Everything has suddenly become difficult

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PasPlus
PasPlus Posts: 31 Member
So, here's the story. I was almost zero carb (and much too low in calories) for about 2 months while posted in south east Asia. No appetite, plenty of energy, a bit worried about not eating enough but hey - I felt pretty amazing. (I had already been eating low (20-30g) carb for around 8 months). Let me restate - I felt physically and mentally amazing, then..... I came home, added dairy (still daily cravings which I hate) and nuts and wham have put on 7kg in 2 months!!!!!! I can however live with that as I was quite underweight and think I am making up for deficiencies. Long story short - I requested a complete blood analysis upon my return and apart from being slightly low in a couple of minerals the bad news was a cholesterol level of 10.5 - and no it wasn't only the good cholesterol that was elevated. Doctors letter said something like, increased risk of cardiovascular events, sudden death, early death, and general death (at least that's what I read). I have added fibre, some low carb vegies, the dreaded dairy and usual supplements every day and will get the tests redone in about a month. I am still in light ketosis most of the time.

Questions for you all - has anyone else had negative effects of this amazing WOE? and can anyone help me to get rid of the confusion I now have? My brain is telling me to go low fat, reduce the meat, coconut oil etc. and increase the vegies - in essence do the opposite of what I believe in.

I am really finding it hard to stay on track - head slaps or support would be appreciated to keep me on the good road.

Replies

  • abi111
    abi111 Posts: 50 Member
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    did you have bloods done before you went keto?
  • DinoChicken
    DinoChicken Posts: 44 Member
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    There are many other risk factors for elevated cholesterol levels other than diet. If you were eating way too few calories there may be another culprit. I do think you made a good decision to at least test to see if diet modification will help, but don't discount other causes especially family history.
  • KnitOrMiss
    KnitOrMiss Posts: 10,104 Member
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    Your LDL (bad cholesterol) and therefore total cholesterol will go up while you are ACTIVELY LOSING WEIGHT. This is normal and a process of fat burning. If you do not eat dietary cholesterol, your body cannot efficiently move energy to your brain, and will have to create cholesterol, so please don't cut your fats from your diet. There were some great articles recently, and if I find the links I'll post them here, but basically until your weight and body composition is in a steady state for 6 months, normal cholesterol tests are completely invalid.

    I'm going through this myself currently. My HDL (good) went up, trigs went down, and LDL went up, but I've lost a lot of inches and a few pounds in the last year, and in the last few years I've lost over 70 pounds. So as long as everything else looks good, I'm not going to worry until I hit steady state. Just make sure you are getting K2 to help process any calcium you take in (grassfed butter or supplements, usually), as the calcium is what tends to harden those arterial walls, which is one of the biggest risks of heart disease.

    Every single rule the doctor and medical profession is judging you by right now applies to the SAD (Standard American Diet), which is heavy in carbs. There are not medical standards fully accepted right now for what levels should be on a fully ketogenic diet.

    Also, depending on what minerals you are short on, it might not be that you aren't getting enough, but rather you don't have the necessary pairings to absorb properly (like K2 with calcium and fat with D3), etc. If you want, share what you're deficient in and if we know, we can tell you how to pair it for better absorption - that's what I'm going through right now.
  • toadqueen
    toadqueen Posts: 592 Member
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    I read that eating keto causes a rise in cholesterol in months 3-4, that levels off again in month 6. I had high cholesterol when I was extremely obese eating the Standard American Diet and needed to take medication for it (Lipitor or Crestor) because the doctor said diet can only impact the levels a little bit.

    My experience has been that my cholesterol has been within range once I stopped taking medication, started eating keto, and incorporated exercise into my routine.

    Try not to worry. I know the confusion you feel.
  • SteveKroll
    SteveKroll Posts: 94 Member
    edited July 2015
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    toadqueen wrote: »
    I read that eating keto causes a rise in cholesterol in months 3-4, that levels off again in month 6.
    Just curious. Where did you read this? And what is the science behind it?

    I'm not doubting you, but it would be nice to know the source. There seems to be a lot of "I read this" and "I heard that" statements surrounding ketogenic diets, and this is one I've never heard before.

  • PasPlus
    PasPlus Posts: 31 Member
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    Thanks all - I am hearing, keep on keeping on :-) My GP actually supported the diet - it's his gatekeepers that gave me grief - and the standard, automated response to the numbers.

    I have never been obese although have lost a lot of weight and have the suggested minerals covered - I am definitely an eyes wide open person but wanted to see if anyone else had experienced 'problems'. I do not live by numbers but the nagging little voice sowed seeds of doubt.

    Back to the plan and a big fat steak for dinner :-) Other opinions/feedback still appreciated - especially if evidenced and cited as per request by SteveKroll.
  • toadqueen
    toadqueen Posts: 592 Member
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    @SteveKroll. I haven't yet found the source. I'm on my phone and was on the computer yesterday. Sorry group for being lazy...

