3/4 new here with high LDL after 3-months keto

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
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floramaria
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Re: 3/4 new here with high LDL after 3-months keto

Postby floramaria » Fri Oct 23, 2020 12:54 pm

apoe4thebetter wrote:It been a while and wanted to provide an update on my n=1 experimentation

Thanks so much for providing the detailed description of what changes you made and the results you have achieved. Very impressive! I’ve known about Berberine for glucose management but had missed the impact it can have on lipids. I appreciate the link am going to check that out.
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Re: 3/4 new here with high LDL after 3-months keto

Postby apoe4thebetter » Fri Oct 23, 2020 3:54 pm

Thanks, floramaria! I'm new to Berberine and wish I knew how much of the LDL-P improvement was influenced by it in my particular case (some don't notice any benefit). One challenge with it seems to be bioavailability because it can "self-aggregate" (ie. bond to itself) in the stomach and then struggle with absorption in the small intestine. To address that, I read a recommendation to take it on an empty stomach with some MCT oil and then give it 30 minutes before you eat anything else. Some report digestive issues with it, but I don't notice any with 500mg at a time. It's also supposed to be an awesome anti-oxidant.
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Re: 3/4 new here with high LDL after 3-months keto

Postby floramaria » Fri Oct 23, 2020 7:44 pm

apoe4thebetter wrote:. One challenge with it seems to be bioavailability because it can "self-aggregate" (ie. bond to itself) in the stomach and then struggle with absorption in the small intestine. To address that, I read a recommendation to take it on an empty stomach with some MCT oil and then give it 30 minutes before you eat anything else. Some report digestive issues with it, but I don't notice any with 500mg at a time. It's also supposed to be an awesome anti-oxidant.

Thanks for the tip. I have some neglected Berberine in my Supplement cabinet and will experiment with this technique.
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Re: 3/4 new here with high LDL after 3-months keto

Postby apoe4thebetter » Wed Nov 04, 2020 1:14 pm

Here’s a quick update after my doctor’s appointment yesterday. Good discussion—she’s comfortable with where my lipids are, but A1c is creeping up again. That could be a side effect of the 2x500mg immediate-release niacin, and she’s aligned with the current thinking around high-dose IR niacin that no longer recommends it (no surprise).

Next steps:

• Stop the niacin: Should give us a good data point to understand where my lipids fall without it (I had resumed 2x500mg IR niacin in late July for 3 months)
• Shift to dihydroberberine (dhBBR): Now supplementing with the more bioavailable dhBBR (2x150mg ie. one 150mg each with two meals per day)

The doctor (conventional MD) did not have any opinion for or against Berberine, but she seemed to appreciate the research I was doing. Here is a paper supporting the better bioavailability of dhBBR: https://diabetes.diabetesjournals.org/content/57/5/1414. I also find dhBBR easier to take since I was previously taking the BBR on an empty stomach with MCT oil 30 minutes before eating, but dhBBR is more expensive. Based on that study, 2x150mg of dhBBR would be roughly equivalent to 2x500mg BBR given the better bioavailability.

Would be interested in whether dhBBR is on anyone else’s radar? I’m interested more in its positive effects on lipids (didn’t see a noticeable effect on blood glucose with plain BBR).

The plan is to do another round of labs in 2-3 months in December, and I’ll report back then.
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Re: 3/4 new here with high LDL after 3-months keto

Postby anne from california » Wed Nov 18, 2020 2:24 pm

apoe4thebetter wrote:It been a while and wanted to provide an update on my n=1 experimentation


Thanks for all this, apoe4thebetter. As you can see from my sig, I'm a 3/3, so I'm not sure how that factors in, but I felt some kinship reading your lipid numbers. I just had mine done, because my TC and LDL-C have been rising steadily since menopause, and I wanted a breakdown. I also sensed that my saturated fat intake was way too high, what with all the coconut products I put in to replace dairy and other things when I began an autoimmune protocol (ankylosing spondylitis/psoriatic arthritis) about six months ago. I started logging foods into Cronometer and was clocking in at 54–62 gms of sat fat a day. In a 1600–2000 calorie day, that seems pretty dang high.

My labs after 14-hour water-only came back thus (I put an h next to the ones the lab marked as high):
Glucose: 84
A1C: 5.1
Insulin: 2.6
Vit D: 28 L
Homocys: 8 H
Total chol: 231 H
HDL-C: 84
TG: 52
LDL-C: 133 H
cardioCRP: 0.3
LDL-P: 1603 H
LDL-small: 188 H
LDL-med: 255 H
LDL-large: 8525
LDL peak size: 225.5
LDL pattern: A
ApoB: 94 H
LipoA: <10

I am trying to figure out how to reduce saturated fat while keeping overall fat high (for mild keto), while still keeping overall calories high. (I seem to be a calorie burner--very hard to keep weight at an adequate level.) So your breakdown of what you did and the changes you saw is very inspiring to me. In the past week, I've cut out the coconut yogurts, cream/milk, MCT, oil. Sure would like something in my coffee, as drinking it black makes me sick to my stomach, but not drinking it all makes me sick in the head! Also, supplements are really hard for me because I have difficulty swallowing pills and often supps make me queasy. With that lousy Vitamin D number, I have recommitted to taking that, plus I'm doing some liquid omega3 fish oil, curcumin and a chewable methylB. Would also love a good choline food source, since eggs cause autoimmune flares. I've considered berberine, but fear it might make me sick. So many things to balance!

