I have studied a bit into how the lipid system works at the immune system/inflammation level and why so perhaps I can answer some questions here.

Just to get some baseline questions out of the way:
How long were you fasted during this test?
Were you eating a normal amount leading up to the test, e.g. not overly eating or undereating?
Were you eating what you normally eat the three days prior to the test?

So first off to answer your first question:
HDL-C is 46, before it was 41-48: This hasn’t changed from your pre-keto baseline
Triglycerides are at 169 when before they were 180-200: These have gone down (but it could be normal fluctuation, but I would expect a downward trend as you continue keto)

HDL-P is your HDL particle count, but when calculating the TG:HDL ratio you use HDL-C.
Your ratio is 3.6 (because your HDL is 45ish and trigs at 169), not 7. From the numbers you provided of your “before” this is about the same.

To determine pattern B LDL:
LDL particle count (>3500) and then small LDL (1600ish) means fairly pattern B.

However!
I have seen this exact profile (normal HDL, high LDL, and high small LDL) when I intentionally got a blood draw while sick. This makes sense because these markers can be changed from something acute (from an infection or injury) or chronic (long term injury from smoking etc).
So testing while you have a gout flare up could have influenced the numbers significantly.
Because LDL and HDL are a part of the immune system, and react as such (specifically to inflammation) sources of inflammation can influence your numbers temporarily. With heart disease, etc, these sources of inflammation are chronic, not temporary.

It may be beneficial to address the gout and then get a follow up a month after resolution to see if the “concerning” numbers (which is really just the small LDL, as your trigs haven’t changed) were just caused by a nonchronic source of inflammation.
I can’t guarantee that’s what it is - but I wouldn’t be surprised.

I’ll also note that for my results I got a follow up three weeks later and while everything wasn’t “normal” it was trending downward, and my inflammation markers (CRP and ferritin) had gone back to normal.

Not sure about the flare ups, I have read in a few places that gout is caused by hyperinsulinemia (high insulin) because high insulin causes you to retain uric acid, which results in build up and eventually a flare. I haven’t really read in depth into it though. Perhaps someone here could share their experience with gout and help you out there - I have no experience with it unfortunately…
You had this prior to keto, so perhaps it will resolve with continuation of keto? I’m not sure.

And of course, if you are concerned to the point where you are absolutely sure you don’t want to continue, and you feel better and healthier when not keto - that’s always an option. You should always be the determiner of what you do, especially regarding your own health!

Final points:

  • Neither your HDL nor TG has changed, they’re about the same
  • Undesirable looking changes can be caused from sources of inflammation like gout flare ups, which may be temporary
  • Your TG:HDL atio is 3.6 which is in range for you
  • The lipid system is also a part of the immune system and thus will fluctuate as needed, with heart disease these “red alert” changes are chronic
  • For high LDL it might be useful to look at Dave Feldman’s site cholesterolcode.com as LDL can go up on keto but for a functional reason
(Dave) #8

@siobhan pretty much covered what I was going to say (no surprise!) – but I’d like to add extra emphasis to two things, and add a third…

This part can’t be overstated. The research we have at CholesterolCode.com is absolutely decisive. You highly influence your resulting cholesterol numbers by what you eat (or don’t eat/fast) in the three days before the test, and your particle count numbers in the five days before the test. Our own Craig just demonstrated this last month himself.

So make sure:

  1. You ate “typical” amounts/composition in the days leading up to the test.
  2. You water fasted for at least 12 hours before the blood draw (typically between the last meal of the night before the morning of the blood draw).
  3. You didn’t drink coffee or anything else the morning of the blood draw. (This keeps coming up as a possible confounder in data people turn into us)

This also can’t be emphasized enough! If you’re actively sick, expect it to impact your lipid numbers! Test when well before drawing any conclusions.

–

Okay, the one thing I’ll add – and always add…

If you aren’t already, start tracking your food closely!

It’s also possible you have “leaks” you are currently unaware of. this comes up commonly with family and friends that I work with closely. They report they are being strictly keto and staying below 20g carbs, but when we do a forensic breakdown of their diet, we often find many hidden carbs they were unaware of, such as condiments, sauces, drinks, even packets of stevia or eggs (which everyone assumes are 0 carbs).

What is a common clue for these leaks when one is metabolically healthy? Triglycerides. If triglycerides aren’t coming down, I often find there isn’t a drop in carbs commensurate with the rise in fat. Some are on a moderate carb diet (instead of low) while upping their sources of fat substantially. This can be a recipe for high trigs. I’d say about 75% of the time a family/friend has unexpectedly high trigs, this ends up being the most common reason.

Other possibilities can include allergies or nutrient defenciencies. Both of which can be spotted much easier from close tracking of your diet.

Once again, get healthy first – then retest. But regardless of when you do that, I strongly advise tracking your food starting now.

#9

Adding to that, how much fat are you eating? Some people might do well, especially those who want to lose bodyfat, to seek caloric deficit by limiting fat as well, after carb restriction and adequate protein. Consuming too much dietary fat, if your system is not able to metabolize it efficiently, can lead to this circumstance.

Additionally, some people have different genetic mutations (SNPs) - we all have our unique genetic mutations - that make them less able to efficiently deal with a keto diet. You could know your genetic makeup using services like 23andme and the like, which give you a good view of some of the currently know genetic mutations. You could also look for fat oxidation defects: https://www.google.ro/search?q=genetic+mutations+for+fat+oxidation

But before that, how much fat are you eating? Is your diet well formulated or you’re just piling up fat and disregarding micronutrients from fibrous vegetables?

