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@ vlada
2023-08-02 20:22:10It’s been four months since I started the carnivore diet. For the past month I have been experimenting with a more “keto” approach and added nuts and dairy products to my diet. The results are mixed, as I’ve stopped losing weight as rapidly as in the first 2 months. My BMI went down from 34 to 26.8, so I am pretty well pleased with the weight loss itself. I also feel more clear headed, more active, and my fatigue is generally gone. I am still a coffee addict, so I do get cranky and tired if I miss my morning cup, but I just love the effect coffee has on me too much to give it up completely, but I did cut back on my overall caffeine consumption. I usually drink coffee with butter, salt and coconut oil once or twice a day, and I don’t drink milk.
I figured I was due for a lab check, and I’ve compared it to the one I had 3 months ago, which was just one month into my new diet. I unfortunately don’t have a baseline test for comparison, as I had no expectations of success, so I didn’t think I’d need one.
At the start of May, my fasting Glucose was 5.4 mmol/l (97.2 mg/dl) with an HbA1c of 5.2%. These results were okay, but I didn’t test for fasting insulin, which gives a more accurate picture of metabolic health. Today, my fasting Glucose was 5 mmol/l (90 mg/dl), my HbA1c was 5.1% (mild improvement) and my fasting insulin was 13 µIU/mL (90.3 pmol/l). These measures allowed me to determine something called HOMA-IR, which takes into account your fasting insulin and fasting glucose levels. HOMA-IR correlates well with insulin resistance and can asses the risk for developing Diabetes. You can calculate the number yourself, there are plenty of calculators online, just beware of unit conversions. My HOMA-IR amounts to 2.9, which is not great, but also not terrible. I definitely think I was on the verge of developing true diabetes, and my guess is that this is an improvement, but I can’t say for sure due to having no baseline study for comparison. It is important to realize that 88% of Americans have at least one symptom of metabolic syndrome. Nobody is healthy, we are all sick due to the influence of the unholy trinity of Big Food, Big Pharma and Government, but that is another topic I intend to write about soon, don’t worry.
So, what about my lipids? Well, this surprised me. Compared to the numbers in May, my total cholesterol decreased, on account of the LDL component (”bad” cholesterol). Total cholesterol went down from 4.5 to 3.6 mmol/l (174 to 139 mg/dl), LDL went down from 3.2 to 2.2 mmol/l (124 to 85 mg/dl). HDL and triglycerides stayed the same at around 1 mmol/l (39 and 89 mg/dl respectively). The LDL reduction was significant and I’d bet you my cardiology colleagues would be surprised I managed to achieve this without a statin. I was a bit surprised that my HDL remained stationary, which is not ideal, but I’m not upset about it that much. A more accurate predictor of metabolic health than LDL is the TG:HDL ratio. In May it was 2.55, and now it’s 2.29, which actually means I have a lower risk of developing metabolic syndrome today than 3 months ago. The role of lipids in developing heart disease, however, might be overstated, and cholesterol (actually LDL) is a much lower risk factor for developing heart disease anyway when compared to diabetes, obesity, smoking and hypertension. I definitely need to do more research here, and I will talk about this in future blog posts, but I think us physicians might have jumped on the statin train a bit too eagerly. Many studies tout the benefits of cholesterol reduction, and falsely imply causality between cholesterol and heart disease, but this is simply impossible to determine without a randomized control trial (rct), which is costly and ethically untenable. These bad studies then get agglomerated into bigger studies called metaanalyses, which are treated as the gold standard of truth among clinicians... but a metaanalysis is only as good as the studies included in it.
I also tested my liver enzymes, which were all good and mean I probably don’t have fatty liver disease. It is important to asses your liver enzymes when looking for signs of metabolic illness because they can point to said fatty liver disease. Fatty liver eventually turns into full blown hepatitis, and cirrhosis soon follows, with a chance for developing cancer. Non-alcoholic fatty liver disease (NAFLD) is the second most common cause of liver transplantation in Europe and the US, and the incidence is only increasing. NAFLD also practically didn’t exist a couple decades ago, which says a lot about the current health state of humanity, and the direction we are heading in.
My serum urate levels were slightly increased, at about 477 umol/l. You probably don’t need to test this, as causation between hyperuricemia and associated diseases like gout and uric renal stones was not demonstrated. It is probably increased due to an increased purine metabolism caused by meat consumption, and might be a leftover from a period when I used to consume more fructose and caffeine. I don’t have the baseline study for comparison, but this lab result is not cause for concern.
Overall, taking into account my lab results, my age (early thirties) and family history of heart disease, I award my metabolic health a C+. I need to continue this diet, and decrease/eliminate all carbohydrates, because I will probably develop diabetes if I re-start eating processed vegetable based foods. My lipids actually showed improvement, but I’d prefer it if my HDL were higher. I don’t think I have to worry about fatty liver disease at least, and I’m not afraid of kidney stones or gout with only a slightly elevated urate level. Diabetes is the most important risk factor for developing heart disease, according to a women’s health study from 2021: https://jamanetwork.com/journals/jamacardiology/article-abstract/2775559, and I would like to avoid it if possible. My father and brother are both diabetic, the former had a heart attack at 50, and the latter at 40.
So, going forward, what’s the plan? So far I have not been exercising, and I should probably change that. Any person who recommends exercise to a patient with 30kg of extra weight should be forced to run a mile with a heavy fatsuit on a hot summer day. The overweight patient will injure himself, fail to exercise properly, fail to lose weight because the diet would remain relatively unchanged, and will proceed to give up on the whole effort of weight loss, which is precisely what Big Food and Big Pharma want you to do. So, if you are obese, focus on your diet ++FIRST++, stop eating junk, and when you shed that extra weight, then begin to exercise.
I will also cut back on the “keto” snacks, i.e. nuts. I love peanuts, pistachios and the like, but they are not a necessary and vital part of my diet either. I’ll probably leave them aside for special occasions, like going to the movies or something like that.
In my next blog entry I will talk more about what kind of food you should be eating and avoiding, what processed food does to us and how we were all victimized by the trinity of evil: Big Food, Big Pharma and Big Government; all based on the excellent book Metabolical, written by Robert Lustig.