Unkind labs with keto diet - where to go from here?

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Re: Unkind labs with keto diet - where to go from here?

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You make me laugh, with your big fluffy LDL cloud images to help you get to sleep, Gigglemush. You definitely are making smile, as my diet is pretty much like your best pick for longevity. Guess my family and friends are going to have to deal with me for a while longer. :)

You are continually gracious, Julie, and I am glad that YOU have found what works for you. What rotten luck about your cats! You even have to have pets with Alzheimer's??? Good grief.
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Re: Unkind labs with keto diet - where to go from here?

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What rotten luck about your cats! You even have to have pets with Alzheimer's??? Good grief.
Only one and I watched him die shortly after I learned about my 4/4 status ...when my cognition was not the best. So hard. My son, who’d become critically ill at age 12 was very bonded with that cat. He missed a year of school and pretty much laid in bed for most of that time. Eli wouldn’t leave his side. He guarded and protected him. My son called him his “healing cat.” When I finally had Eli put to sleep, my son (then healthy and 6’2”) stood on the porch of the vet’s office and cried so hard that he shook. He couldn’t bear to be in the room. Sad memories. I hope I see Eli and all of my pets again. Their unconditional love is one of the greatest privileges of my life.
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Re: Unkind labs with keto diet - where to go from here?

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Juliegee wrote:
No, I haven't tried the blue-blocking glasses. I use f.lux on my computer and Twilight on my phone. Do you think the glasses are a better solution? I already wear glasses, and glasses over glasses are usually uncomfortable.
I use similar programs as well with the blue blocking glasses. I wear contacts and use reading glasses so the eye wear issue is tricky for me too. I did find a comfortable pair that I can wear over my glasses.
I think first I'll try more protein, more fiber, 14-hr IF, less SFA and eating leftovers at room temp, first and save trying carb night if that doesn't work.
At 13%, your protein intake already is a bit on the high side using the .08-1 gram per kg of lean body weight per day formula. I’d think twice about increasing for fear of gluconeogenesis which could further exacerbate your PIR, if that’s what’s going on. That said, I acknowledge that you’ve yielded good numbers in the past by increasing protein. Were you exercising more strenuously when your intake was around 20%? As we both know, playing with macronutrient ratios is trial and error. You’re a smart guy. I suspect you’ll find your sweet spot again.
How low was your WBC? How were your infections detected? DId you have symptoms? But wouldn't it be strange for me to have the LDL-C and LDL-P progressions and the perfectly valid PIR explanation for the anomaly and have it be due instead to h.Pylori? I always suspect my doctor cringes whenever he sees an email from me. I would hate to bug him for an unnecessary test.
My WBC was slightly below the reference range, but it had been elevated for a decade or longer prior to the drop. I promise that I don't want you to do any unnecessary testing. I simply share my story as a cautionary tale and example of how underlying drivers can affect lipids. Three often overlooked causes of worsening lipids are: suboptimal thyroid, gut, and an underlying infection. I recently began working with a FMP, who found that I was dealing with all THREE (described here.) I had my worst lipids ever at this point. (LDL-P: 1524, TC: 238, LDL-C: 126, HDL: 102, TG: 66, A1c: 5.0) Several months after treatment, changing nothing in my diet, my numbers moved to: TC: 238, LDL: 114, HDL: 115, TG: 45, A1c: 4.7) Hence, I’m a strong believer in looking for underlying root causes and suspect that an increase in small particles is a tip-off when diet can’t explain advanced lipid deterioration. My small LDL-P has always been below 90. It bumped up to 267 on my worst test. Your small LDL-P shows a steady increase which made me suspect an underlying driver. Just an idea; could be PIR. Let us know what you find out. i suspect we'll all learn from your experience.
Julie, Sorry, I couldn't respond sooner; I've been really busy. Thank you for all this additional information and the link to your Chronic inflammation post. I will definitely follow up on that if the obvious remedies don't pan out sInce I'm asymptomatic for the problems you mention (chronic fatigue, exercise intolerance, or chronic pain).

Re your better lab numbers: What was the treatment during that period? Did you also get NMR numbers with the 2nd test sset?
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Re: Unkind labs with keto diet - where to go from here?

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Re your better lab numbers: What was the treatment during that period? Did you also get NMR numbers with the 2nd test sset?
The details of my treatment are buried somewhere in that thread, Dan. Too much for me to remember it all. I started with a very complex antimicrobial protocol to heal my gut. When gut healing was well underway, I took several weeks of antibiotics for the h.Pylori. I then also began taking a tincture called MC-BABS-2 for the Babesia, a tiny amount of WP thyroid, and began monthly IVIG therapy to address my immune deficiency. WIP. No NMR on the 2nd test. I just had to do that for my annual insurance physical, but given all of the shifts in the "right" direction, I can guess it was down significantly. I hope these aren't contributors for you, (and I recognize that I'm a bit of a dramatic case :oops:) but I thought I'd throw them out as possibilities.
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Re: Unkind labs with keto diet - where to go from here?

