Diabetes, My ketogenensis, cholesterol & Cholestoff.

[Dag]

I see diabetic eye disease (diabetic retinopathy) nearly every day in my practice as a board certified optometrist in a large group practice. About a year and a half ago I examined four lean men about my age who were recently diagnosed with adult onset diabetes (type 2 DM or T2DM). Most diabetics I see are obese, but these men were skinny like me. My body mass index is about 22. 

These encounters with newly diagnosed lean-adult diabetics led me to examine my diet which was heavy with “healthy” whole grains as shown on the USDA Food Pyramid. My breakfasts were usually “heart-healthy” oat meal or Cheerios with milk, two slices of whole wheat bread and Smart Balance spread or a plain bagel with low fat cream cheese, and black coffee. I was doing the right thing eating things that were healthy for my heart. My lunches and dinners weren’t much different -- healthy! I thought.

Then I realized the tremendous carbohydrate load I was ingesting each day might put me at risk for decreased health, perhaps toward being a lean adult-onset diabetic like the four patients mentioned earlier.

My interest in ketogenic eating evolved from the application toward reversing diabetes to it’s powerful anti-inflammatory power, as inflammation seems to be the source of many of the diseases of civilization (hypertension, heart disease, diabetes and Alzheimer’s disease which is now considered type 3 diabetes).

I started a strict ketogenic diet two days before Thanksgiving 2017 and have been 99% faithful since, straying from the diet rarely and  mildly only when away from home and with little food choices. My carbohydrate intake is <25 gms/day, sometimes much lower and my fat intake is high as tracked with a free app Lifesum.  A typical breakfast is ~ 1000+ calories, 95% fat, 5% protein (2 eggs and cheddar cheese fried in 2-3 tablespoons of olive oil/butter/bacon fat combination and 2 thick slices of bacon, black coffee. 

I told my primary care physician about my ketogenic diet during a physical exam in August – he said  nothing pro or con. The blood work results below include lipid panels done prior to keto, during keto, and my experiment with 1800 milligrams of  Cholestoff daily while on keto.

The “Std Diet” is how I ate without regards to anything. The dates "Std diet" (pre-keto),  8/2018, 9/2018, and 11/2018 are blood draws and analysis dates. 
 
      Std Diet             Keto 8/2018         Keto 9/2018            Keto + Cholestoff 11/2018        “Desired value”
Chol   190                 291                          287                            234                                              <200
 
HDL    76                   80                             83                              84                                                  >40
 
LDL     105                 195                          189                            135                                                   --
 
Trigly   43                  64                             53                              61                                                  <150
 
Chol/HDL  2.5            3.6                           3.5                             2.8                                                   <5.0
 


The ketogenic diet (low carbohydrate, moderate protein, high fat):
Increased my cholesterol from 190 to 291, a 53% increase. Bad.
Increased my LDL from 105 to 195, an 86% increase. Bad. 
Increased my triglycerides from 43 to 64, a 49% increase. Bad. But still <150. Good!
Increased my HDL from 76 to 83, an 10% increase. Good. 
Decreased my weight by 15 pounds. Not desirable in my case. I was skinny already.
 
The addition of 1800 mg of Cholestoff daily for 5 weeks until the 11/2018 blood analysis did lower my cholesterol from 287 to 234, an 18% drop. And it lowered my LDL from 189 to 135, a decrease of 29% without any side affects. 
 
I ordered  the lab work of 9/2018 and 11/2018 myself online via directlabs.com. You can too, without your physicians’ approval – the lab will send the results directly to you.
 
One analysis I had done that I did not include in this report is the Quest  Cardio IQ analysis of my lipoprotein subfractions, that is, the LDL particle number and sizes. The sizes of these cholesterol particles is perhaps a more important cardiovascular health biomarker versus the LDL. 

My Lipoprotein (a) (Lp, little “a”) is extremely optimal @ 15 nmol/L, and this biomarker is also now believed to be highly important in cardiovascular health assessment. I’m happy with that. 

So, these cholesterol numbers would likely make most physicians and cardiologists start me on statins, but my HDL, triglycerides, Lp(a), and weight are normal. And I'm not sedentary -- I do high intensity interval exercising.  I think there's a reassessment of what is “normal” cholesterol levels for eaters of lots of carbohydrates and what’s considered “normal” for those in ketosis and who are lean.  For now, my doctor’s just watching, and I’m enjoying the fat. 
 
Dag
 

[ChrisSmolinski]

Dag,

Congrats on your positive results!

Take a look at some of the most recent research on LDL - it is quite likely not a "bad", but likely neutral at worst or even a benefit (lower incidence of dementia/Alzheimer's, and studies of the elderly also show an inverse correlation between LDL and mortality)

It's quite normal for both LDL and HDL levels to go up on a LCHF/keto diet, as they are the mechanism the body uses to transport lipids to the cells for energy. TG typically goes down when eating LCHF/keto but your numbers are still certainly quite low anyway.

LDL particle size usually correlates inversely with TG, those of us with low TG levels have the larger "better" particle size. There was a study I read a few months ago that showed the LDL/TG ratio could effectively be used as a predictor of particle size, negating the need for the much more expensive tests to determine particle size.

My doctor looked at my blood work from my last physical, saw the higher LDL levels, did some research on her own, and decided it was indeed a non issue. She's a DO vs an MD, which could explain her being more open minded 

[Josh]

When I was in ems I saw people who, for example, fried burgers every day, ate a box of glazed donuts, smoked like a chimney, and were obese yet lived into their late 80s. How did this guy die? He fell and broke his hip and gave up on living. No victim of cancer, heart disease, etc. Sure he would have been more comfortable had he not lived like he did, and perhaps even prolonged his life, but conversely I've seen people who were careful of what they ate, skinny as rails, with their carotids packed full of plaque, causing a stroke. People who tried to eat healthy, get exercise, etc seemingly lived no longer than those who were slobs as far as I could see. Not sure if luck or genes is the main determiner of lifespan.