Last week I introduced my 12 pronged gameplan to bringing down my stubbornly high cholesterol. I followed these 12 steps rigidly for 4 weeks and did a follow up NMR Lipoprofile. I was literally BLOWN AWAY by the results.
My LDL-P, which has been stratospherically off the charts for the past 3 years has finally come down to Earth.
Something I did worked.
Since I have readers that are just finding this site, I’m going to go into some of the background behind my journey up to this point.
If you just want to find out what my latest results were, feel free to skip ahead.
I’ll start 5 years ago in 2010. At that point I was struggling with my weight, having gotten up to around 210 lbs while following the Standard American Diet, trying to count calories, while eating low fat. My LDL-C back then was pretty much ideal at 93, with my Total Cholesterol at 160. If you were to just look at my lipid panel, you’d think I was pretty healthy, but if you saw my face and my body, you’d see a chubby tired dude constantly fighting with his weight.
Later on that year I stumbled across Tim Ferriss’ The 4 Hour Body, which emphasized the importance of glycemic control in his Slow Carb Diet. I became super-inspired by him, followed his diet, and promptly lost weight and inches off my body.
Things were going well and I would check my lipids every once in a while to see how things were. On 8/30/2011 my LDL-C went up to 157 after 8 months of the Slow Carb Diet. I wasn’t sure what to make of this, especially since I had been losing weight and feeling healthier, so I just made a mental note of it and kept on trucking along.
I checked my labs again on 2/7/2012 and saw that my LDL-C came back down to 124, so I stopped worrying.
A few months later I started listening to podcasts and learned about Jimmy Moore’s experiment with Nutritional Ketosis, read The Art and Science of Low Carbohydrate Performance, and was convinced by everything I learned to try it for myself.
I started playing around with eating more fat and even less carbs than what I was already eating on the Slow Carb Diet and decided to do a pre Nutritional Ketosis lipid panel.
On 11/16/2012 my LDL-C went even higher to 176. I started to get worried, but everything I read at the time told me that Nutritional Ketosis would surely improve my numbers, so I figured that this would be a good way to illustrate it. I have my before ketosis lipid panel showing a high LDL-C and I could do another lipid panel after being in ketosis showing a dramatic improvement.
I wanted to document everything which lead to the birth of this blog (here is my embarrassing first post from 12/12/12).
After 60 days of Nutritional Ketosis I showed that I lost more weight and inches and I tested my blood after 72 days of nutritional ketosis on 2/21/2013.
I was expecting to see an improved set of numbers, but to my astonishment, they got worse! This was around the time I first learned about the NMR lipoprofile so I checked that also. It showed an LDL-C of 213 and an LDL-P of 2800. I didn’t know what to make of it, and the internet consensus at the time was all over the place… the prevailing thought was that whether or not your LDL levels are out of control, as long as your inflammatory markers are low and you’re not inflammed, things should be ok. Again, there was no science to back this up, this was just the general thinking floating around the message boards and blogs at the time.
I wanted to look into things further, so I did my own literature search (The Effect of a Ketogenic Diet on Cholesterol Part 1) where I concluded that:
It seems almost universal that following a ketogenic diet leads to an increase in HDL and a decrease in triglycerides. What happens to total cholesterol and especially LDL is unpredictable since both can either go up, go down, or stay the same with no clear explanation as to why this happens.
In the second part of that series, The Effect of a Ketogenic Diet on Cholesterol Part 2, I went over my numbers and came up with 4 possible explanations to what the hell was going on:
- Increased consumption of saturated fats leading to increased LDL synthesis
- Deficiency in certain micronutrients like copper and choline
- Natural response to weight loss leading to more cholesterol being shuttled around the blood
- Ketosis leading to hypothyroidism which causes a decreased expression of LDL receptors, leading to increased LDL in the blood.
At this time I had jumped head first into ketosis and was dousing everything with butter and coconut oil, and making all sorts of fat bombs, so I decided to test things out by cutting out all coconut oil and butter.
Three weeks later, on 3/11/2013, I checked my lipids again: The Effect of a Ketogenic Diet on Cholesterol Part 3. My LDL-C jumped even higher to 231.
It was around this time that I started really trying to deal with the Keto Rash, and the only thing that made the rash go away was eating carbs and jumping out of ketosis. After a few weeks of doing this, I checked another lipid panel on 5/9/2013 (The Effect of a Ketogenic Diet on Cholesterol Part 4) and lo and behold, my LDL-C came down to 168 AND my thyroid numbers improved.
I now had a working hypothesis:
Chronic low carb -> Hypothyroidism (low T3) -> Decreased expression of LDL receptors in the liver -> Higher serum cholesterol
Some more research (Low Carb and High Cholesterol from Around the Web) unearthed data showing that a lot of other folks were experiencing the same thing.
