Carnivore Diet N=1 and High Triglycerides Riddle


(Samuel Ashford) #21

Tom, thank you for this post. This will almost sound cliche, but I think it bears repeating. We are all truly different, and sometimes when we see a bunch of people, in fact the majority, jumping on board Keto, losing a lot of weight, and reducing their TGs from say, 300 down to 50, we assume it’s going to all work for all of us all the time. Or at least, that’s the hope and expectation. Indeed, back in 2003, when I first started low-carb, that was similarly the case for me. My triglycerides went from what I thought was a high 178 down to 47 after 5 months.

Later, when I have a few minutes, I would like to reply a little more in-depth to what you addressed in your post. For now, I would just like to say that I do have some thoughts on what you said and would like to respond in a way that I hope can be helpful.


(Samuel Ashford) #22

Tom,

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.

  • “HDL between 40 and 50”

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.


(Brian) #23

Thanks for sharing this! I’m starting to really like Dr. Berry. He’s not exactly in my neighborhood, probably about 2.5 hours drive from where I live, but I think worthwhile to visit should I feel like I need the help of a keto-friendly doc. Kinda wish I had known him a couple of years ago when I think my parents could have really been helped. (One passed and I don’t think the other has much longer. Seems like he could have saved so much suffering… I know, we can’t go back in time… but it’s hard not to think about sometimes.)


(Topper Sfw) #24

Hello Kairos, I am so glad to have found you, we are both on exactly the same path. I started my weight loss journey first with prolong water fasting, then I move to keto and found that I was a LMHR and recently for 6 weeks I went to carnivore because it is so much more sustainable and I love my meat :slight_smile: Just did my blood work and have Triglycerides of 339~379mg/dL

I am on Dave Feldman’s Facebook LMHR group, I have posted it there also and link him to your post. Interesting times!

Hope to chat more with you and see how things develop.

Regards,
Ferdinand


(Topper Sfw) #25

Just had a quick chat with Dave, he suggest that we should stop coffee for a few days before we run the test again. Refer to the following page:

Regards,
Ferdinand


(Samuel Ashford) #26

This is a follow up. Keto_Tom, you and Topper might be interested.

To recap, I went carnivore all summer and trigs came back at 330. Planned on ditching coffee altogether, but instead implemented three things:

  1. a diet that aligns with The Eades’ Protein Power Lifeplan approach (around 30 grams total carbs per day, moderate protein, fat to satiety);
  2. switched from french press caffeinated coffee to decaf with a paper filter; and
  3. began a regimen of 4 grams per day of pharmaceutical grade fish oil (based on several studies like this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563284/). The brand I used was (and is) Barleans, but there are many high quality fish oils on the market.

Today I received the lab results for my lipid profile done yesterday (all mg/dl):
TGs dropped from 235 to 129
HDL increased from 58 to 78
VLDL down from 47 to 26
Total cholesterol (did not do an NMR) at 516
LDL at 412
Fasting glucose 101

It seems that the omega 3 fatty acids in the fish oil are definitely dampening the VLDL production and clearing the TGs from the blood, as expected per the studies’ findings. I am still mystified at how they can be as high as they have on such a low carb diet.

I have been doing very minimal exercise/workouts. VERY light, if at all.

Hope this helps.


(Omar) #27

Interesting

glad to see you making positive progress.

I had a significant drop in my triglycerides after quitting coffee.I have been cautioned by others it may not been coffee . a view which I tend to disagree with but have no proof.

I quit coffee and after a week I took the November sample.

I feel that coffee and maybe coconut oil interfere with some function in the lliver. I feel the digestion issue very obviously when ingesting coffee including decaf but being a coffee lover I went into denial mode for very long time.


(Samuel Ashford) #28

Your ratio is really looking better. Great job!


(Omar) #29

My hdl looks like engraved in stone.

I will try the omega 3 as you mentioned in your last post.


(Brian) #30

Makes me wonder how much is coffee and how much is caffeine. Would just switching to decaf be the ticket to lower triglycerides?


(Omar) #31

I have no clue but I start to respect Dave Fieldman .

I really start to hate coffee as much as I hate carb. I took it personal.

No substance will take my life quality from me.


#32

:rofl: I don’t blame you!


(Regina) #33

How much coffee were you drinking?


(Omar) #34

three cups all between 7 am and noon


(Regina) #35

I went to the doctor for fasting glucose and I was 89 (no coffee). Every day I drink coffee I am 99. Will try to cut out coffee for two weeks to see the results.