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Juliegee wrote:G, my guess is that you’ve probably looked into this more from an academic perspective that I have. Basically, people who eat less and move more don’t become metabolically inflexible.
Thanks, Julie, and pardon the lack of precision in my formulation of the question. I'm familiar with pathological metabolic inflexibility, but I hear many in our group speaking of the merits of "increasing metabolic flexibility" in a (presumptive) non-pathological context, like being able to switch in and out of ketosis quickly. That seems like a different phenomenon – at least the way I've interpreted some of what's been said here – but maybe it isn't!

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Re: Unkind labs with keto diet - where to go from here?

Post by Julie G »

I'm familiar with pathological metabolic inflexibility, but I hear many in our group speaking of the merits of "increasing metabolic flexibility" in a (presumptive) non-pathological context, like being able to switch in and out of ketosis quickly. That seems like a different phenomenon – at least the way I've interpreted some of what's been said here – but maybe it isn't!
I think metabolic flexibility falls on a spectrum with optimal health on one side and disease on the other. It's certainly "pathological" when E4 carriers are exclusively stuck in a glucose burning state when our brains become unable to effectively utilize cerebral glucose.
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Re: Unkind labs with keto diet - where to go from here?

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Juliegee wrote:
Re your better lab numbers: What was the treatment during that period? Did you also get NMR numbers with the 2nd test sset?
The details of my treatment are buried somewhere in that thread, Dan. Too much for me to remember it all. I started with a very complex antimicrobial protocol to heal my gut. When gut healing was well underway, I took several weeks of antibiotics for the h.Pylori. I then also began taking a tincture called MC-BABS-2 for the Babesia, a tiny amount of WP thyroid, and began monthly IVIG therapy to address my immune deficiency. WIP. No NMR on the 2nd test. I just had to do that for my annual insurance physical, but given all of the shifts in the "right" direction, I can guess it was down significantly. I hope these aren't contributors for you, (and I recognize that I'm a bit of a dramatic case :oops:) but I thought I'd throw them out as possibilities.
Thank you for this additional info, and, really, thank you for everything you do here. This forum is such an amazing resource which has helped me SO much!

I have an update for you. In some routine accounting, I discovered that in the 34 days just prior to my Jul-12 lab draw, I had missed 4 (!) doses of my thyroid meds. On the day I discovered it (Jul-30), I saw that I had missed zero days of thyroid med in the last 18 days. So, suddenly, I didn't trust those lab values. Since my diet had only changed slightly (in the directions we discussed), I ordered myself another NMR panel. Here's the tabular result:

Image

and the graphic result:

Image

The graph isn't ordered by date, so I marked the new, Jul-31, lab with a turquoise arrow. As before, I marked the 3 LDL-P outliers with red circles.

For anyone unfamiliar with statistics, R-squared gives the degree of correlation between the lab valuies (LDL-C and LDL-P) and my SFA intake as a percent of total caloric intake. The lower number for the LDL-P correlation means that as compared to LDL-C, more factors than just dietary SFA are expected to be contributory. But, interestingly, when an value LDL-C value is below/above average, so is the corresponding LDL-P value for the lab draw. Anyway, 'nuf said about that: Lesson learned - 1st thing to check with LDL-P is your thyroid meds! And TSH will only tell you about gross problems.

So, now that I am reassured that my LDL-P is not way out of line, what about the physiological IR? My IR score is still 37. I haven't had a chance to research this yet, but it seems to me that as long as my LDL-P stays midrange, my CAC score is zero, my TGs are lowish, my HDL-C is still way high and I am feeling great, showing a little insulin resistance is not only not a problem, but absolutely necessary to divert glucose from muscle to brain. I have two big contributors to my IR score: VLDL size and count. But, doesn't it make sense that they are bigger and more numerous than average the carb-burner? How else would my cells be getting energy at the moment of the blood draw, me being fasted and dependent on gluconeogenisis and VLDL TG delivery for cellular functioning? Is that conjecture wrong?

So, going forward from here, I upped my running exercise from 2 days/week to 5 days/week and this has abolished my sleep problems, at least so far. I've started bringing my fat down to 65% of cal intake, raising protein a little, and adding the guar gum you take. I started w 1g of that on Jul-30 and have been raising it by 1 g / day since. I also dropped out half my dark choc so as to bring my SFA down to 8% of energy. We'll see if that helps and I'll keep you posted when I do my next testing.
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Re: Unkind labs with keto diet - where to go from here?

