On Jimmy Moore’s podcasts, I’ve heard Dr. Sarah Hallberg speak on the research she follows and is involved in. The typical results of the ketogenic diet (low trigs, low insulin, SWEET lipid particle profile - improvements) are observed, but then there is the few poor chaps who are among the 1% who compose the anomalous. She insists they do not go overlooked or ignored. Well, I’m afraid I’m one of those 1% chaps where the numbers simply don’t add up. After six months last year (May to October) of a diet highly ketogenic (90% fat, 1-2% carbs, the rest protein - about 55 grams/day), coupled with very active work days and low-level aerobic running, my battery of blood tests done at the end of the period baffled me. I’m not new to ketosis or low carb (been on and off for over 12 years), but decided last year to redouble my efforts and get serious for the rest of my life. I realize this forum doesn’t provide a ton of space to unload much data - and I have a LOT of data from last year’s 6-month run - so I won’t dump all that in this post. I would be happy to provide share links to my Google Sheets for anyone who cares to peek. I just need help. For instance, after what I thought was textbook diet and lifestyle for six months and seeing daily glucose (fasting, postprandial, post-workout, all-day) averaging 82, and average blood ketones (Precision Xtra) of 5.5 mmol, I expected the Sarah Hallberg typical outcome. But not so. Where my blood glucose numbers seemed great (HBA1C 5.1, Fasting Insulin 2.3, and many other markers) my trigs were in the 400 range, particle size was large (LDL pattern B), yet high HDL (94), and so on down the list of crazy numbers. Add to the complications that there is no doctor to my knowledge in my area who is friendly to LCHF (I’m in Memphis, TN). So I have no immediate and intimate health professional for guidance. That’s why this forum is so meaningful to me. I’ve just started the new year this way so far: I’ve scheduled a basic Chemistry lab, an NMR, fasting insulin, and HBA1C with Quest Diagnostics for a “Start of 2017 Baseline” so I can sort of reset. Past 24 hours yesterday fasted and plan to do the same today, mixing in intermittent fasting. Plan to dial the fat back a little from 90% to 75% - 80% (based on a talk by Ted Naiman on YouTube). Here’s the crux, and my questions: Are any of you guys experiencing similar things? What’s the science behind our anomalies? Are we any closer to an answer? I’m sure this is not a simple concern that will be solved overnight. I am excited about the journey ahead of finding answers. I hope that among the replies and the full resources of this forum we can find answers and ultimately lead to more optimal health. Please jump in and throw out some ideas.
Anomalies in Nutritional Ketosis: Low Insulin & Glucose but Abnormal Lipids
I’ll start with a suggestion that you break your posts up into smaller paragraphs, as one big block of text is a bit hard on the eyes. 
As for your results, from what I’ve read it’s not that unusual to see high trigs if you’re still liberating stored fat. So if you are still losing weight, that might be what’s going on there. Your HDL is indeed fantastic, so the only lipid concern (assuming that the trigs are the result of fat liberation) is the LDL particle size. Honestly, I don’t have the background to address that.
I’d suggest continuing to research providers in your area. In a large metro area like Memphis, I would be very surprised if there isn’t a primary care doc who “gets” keto. You just have to find them.
Good luck!
Yes, point well taken. I can be too wordy.
As to the weight loss: I didn’t, nor have ever done LCHF for weight loss. I’m 5’8" and 130 lbs. I’m doing it for health primarily, secondarily athletic performance (love to run).
Docs: I get it that I have to search. Any pointers? For instance, say you had to move to a new city - career change, say - how would you go about it, looking for a LCHF doc? I’ve never heard it to be an easy undertaking from the LCHF Community at large. To me it’s a “how to” thing, when the vast majority of the medical world opposes our views.
Thanks!
That’s a tough one. I don’t currently have a primary care doc (my last one went into concierge practice, and I wasn’t prepared at the time to pony up the concierge fee), but my previous doc was pretty supportive.
You might just have to call around. I’d look at smaller family practices, and give them a call and ask. Might take some time, but it’s your health, right, so worth the time.
