Quote from Janelle525 on April 22, 2024, 1:50 pm

Quote from Jessica2 on April 22, 2024, 12:45 pm

@@janelle525 not dismissing what you've said, I dont side with mainstream sources much, but "varied plant based diet" does sound mainstream. 

I put the numbers out there myself so I am not complaining about the discussion, but it would be nice to have a comparison of numbers from someone who follows said varied plant/starch based diets. I follow many many carnivores in YT who post numbers, Jenny Mitich is an excellent channel who posts detailed lipid panels and tests and she's been carnivore for over a year now. Fascinating channel. Her cholesterol does not show an abundance of small LDL particles. I tend to have a healthy dose of incredulity about the claim that low triglycerides is a bad thing. 

We can both point to studies showing what we want to be honest. See my above post about a meta-analysis of 38 studies and 1700 people that found small LDL particles were reduced on keto diets. Tim's study showed the opposite in 1 study with 17 young women. 

I'm honestly more interested in whether carnivores get heart disease than if they have more or less small particles of LDL. That meta analysis just says 'carb restricted diets' what does that even mean? It could mean they eat nothing but low carb veggies and deli meat, or it could mean they eat nothing but bacon and sausage. There's a big difference. 

Low trigs is apparently associated with liver/biliary dysfunction, autoimmune, hyperthyroid, and adrenal hyperfunction. You want trigs to be between 70-110. I attached the screenshot and document that goes over CBC and lipid panel. 

So for you with a T Chol of 254, 44 Triglycerides, 75 HDL, 170 LDL, 9 VLDL 

It could be tissue destruction if your LDH is also high, autoimunity is suspected when HDL is above 70 and Trigs below 70, do you have any other blood labs? 

It doesn't seem like biliary dysfunction as cholesterol is above 150. It could be cholestasis though when cholesterol is over 220, but we'd need to see your other blood labs to verify that. Bilirubin, liver enzymes and LDH. Insulin resistance also causes cholesterol to go over 220. Oxidative stress causes LDL to go over 120. You kinda have opposites going on... high total low trigs. That honestly seems weird according to the charts.  

Even on a diet of 350 grams of carbs with at least 80 grams of saturated fat my trigs never went above 110, it was when I started eating a lot of fatty food (with the carbs) and gaining some weight it started trending up above 100 though never going above 110 at least when I checked it, hard to say after meals, postprandial labs can give some more info about how a meal is effecting your liver vs fasting.

My trigs went from 103 to 77 after following a low vit A diet for a few weeks. That included occasional ice cream. I was mainly eating pasta with a pat of butter, white rice, small amounts of black beans and beef. LDL also went down from 174 to 162. And total down from 229 to 214. HDL improved a bit 36 to 38. VLDL 19 to 14. So it definitely improved things to rely more on starch less on fats and sugars. 

Quote from Janelle525 on April 22, 2024, 4:32 pm

Quote from Jessica2 on April 22, 2024, 2:56 pm

@janelle525 I appreciate the analysis, truly actually. I'll level with you; it really is weird I will admit! I've exhaustedly looked up what could cause high LDL and simultaneously low triglycerides, to no avail or answers. One time I saw something that said when your triglycerides are super low, the high LDL number is thrown off because it is derived as an estimate from the triglycerides,  it isn't directly measured. This was the best explanation I had found. In other words my LDL is probably lower is what I took out of that. Everything else is fine I did get bilirubin, a CBC,  and everything else you mentioned and its all normal. No elevated numbers indicating inflammation or abnormal white blood cells indicating autoimmunity.

The only other thing that is abnormal in my labs is my alkaline phosphatase. It's been below normal for several years now, which is also not common. Most people go over. Also the size of my red blood cells is slightly over the standard size and I see a hematologist for it and he says it's nothing to worry about that it's just slightly over and I see him once a year. He's also not that interested in my alkaline phosphatase either. 

Jenny Mitich that carnivore I just mentioned above has a YT video going over her labs where she mentions this very phenomenon: higher LDL and low triglycerides. She calls it something like a keto hyper responder or something I'll have to go back over that video. She mentioned a woman who's writing a book about this phenomenon in people who are keto.

