March 15, 2015


Random finding (plus pi)

The best part of parenting (so far)? Helping your kids overcome things you struggled with. It’s at least in the top 5.

Read Time 6 minutes

The best part of parenting (so far)? Helping your kids overcome things you struggled with. It’s at least in the top 5.

Last Saturday my daughter came home from dance class—something she normally loves—and seemed upset. A bit of prodding led to the cause: a girl in her dance class told her she was “as fat as a hippopotamus.”  My first reaction (note to self: probably not the right one) was to laugh out loud, given that my daughter is probably in the 10th percentile of weight for her age. I’m worried she’s too skinny!

Of course I realized quickly the “facts” were irrelevant in this case. Her body habitus was moot. But her feelings were hurt, and as we all know this wouldn’t be last time someone said something to her—true or untrue—that would hurt her feelings.  I won’t go through the entire discussion we had, as I’m sure those of you with kids have already been through this, and those of you without kids probably aren’t worrying about this type of interaction.

I did, however, decide to tell her about all the people who dislike me and say mean things about me, usually things that aren’t true. She was shocked, “Like what, daddy?” I gave example after example. She was amazed—and relieved, I suspect—to know that she wasn’t alone and that I was able to shrug it off after temporarily being upset by it. I even told her about folks posting videos on YouTube specifically attacking me.

So, when our little talk was over she asked if she could see one of the videos I alluded to. I was a bit hesitant, if only for some of the language used when folks rant against my existence (if she’s going to learn choice 4-letter words in earnest, it should be from me after all), but I figured it was a good idea. She could actually see for herself that people say mean things about her dad and he’s still, more or less, ok.

Which brings me to the point of this quasi-post…

In searching for said YouTube videos, which I eventually found, I stumbled across two talks I gave last year which made their way online, unbeknownst to me.

In keeping with the current spirit of my co-op blog posts, below are links to the two talks.

Talk 1: Evidence for (and against) the dietary guidelines restricting saturated fat



This talk is an updated version of a talk I gave a few years ago and shared on the blog, in 2012 I think. Even if you watched the earlier version of the talk, if you find this question interesting—what is the case for restricting saturated fat (SFA) intake—it’s worth watching this version. I find this particular topic especially interesting because I think it highlights the challenge we all have, myself included, in setting aside bias when confronted with new information. (My friend Carol’s amazing book, Mistakes Were Made (But Not By Me) cannot be recommend highly enough for people who want to understand how cognitive dissonance wreaks havoc in even otherwise functioning societies.)

And contrary to what some (perhaps many) of you might think, I don’t believe this is a settled debate across the board. What do I mean by that (i.e., “across the board”)? Certainly in this presentation I try to make the case that the continually falling recommendations for SFA—from 12% to 10% to 8% to 5% of total calories—are not supported by convincing science. In fact, such recommendations likely do harm, courtesy of the “substitution effect,” i.e., people end up eating more of other things—namely, sugars and omega-6 polyunsaturated fats (n-6 PUFA)—that likely cause greater metabolic derangement.

However, some readers may interpret the data I present to mean it’s perfectly safe to consume, say, 25% (or more) of total calories from SFA. I realize I may have to turn in my keto-club card, but I am convinced that a subset of the population—I don’t know how large or small, because my “N” is too small—are not better served by mainlining SFA, even in the complete absence of carbohydrates (i.e., nutritional ketosis).  Let me repeat this point: I have seen enough patients whose biomarkers go to hell in a hand basket when they ingest very high amounts of SFA. This leads me to believe some people are not genetically equipped to thrive in prolonged nutritional ketosis.

In one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L1i.e., more particles than could be measured by the NMR machine so the report simply said “>3,500 nmol/L”. despite feeling, performing, and looking great. Based on his through-the-roof desmosterol and cholanstanol levels, and a curb-side consult from the Godfather- I mean Dr. Tom Dayspring, I decided to try an experiment. You see, the logical thing to do in this setting would have been to start two drugs immediately (a potent statin to address the hypersynthesis and ezetimibe to address the hyperabsorption) or tell him to abandon ketosis altogether. But this patient was adamant about staying in ketosis given the other benefits, though obviously worried about the long-term coronary implications. So, we agreed that for a 3 month trial period he would reduce SFA to an average of 25 g/day (vs. about 75 to 100 g/day) and make up the difference with monounsaturated fat (MUFA).2We also reduced his omega-3 PUFA given very high RBC EPA and DHA levels.

