My sharply rising CAC score - and why I'm staying the keto course đź––

(Joey) #70

Excellent suggestion. In my own experience with rising CAC scores I did think about going the CT Angiogram route. Just never got quite that motivated to pursue it. Here’s why…

Frankly, I’ve never really been terribly worried about heart issues. It runs in my family, but not my phenotype… I take after my father in that respect (in many ways I’m a genetic variation on his theme) and that part of our family (gene puddle?) is prone to death by cancer. So while I’ve been alarmed at the rise in CAC while it was happening, it never really scared me to the point of changing course. Also, the scores were going from “minimal” to “moderate” - nothing by comparison to some folks.

In fact, I take more comfort in carb-restriction as a potential way to keep cancerous cells from getting a stronghold somewhere in this aging body of mine than I do seeing it as a way of avoiding heart problems.

[Aside: I’ve done exercise cardio most every day for 30 years, am lean, have a resting pulse of mid-50s, and low blood pressure. Not the profile of a heart victim … unless those arteries clog up or a clot gets thrown.]

But those CAC score increases did weigh on my mind as I was eating all that saturated fat on keto. Hence the monitoring, and hence the post to share my experience thus far in hopes it’s of help/interest to others. :vulcan_salute:

(Joey) #71

While we can’t know for sure, your description tracks closely with what I’ve come to conclude is most likely going on.

If nothing else, it fits squarely with the trajectory of my annual CAC results in the context of an abrupt change in eating (i.e. LCHF from LFHC). I still consider adequate levels of available K2 and D3 (and strength training as it affects bone demands for calcium) to be part of the solution during carb restriction - as these also affect how calcium gets deployed throughout our metabolism.

(Jane) #72

I don’t want to alarm anyone… just posting my hisband’s results for consideration.

A year ago we both had CAC scans - mine was 0 and his was 114 in one artery. He was concerned but his PCP was not since his cholesterol ratios were excellent. He started supplementing with K2 and D3.

Feb of this year his blood pressure and heartrate were high at his annual physical - never been high before. He went from taking no meds to several blood pressure meds and his blood pressure and heartrate came down but not into the normal range, even increasing the dosage.

Two months ago he started having chest pains so I took him to the ER. After 2 days of scans and tests they found nothing and sent him home. A nitroglycerine tablet under the tongue brought his blood pressure down immediately, which typically indicates blockage.

At his follow up with the cardiologist the next week he ordered the “gold standard” - heart catheter test. They found 80% blockage in one artery and 90% in another and installed 2 stents. He has been ok since then.

He has been keto for over 4 years, never overweight by more than 15 lbs, never smoked, normal cholesterol and good ratios, never diabetic. His only risk factor is eating a SAD diet for over 50 years.

So, my advice is to keep on keeping on with your supplements and keto diet but don’t ignore signs like chest pain just because you are on a keto diet - it doesn’t make you bulletproof.

(Joey) #73

Outstanding advice. Excellent to hear that your husband got the medical attention he needed - as you clearly have cautioned, failure to ignore symptoms could have led to a dire outcome.

Keto can slowly stop (and yes, even reverse) years of metabolic damage… assuming the damage hasn’t gone so far such that your body can no longer respond as one would hope. But it is not a quick cure.

Again, outstanding advice. And sometimes “alarming” someone is just what’s needed for their own benefit.

Thank you for adding your husband’s experience to the mix. Hope he’s doing well!

(Bob M) #74

As a point of reference, for Dave Feldman’s LMHR study, they are using CT angiograms. But those are almost impossible for “normal” people to get.

As for CAC scores, even a zero score isn’t a guarantee of anything. Just lower (but non-zero) risk.

I got my CAC because I had been keto for 5.5 years and wanted to see if “saturated fat” “clogged arteries”. Later, I realized that my Lp(a) was insanely high, which also is implicated in atherosclerosis.

I take vitamin D (usually, though see my post about trying to get this via the sun), though try to get k2 via food. Only problem with food is that unless you’re eating natto, you don’t really know how much k2 you’re getting. So, I’ll often order some natto, and I’ve ordered a bottle of vitamin D with k2.

(Joey) #75

BTW, since I started this thread back in 2021, I offered an update covering the sharp decline in my CAC score earlier in 2022. If you’re interested in subsequent discussion on this topic, some points of interest may be found here:

(Jane) #76

I am so happy you were able to decrease your score!

(James) #77

My results for testing APOe type showed Iam APOe3/4. As far as I can see this type, especially the APOe4 means I cannot process fat very well. Difficult to tell if this is causing my sdLDL sub fractions and CAC score to increase. Totally agree that There is evidence that LCHF increases large buoyant LDL but in my case it also seemed to increase sdLDL in number and reduction in diameters.

Low fat and low carb may be my best option. Plan to check HDL/Triglyceride ratio after two months as HDL may go down and trygliceride up.

Bottom line is I don’t know
if there will be any effects on my CAC score

(Bacon is a many-splendoured thing) #78

Not sure how that would work, since you need to get energy from somewhere. Protein is not an efficient energy source, and the body is just as likely to turn to metabolising muscle as to metabolising ingested protein.

