Recently, I learned about my ApoE3/4 status, after a lifetime of elevated LDLc and TC. I am thrilled to have found this community of extremely knowledgeable, educated people! I am a 54 year old oncology pharmacist on a mission to bio-hack herself in order to find the most optimal and sustainable way to live with genes designed to set you up for a challenge. I have a firm understanding of nutrition, and healthcare topics, but I passed on the Koolaid, and prefer to keep thinking outside the box to get on top of my own issues. Thank you for accepting me to this Forum!
After menopause, my lipids really took off (TC 300ish, LDLc 200ish, HDL 65-85, TC 80s-90s). I got the lipid NMR in May for the first time, and it shows high LDLp (2700ish), and sLDL (near 700), with a lipid IR score of < 25, though. Fasting insulin 4-6, and FBG 80s, A1c 5.1. All these numbers while on keto (including saturated fats), eating OMAD on most days. I have been doing this since April this year. I have a diagnosis of Hashimoto's, with a normal functional status of my thyroid, although my T3 could use a little tweaking. Also, I have recovered from severe HPA axis dysfunction (aka adrenal fatigue), which left me bedridden in 2016 after I embarked on a low-fat (go figure), high fiber, and moderate carb (no sugar, processed carbs or the like, just veggies, oats, and legumes) diet with ~1800 kcal/day. After six weeks, my TC dropped from 305 to 200, LDLc from 199 to 125, HDL from 85 to 57, and TG from 134 to 83. Lp(a) was 8. At first I thought they mixed up the labs, as this response to just diet alone was more powerful than the most potent statin on the market. But I turned into a dysfunctional blob, and was on FMLA to recover from this unexplained weakness and muscle pain. I relaxed my diet, which seemed to have helped, and a couple of months later, I made friends with the AIP diet. I wasn't too thrilled about all this meat, and coconut stuff, but it helped some of my symptoms. This was two years ago. After I could not take this kind of eating any longer, I returned to a more balanced, normal diet, but still not anywhere near the SAD. But I started gaining weight - A LOT, even on AIP! And with it, I felt so much better. I need to add that I am obese, and have been for a long time. The weight kept creeping up, and in those last two years, I packed on 44 lbs. No insulin resistance, not even close. I wanted to start IF so badly, but my FM doctor recommended against it for me due to my weak adrenals. In April this year then, when I realized that I can tolerate the feeling of hunger, without feeling shaky, jittery or twitchy, I decided to give IF a try, and worked up to 24 hrs, then eat. I felt great!! I was eating keto-ish when I did eat, and felt energized, had better exercise tolerance, better mood, and a razor-sharp brain. My lipids, as above, still no change for the better. So about two weeks ago, I decided to limit saturated fats, and add more fiber. And now I feel almost as terrible as when I crashed in 2016: weak, elevated HR, low stamina, muscle pain when exercising, or even taking the stairs.
I am concerned that I do not meet my kaloric needs with one meal a day, restricting saturated fats. What is there left to eat? Leafy greens, cruciferous veggies, small amounts of shellfish (curious as to how people do that), a small amount of berries, nuts, seeds. Currently, I use Icelandic lowfat yogurt as a filler to hold me over. I feel like there is not really much variety in foods anymore. Most recipes in vegetarian/vegan keto contain coconut, butter, ghee, etc...I really do not want to abandon my ketosis, but I wonder if there is someone like me out there who successfully turned around their lives while adjusting their lipid profile in the process. I would need approximately one more year to lose to weight to be under a BMI of 25. Not deviating from that. Will weight reduction really help someone's LDLp and size when you're E4? Am I doomed to live a low-fat lifestyle???? Does IF truly elevate LDLp? I know David Feldman thinks so. Right now, I feel like my options are to either expect a heart attack, or have a low QOL in response to a low-fat diet. Sorry, this is my intro post, and it is supposed to be chipper! But the thought of a statin is not very appealing!
There isn't a day going by where I don't learn anything new, or find another piece to the puzzle of me. 