I wonder if the high trig count is nothing to be concerned about it light of excellent HDL and Pattern B LDL. Reading Volek and Phinney’s, The Art and Science of Low Carb Living, at the moment. I would say that the Trigs you are storing would be very different from those stored in adipose tissue.
Based on your high ketone average perhaps that is the link to the high Trigs. The game changer would probably be if your CRP was higher that 1 mg/dl, that and high Trigs could be concerning.
I saw your high ketone average and the first thing that occurred to me was there might be a correlation to the high Trigs. It will be interesting to hear what someone with knowledge would say.
There was one guy in the Keto Ninjas who saw really high triglycerides after keto … I don’t know what the answer is.
There is a rare genetic trait called carnitine palmitoyl transferase deficiency that means people can’t get long chain fats efficiently into their mitochondria. That could cause trigs to back up in circulation because there was not enough consumption of them.
I reckon talk to your physician and ask for testing to rule out unusual deficiencies metabolizing fat. If you can’t get local physicians that will engage with this, I’d consider having a remote Skype consult with Dr Jeffery Gerber.
CRP last October, three tests: .9, .3, and .1 on last test. Very low inflammation marker. As with Richard’s remarks, suspicious of fat metabolism efficiency. Could the high ketones also indicate that they as well aren’t being utilized and are just hanging out in the blood?
First of all thank you for your insights.
Fat metabolism, uptake, and utilization has been a concern of mine ever since I heard Dr Ron Rosedale speak about the issue of high blood ketones. His opinion, as I recall, was that fat and ketones, if being used efficiently, should not be present at high levels in the blood. He recommended L-Carnitine as a supplement in such cases.
Yes, I really need a live expert, a keto-physician. Last fall I emailed Dr Gerber’s office and the RN replied with the same recommendation, to arrange for a Skype session. I think, unless I move out of state or find a keto-friendly MD here in TN, that your Skype idea is the way to go.
Another doctor who lives a ketogenic life is Eric Berg he has hundreds of health related videos on youtube and I think he has an online coaching program you can join,not sure if any of this has anything to do with your liver but he has a good video called how to avoid a fatty liver while losing weight,and mentions eating leafy greens and using Apple cider vinegar ,he is based in Virginia from what I remember, he gives keto recipes as well
Very interesting info and condition…curious myself as well with what is going on here.
I have a question. Have you ever fasted? Either intermittent or extended? Was there a difference? For example, if you ate a 80% fat keto WOE, was this with the normal 3 meals per day regime? Did you repeat the 80% fat keto regime with intermittent fasting, and see if there are any different outcomes?
Yes, I have fasted intermittently quite a bit. In fact, last summer most of my meals were typically a breakfast of around 1000 calories and a dinner of about the same or a little more. I would fast 14 hours in between nearly every day. Some days I would skip breakfast and just eat a large meal at night. Once or twice I did a 24-hour fast. This week I have done two 24-hour fasts.
Did you notice any difference in the data with or without fasting while doing keto WOE?
Interestingly, many years ago when I first started low carb I was not eating ketogenic, but it was under the Drs Eades’ Protein Power Life Plan approach. Their diet certainly includes a good amount of fat, but it is definitely not the 90% I was consuming last summer. In those early days, my health markers were much better. I have lab results from those days with my trigs in the 50s. In October of 2016, they were 400.
Not in home testing. Once I was heavily on board with high fat intake and moderate protein (90/2/8), glucose and ketones remained stable and fairly consistent.
As for labs, that’s the Achilles heel of the N=1. I did no baseline at the start last May. My first labs were at the end, in October. I had a lot of tests done. A LOT. But no baseline. There was some fluctuation from the same test (i.e. insulin, or LDL particle) but only slight and no pattern I could see. But, I’m not an expert.
Sounds like you have the beginnings of the formulation of a hypothesis. Look for a pattern in your history that worked the best, and come up with a test plan. Test it for a decent time period (like maybe a month??), and then test a diametrically opposed condition for same testing period. Compare data of both conditions. This is what I would do if I were you. Good luck…I really hope you find what you are looking for.
Thank you for posting about Dr Eric Berg. I just watched his ACV video and found it most informative. I also noticed his practice is close to me so I’m excited about that.
If I ever need a doctor who will embrace my Keto walk I’ll check him out.