    Here's a different article on the subject that is also exciting. Long-term effects of a ketogenic diet in obese patients
    Hussein M Dashti, MD PhD FICS FACS, Thazhumpal C Mathew, MSc PhD FRCPath, [...], and Naji S Al-Zaid, BSc PhD from NIH. I don't know how to copy it better
  • KnitOrMiss
    KnitOrMiss Posts: 10,104 Member
    edited July 2015
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    toadqueen wrote: »
    @SteveKroll. I haven't yet found the source. I'm on my phone and was on the computer yesterday. Sorry group for being lazy...

    Here's a different article on the subject that is also exciting. Long-term effects of a ketogenic diet in obese patients
    Hussein M Dashti, MD PhD FICS FACS, Thazhumpal C Mathew, MSc PhD FRCPath, [...], and Naji S Al-Zaid, BSc PhD from NIH. I don't know how to copy it better

    I think this is the link, @toadqueen. Let me know if it isn't right.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

    Other links provided by "the Google..."

    http://www.optimalterrainconsulting.com/ncbi-long-term-effects-of-a-ketogenic-diet-in-obese-patients/

    http://www.lowcarbdownunder.com.au/resources/lchf-publications/

    Seems like the might reference the same root article though...
  • toadqueen
    toadqueen Posts: 592 Member
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    @SteveKroll and everyone you were right to doubt me. I found the source of my 3-4 month cholesterol statement and I totally got it wrong! It was from some unsourced Yahoo! discussion of 5 popular diets Atkins, Zone, Ornish, and South Beach. The cholesterol finding was describing Ornish's vegetarian, low-fat diet. Oy!

    I'll make sure to be more careful in the future. Thanks @KnitOrMiss for providing the link to the other article. I will have to learn how to do that.

    I am ashamed to say that I am a lapsed librarian and I definitely know better :(
  • sljohnson1207
    sljohnson1207 Posts: 818 Member
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    I am going through this right now. I started LCHF in June 2014. I lost 48 lbs in 10 months. I had my cholesterol checked in Summer 2014 after losing 13 lbs already. It was pretty good except low HDL, which I've pretty much always had. I think it was 47 (fluke) in 2013, but mostly it's always been below 40, which they say isn't good. It's the highest it has ever been this year.

    40 yrs., 5'7" and 145 lbs were TC=247, HDL = 56, LDL = 171, VLDL = 20, Tri = 102, FBG = 86, BP = 100/55.

    39 yrs., 5'7" and 175 lbs were TC = 151, HDL = 34, LDL = 95, VLDL = 22, Tri = 112, FBG = 77, BP 110/70.

    So while I'm a bit concerned, I'm not going to panic. I'm hoping this is temporary. I'm still trying to settle out into maintenance, and that has been kind of rough. I will ask my cardiologist to run a VAP for me next time I see him because I know these tests were just the calculated type with no further information on particle number or particle size.
  • wabmester
    wabmester Posts: 2,748 Member
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    FWIW, I was very skeptical about the stories of transiently high LDL during weight loss, but I recently stumbled upon the study. It turns out to be from Phinney himself:
    http://www.ncbi.nlm.nih.gov/pubmed/2035468

    We conclude that major weight loss was associated with a late rise in serum cholesterol, possibly from mobilization of adipose cholesterol stores, which resolved when weight loss ceased.

    Not sure it's been replicated, but it's an interesting idea.
  • PasPlus
    PasPlus Posts: 31 Member
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    Thanks for the Phinney publication link. The suggestion (in very base terms) is that the elevation could be due to the loss/mobilisation of my own fat out of adipose tissue!!! Didn't think I had enough fat at that time to raise by so much ;-P Very logical really.

    I will continue reading but I am so back to hard core in August - cannot believe I doubted. I will still get the follow up check done though - just in case something has gone crazy in here. Thanks all.
  • wabmester
    wabmester Posts: 2,748 Member
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    Hang in there, @PasPlus. High LDL seems to be a not-uncommon side effect of the diet. Phinney gives one possible explanation.

    Taubes addressed it recently:
    http://carbfreenation.com/blog/2015/7/23/carb-free-nation-interviews-gary-taubes-author-of-why-we-get-fat-and-what-to-do-about-it

    The avant garde of lipidologists will tell you LDL particle number (LDL-P) is the best predictor of heart disease risk. LDL-P tracks well with small, dense LDL and with ApoB, which is the protein component of LDL and VLDL particles. LDL-P also tracks pretty well with insulin resistance, although when it’s divergent – i.e., LDL-P is high, but there’s no insulin resistance – we really don’t know what that means clinically.

    But when people go on ketogenic or paleo diets, often both their LDL and LDL-P will go up, even as other risk factors related to insulin resistance factors will resolve. There are a lot of people walking around on low carb diets, with no insulin resistance; their triglycerides are low, HDL is high, glucose tolerance is excellent, but their LDL-P is also high. The lipidologists I respect will give that person advice to stay on low carb, but probably prescribe a statin to control the LDL-P. But they will also say they don’t really know what this portends for risk and are just erring on the side of caution.

