Jimmy Moore - background to 6-Month Lipid & Nutritional Ketosis N=1 Experiment

6-Month Lipid Panel Update On My Nutritional Ketosis N=1 Experiment « Jimmy Moore's Livin' La Vida Low Carb Blog

Ever since I began my n=1 experiment of the concept of “nutritional ketosis” in May 2012 that has resulted in a 50+ pound weight loss so far while consuming lots of healthy high-fat foods to raise my level of blood ketones, people have been asking me about what’s been happening with my lipid panel.

But as we heard from Dr. Jonny Bowden in Episode 632 of “The Livin’ La Vida Low-Carb Show” podcast this week discussing his brand new book on this subject entitled The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will, is this something we really need to be concerned about? Whether the answer to that question is yes or no, what do the numbers really mean anyway?

And are they different for people who eat a high-fat, moderate protein, low-carb diet to produce an appropriate level of beta-hydroxybuterate (blood ketones) that Dr. Stephen Phinney and Dr. Jeff Volek discuss as optimal for health and performance in their bestselling 2012 book The Art and Science of Low Carbohydrate Performance?

I’m currently on a personal quest to find the answers to these questions and more by speaking directly with as many of my expert friends in the medical, nutrition and research fields over the next six months researching and writing my book all about this topic tentatively titled A Patient’s Guide to Understanding Your Cholesterol Test Results (releasing Fall 2013). People are so confused about what to believe about their cholesterol test results that this book is way overdue. Arming people with solid information will help them make a more informed decision about what to do about the current state of their health rather than blindly following some dubious drug therapy promoted by their doctor to treat risk factor numbers. It’s high time we start treating actual DISEASE rather than risk factors anyway.

But every single week, I receive at least a dozen e-mails from people all over the world who are concerned about their cholesterol test results. Even for those people who have gotten away from the traditional lipid testing that only shows LDL-C, HDL and total cholesterol to the more advanced particle size testing from places like the Raleigh, NC-based LipoScience who created the NMR Lipoprofile test, there is pause for concern because their doctor tells them they need to be taking a statin drug lest they fall victim to a heart attack or worse. I’ve never understood the scaremongering that goes on regarding “high cholesterol” and the knee jerk reaction that taking a pharmaceutical drug such as a statin will somehow protect people from ever having a heart attack. A timely example of this is the late television newscaster Tim Russert who had “perfect” cholesterol numbers while ostensibly on a statin drug and yet tragically died of a heart attack in June 2008. Watch Justin Smith’s $TATIN NATION documentary for more information about just how insidious this push for a risky drug therapy to treat a non-existent disease has become.

I’ve been a big fan of having my cholesterol tested using the NMR Lipoprofile test for many years because they are the only truly accurate cholesterol particle testing company in the world. According to lipidologist Dr. Thomas Dayspring who addressed cholesterol testing in Episode 29 of the “Ask The Low-Carb Experts” podcast recently, this cholesterol test from LipoScience is the only one that he’s aware of that will directly measure your LDL-P (the total number of LDL particles in the blood) and Small LDL-P (the dangerous Pattern B LDL cholesterol that penetrates the arterial wall and leads to atheroschlerosis). Knowing where your numbers stand is a critical starting point for anyone wanting to optimize their health. Your doctor can actually run this test if you ask for it (although some will think it’s unnecessary or a “fad”) or you can use one of those online health testing outfits like Private MD Labs that work with your local LabCorp offices to pull the blood without a doctor being involved like I did last week to get my latest lipid panel update.

In mid-November before leaving on my trip to Australia for a three week, 5-city “Low Carb Down Under” speaking tour, I’ll be sharing a 6-month update about my nutritional ketosis n=1 experiment (read all of my updates for Day 1-30, Day 31-60, Day 61-90, Day 91-120 and Day 121-150). I’ve got some really interesting information to share with you regarding an experience that has happened to me during this 30-day cycle that could help those of you who might be wondering why your blood ketones aren’t where you want them to be. I’m amazed by how much I’m STILL learning about all this and look forward to passing along what I’ve discovered with you in the months to come. My target date for publishing my Day 151-180 results is November 11, 2012 or sooner. Stay tuned!

There’s still a lot of controversy about whether the LDL-P number (and the parallel marker of Apo B) is as or more important than the LDL particle size. Dr. Dayspring is adamant that it’s all about the LDL-P number and that the size isn’t relevant when it comes to heart health. He explained his reasoning for this position in Episode 585 of “The Livin’ La Vida Low-Carb Show” podcast. And in his popular “The Straight Dope On Cholesterol” blog post series, Dr. Peter Attia notes that the number of LDL particles and not just their size determine the atherogenic risk.

