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

[SomeGuy]

sorry typo. CAC 333.
MAFF is the training popularised by Phil Maffetone, which is really zone 2 (he advocates HR180- your age for a max during these sessions). Lots of others now recommending it, as I’m sure you know. I’m like you on the CAC, not sure what else to do but continue on this road, so following this thread with interest.

Ah, helpful clarification, thanks. Haven’t come across the MAFF/Maffetone perspective.

180 minus age seems like fairly light fare. I haven’t read the MAFF material (yet) but am assuming he recommends longer training periods of lower stress exercise?

My understanding is that max heart rate (subject to wide individual variations around population averages) approximates 220 BPM minus one’s age. Separately, most trainers seem to suggest reaching 80% of your individual max as a “training zone” for cardio improvement and maintenance.

For me, in my mid-60s, my “max” HR ought to be around 155 … but when I engage in bursts of HIIT cardio (e.g., 3 bursts of 20 second duration interspersed within a 10 minute gentle cardio segment as per a number of research papers I’ve read), I typically reach around 140-145 bpm - appreciably higher than 80% of 155.

In short, we’re all different n=1 sample points and population averages are merely that. Will try to make time to learn more about MAFF approach and see if I can learn something. Thanks.

[JonAddison]

There was another man doing all he could to get his arteries supple and calcium score low. I believe his name is Patrick Theut. He mentioned one missing ingredient that after he started adding it to his daily regimen, everything changed for the better. From what I recall, he is heavy on Lysine, vitamin K (huge doses), and Vitamin C.

[SomeGuy]

There was another man doing all he could to get his arteries supple and calcium score low. I believe his name is Patrick Theut. He mentioned one missing ingredient that after he started adding it to his daily regimen, everything changed for the better. From what I recall, he is heavy on Lysine, vitamin K (huge doses), and Vitamin C.

Yes indeed. Having spoken with him a couple of times, I find Pat to be a fascinating guy. In fact, my wife and I are currently taking his “Koncentrated K” [sic] Vit K product. We’ll see if, along with everything else, our CAC scores stabilize and begin to decline over time.

[Hallie]

My personal hack for training or exercising in easy zone is to keep my mouth shut. Or when I’m with a friend, lots of talking without having to gasp it out in phrases. I also have awareness of the timing of my breath with steps when I ran.
In case that’s useful for someone scratching their head over max HR numbers

[carntyne]

First time on forum so please bear with me.
Same situation as you.

Been on keto for 3years but CAC score increasing. Prior to keto I was on a general diet and at 70 years of age first CAC was 94. I did this due younger brother dying of only heart attack.

So, it took me 70 years to get to94 but in the last 3 years on LCHF my score has doubled to 181.

I do not have a solution to this issue but I have been getting my LDL subfractions done. From two peaks I am now on four peaks. This is indication of increasing sdLDL which is not good.

My ferritin was high but I fixed this with restarting blood donor. My CRP is 1 so inflammation does not appear to be an issue but something is damaging my endothelial and sdLDL is increasing the plaque.

My next move is to get a check for APOe4. This is known to be an indicator of an inability to process saturated fat and common in northern latitude populations.(I am Scottish/Irish/Northern Europe heritage)

During las 3 years my BMI has been 22/23 and I am on K2, magnesium, D3 and B3. I exercise HIIT 3/4 times per week and weigh 68kgs. At this stage I am abandoning high fat but keeping carbs as low as possible.

Hope this is of some assistance in resolving increased CAC on LCHF.

[SomeGuy]

@carntyne Welcome to the forum.

Your situation reminds me a lot of my own, as described above. It’s certainly scary to see one’s (modest) Agatston CAC score rise - especially while trying hard to improve one’s health through carb-restriction and other related enhancements.

I can’t predict the future, nor do I know enough to try when it comes to another individual case. All I can say is that, notwithstanding the fear of heart issues (which run in most families, it seems) staying the course really made a difference for me.

I continue to believe that the increase in my annual CAC scores that I experienced at first (from 55 to 68 to a tripling at 207, before then declining down to 157) reflected a “scabbing” over of prior lower level soft plaque damage from a lifetime of eating inflammatory carbs. Could’ve been far worse.

