My version of a Ketogenic Diet

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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Julie G
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Re: My version of a Ketogenic Diet

Post by Julie G »

MAC, I hear your uncertainty and fear re. LCHF for our population and share it to a certain degree. That's why I check biomarkers every 6 months or so especially if I make a major dietary change.

I've been tracking and tweaking diet/lipids for several years now. If you get a chance to look over this thread, you may find answers to some of your questions as they relate to my n=1. Indeed, as I lowered SFA to 10% of TC, while keeping fiber intake high from 10+ cups of non-starchy vegs, my LDL-P came down to 881, small LDL-P less than 90.

Per cronometer, I was deficient in potassium, but supplementing was a disaster. My BP dropped way too low. I learned that dietary intake doesn't always translate to serum levels.

Your first round of advanced lipids may offer you reassurance or at the very least point towards areas to work on. I've followed this diet for about 4 years now and recently did an EBT to check coronary calcium and was somewhat reassured with a zero score. I can't remember if you've done that yet. It might be something to consider.

I appreciate your questions. Despite what some would have you believe, there are no dietary definitives for our population, hence the reason I always recommend testing and tweaking as necessary.
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Re: My version of a Ketogenic Diet

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It's the "testing and tweaking" that has me (likely many of us E4's) in a conundrum.

What are the key CAUSATIVE indicators to watch during testing, and tweak how? I don't think one can be changing protocol every week to run a meaningful (even if n = 1) experiment. I think one has to stay the current conviction course and let the body adapt, especially during a huge step change like I've undertaken..still dropping weight, so my body is clearly going through adaptation. I think 6 months is reasonable snapshot interval.

I started down this path for cognitive, so how to run this experiment re "testing" to then tweak?

From a blood biomarker, we know what Bredesen/Gundry suggest, but what about cognitive response variable, that's what we're all chasing?

1. Do regular MMSE testing or other scientifically accepted cognitive tests? And if same or better, stay the course, if worse, then what?
2. Do advanced biomarkers like functional MRI, ABETA, TAU testing to check for underlying pathology changes?
3. Do nothing, let your family & friends to tell you?

How do I know I'm making any difference...surely not going to just wait 10 years and hope for the best?

Same for CVD. What specific NMR markers to target, and are they 100% causative indicators?

Gundry says to watch ONLY smLDL, forget LDL-P?

Gundry does say SFA type DOES matter...avoid animal fat ESPECIALLY E4's, stick to seafood/shellfish/omega-3. That's a HUGE distinction!

I have never had any coronary tests run, but will do some research and consider whether I should have a baseline done.

As E4's, I don't think do nothing is acceptable...we must leverage epigenetics to increase odds in our favour. Everything I read, E4+ is always an incriminating culprit in cognitive. But what exactly are these epigenetics!!?? I am trying to read as many articles on identical twins I can find...they point towards epigenetics of course, and several point toward "inflammatory events" in life that may be causative (some sickness/illness/disease).
MAC
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Re: My version of a Ketogenic Diet

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MAC wrote:Gundry does say SFA type DOES matter...avoid animal fat ESPECIALLY E4's, stick to seafood/shellfish/omega-3. That's a HUGE distinction!
It's interesting, I believe Gundry also recommends avoiding high amount of Cacao fat, and Coconut fat, particularly in E4s... But he's open to supplementing MCTs in E4s, which is 100% saturated fat at 14g per Tbs. So he's also anti-plant SFA in some regards. I never got around to testing lipids after including more C8 in my diet (up in the 15-40g/d range of supplemental saturated fat) -- I'd really like to see what that does sometime.
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Re: My version of a Ketogenic Diet

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Such great questions, MAC! I hear and share your frustration with all of the unknowns for our population. I’m thrilled to have you as a member constantly pushing for answers. That’s why we created this website.

When I mentioned testing and tweaking, I was referring to lipid and glycemic biomarkers, not cognitive status. Like you, my major focus is on cognition based upon my very high genetic risk, personal & family history. I regularly track that via two different brain training sites: Lumosity & BrainHQ. They both measure various aspects of cognition such as speed processing, attention, problem solving, flexibility, memory, etc. I try to train a few times a week to make sure I’m not losing my edge. While not a substitute for neuropsych testing, they allow me to objectively track my cognition and notice trends.

Re. tracking lipids, I fully acknowledge the uncertainty given the ongoing rethinking of the lipid/heart hypothesis. I see reactionary folks swing in the opposite direction suggesting that lipids don’t matter at all as long as glycemic and inflammation biomarkers are low. I don’t share their certainty, which is why I DO track them. That being said, I’m not stressed about which specific markers to follow: LDL-P vs. sdLDL. (Yes, sdLDL, not small LDL-P, is Gundry’s preferred biomarker.) No one has definitive answers per peer reviewed research. Just make sure your markers are trending in a direction that minimizes your CVD risk. Standard lipids are a cheap substitute for advanced testing. TG/HDL ratios in particular can provide a decent window into particle size and hence particle number. Any strategy you use should improve that ratio. Dyslipidemia (as opposed to hyperpidemia) is much more strongly correlated with CVD risk. IMHO, extreme focus on lowering LDL alone is a huge mistake for our population. If your numbers are moving in the wrong direction or you have a strong family history (or both) definitely do advanced lipid testing, check oxLDL, consider the Corus blood test, do a low radiation EBT to better assess your risk.