So, on balance, he consumed about the same number of calories and even total quantity of fat, but his distribution of fat intake changed and he heavily swapped out SFA for MUFA.

The result?

His LDL-P fell from >3,500 nmol/L to about 1,300 nmol/L (about 55th percentile), and his CRP fell from 2.9 mg/L to <0.3 mg/L (and for the lipoprotein cognoscenti, both desmosterol and cholanstanol fell).

Pretty cool, huh? So, my point is this: while I believe the population-based guidelines for SFA are not supported by a standard of science I consider acceptable, it does not imply I believe SFA is uniformly safe at all levels for all individuals.

Some of you may be wondering about me. It turns out I’m in the group (recall: I have no idea how large or small this group is) that seems to do well—at least by the tools we have available to assess risk—with large amounts of SFA in my diet, if and when I elect to. Even when I was in ketosis, eating 4,000 kcal/day (literally getting 40 to 45% of my calories from SFA alone) my biomarkers—cardiovascular, insulin resistance, inflammation—were excellent. Better than they ever were or even are today. Though, my point still stands: there are some people who do not appear able to safely consume massive amounts of SFA.

One last point I’ll make on this highly charged topic. 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.

(Note: If you post your NMR results, please understand I will not comment on them.)

Talk 2: It was the best of times, it was the worst of times—the tale of the U.S. healthcare system


This presentation has nothing to do with nutrition but is, nevertheless, a topic I’m pretty obsessed with: how do we achieve cost containment on healthcare in the United States? (Sorry non-U.S. readers, but we have a bigger problem right now, so I’m focusing on ours over yours!)

This is a pretty controversial topic, so before you jump down my throat, try to sit through the entire talk, especially the parts where I frame the question as one of optimization. Most problems that have been heavily politicized suffer a common problem: they fail to distinguish between what is desirable in a resource unconstrained world (e.g., free health care for everyone that provides perfect care) and what is plausible the real world (e.g., some combination of features, but not 5 starts across the board).

Hope you enjoy the departure from the usual topics.

Pi Day

The math geeks in the audience will appreciate that yesterday, March 14, 2015, represented a very special variant of pi day. Normally, March 14 represents pi to 3 significant digits, namely, 3, 1, and 4 (i.e., 3.14). Yesterday, however, being the pi day in 2015, was especially cute, because it advanced two more significant digits, 1 and 5, via the year (i.e., 3.1415). If you’re a watch geek, in addition to being a math geek–yes, I realize this is not a huge club–the beauty of a perpetual calendar (a type of watch that shows time, month, date, and year inclusive of leap years), made it a really fun day! Why? Because at 9:26 and 54 seconds you found yourself at the following place in time: the 3rd month, 14th day, 15th year (of this century), 9th hour, 26th minute, and 54th second, that is, 3.141592654–pi to 10 significant digits!

After capturing this wonderful moment in time, I sent the picture, below, to my watch mentor (also a math geek; yes I just wrote the words “watch” and “mentor” next to each other). He loved it, but his response was priceless: “Peter, don’t ever show this to any woman you have the slightest interest in….check that, don’t show it to any woman period. Pretty cool though. You are right. I dig it.”

Good thing my days of trying to impress the ladies are far in the rear view mirror.

Parting shot: I did a follow up podcast with Tim Ferriss a few weeks ago. It’s episode #65 which is available on iTunes. This was my first time doing the strange format of just talking by myself. Feedback appreciated if this should morph into something I do quasi-regularly on the blog.


Pi on abstract background with about 3500 decimal digits by Nicolo Canali De Rossi is licensed under CC by 2.0

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  1. Thanks, I am looking forward to reading it. I have a Ph.D andI very much like your writing and podcast because all of your statements are based on research. You are doing a great service for many people struggling with health and weight issues.

