It been a while and wanted to provide an update on my n=1 experimentation since I have had some favorable results in terms of bringing down my LDL-P. I'm now following a diet that I’ve morphed into cyclic keto with some supplements and time-restricted eating. Let me first say that this experimentation is based on medical advice I’ve gotten previously from my doctor along with new ideas I got through research that I’ve done here on the forum and elsewhere. I have my annual checkup on Nov 3 with a new doctor (my previous doctor moved on) to make sure I’m not missing something.
Since I did my first NMR on June 16 that came back with LDL-P >2000 (very high), here’s a quick summary of the two experimental periods over 16-weeks. The values are from NMR tests through Labcorp after 12 hours of fasting, and I’ve listed the results in this order: TC/TG/HDL-C/LDL-C/LDL-P/Small LDL-P/LDL Size/HDL-P.
June 16: 252/58/67/173/2042/577/21.4/32.9
July 27: 214/46/59/146/1699/269/21.3/28.7
Oct 5: 169/46/58/101/1144/255/21.0/29.5
My focus has been on reducing LDL-P, and in 16 weeks I’ve been able to bring it down from 2042 (very high) to 1144 (moderate). Small LDL-P is also down from 577 to 255 (<527 preferred). I don’t have NMR data before June 16, but my Oct 21, 2019, conventional cholesterol results when my blood glucose had crept into pre-diabetic ranges were 169/53/49/109 (TC/TG/HDL-C/LDL-C), so those cholesterol results are now back to pretty close to that while I'm now much more metabolically healthy (fasting glucose down from 101 to 92 and A1c from 5.8 to 5.2).
Here’s the two experiments over a 16-week period:
For 6 weeks between June 16 and July 27, my first n=1 experiment was changing what I ate, and that yielded a nice 15% reduction in LDL-P from 2042 (very high) to 1699 (high), and it dropped small LDL-P in half. Here’s a run-down:
• Replaced SFA with MUFA: I eliminated coconut (coconut oil, coconut butter, MCT, etc.) and reduced dairy but kept the grass-fed beef, and I added more EVOO, macadamia nuts, and avocados
• Shifted from strict keto to cyclic keto: I added a carb refeed day to every week. Since I was feeling good about my progress to fat adaptation, I bought into the idea of refeeding with healthy carbs as being more ancestral and beneficial to adrenal health and intense exercise, so one day a week I reduce the healthy fats and add ~150 grams of carbs with sweet potatoes, beets, rice, oats, butternut squash, banana, and/or an apple, etc. My family and friends call it my “cheat day”, but I still decline wheat and simple carbs. I time the carb refeed with workouts with heavier weights and higher intensity training to take advantage of the replenished glycogen stores, and I usually increase protein on this day by 30g or so with whey isolate and/or pea protein. Then I time a longer run or longer fast for the day after to burn off the glycogen, and I’m usually pretty quickly back into nutritional ketosis.
Six weeks wasn’t that long, and it may have come down further just with these changes over time, but I still wasn’t comfortable with LDL-P that high. I’m aware of the hypothesis about hyper-responders with low TG and high HDL (Dave Feldman et al), but until that gets a bit more traction, I was determined to see what I could try to stay cyclic keto and bring LDL-P down further. My interest in keto is not just lower blood glucose, lower insulin, lower inflammation, etc. but also endurance performance ie. being fat-adapted to do longer runs without being dependent on carbs.
So, during the 10 weeks between July 27 and October 5, my next experimentation was with adding supplements and timing when I was eating but keeping the cyclic keto diet as it was in the previous 6 weeks ie. with SFA replaced by MUFA. The good news is that these 10 weeks yielded a 33% improvement in LDP-P down from 1699 (high) to 1144 (moderate), but the unfortunate news is that I don’t know how much each of these changes contributed to the improvement. Here’s a run-down:
• Added daily 2x500mg Berberine: Based on what I’ve read here on the forum, from Bredesen, and elsewhere about Berberine’s positive effects on blood glucose and cholesterol, I decided to give it a try. I take it with a little MCT oil (I know it’s from coconut) on an empty stomach to improve bioavailability. It seems to be hit-or-miss with some people seeing a bigger benefit than others. I haven’t noticed any effect on my blood glucose (it’s already nicely controlled by my diet), and I wish I knew how much this might be contributing to the LDL-P change. This reference says “Berberine alone and in combination with other dietary supplements provides an average LDL percentage lowering capability of 20% to 30%.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871262/
• Added daily 2x500mg immediate-release niacin: I was taking this dosage of IR niacin for 20+ years to increase HDL-C before I stopped it several years ago when I started exercising and found I didn’t need it for HDL any more. When I stopped it, my LDL-C increased ~20 points from ~90 to ~110, so I know that niacin was at that time having a non-trivial benefit on my LDL-C. I was reluctant to start it again given that it seems to have lost favor, but since there are still positive reports about it and since I knew I tolerated it well, I decided to resume it. The flushing side effect for me is relatively minor, and after these 10 weeks my liver enzymes are still normal (I recall it’s very important to check liver enzymes regularly on high dosages of niacin because of the burden on the liver, and I’ve never had problems with 2x500mg). I realize that LDL-C is not as meaningful as LDL-P, but during this 10 weeks LDL-C reduced from 146 to 101, so you could conclude that the resumption of niacin contributed perhaps 20 points to that 45-point reduction (almost half). At some point I might try reducing or stopping the niacin again to see how much it actually is contributing to the LDL-P improvement.
• Implemented more deliberate time-restricted eating: I had already started skipping breakfast with black coffee only until lunch, and then I discovered the Zerofasting app—it’s awesome at helping me put more discipline into time-restricted eating. I am now doing mostly 16:8 with some 20:4 days and even some 22:2 OMAD days—it’s so easy with the app! Looking forward to trying some prolonged fasts with it eventually.
A couple of other observations: The 6-week SFA->MUFA and cyclic keto experiment reduced TG and HDL-C about 20% and 10% respectively, and HDL-P dropped below 30.5 where it’s now flagged as low. The 10-week supplement experiment didn’t change TG or HDL-C at all although HDL-P improved a bit (still low). LDL size didn’t move much at all in either experiment which is good since it’s consistently been >20.5 which means the preferred pattern A (fluffy).
My next step is to run this by my new doctor at my annual checkup on Nov 3 to make sure I’m not missing something, and I’m pretty excited with the results so far and wanted to share in case my story helps someone here bring any of this up with their doctor. Thanks again to all who are posting here sharing your journey. Through your stories you are helping me with mine!
apoe4thebetter | 3/4 | currently doing keto experiments to work through A1c and LDL challenges