Our whole ingrained concern for lipid values is based on very faulty evidence. At the very best, all we can say is that whatever causes cardiovascular disease, it isn’t our level of cholesterol. Cholesterol might associate with cardiovascular disease, but even that is doubtful, because a number of large, well-funded government studies have shown the reverse; in other words, lower cholesterol associates with higher cardiovascular disease and all-cause mortality. These studies should have called the standard dogma into question, but it was already too entrenched by the time these studies were done.

In any case, we have to ask ourselves why cholesterol is found in arterial plaque. If it is there as part of the repair process, as many researchers have come to understand, then trying to reduce serum lipids makes about as much sense as selling off our city’s fire engines in an attempt to limit the number of fires within city limits. (What? Fire engines are always found at fires, aren’t they?)

(Joey) #79

@carntyne I’d respond in detail also, but @PaulL nailed every point I’d have hoped to convey.

It’s scary, for sure. But that’s primarily because we’ve been scared.

Do some additional reading and actually review the relevant modern-day research for yourself. You can draw conclusions based on your interpretation. If nothing else, your decisions will be less scary.

(James) #80

Just updating previous post.
I have taken the opposite track of staying the course on keto. I have moved to a very substantial vegan type diet with some salmon and lean chicken. After following this for 8 months I had blood and CAC score repeated. Biggest change was to cholesterol which dropped from previous highs of 6.8mml/l to 5 and HDL/TRG from 0.9 to 0.6. As for CAC it increased to 245 from 181. I also checked and found I am APOe4/3. All this while being on K2, B3 and D3 and magnesium.

I realise many on here are looking for a solution to increasing CAC scores but my taking an opposite track to many who are “staying the course” does not seem to have worked though weight fell to 64/65 kgs. So at 75 years old I also wonder what next ~ statins ?

(Joey) #81

That would be something I would advise against. In fact, higher cholesterol - all else equal - at your age of 75 is more likely to be protective than harmful.

Sure, your total cholesterol dropped, but at the expense of a less favorable HDL/Trig ratio. You were clearly better off at 0.9 than you are at 0.6. Most all reliable research agrees on that point. Ideally, you want to lower your trigs and raise your HDL - not the other way around.

In any event, while your CAC increased, this may not really be of such a grave concern anyhow. Your Agatston score is moderate, not highly elevated for your age. But it’s not stabilizing, and that is also less than ideal.

But most importantly, since restricting fat, how do you feel? Is the vegan eating with some salmon/chicken making you feel better than you did on keto (presumably, it had been high fat with minimal carbs)?

If so, fantastic … keep at it. If not, well… :thinking:

#82

Thanks for sharing that James.

(Robin) #83

Best of luck to you! Look forward to your journey.

(Michael) #84

Appreciate the update. Outside of sickle cell anemia, the greatest risk factor to getting CVD is … age. At your age, your CAC score is average http://www.newportbodyscan.com/ebt-coronary-calcium-scoring-guide/ . While obviously you would want it to be lower, it certainly seems that your vegan trial was a failure as compared to before as noted, since your CVD markers have gotten worse, and your CAC score still increased. Having said this, it takes a while for soft plaque to become hard plaque, so your increased number may not have been from your current diet, and as mentioned by @SomeGuy , it is also possible that your risk fell despite the increased CAC score. I recently had a CCTA done to look at soft plaque - and while expensive and you need to take a radioactive isotope, it is the best way to determine your true current risk. If you really want to go all out (and live in the States), you can get a CCTA that comes with computer analyzing to determine the exact amount of necrotic, soft and hard plaques. This would give a better indication of the effects of your diet on your risk.

#85

Coronary Computed Tomography Angiography (CCTA)

@Naghite Michael thanks for pointing out this diagnostic test may be available.

(Bob M) #86

I like that website, although they say this:

If premature CAD is detected, this can lead to a search for less “traditional” risk factors, such as homocysteine levels, Lp(a), and wider screening of family members for these and other treatable cardiac risk factors.

I have “high” homosysteine levels and extremely high Lp(a), yet a zero score on CAC. These might not be the CAD-causing problems that people think they are.

(B Creighton) #87

Most avocado oil is refined. Use virgin oil if you can find it. Otherwise switch to virgin olive oil or maybe even non-gmo pressed canola oil. If I were you, I would insist on getting an oxLDL test on your next blood panel. You may have to pay $50 or so for it. If it is above 100, you can probably lower it by cooking at 300 F or less, and not eating much leftover animal foods. Also avoid processed and most canned meats - esp canned tuna. Any frozen meats should be essentially vacuum packed. Avoid soybean oil based mayo, etc. Sounds to me like you are doing everything else right. If your CAC is athlerosclerotic plaque based, these suggestions should help.

#88

Calcification is a feature of advanced atherosclerosis. There is very strong evidence that people who have coronary Calcification are at higher risk of a heart attack or stroke than people who do not have coronary calcification. As we age, our coronary calcium does go up, as does our risk for the disease. After about age 60, the CAC test really isn’t helpful. Current guidelines show that most American men by age 60 are at high risk. Woman are about 5-10 years later. Have a look at Dr. Allan Sniderman. He is recognized as one of the world’s leading cardiologists and researchers and a professor of medicine at McGill.

(Bob M) #89

No, they are not. They literally have nothing to do with heart disease. Back when I was on Twitter, I was following a guy who accumulated a massive list of the MANY times ApoB failed at CHD prediction. I can’t remember where he kept the list though.