I’ve posted a few times, but not really a “regular”. I’d love your advice: I had my annual physical in late Jan and had a battery of tests.
First, some background: I’m 52 and have been keto for two years (at least low carb) and “somewhat carnivore” since the beginning of this year (meaning basically no veggies or straight carbs, but do still eat nuts and peanut butter, and cheese and coffee). I had renal cancer a few years ago and have only one kidney now, with no resurgence of the tumor (I had a rare-ish but “lucky” cancer which isn’t as likely to metastasize, and thus far hasn’t, and ideally won’t with the keto diet). I lost roughly 50 pounds on keto (now 157) and have been hitting the gym hard over the past two years (was heavy but still in decent cardiovascular shape — for instance, did a four day backpacking trip through the Grand Canyon at peak weight). But since the beginning of the year I’ve really stepped up my attempt to build muscle (naturally) through heavy weights (deadlifts, squats, chin-ups, etc) and it’s really working (progressing well with noticeable muscle adding, and weights increasing). (By the way: I’m adding muscle for longevity — I’d like to move freely and fluidly when I’m 90 instead of the rampant sarcopenia I see all around me — and not trying to look a certain way , although it’s a definitely positive and becoming noticeable to family/friends…). I’m not taking any medication, except 6g glycine in morning coffee and100mg NACET (for GlyNAC, although no noticeable effects after six months), and 1g citrus bergamot (for LDL via my doctor who would love nothing more than for me to stop being carnivore). I’m not (yet) taking Rapamycin even though I plan to, as I want to sort out the LDL issue first.
By the way: I feel frickin’ terrific, and fit into my clothes from grad school (not that the styles are in fashion…)
Onto the blood tests (morning, and after a flu):
Total cholesterol: 252 (before keto was 260)
Triglyceride: 64 (before keto was 119)
LDL 171 (before keto was 183)
HDL. 68 (before keto was 53)
Chop/HDL ratio: 3.7 (before keto was 4.9)
A1c: 5.2 (before keto was 5.6)
Estimated glucose: 103 (before keto was 114)
Actual glucose: 92
Urine ketones: 5
Vitamin D: 49.9
Estimated globular filtration: >90 (pretty good for one kidney)
There’s more but I’ve already dumped too much on you.
So, am I missing anything? Is my A1c too high for what I’m doing? I’m obviously “concerned” about my LDL but thinking of getting a CAC score and an LDL-particle size/number test before thinking too much more about it.
@Ericross2, I’m mostly carnivore too since 2019 with varying strictness
and my lipids are very similar to yours. I was suspecting I’d be put on cholesterol lowering meds but my doctor didn’t think it was warranted for whatever reason.
Ericross2Your post is interesting to me as many of my biomarkers are nearly the same (with lower LDL), but my diet for years has been mostly carbs, vegetables, nuts and occasional meat. I do keep my calorie intake quite low though and I am thin.
According to Dr. Lustig what matters most is the Triglyceride to HDL ratio. If it is near 1, as yours is, that is optimal.
According to Dr. Attia what matters most is ApoB. They are essentially looking for the same thing: small dense vLDL particles. I believe both of them say that total cholesterol and LDL numbers do not matter much on their own because they do not indicate what type of cholesterol it is. A lot of the LDL is harmless. All that matters is the small dense LDL, which is why ApoB test is so important (and not normally done!) because ApoB proteins carry the vLDL.
Another thing to know is your insulin level (not normally tested) as you could then calculate whether you are becoming insulin resistant using the QUICKI calculation. I think insulin varies a lot week to week which is why it is not used very much. If you have a cold your insulin goes up. For example my insulin was 11.2 one week and 5.2 a couple weeks later (different US labs) which effects the calculation significantly. I think what to look at is the long term QUICKI trend over several years.
It has been said here on the forum that CAC may be a useless test for many people. Dr. Attia concurs (I believe). Not sure of the exact reasons.
Thank you, @John_Hemming . I have a full metabolic panel (and a few other odds and ends) which I didn’t include because I thought the post was getting a bit ridiculous. I’m happy to include them if you find it useful.
