My version of a Ketogenic Diet

[MarkES]

I'm surprised you think my LDL-C will rise with more coconut oil. I expect it will stay the same or even drop as MCTs are metabolized differently than LCTs

It sounded like you were planning to trade coconut oil for MUFA and I think the change to more SFA is more likely to increase LDL-C. If trading another SFA for coconut oil, then maybe the MCTs are a factor. There is evidence that different types of SFA cause varying changes to lipids.

FWIW, I think my experiment can be replicated by anyone attempting to use a ketogenic diet safely.

Based on my own experimentation, I'm confident that my lipids would be overly excessive if I were to replicate your diet. I have "normal" LDL in the 140's, where you have "normal" LDL in the 80's.

[Julie G]

Spunky, we are in full agreement. I am most certainly a work-in progress Looking back at cron-o-meter-data, my SFA intake varies from 25mg-40mg per day. Keep in mind that I'm consuming over 120 grams a day of dietary fat. Also remember that EVOO (as an example) also contains SFA. It adds up. FWIW, I remain unconvinced that SFA is inherently unhealthful. Yes, it raises LDL-C & P; but also provides vital nutrients. It's a balancing act for me.

I've been on this diet for over a year. I'm pretty certain I'm in mild ketosis much of the time. Two non-fasting urinalyses have demonstrated 15mg/dL. My ketostix have demonstrated similarly. It'll be interesting to see what the ketone meter shows.

You're probably right. I should break down and buy the Volek and Phinney "bible. I'm sure it would prove to be very instructive. I eat lots of salt, supplement magnesium (in response to a deficiency present prior to beginning this diet,) and have recently started supplementing potassium. I'd much rather just eat a potato

Interesting that you think I'm not eating enough vegetables. They comprise most of my plate; over 8 cups a day. I'm meeting and greatly exceeding most of my USRDAs- with the exception of potassium. Also interesting that you think my small LDL-particles are too high. They are in the lowest quartile. I'm also surprised that you think eating less frequently would increase my BG; I thought the opposite was true. I'm very unhappy with my A1c and plan to further investigate. Thanks for the advice on testing. I'll share results when I learn more.

FWIW, I agree with you that a diet higher in carbs is most healthful for most. I'm eating in response to my E4 status and presumed symptoms of cerebral glucose hypometabolism. Perhaps, as a 3/4 carrier, your diet is more healthful for you.

Hey Mark, to clarify- I wasn't eating a lot of coconut oil prior to switching to more MUFA. I was using some (never more than one tbs a day,) but also eating more freely of SFA from multiple sources.

YES, there is research indicating that the E4 isoform preferentially binds triglyceride rich lipoprotein particles, such as VLDL. The binding of APOE4 proteins to triglyceride rich particles is sufficient to slow activity of lipases on cell surfaces. Because the lipase activity is reduced, E4 carriers are slower in clearing VLDLs from circulation and therefore have elevated triglycerides in circulation leading to elevated LDL-C and P. Because MCTs bypass our inefficient lipoproteins. They are absorbed directly into the bloodstream through the portal vein, and are then transported to the liver. They are purported NOT to raise cholesterol. From this new baseline LDL-P; I'm going to test that out. I'm going to keep my SFA levels stable and replace some MUFA with coconut oil (65% of which is MCTs.) This is also another way of further testing James's notion that dietary cholesterol is the culprit in E4 carrier's elevated LDL- C and LDL-P. Coconut oil has zero dietary cholesterol.

I hear and respect your personal lipid experience. Certainly, we all have many more genes (beyond APOE) affecting our numbers here. From what you've shared, your prior experience with higher fat wasn't comparable to what I've done. You were eating higher carbs and more SFA. In all fairness, it remains to be seen what effect lower carbs and higher MUFA would have on your lipids. That's not to say I'm recommending this diet for you. You've done much work here & have thought harder about this than most (understatement) and will undoubtably find your way to what works best for you

[SusanJ]

Maybe look at other reasons (than diet) for A1C. Some things that can affect it:

longer lived blood cells : http://chriskresser.com/why-hemoglobin- ... ble-marker

cortisol : you have mast cell issues, so if you have had a low level allergic response recently (assuming you still take antihistamine), your cortisol levels might be a bit higher than normal (which then calls for the body to produce higher blood glucose levels). Have you checked your cortisol levels lately?

low iron : http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#12

hypothyroidism : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992186/

And the list is probably longer.