I'm here even though I'm 3/3 because all my female ancestors on maternal side have had dementia by their late 70s and post-menopausal high cholesterol. My mother, who we're seeing decline now the same way her mother and grandmother did, has been on a statin for at least five years, maybe longer. (She used to use niacin and Metamucil to control her cholesterol, but at some point caved to the statin pressure and gave those other things up.) She's also been in and out of the diabetes range for the past decade or so. She's about five years into noticeable dementia and has been diagnosed with moderate Alzheimer's.

I appreciate any and all insight!
57 years old, ApoE 3/3, mother and grandmother have/had late-onset dementia, eager to save brain and optimize health.
Thank you all for sharing your knowledge!

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Re: 3/4 new here with high LDL after 3-months keto

Postby apoe4thebetter » Thu Nov 19, 2020 10:58 am

Hi Anne,

Thanks for sharing your story! We are not alone, and I also love coming here for inspiration. Sorry to hear about your mother. I would wonder if her blood glucose “in and out of diabetes range” would be a factor with her dementia given what I’ve read from Dr. Bredesen and others. The fasting glucose and A1c values you posted, on the other hand, should indicate that you have that under awesome control.

My understanding of autoimmune protocols is limited, and I hope you have you have good experts advising you on that. What I have read is that inflammation from certain foods can be a factor, and it looks like you are on to that with your comment about eggs causing autoimmune flares. I also understand nuts are not recommended for autoimmune protocols, so I won’t bring them up here.

How about avocados and EVOO? I keep avocados around since they are mostly MUFA and usually eat one every day or so. I’m not sure what you could try in your coffee—perhaps EVOO which is also mostly MUFA? I have seen recipes for coffee with EVOO and cinnamon but haven’t tried it (not sure if that’s autoimmune safe for you or if you like cinnamon).

Regarding choline, I saw you posted a couple months ago about eggs and choline. I get a lot of it from liver. If you’re open to that (many aren’t), I love pasture-raised liverwurst with no fillers (I grew up eating liverwurst). You mentioned fish oil--salmon is also high on the list of choline sources. Shiitake mushrooms are one of the higher plant-based sources, and we love cooking with those. But please check first if any of these fit into your autoimmune protocol before trying if you’re not consuming them already.

What I’ve discovered is that everyone is different, and we just have to find what foods work best for each of us. It looks like you’re doing great with blood glucose which appears at least in the low-carb community to be a higher priority than LDL when TG is low and HDL is high. I applaud you for navigating this space given your autoimmune challenges, and hopefully someone with expertise in this area will chime in with more.
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Re: 3/4 new here with high LDL after 3-months keto

Postby anne from california » Thu Nov 19, 2020 1:29 pm

apoe4thebetter wrote: What I’ve discovered is that everyone is different, and we just have to find what foods work best for each of us. It looks like you’re doing great with blood glucose which appears at least in the low-carb community to be a higher priority than LDL when TG is low and HDL is high. I applaud you for navigating this space given your autoimmune challenges, and hopefully someone with expertise in this area will chime in with more.


Thanks, apoe4thebetter! Yes, I'm in good hands with my autoimmune stuff. Well, mostly my own hands, but that's kinda how it goes when you aren't interested in medications and embark on following the autoimmune protocol. Which I've done to great success--it's helped me narrow down some offenders, via an elimination phase and then systematic reintros. Nuts, thankfully, do not seem to bother me. Even eggs, I'm not totally sure about. I've reintro'd yolks and didn't feel great, so I've shelved them for now and have focused on other reintros. I'm fortunate in that both my diagnosed conditions have been VERY mild.

I'm virtually certain my mom's issues come from sugar control challenges. That and, hate to say it, but statins. She seemed to be doing fine until about the time she would've gone on the statins. She also followed a low-fat diet for decades (it was the thing to do) and drank too much alcohol late at night--an autophagy blow as well as the damage alcohol itself can cause and sugar swings that wine can bring. Throw in a couple of surgeries (knee replacement, then a knee replacement replacement), some hereditary likelihood and I think her brain ended up taking a lot of hits at a vulnerable time. I've been relieved to see that my blood sugar seems to be well-controlled. When I first began clocking it (about three years ago), my A1C was 5.8 and I was pretty addicted to cookies. With mild keto (and a cookie ban), it plummeted quickly and has stayed there. This cholesterol stuff is just more fine-tuning, as far as I'm concerned. I'm grateful my small particles count isn't WAY high, and that the TG/HDL is pretty ideal, and that I'm pattern A. Still, I'd like to bring the LDLs down a bit while still eating relatively high fat and getting enough overall calories to sustain this fine-burning machine. (I'm 5'6" and it's a struggle to stay at 110--requires 2000 calories a day at least. I know my hourlong fast walk factors in, but there's no way in the world I would give that up.)