I would be concerned by those ASTALT scores. Well within range, but the range is much higher than it was 20 years ago, given the propensity towards poor metabolic health. I have had LDL scores that high, and refused to take a statin. If my LDL goes above 100 again, I will take a statin. In the past, I was comforted by the fact that my HDL was very high (last reading my LDL was 96, and my HDL was 82)., so my ratios were in a very healthy range. But then I learned about independent risk variables. High LDL is high LDL, unfortunately.
Something to consider, @RPS , thank you. I don’t think I did a full blood count in January. Immune-wise I’ve been healthy outside of that flu (I haven’t had a flu in maybe five years or more), although my C-reactive protein was higher that day than I would have expected (3.4) which indicates some inflammation — the opposite of what I would expect on a keto diet, although as I mentioned I was just getting over the flu so I thought it wasn’t “typical” (and may have provided out-of-whack white blood cell counts/etc. for the same reason. I’ve been meaning to get it (CRP) retested to make sure it wasn’t something more, but life has gotten in the way.
Great info, thank you, @NakedMoleRat . I’ve read similar articles but haven’t presented it as eloquently as you have. I don’t stay awake at night worrying about LDL partially because I am part psychopath, and partially because I am getting energy from fats generally so if I didn’t have higher LDL I would worry (although note that my LDL before keto was essentially the same value, while my HDL was lower and TG was higher, so less metabolically healthy). I’m probably going to get the full NMR lipid test (we build a simple NMR in college for a physical chemistry class, so if I get motivated I may try to figure it out again, as having a way to test pharmaceuticals from India might be worth it) I’ll probably also get a CAC as a baseline if for no other reason. My uncle was/is always thin and in decent shape (not muscular or athletic, but never heavy) and suddenly required stents when he was 50-ish so it’s always been on my mind that it can come on suddenly. I’m less at risk as I have “luckily” had many recent MRIs and CT scans of abdomen (cancer screening) which may have visualized heart issues.
Interesting about the “carnivore” versus “mostly plant-based” having the same scores, but not surprising if we are both paying attention to our health outcomes and are/have become metabolically healthy. I’m not dogmatic/religious about it and know there are many ways to get to this end. I’ve personally been a vegetarian for several years but never really lost weight except through calorie restriction and never really built muscle (although I’ve never knew how to work out like I’ve been doing recently) and I always craved meat and ended up eating some once a month to keep going; I recently tried mostly vegan keto for a few months (in Fall/Winter 2022) and felt horrible, and I feel great on keto for the past several years (and also surprisingly carnivore) so I’m going to keep this up, with some four-day fasts and mostly 18+ hour non-feeding windows. I am also trying to build substantial muscle (read: a thick layer from which I can draw from when I am 90 ala Peter Attila’s “centegenarian olympics”, and not a Mr. Universe physique) so more protein appears to be better for that. My personal observation (and not trying to start an argument) is that a larger percentage of carnivores are “muscular” (e.g. Sean Baker) while the plant-based scientists I see are more….ummm, “slight” (e.g. David Sinclair). But just an observation. And it works for me.
Thanks for that, @blsm , and for the shared labs. My doc strongly “suggested” taking citrus bergamot so I’m taking 1,000mg each morning since these tests. I haven’t retested to see if it worked, but I needed a few months for it to work anyway, and it appears to have a pretty good track record so I’m hoping LDL has come down. And there don’t seem to be reported side effects from citrus bergamot that I remember. However, I kinda feel a touch less good than I did before taking it, which could be entirely psychosomatic, or could be that I’m actually taking LDL away that I’m using/need. Or it could be nothing. Im panning on getting a deeper lipid panel (Merak Health doesn’t seem to work in NYC and I’d need to hop over to NJ/CT to get it done) but as I mentioned, life has gotten in the way.
I’m not dogmatic about plant based diet either. I eat what I crave up to a point. I mostly followed this path because I had a gout attack in my mid 40’s and wanted to avoid purine intake. Truthfully I’m not sure purines really matter, it was stopping alcohol and fructose and sugar that helped the most with gout. I have noticed that cutting out eggs and cheese really helps my digestion a lot, because I’ve gone back and forth. I am gradually going back to a more mixed diet with more meat. Meat has a lot of very beneficial amino acids that are hard to get from plants, such as carnosine, carnitine. Of course meat also has leucine which is a simulator of mTOR, so good for muscle building, but possibly bad for longevity in excess. It seems to me that a very well muscled person will have activated a lot more mTOR in their lives than a slightly muscled person. If we agree that rapamycin effects longevity by inhibiting mTOR then theoretically excess muscle shortens life. This is just my own thinking I have not read any studies on this. Certainly there are many other health benefits to exercise beyond muscle building, like brain health, lung health etc., So perhaps any excess mTOR activation is balanced out by all the other longevity benefits.
