Missing more deep ketosis

[Orangeblossom]

I noticed in the primer it mentions some members do more deep ketosis and was interested.

Before learning of my APOE (3,4) status I was doing a low carb diet in general for health and weight loss. It was basically around 20g or less carbs a day, little processed foods, unlimited fats including plenty of sat fats. The keto sticks were usually deep pink / purple and the only real problems I had was a bit of 'carb flu' which seemed to resolve with adding sea salt and some potassium rich foods. I was also having mono sats like avocado and fish oils, not just lots of sat fats. But plenty of butter, cheese, and full fat Greek yoghurt with berries.

This diet seemed to work well with me, I think as I had a real sweet tooth and used to really crave carbs. I did use a little Stevia but not much, and had lots of energy. Doing lots of exercise. Moods better, less anxious. Even though I was often eating lots of fat (around 100g a day) I was losing weight and not feeling hungry.

So a few weeks ago (on learning of APOE4) I cut back on the sat fats and started to introduce more olive oil, and I've increased carbs a bit up to around dog (still no processed carbs) but I'm finding it a bit difficult with time. I feel like i had read the books, e.g. Big Fat Surprise, etc and got over my fear of fat, and now it's back again. I'm feeling more restricted as now restricting carbs and fats as well. I've started craving carbs and sugar again- maybe I need the energy as i enjoy exercise and go to the gym most days. My keto sticks said not in ketosis anymore/ or maybe reading was negligible.

So, I have just gone back to not restricting fats again. I'll get some (simple bloods) done end of Jan (basic cholesterol, HBAC1 and fasting blood sugars) and going to keep intermittent fasting.

I still feel I don't really understand what it is specifically about sat fats which is the problem, which is in them and not the other fats. I thought I had it sorted out in my mind and now i'm confused again. (in the context of a low insulin / low carb diet I mean)

I just thought I'd post and maybe see how the other members who also dome deep ketosis are doing and how they keep track of how things are going. Thanks in advance for any comments or advice etc.

These are my last test results: (NHS)

Blood pressure: 128 / 81 (and has got lower over time with low carb)
HBAC1: 35 (at start of going low carb)
Fasting blood sugar: 4.1
Cholesterol Total: 5.2 mmol/l (HDL 2.6)

[SusanJ]

Orange, have you happened to read Theresa's great wiki post on ketosis? Worth the read, and might give you ideas.

https://wiki.apoe4.info/wiki/Ketosis_and_Ketogenic_Diet

[Orangeblossom]

Thanks Susan, no I haven't, I'll have a look.

[Orangeblossom]

Ok I had a read and saw the bit about Dr Gundry and sat fats, on coconut oil but guessing he means sat fats in general have this affect-

of "raising sdLDL in APOE4"

"sdLDL is the cholesterol that oxidizes ultimately resulting in cardiovascular issues and potentially contributing to vascular dementia"

Is that the opinion of the one doctor or a recognised general thing which happens with APOE4 and common in people's lab results, then? Is it recognised opinion in general i mean (as many doctors have different theories and opinions.)

Is this kind of LDL still a problem and oxidised, in a low insulin and low carb environment? I thought it was the inflammation and carbs / triglycerides which caused problems in heart disease.

Also would high HDL combat this I wonder.

Also is it possible to get that tested on the NHS I wonder. My GP just seemed happy that my HDL seemed in good proportion being half of my total cholesterol.

[SusanJ]

Here are some references I've found about saturated fats, which can be found on the new lipids wiki I'm working on. Just lists some of the research, but the answers about saturated fat overall feels about as clear as mud to be honest.

https://wiki.apoe4.info/wiki/Cholestero ... urated_fat

[Orangeblossom]

Thanks Susan. I wonder why it would be oxidised, as well. I checked the NHS on cholesterol tests and they don't seem to routinely test for sLDL.

I know that sometimes, research on sat fats, when you look into the studies you can find that it is not in the context of a very low carb diet, and the combination of higher carbs and sat fats is not good and can add to problems. as well.

When I had a quick look (in general online) at sLDL being a problem, / oxidised it seemed to mention about 'high sat fat diets and sedentary lifestyle' but not about if that was low carb as well, or in a reason who was very active.

"Interestingly, randomized trial data suggests that eating saturated fats can decrease small-dense LDL and increases large buoyant LDL. Consumption of saturated fat may favorably shift LDL proportions to be protective against CHD"- Yes this is what I thought, from my reading.

In terms of polyunsaturated fats being used to replace sat fats I'm unsure on this as thought they were often more inflammatory and can release aldehydes on cooking. Sat fats being more stable. "Replacing saturated fats with other fats like trans-fats or omega-6 polyunsaturated oils has been found to increase all-cause mortality". Yes.

