3/4 new here with high LDL after 3-months keto
Posted: Sun Jun 28, 2020 7:46 pm
Hello, I’m an apoE3/4 new to the forum, and I’ve really gotten a big boost out of all the great info here—thank you to Dr. Stavia for the primer and to all the contributors for sharing!
Here’s my story: I’ve known I have a copy of the apoE4 allele for more than a year now, but I’ve been more concerned with type-2 diabetes risk since both parents have adult-onset T2D and my A1c was creeping up. They are in their 80s and 90s with otherwise good health for their ages, so AD was for me hopefully of secondary concern from a family history perspective (we don’t know their apoE classifications). I’m a lean, fit 56-year old male and have been working to get off the standard American diet. First, I eliminated sugar and simple carbs, and that worked for a couple years. But the A1c crept up again.
Three months ago, I started a keto experiment. I had been wanting to try going keto to improve my fat adaptation, partly for the metabolic benefits and partly for endurance performance as a runner. Shelter-in-place gave me that opportunity since I was home and cooking every day. After the transition to keto I feel great physically and mentally, love the food choices and don’t miss the carbs at all, and was looking forward to seeing how my labs look. A1c was lower—down to 5.2 (yay!), and everything else looked great except LDL was high—LDL-C went from pre-keto 109 (above optimal) to 173 (high). To get a better picture, I did my first NMR profile. LDL-P was 2042 (very high), and small LDL-P was 577 (high) although LDL particle size was 21.4 which I understand indicates the more favorable pattern A (fluffy). HDL and TG both went up a bit from pre-keto and are good (49->67 and 53->58, respectively). LP-IR is <25 (yay!). I water-only fasted for 13 hours before the blood draw.
In the keto/low-carb community, many don’t seem to be concerned about high LDL, but I didn’t want to dismiss it so quickly, so I’ve been digging into how I could bring the LDL back down but still stay keto. That brought me to your site and others where I learned my apoE4 copy not only increases my AD risk but could also be affecting my lipids particularly on a diet with high amounts of saturated fat. Like many who start keto, I replaced a large part of the calories I used to get from carbs with coconut (which I found I like) including MCT oil which is 100% saturated fat.
I realize from reading here and elsewhere that the science in this space requires a lot of n=1 experimentation to find out what works best for me, and I’m encouraged reading about those here and elsewhere who have seen LDL come down from high levels when reducing SFA in their diets. I’m now a couple of days into an experiment where I have replaced SFAs with MUFAs as much as possible. For example, I’ve cut all coconut and replaced it with EVOO and macadamia nuts, was already eating a whole avocado almost every day, and stopped putting butter in my coffee (always pre-keto loved it black). Basically I’m working to drive the SFAs down as close to back to where they were pre-keto hoping to reduce the LDL back to where it was pre-keto, although I realize EVOO and macadamia nuts while mostly MUFAs do contain some SFAs and PUFAs.
Now that I’ve achieved some level of fat adaptation (I can do a longer run without carbs and feel great), I’m also adding to the MUFA experiment a cycle of one day per week with low fat and healthy carb refeeding. My goal is metabolic flexibility ie. giving my body the option to use glycogen and fat stores for longer runs or heavier workouts. Cyclic keto appeals to me as being more ancestral, and I’ve now got some headroom with my A1c to add back a few healthy carbs like (sweet potatoes, oats, LGI fruits, etc.). It will be interesting to see what if anything a cyclic carb refeeding day per week does for LDL.
Going back 20+ years ago when I was less physically active, I had a history of low HDL-C (25). Back then to address that I started supplementing high-dose immediate-release niacin, pantethine, and phytosterols. I continued that supplementation with favorable results until 2016 when my doctor said I could probably drop the niacin supplements because I was much more physically active (running, swimming, weightlifting, etc.). My last TC/TG/HDL/LDL numbers on niacin in 2016 were 156/59/56/88. She was right--dropping the niacin yielded 171/41/54/109, so HDL stayed in the mid-50s, TG was down, and TC and LDL were up but not enough for great concern.
I continued supplementing the pantethine and phytosterols, but after reading in the wiki “Supplementing with plant sterols to reduce total cholesterol and LDL cholesterol doesn't work for E4 carriers”, I’m now dropping the phytosterols as part of the current MUFA cyclic keto experiment. Good to know after 20 years I never needed them! I found a few references on this site to those supplementing pantetheine, so I’ll continue it. Also, I would consider perhaps a later experiment with adding back the immediate-release niacin supplements since four years ago that seemed to give me a 20-point drop in LDL-C, and my numbers since dropping niacin have never been as good. But I see niacin seems to have lost favor over the years, and I’m not sure if the effect is the same on keto. I’m hoping the shift from SFAs to MUFAs will be sufficient (fingers crossed).