In this study where 12 physically active and healthy subjects ate a ketogenic diet for 38 days, there was both a bump in the LDL-C from a median of 116 pre keto to a median of 157 post keto. There was also a corresponding change in TSH from 1.56 up to 2.33. This lead the researchers to say:
Interestingly, subject 11 who took a thyroxin substitute experienced the least dramatic rise in LDL levels. Furthermore, positive associations between TSH and LDL as well as total cholesterol levels have been found in cross-sectional studies in euthyroid healthy subjects, and the strength of these associations seems to depend on an individual’s insulin sensitivity.We therefore hypothesize that the KD has diminished the production of T3 from T4, thereby reducing the number of LDL receptors and thus reducing LDL particle clearance which might be further impaired due to the missing stimulating effect of insulin on LDL uptake into cells.
In the next few months, my life got busy, The BJJ Cavewife and I did some traveling, planned our wedding, and then got married, so my diet was all over the place. I tried to eat low carb and bounced in and out of ketosis depending on how active I was.
On 10/4/2013 I checked my lipids and thyroid (The Effect of a Ketogenic Diet on Cholesterol Part 5) and found that my LDL-C stayed at 172 despite my TSH improving to 1.23.
Now this threw a wrench in my hypothesis about hypothyroidism and cholesterol. If my TSH improved then my LDL-C should also have improved, but that wasn’t the case.
After listening to more podcasts and discovering Kiefer’s work, I was convinced by his research and explanations in the Carb Nite Solution, and decided to try it out for myself. This is essentially a cyclic ketogenic diet where you eat super low carb and keto during the week and then give yourself one cheat day where you throw down as many simple carbs as you can.
In theory this will provide all the benefits of going keto without any of the hits to the thyroid and other hormones. I completed a 10 week trial following the Carb Nite protocol and drew another set of labs on 12/16/2013.
I was certain that science was on my side and that my weekly carb refeeds would optimize my thyroid levels which in turn would bring down my cholesterol. To my dismay, this wasn’t the case. Both my thyroid numbers actually got worse (Cyclic Ketogenic Diet and Thyroid Hormone) AND my cholesterol numbers also got worse, with my LDL-C jumping to 206 and my LDL-P rocketing to 3009 (Cyclic Ketogenic Diet and Cholesterol)!
I moved on to playing around with Kiefer’s Carb Back-Loading, which is essentially Carb Nite, with additional carbs allowed after heavy resistance training, and thought this would be a good opportunity for me to further explore the relationship between arbs, thyroid, and cholesterol.
On 4/8/2014, after 8 weeks of Carb Back-Loading, I saw an improvement in my thyroid numbers (Carb Back-Loading and Thyroid Hormone) AND a drop in my LDL-P to 2694 and a nominal drop in my LDL-C to 196 (Carb Back-Loading and Cholesterol).
For people new to the Paleosphere, there was a brief craze where raw potato starch became the newest superfood, purported to help people normalize blood glucose, sleep better, and improve their cholesterol. I too jumped on the band wagon, eager to see if it would help.
On 4/24/14, after taking the ‘magical’ Bob’s Red Mill Potato Starch for 2 weeks along with some probiotics, I checked my lipids and found no change in my LDL-C which stayed at 202. This wasn’t the magic bullet I hoped for.
On 10/23/14, after a few weeks of travel and reattempting Carb Nite, I checked another set of labs (Cholesterol, CRP, Fasting Insulin, and HbA1c Update: October 2014) which again showed an LDL-P of 2718 and LDL-C of 213. This looked to be the new norm for me.
In the next few months, I improved my sleep by changing jobs (How I Finally Fixed My Sleep Issues as a Shift Worker) and started training BJJ regularly and weight lifting 1-2 times per week. I increased my carbs to 100 gm, cut back my saturated fat to 60 gm, and rechecked my labs on 3/16/2015 (My Health Test Results from March 2015).
All my thyroid numbers normalized and there was a slight drop in my LDL-P to 2470 and LDL-C to 166. This confirmed to me that there was definitely some relationship between my thyroid and my cholesterol… but not enough to explain the whole story.
I then experimented with cutting my saturated fat down to around 50 gm and increasing my carbs slightly to 120 gm, while doing a better job of taking anti-inflammatory supplements (Athletic Greens, Thorne Curcumin, Thorne Omega 3, Lemon Berry, T3 Fuel). More labs were drawn on 5/7/2015 (Cholesterol Update from May 2015: What did taking anti-inflammatory supplements and increasing my carbs do?).
There was no improvement. LDL-P stayed at 2494 and LDL-C bumped up to 192.
It started to really feel like I was treading water. I really didn’t know where to go from here. All I could think of was to tinker a bit more with my macros. I nudged my carbs up to 146 gm and my saturated fat down to 44 gm, and on June 9 2015, did another test (Cholesterol and Thyroid Update from June 2015: Increasing Carbs and Decreasing Fats).
Again, there was no real change. LDL-P stayed at 2434 and LDL-C stayed at 197.