But a Gilbert, AZ-based family physician who specializes in heart attack prevention named Dr. Rocky Patel (listen to him in Episode 62 of the “Low-Carb Conversations” podcast) noted in his September 2012 blog post entitled Does LDL-P Matter? that his personal LDL-P score of “over 3000″ was initially “horrifying” until he had a Carotid Intima Media Thickness (CIMT) test showing his vascular health was equivalent to that of a 16-year old! Additionally, his low-carb diet has helped him lose weight, feel energized and brought his inflammation (CRP) levels to “not detectable.” Cool! Dr. Patel concluded his blog post by stating a truth that should be the basis of all healthcare decisions: “We must always remember to treat the patient/disease and not the number.”

With that in mind, let’s talk about my various health numbers. As you know, I’ve been actively losing weight and body fat (we’ll know for sure I’m losing body fat when I get the comparison results of my DEXA scan coming hopefully before I leave for Australia) on my nutritional ketosis plan and that has not stopped nor do I expect it to in the coming months. But before I even started on this plan in May 2012, I had a Berkeley HeartLab panel of tests run in February 2012 to see how my low-carb diet was working for me. Despite weighing over 300 pounds at the time, some key health markers were pretty remarkable:

C-Reactive Protein (CRP) – 0.7 (less than 1.0 is “low risk”)

HDL-C – 78 (over 50 is considered stellar)

Triglycerides – 89 (under 100 is excellent)

I’ve said it many times before, but reducing your carbohydrate intake, moderating your protein consumption and consuming higher levels of healthy fats that include saturated fat are the best ways to not just lose weight but making critical positive changes for the better in your lipid panel happen.

Laura Dolson discusses Three Reasons Not To Worry About LDL Cholesterol On A Low-Carb Diet and notes that HDL over 50 and triglycerides under 100 will almost always mean your LDL size is the Pattern A (large, buoyant kind) that you want. Dr. Jeff Volek has found in his research patients a greatly improved triglyceride/HDL ratio eating a low-carb diet and that this is a much better marker for heart health than LDL or total cholesterol. As far as I know, the advanced particle size lipid testing has not been used by Dr. Volek, Dr. Eric Westman at Duke or others looking at low-carb diets in their research. I hope that they do add this extra bit of data for the benefit of those who may see some crazy numbers like Dr. Patel and I (and I’m sure many other low-carbers) are seeing.

So what about my latest test results from my fasting blood draw on October 25, 2012? Some of the numbers shouldn’t be a surprise knowing that I’m eating a very strict high-fat, moderated protein, low-carbohydrate diet with a fat/protein/carbohydrate ratio of 85/12/3:

HDL-C is 65 (down slightly from Berkley but still over 50)

Triglycerides are 46 (virtually cut in half since Berkeley)

Small LDL-P is 221 (just 6% of my total LDL-P number)

VLDL was “too low” to measure exact number (A GOOD THING!)

LP-IR Score was 11 (means I’m no longer insulin resistant)As amazing as all of these numbers were, the ones people will likely be most interested in are the “high” ones. Let’s take a look:

Total cholesterol is 359 (not a relevant number at all)

LDL-C is 285 (again, this tells you nothing really)

LDL-P is 3451 (ideally it’s supposed to be below 1000)

Apo B is 238 (parallel to LDL-P and should be under 80)

What I want to know is how I can simultaneously have outstanding insulin sensitivity, an A1c score of 4.5, average blood sugars around 81, a heart scan score of zero, undetectable inflammation, 94% of my LDL particles are the large, fluffy kind (Pattern A), a microscopic triglyceride/HDL ratio of 0.7 and active weight/fat loss AND a greater susceptibility for atherosclerosis because of an extremely high LDL-P and Apo B. The answer is out there and I’m bound and determined to uncover it for my book next year.

But this is more than about some book I’m writing…this is my life. I wholeheartedly believe my healthy high-fat, moderate protein, low-carb diet is vastly improving my health in ways that no other eating plan could even possibly touch. And yet the jury is still out on whether or not there should be concern about the direction my numbers have been going. I did an Excel spreadsheet showing how although my total cholesterol, LDL-C and HDL have all remained relatively constant for the past 4+ years, LDL-P has gone precipitously higher and higher (will it ever stop going up and what’s making that number continue to rise?):


Interestingly, before I started on the Atkins diet in January 2004, my highest total cholesterol was only about 230. Of course, my doctor put me on both Lipitor and Crestor to lower that number and it did get down to 130 at some point (don’t know what the breakdown was of HDL and LDL nor do I know what my triglycerides or LDL-P were at the time either). But people have claimed I have familial hypercholesterolemia because my total cholesterol is now over 300. But I disagree.