  2. Objective: To find the effect that having a cheese omelet of two eggs per day for breakfast along with a low carb wrap has on triglyceride and HDL levels.

    Design, Settings and Participants: One subject (Me) will eat said cheese omelet every day for over two years.

    Main Outcomes and Measures: Participant will have a blood test after a period of over two years, and compare his blood test from 2/28/13 to the blood test on 10/08/2015

    Results: Participant’s Triglycerides were 73 and HDL 46 in 2013. His LDL was 99 and total cholesterol was 160.
    In 2015 his Triglycerides were 74, his HDL was 47, his LDL was 114, and his total cholesterol was 176.

    Conclusions and Relevance: one cheese omelet a day for breakfast had no negative effect on participants HDL and Triglycerides levels. A higher LDL and Total Cholesterol level were observed, but their relevance has not been determined in heart disease.

  3. I heard you mention in the podcast that you read several papers on keto and the like per week, thought you might find this paper from Medical Hypotheses interesting. Ketosis may promote brain macroautophagy by activating Sirt1 and hypoxia-inducible factor-1***

    In addition to a nice discussion of the possible reasons for neuroprotection and ketosis, it outlines a few ideas regarding intermittent ketosis and fast induction of ketosis. They even threw in a bit on drinking jet fuel. Your readers might find it interesting as well, so I’m posting it here.

    ***I’m not one of the authors, just an interested medical student. By the way, have you ever spoken at the Cleveland Clinic medical school? Because, if you haven’t, we would love it. You know, when you have a ton of free time and feel like dropping in to enjoy the weather.

  4. On LCHF for 3y, eat a lot of saturated fat as butter, meat fat etc. A recent lipid profile test shows I have LDL-c 8.1 and TC 10.5 , TG 0.8, and HDL-c 2.0. (mmol/L). Practice intermittent fasting 16:8 most days and 24h water only fast some day per week. I will test to eat more MUFA to bring down my LDL levels.
    However, there is a large variation in the cortisol stress response among individuals. My hyperresponsive LDL to saturated fat might be related to a broken HPA axis function and overproduction of cortisol due to too much stress on my body from the intermittent fasting that tip me over in a life as researcher in a new country and establishing a family…? Cortisol is synthesized from LDL thus an overproduction of cortisol can increase the circulating LDL levels? Any studies that has demonstrated such interrelationships?

  5. Addendum. Two weeks ago cardiography showed I have a sclerotic aortic valve. Induced by my lchf eating? I will never know. Put in heterozygous factor V leiden and allergy in the ring too and it starts to be many factors that can contribute to structural changes in my 41 y old heart together with perturbed LDL-c levels. We all break at some point.

  6. Hi Peter.

    Really glad you posted this story about your patients LDL-P and SFA intake. I found it very interesting.

    This may be a stupid question….so apologies…

    Have you seen any relation between a persons LDL-P reaction to large amounts of SFA and the amount of physical activity they do? You seemed to be able to tolerate huge amounts of SFA when you were permanently in keto but were also doing huge amounts of physical exercise as well.

    I was just stupidly wondering if there could be any connection..

  7. Hello Dr. Attia. I’ll get a bit off the current topic and I hope you don’t mind if you read this. Last 2 years I’ve gained a lot of weight . From 70kg to 89 in just 2 years. From lean person to obese. I went to doctor and after a lot of tests they concluded that everything is fine with my health only my tryglicerides are high I think 137 or something like that and my doctor suggested me to reduce the fat in my diet and than I remembered a TED talk I watched some time ago. Luckily I managed to find your blog. I choose to give low-carb diet a chance. I started 2 days ago but I feel so hungry although I eat more fat, I also feel very weak. Is that normal when changing the diets from low fat to low carb? Or is it just not for me?