I also believe that the Agatston score misses out on properly assessing calcium density. Density simply equals mass divided by volume. In all cases, even as my volume was increasing, my mass was increasing by more … i.e., the density of the calcium was gaining and the protection of the hard (echolucent calcified plaque) was increasing.

In other words, my body was healing as a result of carb-restriction + K2/D3. The danger of loose soft plaque causing a cardiac or brain incident was receding, not increasing.

That’s my theory. My physician does not dispute this interpretation, given the data he’s looking at.

Of course, the rest of my profile is consistent with this… like you, I engage in regular HIIT strength training and daily cardio. My inflammation markers are remarkably low. But my LDL is super high as a LMHR.

I should also note that my subfractions look great (Pattern A, highly insulin-sensitive) and my HDL is just over 100 with Trigs around half that.

Context is everything. Continue doing your research and make sure you compare sibling/family outcomes with associated individualized context before getting overly committed to any particular interpretation of your own health situation.

Best wishes!

[robintemplin]

I have nothing to offer but best wishes. And just wondering if you’ve considered going carnivore? I am not saying I know that it could help. I’m just curious. I ended up carni anyway after eliminating foods that gave me issues. I do not think it is the best answer for everyone. But I think If I were in your shoes, I know I would too would be worried… and I would probably be looking at something drastic like carni.

I don’t think it could hurt. But others may disagree.
Good luck.

[Naghite]

I am awaiting my first CT Angiogram which has been ordered. My doctor felt a CAC score was of little comparative value as he was interested in soft plaque progression. I know you also considered, but would that be a much better test to determine if indeed you soft plaque’s are indeed calcifying or if both soft and calcified volumes are increasing? Thoughts?

[PaulL]

I suspect the real issue is probably where we are in the progression. Ravnskov and Diamond hypothesise that arterial damage occurs all the time, but that when we eat a proper diet, that damage heals and we don’t notice it. The problem comes when the rate of repair can’t keep up with the rate of damage. And for various mechanistic reasons, a low-fat, high-carbohydrate diet increases the rate of damage.

Arterial plaque is part of the healing process, and we see a lot more of it on a high-carb, low-fat diet. So it is likely quite possible that, by the time we go keto, we are in the middle of a goodly amount of damage at various stages, bad enough to require plaque formation to be healed, and that the plaque is therefore going to get worse before it gets better. The key, of course, is to slow the rate of new damage back down to a manageable rate, and a low-carb, high-fat ketogenic diet seems to do that quite well.

[SomeGuy]

I am awaiting my first CT Angiogram which has been ordered. My doctor felt a CAC score was of little comparative value as he was interested in soft plaque progression. I know you also considered, but would that be a much better test to determine if indeed you soft plaque’s are indeed calcifying or if both soft and calcified volumes are increasing? Thoughts?

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.

[SomeGuy]

Arterial plaque is part of the healing process, and we see a lot more of it on a high-carb, low-fat diet. So it is likely quite possible that, by the time we go keto, we are in the middle of a goodly amount of damage at various stages, bad enough to require plaque formation to be healed, and that the plaque is therefore going to get worse before it gets better. The key, of course, is to slow the rate of new damage back down to a manageable rate, and a low-carb, high-fat ketogenic diet seems to do that quite well.

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.

[Janie]

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.

[SomeGuy]

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.

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!

[ctviggen]

I am awaiting my first CT Angiogram which has been ordered. My doctor felt a CAC score was of little comparative value as he was interested in soft plaque progression. I know you also considered, but would that be a much better test to determine if indeed you soft plaque’s are indeed calcifying or if both soft and calcified volumes are increasing? Thoughts?

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.

[SomeGuy]

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:

UPDATE: I finally reduced my CAC Score {seemingly good news}

Here’s an update on a thread I started in May 2021 (link provided below). SHORT VERSION: Yes, my overall CAC Agatston SCORE decreased from May 2021 to Jan 2022 - declined from 207 to 157. Although still higher than my first two scans (2019 & 2020), Agatston scale aggregate level of calcification has clearly headed downward. (Same hospital, same CT machine each time.) FYI, I’ve been minimal-carb keto while taking the following daily supplements: K2 (“Koncentrated K” by Pat Theut), D3 (and plen…

[Janie]

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

[carntyne]

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

[PaulL]

Low fat and low carb may be my best option.

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?)

[SomeGuy]

@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.

[carntyne]

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 ?