Something has happened since I began eating high-fat, low-carb and I can’t help but wonder if there is a purpose for that extra cholesterol in the body since we know there are benefits to higher levels of cholesterol in the body. The jury is certainly still out on this.

If there’s one thing you know about me, it’s this: I won’t stop seeking the truth about this and sharing with you what I find. Dr. Dayspring has already invited me to visit him at the Richmond, VA-based Foundation For Health Improvement And Technology to see why despite all my incredible lipid numbers the LDL-P and Apo B seem to be out of whack. It will be interesting to see if these numbers are found to be less important for people on low-carb diets than those eating other kinds of diets. Now that’s some research that could help a whole lot of people. In preparation for my book, I’ll also be interviewing various health professionals from cardiologists to practitioners and everyone in between to get to the heart of what matters most. I’m anxious to get going on this project and can’t wait to see where my journey takes me on this.

Got any comments about my latest lipid numbers? I’d love to hear your thoughts in the comments section below. Feel free to share any knowledge and experience you may have on this subject.

Low-Carb Cholesterol Concerns Unnecessary

Low-Carb Cholesterol Concerns Unnecessary

Monday, February 13, 2006

Dr. Volek says total cholesterol not as important as triglyceride/HDL ratio

"As people in favor of the low-carb diet will jump on these results, I really try to say that this is limited evidence," Dr. Alain J. Nordmann warned regarding his new study.

Hoo boy, can you tell this one's gonna be a doozy?!

This MedPage Today article is about a new study that shows nearly identical weight loss for people on low-fat and low-carb diets, but there is concern about the low-carb group elevating their LDL cholesterol levels.

Researchers led by Dr. Nordmann from University Hospital in Basel, Switzerland conducted five controlled clinical trials on nearly 450 overweight study participants over a one-year time period, with half of them placed on a low-fat diet and the other half were on a low-carb diet.

Dr. Nordmann found that the low-carb diet group had lost more weight than the low-fat diet group after six months, but the weight loss was almost even after one year. Blood pressure was also nearly identical, the researchers noted.

However, they discovered that there was an increase in the total cholesterol and low-density lipoprotein (LDL "bad") cholesterol for the group following a low-carb diet. They added that the rise in LDL cholesterol for the low-carb diet group completely negated any increase in HDL "good" cholesterol and decreases in triglyceride levels.

This study was published in the Archives of Internal Medicine on Monday.

Okay, so the low-carb diet performed JUST AS WELL as the low-fat diet in the study. Is this not GREAT news?! We've been told that low-carb is not as effective because all you lose is "water weight," but clearly that is not the case. The low-fat recommendation can no longer be held in high esteem for bringing about the most weight loss anymore.

Do you think doctors are gonna start recommending low-carb living all of a sudden, though? Not likely. Here's why. They're still worried about the supposed negative effect it has on cholesterol levels. We'll get into that in a moment.

For the purposes of this study, "low-carb" was defined as 60g of carbohydrates per day while "low-fat" was 30% of energy intake as fat.

I'm sure both sides will balk at these levels of carbs and fat respectively.

Most genuinely "low-carb" diets start off at 20g of carbohydrates and rise to varying rates between 20-60g daily during weight loss. It all depends on the individual and subjecting some people to as many as 60g carbs per day may not have been the ideal way to help them maximize their weight reduction. In other words, some of those in the "low-carb" group COULD have lost more weight if they were allowed to decrease their carb intake to a level where they would still lose weight.

And, to be fair, most people who follow a "low-fat" diet as recommended by low-fat guru Dr. Dean Ornish try to keep their fat intake down to about 20-25% of their total caloric intake. Eating more fat than that, as we have seen from low-fat supporters in the past few days, is not considered "low-fat" to them.

Nevertheless, the study results are intriguing even if the conclusions are just a little bit off.

You see, this business about low-carb diets causing total cholesterol and LDL cholesterol to go up is frankly irrelevant in the face of the remarkable increases seen in HDL cholesterol and drops in triglycerides on a low-carb diet.