  8. Have to say your interview on the Tim Ferriss show and how you described the taste of ketones absolutely hilarious.
    “I couldn’t design anything that taste worse than this”

  9. I am Director of Behavioral Health Science and Professor of Clinical Family Medicine in a Family Medicine at LSU – Health – Shreveport at Conway. I have almost memorized all of your presentations on YouTube. Thanks for all of your work thus far. I totally believe in what your are attempting to do. But, I have a problem when working with patients and residents. I can get the patients to acknowledge the importance of a good diet (like you have outlined) but I struggle to find a way that will motivate them to actually implement the new diet. I have run out of ideal (from a psychological stand point) on how to get patients to actually “change”.

    Can you suggest any methods (anecdotal or empirical) to help incorporate “knowledge” of what to do into actual “behavior” ?

    Thanks a million,
    David Boyle, Ph.D

    • David, I spend 50% of my clinical time thinking about “efficacy”–what is the right intervention (e.g., with respect to diet, drug, hormone, exercise, sleep)–and 50% of my time thinking about “effectiveness”–how do we translate the right intervention into a sustainable behavior.
      So we’re on the same page. Of course, I could produce another blog as lengthy as this one about my approaches, but fundamentally I believe in the work of folks like Richard Thaler and I strive to help my patients create a better “default environment” to promote the intervention.

  10. Peter.
    I don’t have facebook (don’t get me started on ‘being tracked’).
    and have no time for that type of social media.
    I miss your blog postings.
    Anyway, can you provide a link to your views on Red Meat (in a way i do not need facebook to access)?
    thank you.

    and PS, did you stop posting articles here?

  11. Not sure if anyone has seen any info about these studies trying to link pollution to metabolic disease, diabetes and obesity? All I have seen is this BBC article so I am in no way saying that there is any strong evidence. Is interesting to me as I currently live in Hong Kong and the pollution here, while not has horrendous as Beijing, can be pretty awful at times. I do worry about what it does to my lungs and avoid training when it is bad but I never considered it could have impacts on metabolism.

  12. Hi Peter,

    With regards to both raising your daughter and growing yourself:

    *What skills or habits are most important to living a fulfilling, meaningful life?*

    I’m trying to systematically learn skills like writing, negotiation, mindfulness, communication (understanding & being understood), gratitude, happiness, courage, etc. hoping they lead to professional and personal “success” (or are success in themselves). Skills that make you a more effective human being whatever your approach to life.
    An example of how you may have incrementally trained yourself in a a skill/habit would be great to hear, if you’ve the time.

    Even if you don’t get around to my question thanks for everything you do. You’re work has completely changed the way I think about things and opened my eyes to a more scientific perspective, a la Feynman. For that I can’t thank you enough.

  13. I’m 61 years old. About 211 lbs. I’m not happy or comfortable (my feet hurt all the time) but my blood work is good, sugar levels normal and have excellent HDL and LDL levels. I play racquetball twice a week (I’m not a novice – I play hard). I’ve been lean (150) and kept it off for a year only to let the weight creep back on and stay with me. My default food is fat and sugar.
    I was born underweight (5lbs) into a world of plenty. Is my brain hardwired to keep me fat? I just want to give up but my feet are begging me. My husband and I love to travel but exploring on foot – though I don’t stop – is getting more difficult.
    Fat and frustrated (self loathing comes to mind) in Selah, Wa.

  14. Apologies for the length of this post…

    Today I am ending my own (n=1) keto experiment. I am in no way trying to be critical about keto or LCHF or encourage others to quit I just thought I would share my experience and why I have decided that my biomarkers are telling me that Keto probably isn’t for me, at least at the moment.

    Some background, before I started keto I had no weight issues or health issues. I am a 35 year old male with an office job who is also an ultra-runner. I was previously eating a reasonably high amount of carbs but I had been a zero sugar, zero processed food and almost zero pasta guy for 4-5 years. My carbs came in the form of brown rice, sweet potato, veggies and milk. My diet was very low fat and I ran approximately 100-120km per week of hilly trails. I weighed about 135-140 pounds and probably around 10% fat. I decided to give keto a try as I was interested in using fat for fuel and not having to ingest so many highly sugary gels etc. during 100 mile and longer ultras. I had never really had any real problem with carbs but everyones stomach usually gives in eventually so having the ability to fuel from fat and not have to carry large amounts of fuel appealed to me and seemed wholly more logical. So, about 3 months ago (30th Sep) I embarked on my Keto experiment. Before I started keto the last blood tests I had had were about 2 years earlier so tough to compare but the basic lipid profile results were:

    Total Cholesterol: 109 mg/dl
    HDL-C: 43 (somewhat low) mg/dl
    LDL-C: 48 mg/dl
    TG: 41 mg/dl

    About 2 weeks into my keto experiment I decided to get a much deeper set of tests done just to have some benchmark. Yes, it would have been better had I done this before I started and yes, it would have been better if I hadn’t started keto 3 days after finishing a 100 mile ultra…however….life isn’t perfect…so I got the standard lipid profile plus LDL-P and also a set of thyroid tests (TSH, fT4, fT3) just to get a baseline as well as vitamin D as I had been low before.

    Total Cholesterol: 190 mg/dl
    HDL-C: 66 mg/dl
    LDL-C (direct): 104 mg/dl
    TG: 58 mg/dl
    LDL-P: 1471 nmol/L
    LDL-Small:240 nmol/L
    LDL-Medium: 290 mol/L
    HDL-Large: 6317 mol/L
    LDL Pattern: A
    TSH: 0.54 uIU/mL
    fT4: 0.96 ng/dl
    fT3: 2.34 pg/mL
    Vit D: 18ng/mL

    Compared to 2 years earlier these numbers seemed to be worse however it was only 2 weeks after starting a high fat diet and just over 2 weeks since a highly inflammatory endurance event so it was tough to know what was to blame…and I had no previous particle count to compare. My HDL did look better so I decided that the only way to know would be to continue with my keto diet and then re-test a couple of months later…which I have now done.

    In the meantime I tried to get on with life on a keto diet including working, socializing and training. I don’t want to write a huge amount but a few points that people new to keto might find useful:

    1. I didn’t find adhering to the diet particularly difficult. It was slightly more tricky than it might have been as I had to drop red meat (I have hemochromatosis and so until I get my iron levels down I am staying off red meat). I ate a lot of dairy but I have never had any ill effects and that didn’t change. I ate mac nuts, eggs, plenty of green veggies
    2. I have to be honest and say that I don’t feel like I felt amazingly better. This is just my own personal feeling and I know lots of others feel a lot better. I did feel more stable in terms of blood sugar and hunger but I don’t feel like Ive slept any better and maybe slightly worse.
    3. I struggled at first with too much protein but that was easily fixed and I would seriously advise anyone trying this to be very careful on the amount of protein. I would say even more so than the amount of veggies.
    4. Once protein was under control I have been solidly in ketosis for about 2.5 months. I have fasting levels well above 1MM, often above 2. I have post exercise levels as high as 6+.
    5. My main struggle has been getting salt/water balance correct and not letting it slip. I was previously a very low salt guy. Not because I was worried I just didn’t eat any processed food and very lightly salted food at home. I had a b.p. of about 110/65 and so when I went on keto I got very lightheaded and it took me a while to realize that it was the salt and also to realize that it took me multiple days of taking adequate salt to recover from a deficiency. I thought that if I took a bouillon cube with water it would suddenly make me feel ok. My experience was that it didn’t but that over a period of 2-3 days it would resolve. I also made the mistake of taking lots of salt and not enough water. This just dehydrated me and jacked up my heart rate. Then I did the opposite of too much water and not enough salt…that just causes nasty headaches! 🙂 I would say the best is the same as Peter suggests…just build in a couple of cups of bouillon every day into your schedule. Living in Hong Kong didn’t help so much as you lose a lot in sweat outside and the buildings are heavily air-conditioned (so cold that you need sweater inside) so you lose a lot of water.
    6. My training was very tough. heart rate higher by 10-25 beats for equivalent exertion. I found that ensuring I was taking in enough water/salt helped and that it did improve but I have not been able to get a really consistent month of training whilst on keto to fully get my body adapted and make it work. I did a metabolic test and found out my RQ at different HR/pace and I did feel that I got some improvement but I have found that I was struggling a bit with feeling good generally (mainly salt/water issues) to train enough. I believe with time I could adapt and Im sorry that I haven’t done more. My resting HR had previously been about 38-42 and is currently 50-55 but I expect that may also have improved with more training.
    7. I found that on the one occasion I ate too many carbs (brussels sprouts and super starch) and knocked myself out of ketosis. My blood ketone levels dropped to 0.3 around midday but I carried on eating lots of fat and within 2 hours they were back above 2MM. However, I discovered that my body didn’t recover for a few days regardless of what my ketone levels were saying. I was producing tons of ketones but it felt as if by being exposed to too much glucose my body was not utilizing the ketones as much. This was most noticeable overnight after I ate too many carbs at lunchtime. I went to bed with ketone levels of 3.5 after a high fat evening meal and I woke up with levels of 0.8, glucose levels of 5.9 and a feeling I can only describe as a hangover…my ketone levels rebounded quickly after breakfast but it took another day or 2 before I felt better again. This was interesting to me as people often seem to talk as if they feel good once they get their ketone levels back up after being knocked out but that wasn’t my experience. Perhaps it is because I hadn’t been in keto long enough and my body would behave differently after a year or 2. My daytime levels were immediately back up but for 2-3 days I felt bad, my fasting glucose was spiked and my morning ketone levels were lower. It was almost like I had to go back through a few days of adaption and running down glycogen stores but my body was still producing ketones…This surprised me.