Thinking testing glucose levels might be better for those of us already doing a lower carb diet (and less likely to influence the results from last nights brownie). Here's Kresser's take on what to look for: http://chriskresser.com/how-to-prevent- ... ase-for-16

[MarkES]

YES, there is research indicating that the E4 isoform preferentially binds triglyceride rich lipoprotein particles, such as VLDL. The binding of APOE4 proteins to triglyceride rich particles is sufficient to slow activity of lipases on cell surfaces. Because the lipase activity is reduced, E4 carriers are slower in clearing VLDLs from circulation and therefore have elevated triglycerides in circulation leading to elevated LDL-C and P. Because MCTs bypass our inefficient lipoproteins. They are absorbed directly into the bloodstream through the portal vein, and are then transported to the liver. They are purported NOT to raise cholesterol. From this new baseline LDL-P; I'm going to test that out.

Sounds good in theory. If this were generally true, I would have expected to hear many anecdotal reports of folks reducing cholesterol levels switching to coconut oil. I appreciate the value in self experimentation and I hope it works for you as you're hoping. I'm interested in the results, as well. You lipid experience is certainly different than mine and perhaps this is another case. For me, I had LDL-C 300 eating 2 TBS coconut oil daily, following PHD with 30% carb, 50% fat. Maybe I should have reduced my carbs by 15%, instead of removing the coconut oil.

I'm going to keep my SFA levels stable and replace some MUFA with coconut oil (65% of which is MCTs.) This is also another way of further testing James's notion that dietary cholesterol is the culprit in E4 carrier's elevated LDL- C and LDL-P. Coconut oil has zero dietary cholesterol.

What MUFA sources are being replaced? Of course, olive oil also has zero dietary cholesterol. Dairy fats are SFA.

In all fairness, it remains to be seen what effect lower carbs and higher MUFA would have on your lipids. That's not to say I'm recommending this diet for you. You've done much work here & have thought harder about this than most (understatement) and will undoubtably find your way to what works best for you

Before PHD, I did try VLC and I ate piles of high quality, fresh vegetables, no tubers or high starch foods, no dairy, bottles of olive oil. My vegetables were at an all time high, while my energy was at an all time low. I had muscle, but felt weaker. At the time, this was influenced more by The Paleo Diet, The Paleo Solution, and The Primal Blueprint. I wasn't adding salt as those sources weren't encouraging it. I stopped this diet when I got shingles. Evidently, my immunity suffered on this diet. I normally have great immunity. I didn't have my lipids checked during this time. This is when I started following PHD.

[Julie G]

Susan, great links- Thanks. I checked my first fasting BG this AM and got 63. My husband, who eats similarly (but travels regularly) had 109 We're not happy. We'll test PPs on both and keep charting. A relief for me....so far; but I'm worried about my man.

Mark, wow- I wish you had lipids tested when you were eating similarly to me; would have been revealing. Yeah, low salt on low carb would be disastrous. Luckily, I naturally gravitated to higher amounts when I began the diet. My BP runs low, so OK for me. What % of protein were you eating then? The Primal Blueprint is basically a good model for my diet. Dr. P sells that book & cookbooks in his office. Sorry about the shingles; I know that's awful. Interesting about your immune system. Mine was so low as measured by IgG and IgA that my hemotologist was considering IVIG therapy. My numbers are almost normal since eating my current diet.

To answer your question, I will replace some EVOO with coconut oil. It will be interesting to see if it has any effect on my lipids. The research may demonstrate one thing; real life another.

[KatieS]

Julie, if your RBC's lifespan is longer, have you considered the fructamine test? This test confirmed a borderline high A1c for me. Somewhere (can't find it) I've read, A1c tends to reflect an erroreous higher average BG in non-diabetics than diabetics. I suspect it's the latter is the cause of our high normal A1c.

