LMHR are not about high LDL
It is literally like being on top of the world. It is about being invisible.
I haven’t written a post for a long time as my focus is in building Ketobox.
But the recent Keto-CTA study has triggered many feelings. Especially a comment from Darius Sharpe in his YouTube chat with Dave Feldman.
He said “I feel fantastic!”.
I get him. Don’t all LMHR feel on top of the world?!
The LMHR phenotype described
I actually believe that the LMHR phenotype is not characterised by a high LDL. A LMHR is a lifestyle.
LMHR are lean, athletic and know no boundaries.
Running on fat gives you such energy to do things that most people don’t in their respective age group. Sometimes in our own demise.But I don’t want to be the one to describe the phenotype. There are better suited people than me. If you are a LMHR, I trust you know Clay Butler. Clay was a respected member of the LMHR community who liked writing a lot. I knew Clay and appreciated his opinions and the way he supported everyone.
In his pdf called Thoughts_on_Keto_Fasting_and_Excercise_Clay_Butler.pdf, Clay lays out his own journey of high LDL.
Here are some of the quotes he used to describe the LMHR lifestyle.
Keto plus meat was magic. But I’m also an extremist by nature. I struggle with moderation. So of course, I can’t just stop and coast through a plan that is obviously working. Nope. Let’s take this new lifestyle as far as it can take me.
As my carbohydrates dropped more and more overtime, and as I incorporated more time restricted feeding, as well as increased my exercise, my LDL kept climbing.
But I still felt amazing. More than amazing actually, kind of invincible. I was putting on muscle. My connective tissue was getting more resilient ever month, which is quite remarkable for someone middle aged with a history of tendonitis. Recovery time was excellent. I could fast all day without issues and have endless energy. There is definitely a certain high you get from this lifestyle. Running on fat and ketones as well as coffee is definitely an altered state.
I bet most of you relate. :-)
But being on top of mount Everest can be a dangerous business. You may think you are invisible, but the balancing act, when you have little wiggling room, is one you can’t take lightly. He continues saying
For myself and as well as many others it starts off going low-carb and feeling amazing. So, imagine how good you’ll feel if you reduce carbs even more! Pretty soon you just naturally start skipping your first meal. This is usually also when the coffee consumption starts or increases. Now you're running on adrenaline, cortisol, coffee on top of your free fatty acids, ketones and glucose generated by your liver. Then you start skipping lunch. And you still feel great.
Is LDL to blame?
The famous Keto-CTA, in my humble opinion, has correctly pointed out that LDL does not cause plaque although the paper itself does not provide more evidence about this. However the mechanism has been described by Malcolm Kendrick and by others, while I wonder why no-one points out the graph below or studies like the “Blood biomarker profiles and exceptional longevity: comparison of centenarians and non-centenarians in a 35-year follow-up of the Swedish AMORIS cohort”.
(Note: I have more but feel free to put in the comments any serious paper you know of.)
This graph point out that the sweet spot for the lowest all-cause mortality is a cholesterol of around 230mg/dl. As usually there is always some Gaussian “bell curve” involved. Maybe some have gone too far down the slippery slope?
The problem with feeling too great!
But KETO is SLIPPERY SLOPE and if the keto diet was a pill that came in a bottle, it would require a warning label.
What is the warning sign that Clay was referring to? Clay describes Keto (as many of Ray Peat crowd like Jay Feldman) as a state of high adrenaline and cortisol. A high stress state.
And the paper (that Nick Norwitz was part of) “Thyroid markers and body composition predict LDL-cholesterol change in lean healthy women on a ketogenic diet” says
“Additionally, fT3 is an independent predictor of LDLc changes, separate from BMI.”
A high stress state, is a state of high(ish) TSH and low T3, that correlates very well with an increase in LDL. And we know that T3 and the thyroid gland, are the overall regulators of our metabolism, and tell the body how much fuel we're going to be converting to energy. This a key indicator for our health.
And as obvious as it may sound metabolic health means having a healthy metabolism!
The other thing that typically happens with T3 is it increases the cellular uptake of cholesterol and its conversion into the steroid hormones. So with low(ish) T3 you're going to have less cholesterol uptake and utilization.
These points might be representative, for some individuals, of an energy depleted state, since these individuals are lean, athletic and may operate past their available energy. This is what Dr.Cywes describes as insulin suppression.
Clays hypothesis was that
In a lean athlete, eating at maintenance, exponentially elevated levels of LDL may not be an indication of healthy homeostasis and instead may be an indication of a body in crisis. Your LDL goes sky high, your triglycerides may start to creep up, your fasting blood glucose gets higher and higher and you feel “edgy” instead of focused and calm.
What to do next
Keto people, like doing more keto, more fasting, more exercise. And maybe they haven’t read the warning label on the bottle that says
KETO, FASTING, EXERCISE – PICK ONLY TWO
I personally share the same experiences as Clay has. I remember had difficulty keeping-up with two meals a day while exercising 5 days a week.
I still do keto and fasting and exercise but I have adjusted my routine. I have increased my calorie intake do 3-meals a day (most day), have added some carbs and try to recover the best I can. I am still in ketosis every day, but I am not afraid of carbs and try to listen to the cues my body is sending. My CAC is 0 but I am not letting my guard down.
These days, being 50 years old, I view my world depending how much energy I have and how recovered I am.
I am also sure that Dave Feldman and team are looking into the data from this perspective as well, as I think there many other markers that LMHR should be looking into, in order to interpret their metabolic health other than LDL.
For better or for worse LMHR is not LDL, it is a lifestyle.
Let me know your thoughts, and if you enjoyed this maybe i pick-up writing posts again.