Where do you get the guideline that it should be 70 to 110? Because everything I've looked at says there really is no low that's too low when it comes to triglycerides.

Edit: Andrew B and I have recently speculated autoimmunity issues, and I was thinking that could explain my hair shedding, which doesn't respond much to many dietary changes including low A, but no markers indicate that.

 

That's really interesting, yeah actually my alk. phos. has always been kinda low too going back all the way to 2011 when I was pregnant. Recently it was 52. Good is 60-100. It's a zinc dependent enzyme, low means low stomach acid. Which is what I've struggled with probably my whole life. I was probably zinc deficient most of my life. Had copper pipes and drank tap water growing up. My LDH has always been on the low end too, what I wrote in my notes from a metabolic typing practitioner I was working with a long time ago was that it was related to blood sugar, pyruvate to lactate, low means hypoglycemia which is something I've struggled with my whole life too! What is your LDH? 140-200 is the range. Mine is always below 140 recently it was 110 which is not surprising as I wasn't eating enough on the low vit A diet. 

So the low trigs could be autoimmunity then? Have you ever tried dessicated thyroid? My blood labs looked amazing the yr I was taking 1 grain dessicated thyroid, unfortunately I ended up with severe adrenal burnout due to other issues at the time so I struggle to take anything that increases thyroid ever since. 

Someone posted that guideline in the ray peat forum, I agree with a lot of it it backed up some of my notes on blood markers. 

Yeah I had briefly heard about the hyperesponder in videos I've watched, that high LDL was nothing to be concerned about when everything else looks good on keto. 

Quote from tim on April 22, 2024, 7:52 pm

@jessica2

When did I mention your LDL levels? Not sure what you mean?

The studies you posted were of overweight people losing weight. The study I posted was of young healthy people.

This debate came about because of you confusing what I said about VLDL with triglycerides. You continued to falsely claim I was wrong while talking about your low triglycerides.

So I defended myself.

What I have pointed out is that low triglycerides on a keto diet are due to ketosis and increased fat metabolism.

Because any blood tests you have had estimate VLDL and LDL from triglycerides you may have an inaccurate idea of your LDL levels.

I'm not the one seeking a lot of meaning from cholesterol levels, you are.

Quote from tim on April 22, 2024, 8:32 pm

@jessica2

I've exhaustedly looked up what could cause high LDL and simultaneously low triglycerides, to no avail or answers.

I literally explained this to you yesterday, with references and an illustration.

Ketones aren't triglycerides. They leave the liver without being packaged in VLDL. You still produce as many or more VLDLs when in ketosis they just contain less triglycerol.

All LDL comes from VLDL.

When fat metabolism is upregulated the triglycerol contained in VLDL will be used faster.

On a ketogenic diet LDL transport from the blood to the liver tends to be slowed.

Quote from tim on April 23, 2024, 1:32 am

@jessica2

However, earlier in this thread you indeed did claim that triglycerides are most likely raised by fats; that's what I was talking about much earlier.

Where? I didn't. I mentioned VLDL can be elevated in those following a carnivore diet. I didn't even mention elevated triglycerides in the post you reacted to.

I wrote:

On a meat and fat diet the liver is forced to synthesize glucose from protein and metabolize large amounts of fat that's why VLDL tends to be high in those following such a diet.

I said nothing about triglycerides.

You then wrote: 

It is in fact a lie, and is born out through evidence in many studies, that high triglycerides are not high due to fat they are high due to carbohydrates. This is just a plain untruth you are spouting. I can post a million studies showing this.

I then said I was done debating you.

You then continued:

Posted are my most recent lab results in January after 4 1/2 months of very low carb carnivore. According to conventional (your @tim-2) wisdom, my triglycerides should be off charts, my VLDL as well. However, this is NOT the case.

You then posted studies while ranting about triglycerides.

You then wrote:

@janelle525 well we could have that discussion, true, about whether it's fructose or glucose that raises triglycerides; what it's definitely NOT is mostly fat...which is what Tim asserted.

Of course I'm going to feel the need to defend myself against that.

The irony is you misinterpreted something I wrote and made a huge deal about it while you have been stating falsehoods post after post without a care in the world.

Quote from tim on April 23, 2024, 3:17 am

@jessica2

How does that statement cause you to start writing what you did?