    And the problem is that we don’t really know what a high LDL-P means in the context of a ketogenic population that has no insulin resistance. The epidemiological studies that determined LDL-P is the best predictor of cardiovascular risk are done in free-living populations of Americans eating the so-called Standard American Diet. Now that we’ve removed the insulin resistance, what does the LDL-P mean? The lipidologists don’t really know. I certainly don’t.

    Statins seem to be effective in bringing LDL-P down. I do know some ketogenic dieters who have been successful lowering their LDL-P without statins, by modulating their diet, removing saturated fats, adding some low-GI carbs, chewing hemp seeds, even using red rice or probiotics. Some ketogenic dieters get their calcium scores and artery scans, showing zero calcium in their arteries, and have a plan to ignore their LDL-P, because whatever is happening they see it is not atherosclerotic.


    He's working with Peter Attia, who recently wrote this:
    http://eatingacademy.com/cholesterol-2/random-finding-plus-pi

    I realize there is a contingent within the LCHF community who argue that traditional biomarkers of coronary risk—such as LDL-C or its superior cousin LDL-P—“don’t matter” if one is on a low carb or ketogenic diet. Maybe they are right. I guess time will tell. But I am not convinced, at least not yet. As a doctor I can’t look a patient in the eye and tell them a sky-high LDL-P is ok because they don’t eat carbohydrates. So if you’re following such a diet, and your LDL-P goes through the roof, I’d urge you to consider a variation of the diet.

    Specifically, he recommends changing the types of fat you consume.

    If it were me, I'd take the Attia approach. You now have a baseline. Experiment, and get rechecked.
  • KnitOrMiss
    KnitOrMiss Posts: 10,104 Member
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    wabmester wrote: »
    Hang in there, @PasPlus. High LDL seems to be a not-uncommon side effect of the diet. Phinney gives one possible explanation.

    Taubes addressed it recently:
    http://carbfreenation.com/blog/2015/7/23/carb-free-nation-interviews-gary-taubes-author-of-why-we-get-fat-and-what-to-do-about-it

    The avant garde of lipidologists will tell you LDL particle number (LDL-P) is the best predictor of heart disease risk. LDL-P tracks well with small, dense LDL and with ApoB, which is the protein component of LDL and VLDL particles. LDL-P also tracks pretty well with insulin resistance, although when it’s divergent – i.e., LDL-P is high, but there’s no insulin resistance – we really don’t know what that means clinically.

    But when people go on ketogenic or paleo diets, often both their LDL and LDL-P will go up, even as other risk factors related to insulin resistance factors will resolve. There are a lot of people walking around on low carb diets, with no insulin resistance; their triglycerides are low, HDL is high, glucose tolerance is excellent, but their LDL-P is also high. The lipidologists I respect will give that person advice to stay on low carb, but probably prescribe a statin to control the LDL-P. But they will also say they don’t really know what this portends for risk and are just erring on the side of caution.

    And the problem is that we don’t really know what a high LDL-P means in the context of a ketogenic population that has no insulin resistance. The epidemiological studies that determined LDL-P is the best predictor of cardiovascular risk are done in free-living populations of Americans eating the so-called Standard American Diet. Now that we’ve removed the insulin resistance, what does the LDL-P mean? The lipidologists don’t really know. I certainly don’t.

    Statins seem to be effective in bringing LDL-P down. I do know some ketogenic dieters who have been successful lowering their LDL-P without statins, by modulating their diet, removing saturated fats, adding some low-GI carbs, chewing hemp seeds, even using red rice or probiotics. Some ketogenic dieters get their calcium scores and artery scans, showing zero calcium in their arteries, and have a plan to ignore their LDL-P, because whatever is happening they see it is not atherosclerotic.


    He's working with Peter Attia, who recently wrote this:
    http://eatingacademy.com/cholesterol-2/random-finding-plus-pi

    I realize there is a contingent within the LCHF community who argue that traditional biomarkers of coronary risk—such as LDL-C or its superior cousin LDL-P—“don’t matter” if one is on a low carb or ketogenic diet. Maybe they are right. I guess time will tell. But I am not convinced, at least not yet. As a doctor I can’t look a patient in the eye and tell them a sky-high LDL-P is ok because they don’t eat carbohydrates. So if you’re following such a diet, and your LDL-P goes through the roof, I’d urge you to consider a variation of the diet.

    Specifically, he recommends changing the types of fat you consume.

    If it were me, I'd take the Attia approach. You now have a baseline. Experiment, and get rechecked.

    @wabmester I'll go back and read all the links when I can, but I'm curious what it said about high LDL WITH insulin resistance, if you have that info easily accessible...
  • wabmester
    wabmester Posts: 2,748 Member
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    Knit, I think Taubes point was that IR is strongly associated with heart disease, and many with high LDL also have IR. He's suggesting that perhaps IR is causal. For example, plaque formation requires both LDL penetration and IR-related inflammation.

    So maybe high LDL without IR is harmless.