    So, I would say that up to today I have had a couple of periods of feeling very good and lots of ups and downs as I try to dial it in and get it right. I definitely feel that getting it right for day to day life is a LOT easier than getting it right whilst trying to train athletically but that is just my opinion. I think I was maybe just bad at getting salt intake correct but when I dropped my training and just tried to live my life things became easier. I had thought of ditching it a couple of times just when I was struggling with lightheadedness that would seem to not go away but I wanted to stick with it and try to make it work for me. I never really craved carbs and have enjoyed the food very much.

    The only thing I wanted to be sure of was that I was not doing more harm than good by adopting this diet and I decided I would be guided by the numbers. I have got to the point of having the salt and other small issues pretty dialed in and I take several ketone and glucose blood readings per day so have been able to understand how my body reacts to different foods. The main issue for me was to see if those blood markers that looked sub-optimal 2 weeks in had got better, worse or stayed the same 2 months later. I had not done a lot of heavy training or races so none of the numbers would be skewed by that. I added a few more tests ApoB, HbA1C and reverse T3. I got the initial results back today. I am still waiting for the reverse T3 and the particle count but sadly nearly every single number that I did get so far has got worse..

    Total Cholesterol: 251 mg/dl
    HDL-C: 62 mg/dl
    LDL-C (direct): 163 mg/dl
    TG: 80 mg/dl
    HbA1C: 4.7%
    ApoB: 149 mg/dl
    Lp(a): 3.4 mg/dl
    TSH: 0.75 uIU/mL
    fT4: 0.94 ng/dl
    fT3: 1.96 pg/mL
    Vit D: 38.5ng/mL

    The total cholesterol increase and LDL increase I was less surprised about and by itself I wouldn’t worry but with an ApoB of 149mg/dl I expect the particle count to also come back very high. Another thing that I was surprised by was an increase in TG from 2 months ago, which was already an increase over my low fat diet. I really hadn’t expected worse TG. There is a slight change in thyroid numbers but I honestly don’t have any symptoms of thyroid problems and was mainly getting these to check. My Vit D numbers improved which just showed that my 5000IU supplementation had helped.

    Given the fact that a) I had pretty decent health and biomarkers before I started keto. b) I had no signs of metabolic syndrome or any issues with carbs in my diet. c) since starting keto many of my biomarkers appear to be going in the wrong direction. I feel like I have 2 choices.

    1. Try to continue with Keto but drop my SF intake and replace with MUFA (I am obviously aware that people have had success with this).
    2. Try moving back to something closer to my old diet with more carbs and less SF

    I have decided to go for option 2. If I had any metabolic issues before I started then I would think it worth trying to make keto work but I was doing this as an aid to my training/racing and it seems to me that this diet is probably not the one best suited to my genetics/metabolism. I was really hoping I would have numbers like Peter whereby my SF intake had only +ve effects on my lipid profile but thats not the case.