After six months, the researchers found the low-carb diet participants saw their HDLs go up an average of 4.6 mg/dL and their triglycerides go down 22.1 mg/dL, with slight increases in LDL cholesterol. On the flip side, the low-fat diets saw their LDL cholesterol fall an average of 5.4 mg/dL and the total cholesterol drop an average of 10.1 mg/dL.

So which is better? How about if we ask University of Connecticut, Storrs assistant professor Dr. Jeff Volek for the answer to that question.

I met Dr. Volek during the Nutritional & Metabolic Aspects of Carbohydrate Restriction conference in Brooklyn, NY in January. He presented the findings of a recent research study of his own regarding the effect of a very high-fat, low-carb diet on cholesterol compared with a standard low-fat diet.

In his 12-week study, Dr. Volek used study participants who had moderately high triglycerides (over 150) and relatively normal HDL levels (below 50). Half of the participants were placed on a low-fat diet consisting of less than 30 percent of total caloric intake from fat (as is the standard with the American Heart Association) and the other half consumed a low-carb diet with an extraordinarily-high 85 percent fat intake to test the fat tolerance of the study participants.

What were the results of this study after just three months?

The low-carb diet group lost TWICE as much weight as the low-fat diet group while total cholesterol and LDL cholesterol levels decreased equally among both groups.

But the most compelling and exciting results of this study is what happened to the HDL and triglycerides. The HDL rose by 8 percent in the male participants and 17 percent in the female participants in the low-carb diet group. The low-fat diet group, on the other hand, actually saw their HDL "good" cholesterol numbers FALL by 1 percent!

As for the triglyceride numbers, the low-carb diet group decreased their triglycerides by a whopping 51 percent compared with a mere 15 percent drop by the low-fat diet group. This was a SIGNIFICANT difference between the two groups in the study.

Dr. Volek pointed out that the reason this study is noteworthy is because it underlines the importance of how a low-carb diet makes the triglyceride/HDL ratio so much better than a low-fat diet. He said this ratio is the real key when looking at cholesterol numbers.

For far too long, doctors have exclaimed how important it is to keep your total cholesterol number below 200, right? Isn't that what all the hoopla over statin drugs is about? "Aim lower," one of the obnoxious ads for cholesterol-lowering medicine blares out to us on our television sets, but why? If your triglyceride/HDL ratio is incredible, then you don't need to worry about how high your total cholesterol is. You just don't.

My most recent blood work revealed that my triglycerides are 57 and my HDL is 71. That makes my triglyceride/HDL ratio a miniscule 0.83. My doctor has even said with a ratio that good (it was A LOT BETTER than his!), I don't need to worry that my total cholesterol being 201.

And that's the message of the study conducted by Dr. Volek, too. Just like on the issue of fat, Americans have been scared half to death about the supposed dangers of what they perceive as high cholesterol numbers. But they've been duped yet again! We need to learn from the work of people like Dr. Volek and realize there are much more important numbers to look at (trigylcerides and HDL cholesterol) than the total cholesterol and LDL cholesterol.

Unfortunately, this fact has been completely overlooked by Dr. Nordemann.

"Because no trials have yet examined the risk of heart attack or death in people on low-carbohydrate diets, it's unclear whether the beneficial effects that low-carbohydrate diets appear to have on HDL and triglyceride levels cancel out their apparent negative effects on overall and LDL cholesterol levels," Dr. Nordmann said.

Why is that, Dr. Nordemann? Why are the positive effects on HDL and triglyceride levels negated? You can't just overlook these improvements and write them off as irrelevant for the low-carb dieters! The results of your study may not be what you want them to be, but they are what they are.

As for weight loss, Dr. Nordemann said the "not clinically relevant" differences in weight reduction make it impossible for him to recommend a low-fat diet over the long-term.

"We believe there is still insufficient evidence to make recommendations for or against the use of low-carbohydrate diets to induce weight loss, especially for durations longer than six months," he exclaimed. "Such diets currently cannot be recommended for prevention of cardiovascular disease."

Well, we'll see about that won't we, Dr. Nordemann?! I've been livin' la vida low-carb for over two years (AND I'VE LIVED TO TELL ABOUT IT, TOO!) with nothing but positive news to share about my weight and health. This garbage science from people like Dr. Nordemann just makes me want to hurl. Thank God for brave and bold researchers like Dr. Volek who are so willing to just share the facts about how a low-carb diet is making a real difference in the lives of the people who do them.

You can e-mail Dr. Alain J. Nordmann about his study at dok20052@healthindex.ch as well as Dr. Jeff Volek about his study at jeff.volek@uconn.edu.