Apod -- Advanced Lipids #3 (HFLC!)

[apod]

I've been trending between 3,000kcal per day to around 2,100kcal, averaging ~2,500kcal. A lot of this energy is coming from nuts / avocados / olives combined with lots of fiber which is likely decreasing bioavailability. I've upgraded to a standing desk and have been going on long walks, which has ramped up my TDEE. I've been keeping net carbs under 50g, usually around 40g with ketones measuring between 1.0-3.0mmol/L. Protein intake ranges from 90g-125g, usually hitting around 100g. I'm averaging around 200+ grams of fat per day often as 1 very large, bordering on an uncomfortably huge meal, or two pretty large meals -- listening to Mercola's recent "Peak Fasting" talks, I've been playing around with more liberal snacks throughout a 4-8hr eating window. Prior to my blood test, I threw in a 24hr fast (the test was at ~3pm, so I had dinner at ~3pm the day before). I've been averaging around 34grams of saturated fat per day -- this is more than double the amount from my last test. This is coming from Macadamia + Avocado + Dark Chocolate -- there's very little if any animal fat in my diet, aside from what I get from eggs (daily cholesterol intake averages ~140mg/d, which is lower than my phytosterol intake from nuts+plants.) My BMI right now is at ~20.8, with low body fat but some muscle mass from deadlifts+squats+presses, etc. I've gained a bit of body fat since my last test, but not too much.

Supplements include ~0.5 - 1.0g of n-3 via algae oil. (I'm now switching this out for LEF's distilled EPA/DHA with sesame + olive extract). I've been throwing in ashwagandha, which I've read lowers lipids. I've also been using Pantethine for B5, which lowers lipids. And, occasionally some tocotrienols, which can lower lipids. Taurine + Garlic extract, which can lower lipids. CoQ10 + PQQ. Other supplements include Magnesium, Iodine, B12+Folate (methylated), and K2. I often have some whey protein or a vegan protein using Rice+Hemp+Pea, and I eat some meat throughout the week with eggs (usually 2x at a time, raw or lightly boiled.) I've really dialed up soluble fiber via avocado+garlic+onions+leeks+cauliflower+flax+psyllium+chia+shirataki noodle, averaging around 60g/d of fiber (a large portion of which is soluble). I've been supplementing 5g of leucine with workouts, at 10g BCAAs 3-4x per week. Workouts include running, HIIT, rock climbing, bodyweight exercises, swimming, and resistance training (circuit / compound) -- I mix it up.

So, here's what I'm looking at, this time going with SpectraCell's CardioMetabolic Panel (cheaper than NMR Lipoprofile + Metabolic panel)

I was expecting to see lower Tg's, lower sdLDL, and lower VLDL. I seemed to have lower TG's when eating much more sugar + white rice + potatoes (up around 400g some days containing 200g of sugar) with high-fat days eaten at a caloric deficit via a "LeanGains-esque" diet-- that test measured TG at 56, and Small LDL-P <90 with no detectable VLDL, although this brought my A1C up around 5.3% at the time, likely from the massive quantities of high-GI carbs. Perhaps somewhere between these extremes lies healthy moderation and optimal results.

[apod]

I've also been eating a lot of n-6 via nuts + avocado. It seems like I could dial this back (in place of more MUFA? somehow.) Or, maybe more long-chain n-3.

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[Julie G]

Wow, apod, I just took a cursory glance, but overall your results looks amazing- kudos! Bearing in mind that 1,300 is the 50%ile for LDL-P on an NMR Lipoprofile, my guess is that your result is around 1,000-1,100 using that scale. Is that about what you've estimated? How does this result compare to your past advanced lipids?

My only real concern is your Omega-3 level. I think the goal for E4 carriers is >10%. Are you eating any fish? Or supplementing with fish oil or algae? Also, as you've noted, your sdLDL is really surprising just under 300. This kind of overturns Dr. Gundry's theory that animal fat raises sdLDL...

Your results add to our database of evidence challenging the traditional dietary advice for E4 carriers. Thanks for sharing.

[apod]

While eating my sort of high-carb (surplus) / high-fat (deficit) split while keeping my weekly average SFA down around 15g/d, my LDL-P measured 908, which was marked Low on a NMR LipoProfile test. If this does round out to around 1,000 particles on the new test, that's not too bad for more than doubling the intake.

On Peter Attia's site:
http://eatingacademy.com/nutrition/the- ... rol-part-v
http://eatingacademy.com/how-low-carb-d ... rt-disease

He writes: "What seems clear is that in patients with low LDL-P (i.e., apoB < 120 mg/dl), size does not matter. The relative risk is 1.0 in both cases, regardless of peak LDL size. Guidelines for ApoB are also not black and white, but generally an ApoB under 109 is considered ideal. Finally, my ratio of ApoB to ApoA1 was 0.41, which is ideal, as most lipidologists like to see that ratio below 0.92."

My ApoB measured 72 mg/dl, with a ratio of ApoB to ApoA1 of 0.375, which doesn't seem too risky.

I am curious what's going on with sdLDL.