This was when I decided that I had taken things as far as I could on my own and enlisted the help of an expert.
Here are links to the recent posts documenting my consultation with the lipidologist:
- What a Doctor Asks His Lipidologist
- Consultation with the Lipidologist
- Reviewing the Labs My Lipidologist Ordered
After considering the recommendations of the lipidologist and other research, I formulated My Anti-Cholesterol Gameplan, and followed it for 30 days.
Here are the results after those 30 days.
Results from 8/17/15
To give you a better sense of these results in the context of the long winded history I provided, here is the data in a tabulated format (click on it to make it bigger):
As you can see, there was a dramatic improvement.
LDL-P fell to the lowest it’s ever been at 1489. While this still puts me in the “Borderline-High” risk category, it’s still better than being in the “off-the-charts-ludicrously-High” risk category that I’ve been in since 2013.
Small LDL-P also fell dramatically to 592 which is only 65 points higher than the normal limit of 527.
LDL-C fell to 125, the lowest it’s been since 2012, bringing me into the “Above optimal” range which is much better than the “Astronomically high” range I’ve been bouncing around in the past two years.
Thoughts on My Anti-Cholesterol Gameplan
1. Reduce Saturated Fat
I thought I did a great job of this, but now that I’m looking back at the numbers, it wasn’t that impressive. I managed to cut my average intake from 44 gm in the period leading up to my blood draw in 6/2015, down to 43 gm in the 30 days leading up to this test.
It’s strange, but I really remember feeling like I was crushing it in this department… but that’s not what the numbers showed. If you want to see what the hell I was eating during this time period, you can add me on myfitnesspal.com.
2. Eat More Beans
I know I did a good job of this since I typically get Chipotle a few times a week, I made sure to ask for beans each of those times.
3. Eat Low Carb but not Ketogenic
My average carb intake was 161 gm, but if you factor in all the fiber I was eating from the beans and the bionic fiber which averaged 58 gm, my net carb intake came out to around 103 gm, which is right smack dab in the middle of the 50-120 gm range I was shooting for.
4. Reduce Coffee
I did a good job of really cutting this back and only drank 1 cup per week on Sundays.
5. Grace Liu’s Bionic Fiber
This consists of:
- Inulin FOS Powder – 1 tbsp
- Acacia Fiber – 1 tbsp
- Psyllium Husk Powder – 1 tbsp
- Raw Reserve High ORAC Green Powder Berry Flavor – 1 tbsp
I also rotated in some of the following:
I started taking off taking two doses per day for the first two weeks and then brought it down to one dose per day for the next two weeks.
I’ll write a separate post on my thoughts on bionic fiber.
I took one dose of this in the morning and one dose at night.
I used Thorne Research Berberine 500 mg once in the morning and once in the evening.
8. Citrus Bergamot
I used HP LifeScience Citrus Bergamot 250 mg once in the morning and once in the evening.
9. Omega 3
I took 3 tsp of Exos Lemon Berry Omega 3 each day.
10. Other Vitamins and Minerals
I was generally very good about taking these thing regularly, but forgot to take them on occasion. I wasn’t as strict with these as I was with everything else.
11. Optimize Oral Hygiene
I did a good job of maintaining my regimen of
- Oil pulling with coconut oil
- Brushing with my Oral B electric brush
- Using Oxyfresh Mouthwash
- Using angled go between brushes, although I started doing this every other day instead of daily.
12. Maintaining My Exercise Regimen
I still trained BJJ regularly but had to cut back on weight lifting because things started to get really busy at work.
It’s obvious that something I did worked. At this point it’s hard to say if it was just one thing, some of the things, or all of them combined that made the difference.
While I’m not out of the woods yet because my LDL-P still isn’t at an optimal level, I’m at a much better place than I was in the past 2 years.
My hunch about what’s going on here is that a lot of my issues are gut related. It just doesn’t make sense that all of my cholesterol issues are genetic, especially since my numbers were normal in the past and are almost normal after these 30 days. I still have the same genes I did 30 days ago. I’m still an ApoE 3/4. Maybe I did something to change my epi-genome?
I really suspect that the gut is the source of all of this. Somehow when I went Slow Carb and then Ketogenic I altered my gut flora, which in turn altered my cholesterol metabolism causing me to become a cholesterol hyper-synthesizer AND hyper-absorber. Now that I’m taking steps to address my gut, things are finally starting to normalize.
Can I prove this? Of course not… but this is the only explanation that makes sense to me.
I’m definitely open to any other ideas out there. Since a lot of you guys are great about chiming in with your thoughts, I invite you to keep them coming.
My plan is to slowly remove each of these supplements and retest at regular intervals to see what changes come about.
The first thing I’ll stop is Citrus Bergamot, simply because it’s so new and there’s so little data on it.
*Image found here (I love Johnny Drama, he was my favorite character on Entourage)