If you don't metabolize triglycerol from starches or carbs, then where do you metabolize it from?

I've already covered this. Fat is a direct source of triglycerol. Some fructose is metabolized into triglycerol. Most glucose is used to replenish glycogen stores, it's the least lipogenic energy source.

A mistake you are making is looking at serum triglycerides without understanding the mechanisms behind it.

A low fat whole foods diet can cause high triglycerides with low LDL. It's not that such a diet is causing the liver to produce a lot of triglycerol. It's probably more that cells are glucose adapted so little triglycerol is being metabolized leading to lower LDL.

Basically the opposite of a high fat diet.

It is up for debate what the implications of this are but it's unlikely that low triglycerides on a ketogenic diet mean that it is healthier.

Quote from tim on April 23, 2024, 4:40 am

I've said that people with liver dysfunction may benefit from a more starch based diet. That's because with liver dysfunction there is often less ability to export triglycerides. Glucose doesn't need to be metabolized by the liver.

This doesn't mean anything extreme just a bit less fat and sugar than normal.

From my perspective the goal is to restore liver function and then return to a regular diet. In general I don't see fructose and fat as a big problem when liver function is good.

A common approach for many is to know little about physiology and nutrition and try random fad diets and dietary ideas. Often this approach causes more harm than good.

It's a deeply flawed approach for a number of reasons but one reason is the implicit assumption that most of the public is eating in a very unnatural and dysfunctional way, which is false. The reality is that the SAD is healthier and more balanced than almost any fad diet. The SAD or standard western diet is largely based on people's instincts whereas fad diets are based on flawed theories or pseudoscience.

This implicit acknowledgement that everyone else that isn't following the fad diet of one's choice is consuming a very unhealthy diet gives the follower of the diet a delusional comfort that they are on a much more promising health path than everyone else.

Another flaw is it's absolutist approach. Rather than investigating and understanding the different components of diet and making small adjustments to the standard diet based on deep understanding a scorched earth approach is taken and a fad diet can end up being as extreme as only allowing one food group. This seems at least partly physiologically motivated. It gives the dieter a feeling of control. They can easily understand and master the specifics of their chosen fad diet.

Another flaw is that any fad diet is a tribe. People naturally seek exclusively. It might not be so bad if it's a sporting or music subculture but it's insane to join a dietary tribe.

Health is more about organ function and less about how many IUs of vitamin A you consumed in a day or how much fructose was in a dessert.

By restoring organ function one can become able to remain healthy not matter what food is served to you.

Eating is a social activity, health is not about isolating oneself from that aspect.

Quote from tim on April 23, 2024, 4:57 am

@jessica2

High triglycerides may often be a flag for disease. That doesn't mean that a keto diet in which ketones bypass VLDL and in which fat metabolism is upregulated resulting in low triglycerides and high LDL is healthier than a low fat diet in which less triglycerol is exported from the liver but in which glucose metabolism is upregulated resulting in triglycerides being less utilised and higher resulting in lower LDL.

Whatever fat is consumed it either has to be metabolized into a ketone in the liver or exported in VLDL. A lot can be exported via VLDL but serum triglycerides can be low. Serum triglyceride level is strongly affected by how active fat metabolism is, how quickly triglycerol in VLDL is being used and how quickly VLDL becomes IDL.

Quote from Sarabeth on April 23, 2024, 6:59 am

Really quick, am trying to formulate some ideas I will post in a new thread, but looking up my most recent lipid panel to compare with various of the high numbers I had prior to 2022 (I cannot find all my bloodwork, annoyingly - particularly the one I remember with the super high levels, so this is only base on the labwork I could find):

Cholesterol, total: 186 (down from 258)

LDL/HDL ratio: 1.4 (down from 2.8)

Triglycerides: 51 (down from at least 88)

hdl cholesterol: 72 (up from 54)

ldl chlesterol: 101 (down from 181)

 

Other things I noticed on various reports:

low albumin 3.3

low: potassium, creatinine, calcium, total protein

recently: low "absolute neutraphils" (??)