I have read that ketones can convert back into triglycerides -- maybe some of this is going on? I've also read a couple reports of supplementing resistant starch raising particles -- maybe my high soluble fiber intake (or protein / supplement powders?) is contributing to some small particles? Or, maybe I'm slightly eating at a caloric surplus (large meals?) which is triggering lipogenesis? Looking at 3 weeks of cronometer data, my average fructose intake is at 3.7 grams per day -- basically none.... it looks like I'm getting the most fructose in my diet from lettuce. Overall daily sugar intake is averaging 21g, but this seems to be from a bunch of tiny sources adding up -- the biggest contributor to my daily sugar intake is macadamia nuts at around 2.4 grams of sugar. My largest contributor of net carbohydrates is coming from avocados, which are also my largest source of saturated fat (followed by macadamia, cacao, and olives.)

Perhaps it's the saturated fat content driving up sdLDL? My SFA intake is almost exclusively from plants, primarily from high-MUFA foods, with some very dark (90-100%) chocolate. Hmmm. I could trade some sfa-rich nuts / avocado / chocolate for olive oil + higher omega-6 nuts.

I eat a pretty good amount of seafood. I just had a piece of salmon tonight -- I eat salmon almost every week. I eat lots of sardines... and I supplement EPA/DHA (albeit in low doses.) When I eat eggs, I'm eating the Pastured Soy-Free Organic Omega-3 eggs. I'm surprised this intake was still marked Low (perhaps ALA from flax / chia + omega-6 competes for absorption?) On the bright side, I'm down to increase my fatty fish intake -- I've read that this might increase mercury in E4 brains, but it doesn't seem to be associated with cognitive decline. I'm curious if adding in more selenium to these seafood-rich meals would hedge against the mercury toxicity (brazil nuts?) I was planning on just supplementing 1x LEF's "super omega" per day... maybe I'll do the full 2x capsule dosage for 1.2g omega-3 via 4g of fish oil concentrate (2.5g fat) divided between meals. Hmm.

It seems like increasing carbohydrates + insulin might help to raise leptin (which looked very low on my results) / thyroid hormones (increasing LDL receptors), while also lowering my SFA intake, which should allow me to comfortably operate at a lower caloric intake / level of body fat with lower LDL-P / sdLDL / TGs. This approach did seem to work well on the last go around. It should also make some activities a little better fueled. Although, I'm not quite sure how I might want to approach this (low-fat refeeds vs carbs with fatty meals, pre-workout vs intra-workout vs post-workout vs 'carb nite' carbs, or more fruit vs more starches vs more veg.) From IF and macro cycling, I can easily maintain some small level of ketones, although... I do really like the feeling of staying up over 1.5 mmol/L. Higher carbs would likely translate into higher A1C / Lower HDL. I'm tempted to go CGM-mode and try to nerd out on some meals to really dive down the rabbit hole. Alternatively, I might just need to give this HFLC diet a longer run to allow further adaptation to take place... and maybe my SFA intake / overall diet is right about on track, where I could further increase fat in place of protein. My A1C has dropped from 5.3 to 4.9, where it should continue to drop down. I would also be curious to play with higher intakes of cholesterol (eggs) vs MCTs (C8 vs C8+C10 vs coconut), or frequent smaller meals vs larger fasting windows with big meals. Tricky.

/Random thoughts.

Overall, I'm happy with the results and enjoying the dietary tinkering process. It's interesting to compare this data against the blood work from my previous standard american diet in the past (sodas, fast food, snacks, chips, etc), where I now have much lower LDL, much lower TGs, lower TC, and higher HDL, despite a much higher intake of fats / saturated fat.

[circular]

My only real concern is your Omega-3 level. I think the goal for E4 carriers is >10%.

I spotted that too, but it's a good example of why the biomarker lab range comparison chart can be handy. Here's a distinction to note:

HDLabs, now True Health
'HS-Omega-3 Index, (RBC EPA+DHA)'
Optimal is > 8%

Spectracell
'OmegaCheck, Whole Blood EPA+DPA+DHA'
Optimal is ≧ 5.5%

So I'm not sure these are apples to apples and may account for why apod is shown as 'in range' when we'r used to seeing higher numbers.

[circular]

Also, as you've noted, your sdLDL is really surprising just under 300. This kind of overturns Dr. Gundry's theory that animal fat raises sdLDL…

Can you guys say more? I'm not clear how many oz of animal fat apod is taking in per day from his description, and I'm not clear what his sdLDL status is.

I'm having trouble converting Spectracell's nmol/L sdLDL numbers to mg/dL for comparison with True Health's reports:

True Health
sdLDL is listed generically at optimal <21 (mg/dL).

SpectraHealth
Breaks down sdLDL into different types:

Small dense LDL III where range is <300 nmol/L
Small dense LDL IV with HDL2b where range is <100 nmol/L

Do we think that True Health is testing LDL III?

It seems online that the only way to convert is to know something's molecular weight? Argh.