(Juliana Szabluk) #36

Kairos, your comment is simply precious. I’m having the same problem.

I was in Primal Diet and my lipid panel was ok, not perfect, but ok. I got into keto and I’m a little desperate, since my total cholesterol went from 200 to 511.

My apob and Ldl are simply scaring now. My trigs went up also, from 100 to 156.

Gladly, I’ve been seeing the greatest low carb Doctor in Brazil. He asked me to take the exames again in another place.

Also, he sent me a link that can explain what we’ve been going through. I’ll come back after the new exams, but, for now, I’ll share with you the link he sent me and another one I found while researching for a few days.

One thing is important to mention: I’m a Noakes Foundation student. I’m specializing in keto. I’ll ask my teachers to answer us, because there are too many cases this “saturated fat is not a problem” simply doesn’t work.

Actually, you’ll see in the article, 1/3 get worse lipid panels, it’s a huge number if it’s true.

They must say something about it. We cannot be ignored. There are virtually no articles talking about our case. Someone must explain this or at least they should start talking about us.

My guess is that it’s probably the saturated fat. More likely yet, the Bulletproof coffee. I drink two a day. You see, I’m not eating tons of fat. I’m talking about one spoon of MCT a day. Four spoons of heavy cream. Six slices of cheese. Three eggs. Meat (as Phinney says, between 1,2 and 1,5 per kilo). Still, I’m less healthy now.

I’ll wait for my new exams to arrive and I’ll come back. Then, I’m gonna try some experiments with less saturated fat. But I’m not very sure it will work.

I’ll probably have to go back to Paleo or primal. I see no way doing keto with low saturated fat. There’s almost nothing to eat. It would just be sad. I’ll figure something out. I’ll let you know.

Im sending you a video too, from high intensity health. very interesting hypothesis about Bulletproof coffee and trigs.

Article I found about Bulletproof Coffees https://www.healthline.com/nutrition/3-reasons-why-bulletproof-coffee-is-a-bad-idea

Article my doc sent me http://bjjcaveman.com/2014/11/17/ketosis-and-high-cholesterol-according-dr-thomas-dayspring/

Video https://youtu.be/yLDq7Hx8gjg


(Nicole) #37

Have you thought about just dropping the BPC and MCT oil and eating more leaner meats and protein instead of dropping keto? Like more eggs whites with your eggs?

Have you had particle size, crp, calcium scores or BP checked too? I’m just wondering if everything was worse.


(Omar) #38

Dave Fieldman suggests (him and many other people visiting his page ) dropping the mct and coffee few weeks prior to the lipid panel. I read this information more than 6 month ago. Unfortunately I did not take serious then I deserve the suffering for the last six month for being negligent.

I think it should be given a try prior going paleo or quitting keto.

these substances and who knows maybe others impairing some liver functions in some people.

while It is premature to make such conclusion in my case but the improvement I observed in my digestion and life quality is beyond doubt.


(Samuel Ashford) #39

Well, first of all, thank you for your gracious comments. Here in the states, it’s our Thanksgiving Holiday today. If you do this holiday also, then Happy Thanksgiving!

As to your journey, I completely understand, and as we go through this together, I wish you the best on figuring out what is happening to your metabolism. I think there is hope, and if we keep at it, we will continue uncovering the answers. Science is in our favor.

I also think it is important for those of us on similar paths to continue collaborating. It can get difficult and lonely on a path that is “outlier” - out in the fringe or margins. I am deeply grateful that most who embark on a LCHF diet see fantastic results. The typical person is one who is overweight and has all the complications of type 2 diabetes. When they begin, their body likes the change, insulin starts working in their favor, they lose weight, and their health markers become quite favorable. In essence, they reverse type 2 diabetes, and they get their health and their life back. And I applaud these people, and love them and their journey. But I also care about the outliers who, quite frankly, don’t meet the template and consequently - not due to anyone’s intention - (to me) seem to get marginalized and overlooked along the way. Sometimes the diet is problematic to them, and I feel many of our brethren who more closely fit the template (and even many health professionals in our community) don’t realize the subtle nuances and needs of a certain percentage of us who desperately want to enjoy a thriving keto life, but aren’t because of our difference in metabolic response to the keto diet.