    I don’t believe that my experience means keto is dangerous. I don’t believe anyone else should use my experience as a reason not to try this diet. I do think that I will still incorporate more fat in my diet than I did before I started keto (butter, animal fat etc.). I do think everyone should make their own minds up about their diet and not try to be pigeon-holed into what someone is telling them. I do also think that having the appropriate tests to really see what your body is doing is important to help guide decisions.

    If in 1 year, 2 year, 5 years time we are able to understand the cholesterol profile changes I have seen and we are able to either scientifically explain them as safe or understand what causes and how to prevent them I would definitely try a keto diet again. I may also want to try it again if my body starts to show metabolic issues with carbs. If that happens then I will be optimizing for something different. I may be willing to be more restricted in my eating to stay in keto. For now I plan to switch back to my previous diet by adding more carbs to my diet in the form of veggies, sweet potatoes and maybe some rice and remove some of the saturated fat from cream and cheese and then re-test in 2 months.

    I do feel sad to be changing my diet but I think that is mainly because I saw such potential and had spent 3 months struggling with it and learning the ins and outs. I hope I can incorporate some of what I have learned into my new diet, even if it is not a full on keto diet.

    I find the whole subject of nutrition extremely interesting so I will definitely be continuing to read this blog and other sites to learn more from other peoples experiences.

    Tsk again Peter for all the time you spend on this site. I have found it an invaluable resource.

  15. Peter,

    Regarding this: ” 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”

    I have actually not seen discussions specific to LDL-P not being important. Actually, I have seen the exact opposite in the LCHF community. I am LCHF and my LDL-P spiked and had to reduced my SF intake and rebalanced the Fat and protein mix and they have reduced significantly.


  16. Hi Peter,

    I have come to suspect that I might have a rare disease called hereditary fructose intolerance (HFI) in which newer evidence suggest that both heterozygotes as well as homozygotes suffer from an deficiency in fructose metabolism, leading to a paradoxical reaction of hypoglycemia after ingestion of sucrose, fructose and its cognate sugars. I´ve tried reaching out to Dr. Tolan of Boston Uni. ( before going to my physician next week in order to convince her of doing a genetic test for this condition. There are other diagnostic tests (fructose challenges) but for homozygotes of HFI they are risky, i.e. sufferers are reported to have died from I.V.´s containing fructose and sorbitol (a cognate sugar).

    I thought you might find this topic interesting considering your involvements and interests you´ve shared on this blog as well as NUSI, so I just wanted to let you know. Also, I am no scientist so I believe you are much better off researching (if needed) aldolase B deficiency ( – I know wikipedia is a terrible source, sorry) yourself rather than me trying to explain it to you in detail. But, I was wondering if synthetic ketones or perhaps MCT-oils might get around how this deficiency kills people (hypoglycemia due to inhibition of convertion of glycogen to glucose, in my simple understanding) and perhaps be life saving for sufferers of HFI?

    I would love to hear your thoughts on this, and I hope you find the subject interesting. There is so much we don´t know about sugar metabolism, so I hope this rare disease might be a way to learn more about it.

    Thank you kindly,

    Christopher N.

  17. Peter, you’re very busy. But we still miss your posts. 🙂

    You said you had a few dozen topics to write about. Maybe put 1 to 2 days aside and deliver at once 3 to 6 posts you think should have been written? There must be some that are high value but quick. Or some short and to-the-point summaries.

    Imagine seeing them published and everyone happier and healthier? 🙂

    Hapy new year!

    • @peter

      Posts I’d love to see and believe, from your previous comments, that you’d like to write about too.

      The straight dope on Fasting (intermittent, multi-day, how-to safely, benefits and risks, using it to help get into NK, etcetera).

      Appetite regulation.

      Effects of caffeine and alcohol on insulin sensitivity and NK and how to minimize bad effects through dosage and timing.

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