Jimmy Moore, author of the books Cholesterol Clarity and Keto Clarity (both of which I’ve reviewed here and here), and champion of all things keto just posted his most recent health test results and and even shared his personal consultation with Christopher Kelly, a Certified Functional Diagnostic Practitioner where they discussed the results.

Jimmy last shared his health tests this past fall and I had a few thoughts on his results then.  I know Jimmy gets a lot of hate online, but say what you will, the guy is as open as a book.  It’s fantastic that he’s so open and transparent about sharing his results. It doesn’t matter if the lab work isn’t pretty and doesn’t fit into his keto = super-amazing-fix-everything-diet narrative. He still puts it out there, warts and all, and I respect the hell out of him for this.

And like I said in my prior post… I LIKE the guy.  He helped publicize my blog when I was just getting started (look at #3 on the list) and has always been responsive to my e-mails and tweets.  His n=1 nutritional ketosis studies served as a model for my own.

That being said, it’s been hard for me to ignore Jimmy’s recent weight gain.  The photo on the left in the title is from the last post of his nutritional ketosis experiment (click on the link to see more pics) after losing 78 lbs going from 306.2 lbs to 228.2 lbs.  The photo on the right is from a tweet on May 24, 2015.

He hasn’t said recently how much weight he’s regained, but last fall he mentioned that he put back on almost 50 lbs.  Here is a photo from a tweet posted on November 14, 2014:

Comparing this photo to the one from May 2015 it looks to me like in the interim, his face is a little fuller and he’s filling out the jacket a bit more (looks to be the same jacket), so I think it’d be reasonable to say that he has put on a little more weight since the fall.  If we were to say that he put on an additional 10-20 lbs since November 2014, that would bring him close to his starting pre-nutritional ketosis weight of 300ish lbs.

It’s with this background that I want to share some of my own thoughts… but before doing so, I want to share the notes I took from Jimmy’s consultation with Chris Kelly (I know I’ve been in the habit of sharing a lot of notes from podcasts recently… but it’s just a way for me to process the information better, so bear with me):

Jimmy’s Main Complaints

1. He gained weight – Jimmy again attributes this mainly to the stress from writing his recent books.
2. Low back pain – Jimmy thinks this is probably related to the weight gain. He’s tried using foam rollers and inverted tables to address this.

• Jimmy believes that he is still highly insulin resistant.
• Jimmy says he’s keto pretty much all the time.  He’s tried using safe starches and resistant starches and doesn’t do well.  He starts to gain weight, he loses his ketones, and his blood sugars start to go up.
• He eats 80-100 gm protein per day and he’s found that that’s his threshold for staying in ketosis.
• He’s been trying to add in more probiotics like Kombucha and supplements to be more conscious of his gut health.

Salivary Adrenal Panel

• Jimmy is convinced that his insulin resistance is related to stress and cortisol, so they dive into the cortisol panel.
• It turns out that he actually has low cortisol.

Salivary Cortisol

• In the morning Jimmy’s cortisol is 15.3 when ideally it should be 24 (the reference range is 13.0 – 24.0).
• At Noon, Jimmy’s cortisol is low, at 1.9 (normal is 5.0 – 8.0).  Chris says that when he sees this, people normally feel lethargic because of the low cortisol, but Jimmy says that he still feels great.  He only gets tired at night.
• At Nighttime, Jimmy’s cortisol is very low at 0.6 (normal is 1.0 – 3.0).  Chris says that the normal problem he sees is people having too high of a cortisol at night.

The first question Chris asks is how Jimmy’s sleep is. Jimmy says that he gets 7.5 – 8 hrs per night and tracks it with a fitbit.

DHEA-S:  Jimmy’s is very low at 1.22 (2.0 – 10.0).  Chris describes this as the antagonist of cortisol, and says this is a sign that something is not right.

Salivary Testosterone – Jimmy’s is low at 65.2 (40.0 – 130.0 for males), and Chris says that ideal should be around 100.