I'm glad I found this site and excited to be a new member. Based on all the positive feedback I have ordered Dale Bredesen’s “The End of Alzheimer’s”. I will also continue to dig into all the great info here for further insights and again appreciate all the sharing.
Here’s my story: I’ve known I have a copy of the apoE4 allele for more than a year now, but I’ve been more concerned with type-2 diabetes risk since both parents have adult-onset T2D and my A1c was creeping up. They are in their 80s and 90s with otherwise good health for their ages, so AD was for me hopefully of secondary concern from a family history perspective (we don’t know their apoE classifications). I’m a lean, fit 56-year old male and have been working to get off the standard American diet. First, I eliminated sugar and simple carbs, and that worked for a couple years. But the A1c crept up again.
Three months ago, I started a keto experiment. I had been wanting to try going keto to improve my fat adaptation, partly for the metabolic benefits and partly for endurance performance as a runner. Shelter-in-place gave me that opportunity since I was home and cooking every day. After the transition to keto I feel great physically and mentally, love the food choices and don’t miss the carbs at all, and was looking forward to seeing how my labs look. A1c was lower—down to 5.2 (yay!), and everything else looked great except LDL was high—LDL-C went from pre-keto 109 (above optimal) to 173 (high). To get a better picture, I did my first NMR profile. LDL-P was 2042 (very high), and small LDL-P was 577 (high) although LDL particle size was 21.4 which I understand indicates the more favorable pattern A (fluffy). HDL and TG both went up a bit from pre-keto and are good (49->67 and 53->58, respectively). LP-IR is <25 (yay!). I water-only fasted for 13 hours before the blood draw.
In the keto/low-carb community, many don’t seem to be concerned about high LDL, but I didn’t want to dismiss it so quickly, so I’ve been digging into how I could bring the LDL back down but still stay keto. That brought me to your site and others where I learned my apoE4 copy not only increases my AD risk but could also be affecting my lipids particularly on a diet with high amounts of saturated fat. Like many who start keto, I replaced a large part of the calories I used to get from carbs with coconut (which I found I like) including MCT oil which is 100% saturated fat.
I realize from reading here and elsewhere that the science in this space requires a lot of n=1 experimentation to find out what works best for me, and I’m encouraged reading about those here and elsewhere who have seen LDL come down from high levels when reducing SFA in their diets. I’m now a couple of days into an experiment where I have replaced SFAs with MUFAs as much as possible. For example, I’ve cut all coconut and replaced it with EVOO and macadamia nuts, was already eating a whole avocado almost every day, and stopped putting butter in my coffee (always pre-keto loved it black). Basically I’m working to drive the SFAs down as close to back to where they were pre-keto hoping to reduce the LDL back to where it was pre-keto, although I realize EVOO and macadamia nuts while mostly MUFAs do contain some SFAs and PUFAs.
Now that I’ve achieved some level of fat adaptation (I can do a longer run without carbs and feel great), I’m also adding to the MUFA experiment a cycle of one day per week with low fat and healthy carb refeeding. My goal is metabolic flexibility ie. giving my body the option to use glycogen and fat stores for longer runs or heavier workouts. Cyclic keto appeals to me as being more ancestral, and I’ve now got some headroom with my A1c to add back a few healthy carbs like (sweet potatoes, oats, LGI fruits, etc.). It will be interesting to see what if anything a cyclic carb refeeding day per week does for LDL.
Going back 20+ years ago when I was less physically active, I had a history of low HDL-C (25). Back then to address that I started supplementing high-dose immediate-release niacin, pantethine, and phytosterols. I continued that supplementation with favorable results until 2016 when my doctor said I could probably drop the niacin supplements because I was much more physically active (running, swimming, weightlifting, etc.). My last TC/TG/HDL/LDL numbers on niacin in 2016 were 156/59/56/88. She was right--dropping the niacin yielded 171/41/54/109, so HDL stayed in the mid-50s, TG was down, and TC and LDL were up but not enough for great concern.
I continued supplementing the pantethine and phytosterols, but after reading in the wiki “Supplementing with plant sterols to reduce total cholesterol and LDL cholesterol doesn't work for E4 carriers”, I’m now dropping the phytosterols as part of the current MUFA cyclic keto experiment. Good to know after 20 years I never needed them! I found a few references on this site to those supplementing pantetheine, so I’ll continue it. Also, I would consider perhaps a later experiment with adding back the immediate-release niacin supplements since four years ago that seemed to give me a 20-point drop in LDL-C, and my numbers since dropping niacin have never been as good. But I see niacin seems to have lost favor over the years, and I’m not sure if the effect is the same on keto. I’m hoping the shift from SFAs to MUFAs will be sufficient (fingers crossed).
I'm glad I found this site and excited to be a new member. Based on all the positive feedback I have ordered Dale Bredesen’s “The End of Alzheimer’s”. I will also continue to dig into all the great info here for further insights and again appreciate all the sharing.