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Juliegee wrote:... I noticed that your SFA intake has slowly risen while your fiber intake has concurrently dropped. It could be that simple. I get around 50 grams of fiber a day from a combo of my vegs and SunFiber, a prebiotic guar gum, recommended by my FMP. I was shocked at the positive effect that it had on both my lipids and glycemic markers ...and quality of my sleep. (That last one is weird, but I suspect that it fed the gut bugs that help produce serotonin.)
Julie, I think that SunFiber is really great stuff! Once I got to 5g / day, my sleep problems were over. I thought this was due to the extra running, but the sleep has been too, too consistent to be that. I'm at 12g now, and I will continue adding until I get 50g total per day - like you say you get. I also added a probiotic; maybe that contributed.

I'll be getting my labs retested in a month or two to see where I'm at with the cholesterol.

Here's something I found interesting. Taking my old data (see last chart in my prev post), but plotting nonHDL-C instead of LDL-C, I adjusted the scale for LDL-P so as to get the trendlines to superimpose. The greater variance of LDL-P vs nonHDL-c is reflected in the lower R-value and the greater distance of LDL-P from the trendline: Image
Clearly, particle counts are affected by some unaccounted-for factors. Or could be simply that the error bar in their measurement is greater.
Last edited by DanH44 on Sat Aug 12, 2017 10:58 am, edited 1 time in total.
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Re: Unkind labs with keto diet - where to go from here?

Post by apod »

It's interesting looking at the data that a ~8% SFA intake of ~17g/d provides the lowest LDL-P, while an 10-11% SFA intake brings you up to the highest LDL-P at ~20g of SFA. That's the difference of about 1 small can of sardines or a single square of dark chocolate... splitting the difference, the addition or removal of a half of a single square of dark chocolate is seemingly enough to slide from one end to the other of the scale?
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Re: Unkind labs with keto diet - where to go from here?

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apod wrote:It's interesting looking at the data that a ~8% SFA intake of ~17g/d provides the lowest LDL-P, while an 10-11% SFA intake brings you up to the highest LDL-P at ~20g of SFA. That's the difference of about 1 small can of sardines or a single square of dark chocolate... splitting the difference, the addition or removal of a half of a single square of dark chocolate is seemingly enough to slide from one end to the other of the scale?
Looking at individual data points will get you into trouble. As you add more points to a data collection, your results become more or less significant, depending on what R-squared tells you. With this collection of 8 points,
  • particle counts are less associated with SFA than nonHDL-C
  • as always, the collection has power, indiv points do not
  • you picked the two greatest outliers to compare
So, by picking out only two LDL-P points, you chose to look at the less associated dependent variable and ignored the data as a whole. The data as a whole says over a range of SFA varying by 4% of calorie intake, for me, nonHDL-C can be expected to vary by about 40 mg/dl, all other factors being held constant. But all other factors weren't held constant. Among other things, my sleep deteriorated, and my fiber went from 75g per day to 30 g per day, in a somewhat linear progression. These variables are not independent, and if you correct for them being associated, they fall out, but that doesn't mean they have no effect. Here's the SFA chart (upper) and a similar fiber chart (on a reversed axis, lower). You can see how the individual lab tests line up almost the same whether you plot them against SFA or fiber: Image
It is noteworthy that switching the independent variable from %SFA to fiber (g) did not change the scaling between nonHDL-C and LDL-P, but did slightly reduce the slope of the line due to the influence of the Jul 31, 2017 labs.

EDIT: better chart set for demonstrating linked variables, fix error and typos, and this:

Part of the changes I made between the 7/12/2017 and the 7/31/2017 labs was to change up the proportions of what I was eating by reducing my SFA without doing much to increase fiber. You can see the red-circled point-set for that lab showing up in the middle of the upper SFA, but showing up at the right on the lower fiber chart. This is the 1st lab test of mine to unlink SFA and fiber, so we can possibly distinguish the effect difference. So, reducing SFA without increasing fiber was enough to lower my LDL-P, but not enough to drag it back to the SFA trendline. The LDL-P R-squared concurs, showing greater association of LDL-P with fiber than with SFA, suggesting that increasing fiber might be more beneficial than decreasing SFA, and begs the question: if I had increased my fiber to the extent that I decreased by SFA, would the LDL-P have dropped even further, ie, enough to get it back to the SFA trendline?
Last edited by DanH44 on Sat Aug 12, 2017 8:22 pm, edited 3 times in total.
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