Melatonin – Jimmy’s is sky high and off the charts at > 50.0 (normal is 12.0 – 35.9), but it turns out that he uses melatonin as a sleep aid, which explains this.

Estrogen – This is within normal limits. There are no signs of Jimmy having too much estrogen or being an over-aromatizer (process by which the body converts testosterone into estrogen)

GI Pathogen Screen with H. Pylori

This was completely normal. There were no signs of abnormal pathogens.  A lot of times Chris sees that people become stressed and pick up an infection which causes a lot of their problems, but he doesn’t see any of that with Jimmy.

[I was expecting a little more data from the GI test regarding Jimmy’s gut biome… but I guess this was a simple screen for pathogens which ‘duh’ is the title of the test.  Jimmy mentioned a few times that he’s planning to get a UBiome test that will sequence his entire gut biome… which is more inline with what I was expecting.]

Comprehensive Urine Panel

• Chris saw some findings in the urine organic acids that suggest Jimmy might have a folate deficiency.
• Chris actually said that he worries about the nutrient density of a ketogenic diet. The best place to get folate is from leafy green vegetables. Jimmy says that he eats spinach but they both agree that he may need to increase the variety of his veggies.
• Chris says that the organic acid findings can also reflect a MTHFR mutation, which Jimmy plans on getting tested. Jimmy says that he doesn’t have any brain fog or allergies, which can be symptoms of MTHFR mutations.
• Chris also notes that Jimmy has a build up of lactic acid in the urine. Potential causes of this are micronutrient deficiencies that are needed for the Krebs cycle, which then causes shunting of the metabolism into the anaerobic cycle, which generates lactic acid.
• Nutrients like Coq10 and B vitamins are the ones typically deficient… but Jimmy is actually supplementing with these things.

Blood Panel

• It looks like Jimmy is a little anemic. His hemoglobin is 13.00 (normal is 14.00 – 15.00).
• Jimmy explains that he gave blood a few years ago and was told that he had borderline hemochromatosis, so he made a conscious effort to donate blood regularly while at the same time avoiding red meat and supplements with iron.
• Chris thinks that Jimmy probably went a little overboard now because his numbers the RDW and MCV values are show that Jimmy’s red blood cells are iron deficient.
• Because red blood cells are the route of oxygen delivery throughout the body, and Jimmy isn’t transporting oxygen well because of his iron deficiency anemia, this can explain that lactic acid in the urine panel and possibly the low cortisol.

Blood Chemistries

• Jimmy was slightly dehydrated at the time he took the test because his BUN/Creatinine ratio was slightly elevated, although this is normal for people who fast before a blood draw.
• Chris points out that Jimmy has a low alkaline phosphatase, which can be related to vitamin C and zinc deficiencies.
• People who are in ketosis are susceptible to vitamin C deficiency because they don’t eat enough fruits and they cook their vegetables breaking down the inherent vitamin C, which is very heat sensitive.

Blood Sugar – Chris says that Jimmy’s fasting blood glucose is sort of high at 94, especially for someone in ketosis.

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Jimmy’s Homework

Chris gave Jimmy a list of things to do:

1. Keep a food diary for 3 days
2. Sleep at least 8 hours
3. Walk more
4. Incorporate more resistance training. Chris recommends Pavel’s Sinister and Simple
5. Stress reduction. Use guided meditation. Chris recommends the Headspace app.
6. Track HRV.

After the consultation, Jimmy got the labs recommended by Chris including a HS-CRP, thyroid panel, iron panel, sex hormone panel, cholesterol panel, CBC, Vitamin D, and blood chemistries which he shows at the bottom of this post.

Looking over Jimmy’s Post-Consultation Numbers

Jimmy plans on going over these numbers with Chris when they meet again later in the year… so until then you’ll be stuck with my interpretation!