(Karen) #10

Regarding tracking. Be careful which sites you use for tracking. Fitnesspal has billions of items but it’s like Wikipedia in a way. People add to the items. Many are not accurate. Eg acchicken thigh might be 100-400 calories. Not all entries include carb, protein, fat grams. I was using an item that had calories listed but not macros an thought my carbs were OK at the end of the day. They weren’t. Watch for hidden carbs. Fake crab has wheat in it…what? And best of luck, your body can recover.

K

(Cathy) #11

The best site for finding food composition is USDA. Don’t assume that the numbers on sites that allow user input to be even close to being accurate. The are not for almost everything. Eventually you will learn what foods represent what breakdown and it will become easier. Definitely a learning curve so arm yourself with reliable information.

https://ndb.nal.usda.gov/ndb/

(Crow T. Robot) #12

Which is a big reason why I prefer Cronometer.

(Matthew) #13

Athena, thank you for taking the time to reply.

Do you know how long the rise in cholesterol would persist after you are “actively losing weight”? I got down to my current weight pretty quickly - I have been at this weight for at least one month before I had these latest blood numbers checked. Not sure if I would consider myself “actively losing weight”

Also, which cholesterol numbers specifically would you see go up while “actively losing weight” (HDL, LDL, etc?)

Matt

(Matthew) #14

Looks like they have come along - :slight_smile:

(Matthew) #15

Thank you for the reply. I have looked at this on Google. Seems the things that set me off are shellfish - especially if I have a glass of wine as well.

Matt

(Matthew) #16

Saphire,
Thank you for the reply. A very interesting read- I am not sure if the fructose idea applies to me - since going keto I have not eaten any fructose for 3 months - no fruit - nothing. My gout pain has consisted of a few flares and a persistent pain in the toe area. I am going to go see a podiatrist and get to the bottom of this.

Matt

(Matthew) #17

Siobhan,
Thank you for your reply - I was hoping that you would jump in.

First of all - I wanted to say that I was VERY impressed with your work presented on the 2 Keto Dudes podcast - the one where you were inspired by Dave F’s unresolved questions and began your own research - wow.

I will try to address you questions/ comments

  • I had NOT been fasting directly before this bloodwork - my last fast was in Oct and I began my next the 4 days fast the day after the blood work - I schedule my fasts around the solstice.

  • I was eating normally before the blood work. Same macros as I described in my post. Basically under 20 carbs, about 80g protein and about 135g fat. I am aware of the Dave F - cholesterol test hacking protocol - very interesting - but I don’t want to hack my results - I want to know what my results are based on the diet I am living with.

Thank you for the clarification of the HDL and the HDL/trig ratio. I was using the HDL-P number (23) and not the HDL-C number (46) and getting a 7.x ratio result. I was freaked out.

I am still not sure I understand how to interpret my pattern A and B numbers based on my NMR results. Any help here is appreciated - Do I have high small dense (bad) particles? Do I have high large fluffy (good) particles? Can you tell based on my results?

As far as being sick - I had been quite sick (flu?) leading up to the blood draw- I actually was prescribed an antibiotic right after the blood draw. I had been coughing really badly - up at night etc.

I think I am going to stay keto - but move toward some healthier fats - no more bullet coffee - lots less cheese. I will retest in a few months. Also - I am getting a CAC test in about a week.

Again, thank you so much. I hope to hear more about your cholesterol research.

Matt

(Matthew) #18

Dave,
Thank you so much for the reply. You truly are the “guest expert” listed on your profile :slight_smile:

I did my absolute best to keep in line with my macros leading up to the test. I have listened with great interest to all the discussions about how the cholesterol test can be “hacked” based on a low calorie(keto) period followed by a high (5000) calorie period just before the test. I think these experiment are fascinating and go along way to show that the understanding of cholesterol in the medical community is flawed. I really wanted to get a measure of what my numbers are based on my real life eating (keto) habits. Also, I did water fast for the 12 hours leading up to the test and I did not drink any coffee or have any other confounding factors (other than maybe sickness - see my response to Siobhan)

As far as tracking goes - I am VERY METICULOUS and reference multiple nutritional resources before I enter them into myfitnesspal. I am very confident that “leaks” are not the issue. I know it is a real issue for some people and you provided very sound advice - but my data entry and monitoring is solid.

I plan to shift to some healthier fats and retest in a month of so - when I am not sick. I am also getting a CAC test next week.

Again, THANK YOU so much.

Matt

(Matthew) #19

CristiVlad,
Thank you for the reply.

I have been eating about 130-140 g of fat a day - this is the number the keto calculator gave me based on a desire to loose weight - vs. maintaining weight. I have hit my goal weight and need to see about getting back into the calculator and seeing how much I need to increase it by.

I think getting the genetic testing is a great idea.

I eat spinach everyday as my primary veg/fiber. The spinach give me great nutrients without adding too many carbs. I do want to start adding more vegetables - but when starting out on keto I wanted to stay below 20 (incidental) carbs. Now I am going to start expirimenting with adding more vegs - even if it means increasing carbs to 30(+). I will watch my numbers closely and make sure I am not busting out of nutritional ketosis as a result. I am also going to start moving to more healthier fats vs - just eating any and all fats.

Matt

(Matthew) #20

Karen,

Thank you for the reply.

As far as tracking goes - I am VERY METICULOUS and reference multiple nutritional resources before I enter them into myfitnesspal. I am very confident that “leaks” are not the issue. I know it is a real issue for some people and you provided very sound advice - but my data entry and monitoring is solid.

Matt