Thank you for the reminder about shiitake mushrooms. I do love them. Avocados and evoo are always on the menu. Liver . . . ulgh. I tried it, and found myself always coming up with a reason "not to eat it today." Liverwurst might be a possibility. Haven't had it in years. Just bought another big bag of frozen wild salmon filets at Costco. (Off topic, but every single cart that went by had a case of toilet paper in it. I think hoarding has restarted in earnest!)

Mostly, thank you for your reply and for sharing your story. It helps so much to see what others are doing and how it has helped (or not).
57 years old, ApoE 3/3, mother and grandmother have/had late-onset dementia, eager to save brain and optimize health.
Thank you all for sharing your knowledge!

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Re: 3/4 new here with high LDL after 3-months keto

Postby NewRon » Thu Nov 19, 2020 3:29 pm

Interesting post, wrt TG/HDL ratios. I don't have access to particle numbers nor particle size without great expense, so I tend to rely on the TG?HDL ratio. See https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/

I notice in your last post that your LDL particle size seems to track your TG/HDL ratio, so that's a positive corroboration. Your particle number, slightly less so, though.

I've just done a months experiment using spirulina. I didn't mention it in the thread linked below, but my FBG dropped by 10% over the month, as well as the 36% drop in LDL.

viewtopic.php?f=4&t=7371#p77747

You do seem to be using some very concentrated supplements, niacin and berberine. In Chinese medicine (which has used berberine for more than a few years ;)) they'd be reluctant to use it on it's own for any length of time, I gather. It's really only an acute intervention, unless mixed with other herbs.
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Re: 3/4 new here with high LDL after 3-months keto

Postby floramaria » Sat Nov 21, 2020 12:22 pm

anne from california wrote:Sure would like something in my coffee, as drinking it black makes me sick to my stomach, but not drinking it all makes me sick in the head!

Hi anne from california, I have also searched for ways to drink my coffee that work for me without adding saturated fats and raising my already high cholesterol levels even higher. For awhile, I was making cashew milk by soaking cashews and then processing with water using a high speed blender. Reading The Plant Paradox caused me to abandon that, since I am also watching lectin intake.
Since you tolerate nuts well, you might experiment with finding some nut or seed you could use to prepare your own nut/seed milk. Most packaged ones have all sorts of added junk that allows them to use very few nuts and thicken the product with things I don't want.
Being both lazy and adverse to waste, I found that almond milk had to be strained and all the solids removed (waste) or dried and used in baked goods. (Too much work.) I've used both hemp seeds and pine nuts put directly into the blender with 1/2 -3/4 C coffee plus a Tablespoon of Thrive algal oil blended until smooth-ish. Not completely smooth, but good enough. (Thrive isn't being made anymore so when I run out I'll switch to avocado oil). This mix is the "milk" that I add to the black coffee, making a pseudo-latte. I use a heaping T. or two or either pine nuts or hemp or a combination. Lately, I prefer the flavor of the pine nuts. Macadamias also blend up well enough that I've used them without straining the milk. This week I am experimenting with adding in some collagen as I blend my coffee. I am enjoying that texture and foam.
If you have a high speed blender and you experiment a little, you can probably find a nut/ seed and oil combo that works for you.
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Re: 3/4 new here with high LDL after 3-months keto

Postby anne from california » Sat Nov 21, 2020 1:08 pm

floramaria wrote: Since you tolerate nuts well, you might experiment with finding some nut or seed you could use to prepare your own nut/seed milk. Most packaged ones have all sorts of added junk that allows them to use very few nuts and thicken the product with things I don't want.
Being both lazy and adverse to waste, I found that almond milk had to be strained and all the solids removed (waste) or dried and used in baked goods. (Too much work.)
If you have a high speed blender and you experiment a little, you can probably find a nut/ seed and oil combo that works for you.


Yes to all of this, Floramaria! I used to make my own almond milk, too--wasteful and messy and labor intensive. It annoys me that any commercially available almond milk without junk in it costs about five times as much as the stuff with the gums. I do have a well-loved Vitamix and will do some more experimenting. I, too, did a cashew latte-type drink at some point, but I think if there are any nuts that don't work well for me, cashews might be the ones. I can eat a few, but too many and I just feel sluggish and bloated. Not sure where they fall on the prebiotic fiber scale, but that's a known irritant for me. I haven't reintro'd pine nuts yet, but macadamias are good (expensive little buggers). I'm also toying with the idea of letting my coffee addition be most of my saturated fat for the day. I went back and looked at my lab values from the past few years and my best-looking set of numbers came, oddly, after I'd been putting organic whole grassfed cream in my coffee! (Butyrate anyone?) I'd have to reintro dairy to try it, though, and that's a ways down my AIP list. I want to get through all the nuts first.

Thank you so much for your reply. I'm continually astonished by the wealth of knowledge--and willingness to share--here.
57 years old, ApoE 3/3, mother and grandmother have/had late-onset dementia, eager to save brain and optimize health.
Thank you all for sharing your knowledge!


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