[Julie G]

Thanks, Kit. I see my internist at the end if the month. I will ask for the fructamine test. After seeing my 1st fasting BG: 63 & 3 PPs at 1,2 & 3 hours: 70, 94, 82; I'm really not concerned any longer. The 5.3 A1c shocked me; but I suspect it is not valid in my case, perhaps because my RBCs are long-lived. I know YOU just had the same experience- shocking! Thanks to you, Merouleau, and Susan for helping my figure this out.

A quick thought, I found it interesting that my 2nd PP was higher than my first. My meal consisted of eggs, vegs, and lots of EVOO. Proof that it takes time for those LCTs to travel throughout the bloodstream via lipoproteins before being converted into ketones. It'll be interesting to eat similarly tomorrow AM, but substitute coconut oil for EVOO. MCTs are supposed to be converted almost immediately and are apparently preferential to glucose/easier to access. Let's see if that's true.

[MarkES]

I found it interesting that my 2nd PP was higher than my first

One possibility might be measurement error, maybe not enough blood. I recently tried a glucose monitor and tried it twice in a row, because I didn't believe the first result, and the second result was much different. In my case, I think it was due to my inexperience and not enough blood in the first result (even though the meter beeped like it was done).

What % of protein were you eating then?

I wasn't tracking it during that VLC period, but I would guess around 25-30%.

Sorry about the shingles; I know that's awful.

Fortunately, I caught it early and anti-virals kept it at bay before it could get bad.

I'm going to keep my SFA levels stable and replace some MUFA with coconut oil (65% of which is MCTs.) This is also another way of further testing James's notion that dietary cholesterol is the culprit in E4 carrier's elevated LDL- C and LDL-P. Coconut oil has zero dietary cholesterol.
...
I will replace some EVOO with coconut oil.

Replacing EVOO with coconut oil will increase SFA. What change will you make to keep SFA stable? What change will you make to reduce dietary cholesterol? Is this based on what you were eating during your more recent NMR or your previous NMR?

[Julie G]

I know there's a learning curve with a glucose meter. I used to use one regularly when BG was too low. I'll keep checking regularly....but I'm feeling pretty certain high levels aren't an issue. Phew.

Thank goodness re. the shingles. That can be devastating.

Mark, YES, I am fully aware that coconut oil is an SFA. I am also aware that SFAs supposedly raise LDL-C and LDL-P in E4 carriers. I'm challenging that notion by replacing some of my EVOO with coconut oil. I'm playing around with the idea that plant SFA may not have the same effect. I'm not cutting out all animal SFA. I'm still going to eat a dozen eggs a week, daily kefir, cream in coffee, small amounts of cheese- like I am now (Look back to page one for details.) Instead of eating 4-5 tbs of EVOO a day, I'll eat 3-4 and make up the difference in coconut oil.

This change is based on my most recent NMR. I ate very little coconut oil during this period.

[MarkES]

By the way, on a related matter, see:

http://arc.crsociety.org/read.php?3,219 ... msg-220094

I'm pretty sure Dean is ε3/ε3, by the way, though his results are what the standard wisdom says are more likely with ε4s.

Adding the relevant portion here:

For me, going from a diet of 39F/47C/14P (with the fat from nuts and olive
oil) to 13F/75C/12P (with the extra carbs from more fruit, veggies, beans
and barley) my total cholesterol dropped from 179 to 121 mg/dl. My LDL
dropped from 92 to 60 mg/dl, and my HDL dropped from 72 to 47 mg/dl.

You can see the full results of higher fat vs. higher carb in columns
labeled "2/21/13 (8)" vs. "5/10/13 (11)" in this table:

http://dl.dropboxusercontent.com/u/2521 ... tests.html

But the summary wrt blood lipids is as follows:

39F/47C/14P 13F/75C/12P
-----------------------------------------------------------------------------------------------
Total Chol 179 121
LDL 92 60
HDL 73 47
Total Chol / HDL 2.45 2.57
Triglicerides 68 70

GB, I thought dietary constituents didn't matter on CR?