A "red cell lipid biopsy" showed acrosss the board low omega 6 fats, and similarly high omega 3s (prior I had been taking that horrible cod liver oil and fish oil, and kept doing so for a couple years after anyway! 🙁 )

 

Most notable, and I will write more about this soon, in 2022 my B12 was 357, after years and years (8?) of supplementing. I had stopped taking it after beginning our low A adventures, but noting this level in 2022, I decided to try supplementing again. (Even on the lab report, it says: "...Please Note: Although the reference range for vitamin B12 is 200-1100 pg/mL, it has been reported that between 5 and 10% of patients with values between 200 and 400pg/mL may experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency")

I didn't have any major issues at that point, but I started in October 2022 with a sublingual b12hydroxy each morning to see what would happen. Interestingly, I noticed that my hair immediately started growing more thickly, especially in the spots in the front where it seemed to be thinning/growing more slowly in middle age. But also immediately, I got very pronounced and painful acne, and after two months, the good hair days were not able to overcome my vanity, so I stopped the B12. The acne went away, my hair returned to its normal just-okay self...and fast forward to May 2023, when I got pregnant with Baby #6.

From June 2023-January 2024, I took B12, mostly just idly because it seemed like a good idea and it was the only real anomaly that my bloodwork showed, now that zinc and vitamin D and copper had normalized withOUT supplementing/avoiding (as the case with copper for me). I did not get acne from B12 while pregnant. But the few days when I forgot to take it, the varicose veins came on with a vengeance, and the pain did not abate until I resumed regular supplementation of B12. With b12, my legs looked and felt WAY better than with baby#5!

But, and this is what might be relevant to others: even with all of that B12 supplementation, my now-12-week-old had severe feeding issues and yet another (6 for 6!!) tongue tie plus a retracted jaw, and did not even begin to improve nor gain weight (in a scary reprise of the issues that plagued baby #3) until I began supplementing her with Vitamin b12. This says to me that even though I have adequate stomach acid, I do NOT have adequate absorption of B12. I also now know that B12 deficiency is hugely associated with midline defects (all my poor babies!!), most moms of deficient babies are asymptomatic (although hair loss is one symptom, as are gastro issues and loss of appetite), deficiency is definitely associated with vegetarian and vegan diets but is usually due to maternal malabsorption ("pernicious non-iron-deficiency anemia"), and it definitively and usually causes severe neurological issues affecting feeding in infants who are deficient.

Within 12 hours of supplementation (this was five weeks ago), my baby's color and entire demeanor changed, she began smiling, and she started FINALLY gaining weight - albeit sloooooowly. She also is dealing with significant poor habits that she got from weeks of poor feeding (and months in utero with her poor little slightly deformed mouth), plus the trauma of the tongue tie surgery, and the lack of ability to self soothe that comes along with a baby who can't utilize her primary soothing mechanism: sucking and swallowing... Additionally, I can't find a doctor who knows about this anywhere (all the numerous studies online involve researchers who are mostly in other countries), and I could only find one study that used oral (as opposed to injected) vitamin B12 and published their dosages, and I have no way of measuring the pure encapsulations/100% B12 powder. So I'm having to estimate and go on symptoms and intuition, but the nightmare of infant feeding issues is really awful, and I know other moms have faced this...and I wish so much I had known about it way back when my now-nearly-12-year-old was starving and screaming round the clock (and NONE of the very many doctors and professionals we took her to ever even suggested this...this time it was mentioned in passing by an extremely skilled lactation consultant with whom we were meeting over zoom!)

@Jessica2, I wonder if the B12 thing would have relevance for your hair issues?

@Tim, I think you could be right about SAD not being about a bad ratio of macros, for most people (I know that some really need/benefit from very adjusted levels of various macros)...but instead it's the processed and adulterated nature of the food. When we started Low A, that's what I noticed right away: we didn't change our intake of protein/carbs/fats, and each of us ate of each until we felt full (different macros for each person), and the low A diet felt the most "normal" even while it is literally the hardest to explain of any of the Fad Diets we'd tried before! Now, our diet speaks for itself because save for my most recent addition, my kids are sparkling and happy and feel well, and their hair and nails grow nicely, and they eat tons of protein and starch and fat to taste, with some maple syrup and fruit for good measure, and a little bit of dairy. It's way better than force-feeding stews full of green leafies and liver pate...