I’ve compiled some of his labs in this table:

Cholesterol and Thyroid Panels

These were both essentially unchanged since the Fall of 2014.   I won’t rehash everything I wrote before, except to say that if he is in ketosis less often or to a lesser degree than during his his n=1 experiment, then this can be a potential explanation for the improved cholesterol and thyroid numbers from 2013 to 2014… and the stability of these numbers from 2014 to 2015.

The triglyceride of 64 indicates that Jimmy isn’t eating too many carbs, so it doesn’t look like he’s been cheating with carbs… at least not enough to change these numbers.

Iron Panel

Jimmy’s ferritin and %transferrin saturation are super low and his total iron binding capacity (TIBC) is high which confirms that he is iron deficient.

Blood Sugar

His blood sugar went even higher up to 100. Jimmy’s HbA1c is elevated at 6.0 telling us that his blood sugar has been high for at least 3 months.

Vitamin D

His levels are low at 34.9 which is incidentally close to mine!

Jimmy’s Diet:

I looked over Jimmy’s 3 day diet update and plugged them into myfitnesspal and this is what it looks like (I estimated the amount of heavy cream he had with each meal to be 1/2 cup):

Total calories: 2459

My Thoughts

Jimmy Moore really is an interesting case study isn’t he?  His narrative as I understand things goes something like this:  He tried Atkins and went low carb, found success and lost of lot of weight, but then put it back on.  Then he discovered nutritional ketosis and found astounding success, lost a ton of weight… and now it looks like he’s putting it back on.

So here are the things we know are going on:

• Weight gain
• Rising blood sugars
• Iron deficiency anemia
• Low Vitamin D
• High total cholesterol and LDL (albeit improved from 2013)

Looking over his diet, my first impulse is to say that he probably isn’t eating enough.  For someone who’s approaching 300 lbs, 2459 calories per day doesn’t seem like nearly enough.  We know from research that people who are chronically hypocaloric can induce hormonal changes that lead to a slower metabolism as the body attempts to adjust to energy deprivation (hence Tim Ferriss recommendation for a weekly cheat day and Kiefer’s recommendation for a weekly Carb Nite).

Maybe Jimmy just needs to eat more.  The thing that confounds is that his thyroid numbers look ok.  His Free T3 is slightly out of the optimal range but not enough to explain everything.

I’m not sure what to make of this.

I also don’t know what to make of his rising blood sugars.  For someone who’s only eating 8% carbs, it doesn’t make sense that his fasting sugars are creeping up.  Having an HbA1c of 6.0% makes him prediabetic.  How does someone who is in ketosis have worsened blood sugars?  It really doesn’t make sense at all.  Maybe he’s sneaking in carbs somehow?

I also wonder if he’s still taking the Berberine and Banaba leaf. I seem to remember these ads a lot in his podcasts and they supposedly helped him with his blood sugars.

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In any case, I’d be interested to see what his fasting insulin is.  If it’s high, then that would tell us that he has some degree of insulin resistance, since we know that people who go low carb and are not insulin resistant tend to have low fasting insulin (like yours truly).  I’d also be interested to see him do another n=1 nutritional ketosis experiment for a month documenting his ketones and blood sugars daily.  This would show without a doubt that he is in ketosis and give a sense as to how deep into ketosis he is.

Maybe his adrenals ARE really screwed up.  According to this handout put out by Genova Diagnostics, since Jimmy his low salivary DHEA and low to low normal cortisol, he would fall somewhere in the A4 to C range which indicates chronic stress (don’t ask me about the accuracy of this).  Chris seemed to dismiss this because Jimmy didn’t FEEL fatigued… but who knows… maybe instead of feeling fatigued, Jimmy’s symptom was simply just weight gain?

Maybe Jimmy’s iron deficiency really is the underlying culprit of it all.  I found this article on the Wellness Resources website (again take it for what it’s worth, it’s a site on the internets) written by a nutritionist, describing a link between iron deficiency and weight gain:

A new study details the dire metabolic consequences of low iron status. It shows that low iron turns on genes in your liver and muscles that promote fat storage and cause abnormal blood sugar elevation – precisely what goes wrong with metabolism that leads to the metabolic syndrome.

