I found your reply very interesting and felt it deserved a thoughtful reply (as it was very thought provoking to me). Please forgive the long response - I’m not trying to pick your post apart, but I thought that if any of this helps I’m happy to have added some value to your journey.
- “what exactly have you concluded so far?”
I don’t think I’ve concluded anything. I’m still on the journey, and the longer I’m on it, I think the less I know. Not to mince words, but I’d rather say it like this: what have I learned? I used to think that I’d quickly draw down on something conclusive and be done with it. My body has been a strict teacher and schooled me well on that notion. When I got my lab results in August of 2016, I was truly expecting TGs of around 50-60. The resulting 202 floored me, and it’s been much higher since then. That lab result was the beginning of trying to understand was has been happening for the past two plus years.
- “your switch to protein power from carnivore presumably means that you’re now eating less protein?”
On the carnivore diet I ate approximately 1.5 to 2 lbs of meat a day. That’s between 168 and 224 grams per day. That was to satiety, and almost always two meals a day. The Protein Power Lifeplan program is much different. It’s like a more structured version of the Atkins plan. There are three phases: Intervention, Transition, and Maintenance. These only differ in carb allowances based on progress. Protein is always kept at about 27 grams a meal plus allowance for snacks of protein if you’re hungry, for my weight range. Basically it was the eyeball approach of about the size of the palm of your hand. So, the Protein Power approach is around 80-100 grams a day. Yeah, a lot less protein.
- “I presume sat fat has now reduced on protein power”
This is a really good point to bring up. Protein Power never preached guzzling the fats and oils. Keto really doesn’t either, per se, but keto is a lot more liberal about exogenous fats of all kinds, and we regularly hear the “don’t fear the fat” mantra (and believe me I totally get it), and we tend to champion the notion of slathering our meats with Kerrygold butter and so on. Protein Power isn’t like that. The emphasis in Protein Power is carbohydrate restriction, not fat consumption. For PP, consumption of healthy fats is acknowledged and assumed, but not the focus. The focus when it comes to fat is a shift from unhealthy fats (i.e. seed oils - omega 6 laden) to healthy fats. But not in volume. So, by its nature, the PP plan would reduce fat intake, but not as a goal - such as the fat-fearing low-fat diets. Or, better stated, fats on PP are mostly about those that are naturally occurring in the foods, not by adding a lot just to ramp up ketone production and have something to talk about on social media.
- “Just had my recent labs back and basically my numbers have gotten ‘worse’ again.”
Just curious: in the past did you have a lot of lab work done? Did you have a baseline to use for comparison before going keto? I know that before I went hard core keto (90/2/8 macros) back in 2016 and came back with “horrible” results four months in, I did not do a baseline at the start of the N=1. Bad mistake on my part, because I was comparing past very favorable labs (2+ years before and longer), instead of a snapshot at the start of the diet shift.
- “my cholesterol refuses to move in the right direction”
Have you looked into Dave Feldman’s work? He (and many others) promote and demonstrate that cholesterol proper is a non-issue. Higher cholesterol has been demonstrated to be actually protective than super low, especially in women. Don’t have any bibliography off the top of my head, but the issue isn’t so much the amount of total or LDL but the nature or type of particle.
For me, what moves the needle more than anything when it comes to HDL are two things: endurance running, and saturated fat. Those two I’m confident about. It’s been nearly one of the only consistencies for me over the years.
- “my Hba1c was 5.2 before keto when I was 50 lbs heavier”
That’s definitely a high point. Great A1C. As far as I can see, you all (family) are on the insulin sensitive side, and can take far more of a beating from the Western Diet than most.
- “I’ve done two 5 day fasts as well as multiple 24 hour and IF most days…”
Same here. In 2017, I did an 84-hour and another four-day fast, but with decent results, though I must say it wasn’t pleasant for me. Consistently IF most days as well, and a lot of 24-hour ones too, which are much more appropriate for me. I think (assume) this regular IF practice has kept insulin at bay, but since the technology isn’t there for advanced insulin tracking (reliable home testing), the once in a while snapshot of fasting insulin doesn’t satisfy the question for me. I know this is a dream, but once Continuous Insulin Monitoring is a reality, the game will change forever and we won’t have to make long shot guesses at insulin trends.
- “The high trigs and complete lack of HDL improvement since I started keto…”
Do you track macros? What’s fat like? And what about saturated? When my HDL was 84 in 2016 and 102 in early 2017, I was consuming a lot of coconut oil and butter. A LOT.
- “Both of these may somehow influence the way the body uses cholesterol…”
So, for you, the apoE4 and MTHFR genes may very well be a great lead. The more I think about everyone’s unique biological individuality, the more I’m leaning harder in to the snowflake concept. Here are two compelling examples that come to mind right away:
Brenda Zorn and Donna Lordi and the 30-Day Steak Challenge. Brenda’s TGs had been in the 900s before keto. Then after going keto, they dropped to within the standard <150 range. Donna’s had been no more than 50 at her heaviest, pre-keto point. After the steak challenge, Brenda’s soared to above 500, and Donna’s were an 8! To me, this proves that people definitely respond differently to different diets. NOBODY can just play the “template” game here, it seems to me.
The Algorithm Diet. There is an Israeli scientist, Eran Segal, who is a part of a research team developing a computer (and diet) program based on large studies of people who tracked greatly varying serum glucose responses to different foods and meals. The program has been shown to accurately predict favorable outcomes in glucose control based on sophisticated algorithms from the subjects’ wildly different glucose responses from the same foods. In other words, some could eat ice cream with nearly zero glucose response, while having glucose in the stratosphere after eating rice. And vice-versa.
As for me, I’m down for a lot more experimenting to rule out things myself. In the near future, I plan on retesting the carnivore diet with 100% grass finished ribeyes for three days without coffee (a Dave Feldman idea), and then a week later with coffee, testing for TG after each. I have several other regimens I plan to try to rule out other things. I don’t really see any other way. Thankfully I’m content after all this, to live with the fact that we’re all incredibly dynamic beings, to use Jason Fung’s expression of it. We’re not static; we are fascinating, complex, hard to predict (and understand) biological machines.
First, beginning right away, I plan to try pharmaceutical-grade triglyceride-form fish oil. I will keep everything the same (not messing with too many variables, if I can help it), and try the doses necessary to stimulate change. This paper (Fish oil – how does it reduce plasma triglycerides?) was compelling to me. I’ve always taken fish oil, but not at the therapeutic level done in the study. I’m going to give it thirty days with 4 grams of EPA/DHA a day and see what it brings me.
The entire reason I started this post and thread is to raise a little beacon. I am firmly convinced that “lower carbs / higher fat” doesn’t absolutely and necessarily mean “lower triglycerides” for everyone. Furthermore, high TGs don’t always absolutely result from high dietary carbohydrates. I know this because of my own experience, strictly adhering - with everything in me (weighing everything and keeping meticulous records) - to a high fat and nearly zero carb diet, only to land 202 mg/dl TGs. I don’t feel that anomalies like this get enough attention, and that those suffering with these dilemmas are more in number than we realize. And most importantly, since it seems unanimous among all parties that high TGs seem to be a major player in the advancement of atherosclerosis (and therefore early mortality if unmitigated), then lowering them trumps nearly everything else when it comes to dialing in our health. The ketogenic community already has a proud legacy of spearheading remarkable success in reversal of T2 Diabetes and weight loss. I think we need to spearhead something for the skinny keto people who don’t respond so smoothly and gracefully to classic keto, who might look “normal” on the outside but are metabolically challenged nonetheless. There is definitely an opportunity for such an effort.