I'm not readily seeing a link to the conclusion that Dr. Gundry's perspective is overturned here, although it may be. Even if apod doesn't fit a trend Dr. Gundry sees in his practice, it may not be overturning his theory so much as showing that there are exceptions, and ones which Dr. Gundry may be aware of, but unfortunately for us he isn't given to speaking in nuance. I think that's because most of his audience is people who want simple statements that inspire them to act. In any case, I've fact checked him and found him wrong on occasion, so it's not that I mind if he has a broader theory that goes down, I'm just not clear yet that's happening here, but maybe I'm missing something obvious?

[marthaNH]

Thank you, apod, for sharing all this. If I take all your lifestyle data and divide calories and macros by two and adjust volume and intensity of exercise by about the same amount, I get... me. Very similar diet. And similar strategies in terms of ketones and soluble fiber. BMI about the same (mine about a point lower, but probably due to less muscle mass.) So it just makes for an interesting and educational sort of read.

You've really got your strategy focused and these results are --- as we say here --- stellar!

[Julie G]

Circ, good eye on the sdLDL markers. We may not be comparing apples to apples, but like you I'm not sure how we can convert . FWIW, I suspect that LDL III is the marker True Health is using. Re. apod's diet, (I'll let him confirm) but my take is that it's quite low in animal fat and heavily plant-based.

Also nice catch on the possible difference in how Omega-3 is measured on the various tests. SpectraCell uses whole blood as opposed to RBC concentration of EPA & DHA. Given that, it might make sense that the optimal range is lower. Further confusing the issue, the optimal range for E4 carriers will invariable differ from the optimal range for the general public. All of these confounders point to the importance of your newly created spreadsheet, brilliant girl .

[apod]

Thanks for the kind replies guys!

I'm not clear how many oz of animal fat apod is taking in per day from his description

Looking back in my cronometer data at the days leading up to the blood test, I'm seeing:

-01d: 0grams animal fat (no meat / seafood / eggs eaten)
-02d: 0grams animal fat (no meat / seafood / eggs eaten)
-03d: 1 can of wild sardines (~21g protein, 2g omegas-3 / 2g sfa), no other meat
-04d: 2x boiled pastured soy-free omega-3 eggs (12g protein / 3g sfa), no other meat
-05d: 0grams of animal fat (no meat / seafood / eggs eaten)
-06d: 3oz steamed wild Copper River salmon (~21g protein, 2g omega-3, 1g sfa), no other meat
-07d: 0grams of animal fat (no meat / seafood / eggs eaten)
-08d: 1 raw pastured soy-free omega-3 egg yolk, 3oz steamed wild Copper River salmon (25g protein, 2g omega-3 / 3g sfa), no other meat
-09d: 0grams animal fat (no meat / seafood / eggs eaten)
-10d: 1 pot of boiled wild mussels (~20g protein, 1g omega-3 / 1g sfa), no other meat
-11d: 1 large bowl of chicken soup (organic heirloom pastured slow-grown chicken with skin removed and skimmed shredded meat -- lots of gelatin) (~25-30g protein, 1g sfa), no other meat
-12d: 1 large bowl of chicken soup (organic heirloom pastured slow-grown chicken with skin removed and skimmed shredded meat -- lots of gelatin) (~25-30g protein, 1g sfa), no other meat
-13d: 1 large bowl of chicken soup (organic heirloom pastured slow-grown chicken with skin removed and skimmed shredded meat -- lots of gelatin) (~25-30g protein, 1g sfa), no other meat
-14d: 1 can of wild sardines, stewed marinated extremely lean grass-fed veal (~50g protein / 4g sfa) -- this was a very active day (~3,000kcal) and very heavy on vegetables. Net carbs landed at 50g, while fiber intake that day measured 96g. This is how that meat was used in the meal, and the bottom-right plate depicts my usual ratio of animal:plant in meat-heavy meals. The dark color of the meat is from the antioxidant rich marinade + spice mix (mexican oregano, sumac berries, maqui, fresh rosemary, turmeric, cumin, black pepper, garlic, onion, parsley, bay, tamari, coconut aminos, chili pepper, lime, 400poly olive oil, etc.), as it was gently cooked with water.

Here's how the egg / sardine was used:


("cheese" created with fermented cashews + almond milk + lemon juice / baobab fruit + sea salt + seasonings, while the tofu shirataki noodles were boiled with turmeric and spices. Pic taken of eggs before drenched in olive oil w/ 1-2tbs vinegar.)

Adding this up and dividing by 14, I'm averaging around 1-2 grams of saturated fat from animal sources per day -- this is around 1 quarter to a half of a small teaspoon's worth of coconut oil. My rough tracking / math might be a little off, but it still seems like a relatively small amount. It wouldn't take me too much effort to go fully vegan with my diet from here, although I do enjoy meat+eggs+seafood for the variety. With the amount of antioxidants / polyphenols / tannins / phytic acid in my diet with lots of activity / fasting + big meals, I would be curious if I would need to supplement iron if I was to go fully meat-free.

[Ruth]

Wow, your meals look delicious! Kudos to you for feeding yourself well.