The consequence to thyroid metabolism is twofold. First, the inactive thyroid hormone, T4, is converted to the biologically active hormone, T3, mostly on cell membranes of liver cells. Hepcidin is made in your liver and is produced excessively in response to high inflammation. Such inflammation will also damage liver cell membranes, thus reducing the conversion of T4 to T3. This is one main reason why inflammation of any type disturbs thyroid function.

Second, when biologically active thyroid, T3, binds to cell membranes and communicates to the nucleus of your cells how fast their metabolic pace should be set, it is like a hormone manager giving an order to a cell factory. The worker bees in the cell factory then need iron for the genes that will implement the thyroid order. In fact, the next 80 metabolic genes responding to a thyroid order all need iron. If iron is lacking, metabolism simply cannot run at an optimal pace, resulting in all the symptoms of hypothyroid—even in the presence of normal T4 and normal T3.

Even if iron is normal on a blood test, a person can still have all the problems above, though levels tend to be toward the lower end of the normal range. Hemoglobin (Hgb) and hematocrit (Hct) are also on the low side of the normal with this problem. One or another being out of range or on the low side signifies a major problem. Serum ferritin is typically low or low normal, unless inflammation is very high, which can actually drive up ferritin scores. Lab tests can help; however, fatigue along with trouble losing weight despite eating better and exercising are general indicators of a potential problem.

Then there’s this study I found on the more reputable PubMed, published in La Clinica Terapeutica (which I think is Italian?), where they treated 21 women with iron deficiency anemia with oral iron and found improvements in their waist circumference, body weight, HDL, and triglycerides.

So what would I recommend to Jimmy?

1.  Fix your iron status – Stop giving blood.  Consider adding red meat back into your diet and even adding in some oral iron supplementation with something like the Thorne Iron Supplement.  How much? I’m not sure, but I think Chris Kelly would have a good idea.  I’d imagine it’d be something like take X amount, retest in a month, and adjust accordingly.

2.  Reduce your stress – Jimmy is already planning on taking the months of July and August off to take care of himself.  I’d recommend cutting back on podcasts and social media and book tours, and focusing instead on taking it easy.  Get out of the spotlight and away from all of the negativity.  Try out yoga.  Focus on meditating consistently, once in the morning and once in the evening.  Consider taking an adrenal support supplement like the Thorne Vitamin B and Relora.  Of course getting good sleep is essential and minimizing the crossing of time zones  from all the speaking engagements and book promotions would be tremendously helpful for him.

3.  Check fasting insulin – To give us a better understanding of what the heck is happening with his blood sugars.

4.  Check ketones and blood sugars regularly – This seemed to work really well for him before and now that he’s not checking in as regularly things seem to be falling apart.  Maybe he just needs the consistency and accountability of it all to keep things in check.

5.  Think about adding carbs back in at least once a week or every two weeks – Try this out for a month and see if it helps to get things going.

6.  Raise your Vitamin D – It wouldn’t hurt to get his vitamin d levels up.  The best way of course is to get it via sunlight.  Maybe he can meditate or do yoga outside, killing two birds.  If not, he could try the Athletic Greens Vitamin D supplement or the Exos fuel Vitamin D and K2 supplement.

7.  Do more resistance training – Chris’ recommendation of kettelbells is fantastic.  Barbell work is great.  Maybe he can try something like Stronglifts 5×5.  And of course I’d be remiss if I didn’t mention brazilian jiu jitsu.  It’s a great way to learn some self defense while getting in an amazing work out.  I’m not sure where he lives in South Carolina, but here’s a start.

It’ll be really interesting to see his Ubiome results and what happens when he follows up with Chris Kelly in the next few months.  I really do hope Jimmy will be able to get to the bottom of what’s going on and I wish him the best.