I pay attention to any food cravings. This is the language your body uses to communicate with the conscious brain. I have recently become fascinated trying to decipher the language the body uses to communicate, it could be that there are no real mysteries in nature at all, we just don’t understand the particular language nature is using.
It is really good that you have tried a bunch of different diets and noted how they effect you. One thing about building muscle is to try not to injure joints and tendons with repetitive motions (I have some repetitive injuries to tendons). I think people feel really strong in youth and build up tremendous strength, but in so doing can create micro- and macro- trauma to their joints . These types of injuries do not heal well and cause further problems in old age with calcification of cartilage for example. The one common thing for older people is to also have joint problems. I certainly wish I had been more careful with my joints in my 30’s, one single injury to a joint can reemerge in old age and really slow you down.
@zazim I recently heard the same thing about ALT having a lower range in the past, BUT I was reading a US nursing handbook published in the 1980’s last week (don’t ask me why) and the ranges given for ALT were all the way up to 50 as being normal. Differnt labs had different ranges. It made me realize that facts about the past that we hear repeated today are sometimes cherry-picked to prove the speakers point.
I’m not saying high ALT is good, its just that numbers are numbers and it was printed in an old book, so who to believe?
@DMac, I was thinking it could be related to starting rapa. I was just a tad beyond my first 30 days for those labs. On my prior labs a year earlier AST was 18 and my ALT was basically the same at 30. Thanks for letting me know your experience.
A lot of good points on the responses to your post so i wont duplicate other than to mention how long i struggled to form an opinion on statins. It took me 4 years of listening to the full spectrum of voices and reading many studies to finally decide to take them.
Here’s how i came to that conclusion.
First. I took Bergamot for a while to no effect. But I realized that Bergamot interferes with production of hmg coA reductase just like many statins. So, I’m not taking statins but instead I’m taking a weak version of a statin…
Second. When I realized that I’m willing to take Sirolimus (a pharmaceutical) but not statins because I dont trust the pharma industry I realized my thinking was skewed…
Also, I knew a bunch of old wealthy guys who didn’t exercise or eat well, who were stressed but seemed to be getting along fine into old age. They all could afford the best health care and I realised that they were being kept alive by pharmaceuticals and (high quality) standard medical care. Why was I resisting that?
So I started taking atorvastatin and ezetimibe. My LDL and total cholesterol dropped by half. I feel fine and dont have problems with side effects. My ApoB is under 70.
I suggest you study the mechanism of heart disease and also reflect on whether your opinions on the subject are skewed like mine were.
Its completely rational to not trust the pharma industry… they have a long history of maximizing profits over people’s health (the opioid pandemic is just one of many examples).
At the same time there is no question that many pharmaceuticals are very helpful for longevity and disease. But parsing the real evidence for efficacy vs. hype and inaccurate data pushed via the influence campaigns of pharma throughout the medical system makes things hard for everyone.
The key I think, is to review the opinions of experts who have no financial stake in the outcomes.
Well that’s a great GFR for 1 kidney (I’ve got half that with 2, but that’s what I bought with fatty liver cirrhosis and hepato renal syndrome, pre liver transplant). The thing about mostly carnivore diets and Rapa is they conflict in their effect upon mTOR: rapa shuts it down and conserves resources; meat says let’s build stuff. This is why I, an omnivore, whenever I can, take my rapa on day 3 of a fast, having exercised heavily during the fast. This gets me deep in ketosis, and mTOR suppression, maybe even autophagy, before the rapa and the GFJ arrive (not to mention the fasting depletes amino acids which otherwise upregulate mTOR). My diet is low glycemic, very low sugar, grains, but I have been convinced there are marvelous molecules in plants like tumeric, broccoli sprouts, coffee, chocolate, prunes(!), natto, all kinds of fermented foods, etc., that wouldn’t be available for my body to rebuild with if I didn’t get the veggies, and pre-and-probiotics with my meat.