So- I had that kind of clear and now I'm bogged down with the sLDL / oxidation issue. I wonder if that applied to 3/4 as well, or it's not the same. So confusing

[SusanJ]

Yep, confusing indeed, and the studies often fall down in the other dietary component arena. That's why it seems "clear as mud".

This seems like an area to do N=1. If they boost your numbers the wrong way, then cut back. If they don't and your inflammation is low, then do what works for you.

[TheresaB]

[q

Is that the opinion of the one doctor or a recognised general thing which happens with APOE4 and common in people's lab results, then? Is it recognised opinion in general i mean (as many doctors have different theories and opinions.)

It’s the opinion of Dr Gundry who has been testing for ApoE4 for about 17 years (don't know of any other doctor who has tested/followed ApoE4s to such an extent) and following bloodwork on his patients to see what the results are. He’s seen elevated sdLDLs over and over again in his ApoE4s. (sdLDLs are the precursor to oxLDL, he's only recently been able to test oxLDL, so he used sdLDLs as a proxy.)

I can certainly back this up. My husband (3/4) and I (4/4) struggle to keep our oxidized LDL within proper levels and we are strict about keeping our saturated fats low. Unlike our ApoE3/3 friend who pays attention to her diet, but not to her saturated fat level and her sdLDLs/oxLDL are always low.

Dr Bredesen backs up Dr Gundry’s thoughts on saturated fat. He’s a little more lenient about using it as a crutch when an ApoE4 is initially trying to get into ketosis. But he also cautions about getting one’s sdLDL or oxidized LDL in order and tracking them. He recommends that once insulin sensitivity is achieved, that an ApoE4 migrate toward extra virgin olive oil, and more unsaturated fats.

[Orangeblossom]

Ok, thanks. And do you follow a low carb / ketogenic diet as well, Theresa? What amount of carbs per day are you on? (ketogenic is generally under 20g) How do you get it measured, the oxidised sLDL I mean?

Can anyone explain (or do the docs explain) what is specific to sat fats that they can't compete for space in the way described, when there is no problem with other fats? When the difference between mono and sat fats is simply a single, double bond? Thanks.

I also read oils can be very much oxidised as well. Polyunsaturated especially.

Overall, my concern is that sat fats might be very useful and esp coconut oil for example as an energy source in terms of ketones for the brain, much more valuable than a 'crutch' as described. and I'm a bit unwilling to swap them for more oils and carbs. I also know that sat fats have been demonised in the past by some and want to make sure this isn't happening here as well.

Susan: "If they boost your numbers the wrong way, then cut back. If they don't and your inflammation is low, then do what works for you." yes that sound good. Only thing is the NHS only test total cholesterol, trigs and LDL/ HDL. Would that in itself be helpful I wonder. Last time my LDL was less than my HDL...so that is a good ratio I think. I thought triglycerides were the main thing to watch for anyway.

[TheresaB]

I thought it was the inflammation and carbs / triglycerides which caused problems in heart disease.

Also would high HDL combat this I wonder.

Just an N=1, but I have good HDL (one of the key markers Dr Gundry likes to see is a high level of HDL and an HDL to Triglyceride ratio that is 1 to 1 or better. Mine has been 1.6 to 1 over the last year (last two tests) but like I said, I struggle with oxLDL levels, they’re at an acceptable level, but barely.

As I understand it, sdLDLs are the “little guys” that are just the right size to get into blood vessel wall but not get out. For some unknown reason, the sdLDLs in ApoE4s seem to last longer. They oxidize, and when they do that creates inflammation. The body tries to protect itself from the inflammation and plaque develops on the blood vessel walls (much like the amyloid is just the body trying to protect itself).

nd do you follow a low carb / ketogenic diet as well, Theresa? What amount of carbs per day are you on? (ketogenic is generally under 20g) How do you get it measured, the oxidised sLDL I mean?

Yes, I follow a ketogenic diet. I don't really know how many carbs I eat a day (every person's body is different with regard to how many carbs they can get away with anyway, so my number would likely be meaningless to you.) I'm sure I eat more than 20g a day because I eat lots of low net carb raw veggies and some resistant starches. I also eat lots of nuts (real tree nuts, not seeds or legumes), extra virgin olive oil, and avocados, so lots of good fats. I augment my diet with daily 15-16 hour intermittent fasting and exercise to enhance the ketosis. When I test my ketones and glucose levels, (regularly, but not every day) I'm typically in mild ketosis and when I do a more extended fast, my ketones go upward quite rapidly indicating metabolic flexibility, which is my true goal since I have not experienced any cognitive issues.

My doctor is Dr Gundry, and he gets oxLDL measured through at laboratory called Vibrant. Not many labs will test oxLDL, but testing for sdLDL is fairly common, I believe.