I see you very focused on the dietary unknowns. Remember that E4 carriers from all over the world, who maintain an indigenous diet and lifestyle, do NOT go on to develop AD & CVD. These folks eat widely varying diets comprised of clean whole foods as opposed to one single magical diet. The one thing they all have in common is the avoidance of processed foods, highly engineered oils, refined grains & sugars, etc. that epitomize the Western diet. FWIW, in addition to cleaning up our diets, I suspect that it's equally important for us to prioritize exercise, sleep, stress reduction.

From what you've been sharing, I see you making tremendous progress. Kudos. Keep asking questions. You keep us all on our toes focused on the questions we SHOULD be asking.
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Re: My version of a Ketogenic Diet

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It's interesting, I believe Gundry also recommends avoiding high amount of Cacao fat, and Coconut fat, particularly in E4s... But he's open to supplementing MCTs in E4s, which is 100% saturated fat at 14g per Tbs. So he's also anti-plant SFA in some regards. I never got around to testing lipids after including more C8 in my diet (up in the 15-40g/d range of supplemental saturated fat) -- I'd really like to see what that does sometime.
Apod, I'll defer to anyone with superior knowledge, but I'm pretty sure Gundry encourages both coconut oil and MCT for our population. He does recommend avoiding both several days before testing lipids as [he contends] they can contribute to false high readings. I'm unsure of his position on cacao fat for E4s, but I did have the pleasure of sitting next to him at dinner in Boulder where he shared his n=1 on that topic. Apparently, he wanted to test the effect that eating a whole chocolate bar a night would have on his lipids. He did so for a week or more- can't remember. He said his lipids were VERY high. Stearic acid is purported to have a neutral effect on lipids. He disagrees.
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Re: My version of a Ketogenic Diet

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Thanks Juliegee, re:
No one has definitive answers per peer reviewed research. Just make sure your markers are trending in a direction that minimizes your CVD risk. Standard lipids are a cheap substitute for advanced testing. TG/HDL ratios in particular can provide a decent window into particle size and hence particle number. Any strategy you use should improve that ratio. Dyslipidemia (as opposed to hyperpidemia) is much more strongly correlated with CVD risk. IMHO, extreme focus on lowering LDL alone is a huge mistake for our population. If your numbers are moving in the wrong direction or you have a strong family history (or both) definitely do advanced lipid testing"
Just so am understanding you 100%, can you please clarify:

So what markers...low LDL, high HDL, low TG, don't worry too much smLDL, LDL-P? I thought it was pretty rock solid as it relates to CVD that plaque buildup, ergo eventual MI, is in fact oxidized small LDL inside arteries? Absolute causation perhaps unknown, but smLDL = MI.

Sorry, dosen't Dyslipidemia mean hyperlipidemia? https://en.wikipedia.org/wiki/Hyperlipidemia

Isn't the term TOO general, "elevated lipids", when there's a raging debate dissecting our lipids for true "meaning"?

And why is lowering LDL alone a HUGE mistake for us, I take it you mean E4's?

And so if my next LCHF labs (no animal fat/dairy/carb/sugar) shows LDL, TG, HDL trending in your defined wrong direction, I should do what?

And for CVD, AD, both? Are they concordant or can they be discordant??
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Re: My version of a Ketogenic Diet

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So what markers...low LDL, high HDL, low TG, don't worry too much smLDL, LDL-P?
Definitely, high HDL, low TG. I’m not overly focused on LDL itself. Bear in mind, per MESA data, a discordant LDL-C/LDL-P (with high LDL-C & low LDL-P) is most protective against CVD. I think larger LDL particle sizes are better simply because they lead to lower overall particle count; not to mention the evidence that associates smaller particles with higher oxidation, etc.
I thought it was pretty rock solid as it relates to CVD that plaque buildup, ergo eventual MI, is in fact oxidized small LDL inside arteries? Absolute causation perhaps unknown, but smLDL = MI.
Still a theory… LOTS of correlation. Have you delved into Subbotin’s hypothesis?
Sorry, dosen't Dyslipidemia mean hyperlipidemia? m https://en.wikipedia.org/wiki/Hyperlipidemia
Not exactly. Lumping them together causes all sorts of confusion and misinformation. Hyperlipidemia is more of an umbrella term that refers to a general elevation of lipids in the blood or high cholesterol without distinguishing between the various lipids. Dyslipidemia typically refers to a state where LDL and TGs are elevated and HDL is low. This is strongly associated with increased CVD risk.
And why is lowering LDL alone a HUGE mistake for us, I take it you mean E4's?
As Hep recently suggested in another thread, we all maintain a balance between our lipid biomarkers and our glycemic biomarkers. Think of each on one side of a teeter-totter. When we singularly focus on reducing LDL-C (the lipid side) our glycemic markers and TGs tends to rise. Additionally, HDL drops. LDL particle size is also reduced which can lead to an overall increase in LDL-P or apoB that has been correlated with CVD. Also, don’t forget the evidence linking low LDL with a reduction in longevity and impaired cognition.
And so if my next LCHF labs (no animal fat/dairy/carb/sugar) shows LDL, TG, HDL trending in your defined wrong direction, I should do what?