Thankfully, Dave Feldman is addressing this to a degree in his LMHR effort on the Cholesterol Code website and in the FB group, LMHR (https://www.facebook.com/groups/LeanMassHyperResponder/). His leads on coffee have been most helpful.

I understand your fear and your concerns about returning to the middle of the road type diet like Paleo. A little less fat, a little more carbs. And sensible protein (whatever your body needs). I have considered this as well. While I find the benefits of ketosis so attractive (and there are many benefits), nonetheless, I personally believe that high TGs are harmful, and that their proliferation in the blood must be mitigated in order to stay clear of arterial blockage in the future. Unless I come across research that is to the contrary, the studies I’ve seen show convincing correlation (if not causation) of high TGs and future cardiac events.

So, where do we go from here? I think that, unfortunately (because of the monetary and time cost), we are in for a good amount of personal testing and experimentation. We have to find out what our personal physiological needs are, and do our best to meet those needs. We know that inflammation, high glucose, high insulin, high TGs, and other hormonal dysregulation is what we need to avoid. But what diet, for each of us, keeps these things where they should be?

The title of this thread is a little misleading in terms of my long term goal. My long term goal is not carnivore. My long term goal (as it sounds like yours is) is optimum health - as favorable a healthy life I can have, within reason. I have no philosophical angle or rationale for carnivore. I think carnivore makes a lot of sense with the Paleolithic origins narrative. But if my body doesn’t respond well to it, I must discard it. I am not a servant of any particular diet.

Specifically, I have two goals:

  1. To find a way of eating that produces favorable and healthy outcomes
  2. To understand the metabolic pathways that produce such good outcomes

Finding out what makes for a good lab result is a matter of eating and testing. But it doesn’t tell me how that way of eating brought about the good lab result. All it tells me is that is DID produce a good lab result.

I want to also understand it - to know WHY eating a certain way leads to good results, and conversely why eating another way leads to bad results. I feel that without the understanding, I will not truly be able to consume what my body needs, or avoid what it doesn’t need.

The “standard” understanding in the LCHF community is that consumption of high carbohydrates leads to production of triglycerides in the liver, which causes high serum triglycerides. And that is true. But eating high carbohydrates is not the only cause.

I like to cite Brenda Zorn’s steak challenge example, because it is well documented, and because it clearly illustrates dramatic rise in serum triglycerides for Brenda APART FROM high carbohydrate consumption.

Similarly, I have seen the same high triglycerides in myself over the past two years on keto and carnivore, at completely different points in time. And while consuming little to zero carbs.

Thankfully, I think I’m beginning to make some progress in my search. Here’s why:

  1. The fish oil test worked. And it’s backed up by science (see these studies: https://www.ncbi.nlm.nih.gov/pubmed/8352438, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563284/#).
  2. Coffee during the test wasn’t a confounding variable. This is because the cafestol compounds in coffee that cause high triglycerides are present in decaf as well as caffeinated coffee, whether or not the coffee is filtered. This is according to a new study I found here: https://www.ncbi.nlm.nih.gov/pubmed/9409294, https://www.ncbi.nlm.nih.gov/pubmed/11124749. And there’s a lot more. So, this is something we know.

What I seem to be finding so far are three players:

  1. Lipase activity, and substances that inhibit lipase (like alcohol)
  2. Triglyceride production, and substances that dramatically increase it (like high carbs and cafestol in coffee)
  3. Triglyceride clearance, and substances that inhibit or interfere with clearance (like cafestol)

The fish oil seems to me to powerfully reduce liver production of TGs and increase clearance, as the studies show. This actually tells me nothing about what is causing the high liver production or sluggish clearance. But it shows that the Eicosanoids produced by O-3 fatty acids can powerfully affect TG levels in the blood.

As for the coffee, I’m eager to see what testing will reveal. I intend to test soon, to go off coffee for 10-15 days and then test TGs in the blood (without taking any fish oil during that period). This should show something of the nature of cafestol’s effect on TG and clearance.

I hope I didn’t get too “sciencey” with this reply. I truly feel your pain with all the trouble you’re having. After my next testing, I’ll either continue this thread or start a new one with the new testing. Either way I hope to hear your comments again.

Thank you for sharing the articles. I look forward to reading them after this reply.

Once more, thank you, and welcome to the journey!


(Samuel Ashford) #40

Omar, thank you. I wonder about the time frame. I have been conversing with Siobhan Huggins on LMHR and she recommended I sideline the coffee for ten days and test TGs again.