It depends on where you started and which number is moving in the wrong direction. If your LDL is somewhat elevated, with a corresponding elevation in HDL, and decrease in TGs; that’s generally a move in the right direction- no action necessary. If your HDL is dropping and your TGs are raising, I would definitely reassess your current direction and tweak accordingly. It’s impossible to get into all of the hypothetical scenarios until we see your numbers.
And for CVD, AD, both? Are they concordant or can they be discordant??
I'm not sure I understand the question. Lipids are concordant when LDL-C and LDL-P are relatively parallel; LDL-C of 100 = LDL-P of 1,000. When one or the other is high/low that's discordant. Depending on which direction you're discordant (discussed above) it can be a positive or negative in terms of CVD risk. To my knowledge. this hasn't been studied with regards to AD risk.

You mention that you're on an all plant diet. Without some careful tracking and supplementation, that CAN lead to trouble for E4 carriers. Have you done 23and Me? I ask as you may want to run your FADS1 & 2 snips to see if your genes are well suited to veganism. Some members have found they need a little more help with choline and DHA. Both are vital to brain health and generally require some animal based foods to reach optimal levels. This may be particularly important for us as recent evidence is indicating that E4 carriers benefit more from higher Omega-3 levels. This can be tested with an Omega-3 Index test (RBC EPA+DHA.) Experts focused on AD & CVD prevention want it to be around 10% for us. We touch on FADS1 & 2 in this thread. Also, apologies if you've posted it elsewhere, have you checked homocysteine? Some -vegans especially- with MTHFR mutations have found that they need to supplement B12 (and other specific B vitamins) to keep that in check. Many of us target levels around 7-8 µmol/L.
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Re: My version of a Ketogenic Diet

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So it's almost 2017, and we don't know definitively the root pathogenic pathway of CVD disease re lipids? (Reviewed the Subbotin thread, ty). Yet, more unknowns.

My 1st labs below after only a few weeks on LCHF protocol (your original comments to me in CAPS)
I am homozygous MTHFR so supplementing B6/B12/L-Methylfolate as well as taking 880 mg EPA/560 mg DPA daily fish oil.

TC of 194 is DESIRABLE
LDL of 125 is NEAR OPTIMAL
HDL of 53 is NORMAL
TG level of 80 is NORMAL
RATIOS:
Your Total Cholesterol/HDL ratio is: 3.66 - (preferably under 5.0, ideally under 3.5) GOOD
Your HDL/LDL ratio is: 0.424 - (preferably over 0.3, ideally over 0.4) IDEAL
Your triglycerides/HDL ratio is: 1.509 - (preferably under 4, ideally under 2) IDEAL

Other 1st labs data points:

apoB 1.08 g/L
HCY 8.4
HA1C 5.2%
FG 89 mg/DL
Insulin 3 µIU/mL
Ketones 0.5

My diet is seafood/nuts/berries/EVOO/plant based, NO animal (meat/dairy), except for a bit of chicken here and there, and NO carbs/sugar.

As for FADS1/FADS2, I am rs174548 (C/C) and rs1535 (A/A), context?

So I am pretty certain I am taking in way less SFA, and likely more MUSA/PUSA on this LCHF protocol.

As I am currently loosing weight, and given my FFA intake profile, the fat being drawn from my body is now floating around my plasma yes...do LDL/TG rise during ketogenic weight loss before steady state level?

Interested in predicting my lipids in 3 months?
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Re: My version of a Ketogenic Diet

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Ah, thanks for that clarification on your diet, MAC. You are not a vegan, but avoid dairy & meat. Interestingly, your FADS1 & 2 genes suggest you WOULD do better than most as a vegan ;). Good for you for staying on top of your MTHFR mutation. Your homocysteine is decent, and may drop even further as you continue optimizing health. If not, you could consider a small does of TMG.

I do recall your lipids and remember that your ratios were an improvement over your baseline. I suspect that you'll continue to move in a positive direction.
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Re: My version of a Ketogenic Diet

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Thank you. The labs referenced/posted were my very 1st results...I have no other baseline, so these ARE my baseline after only 3 weeks on LCHF/supplements.

I am about 3 months in now, have lost (continue to) significant weight (exercise intensely daily vs. before protocol), will do another set of labs at 6 months, holding everything constant til then. Feel great, zero side effects notable.

Sorry, what I meant to ask in my previous posting re lipids and AD/CVD discordance: is doing all the things trending positive for CVD, are they all positive for AD (E4 specific of course)?
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