tl;dr: I lost ~30 pounds in ~100 days via a LCHF+IF diet, and then took a blood test (for the first time in many years). My LDL count was found to be through the roof (221!). I was terrified, primarily because I had no cholesterol baseline to compare my latest numbers against (since I had, to my knowledge, and despite being 40 years old, never before taken a cholesterol test) -- I had no idea whether my weight loss had spiked my LDL, or if my LDL had been severly elevated for decades. I did a bunch of research online, and learned about (amongst other things) Dave Feldman's hyper-responder theory. I also dropped the LCHF+IF diet and moved immediatley to a low-fat, complex-carb-friendly diet. In less than 30 days, my LDL went from 221 to 105! It was a roller coaster of emotion, stress, and rapid learning, to say the least. For context, note that I'm 40 years old, live in the United States, and have otherwise good health with no known issues or medication requirements.
Note: For readability purposes I've organized the narrative below using discrete and serial chapters. In reality, however, I navigated many of these chapters concurrently and in parallel.
On March 14, 2022, I weighed exactly 183.2 pounds. For my height (I'm 5'8.5), that left me with a BMI of 27.1 -- this is firmly within the "overweight" zone, and only 2.9 points away from "obese."
On this day I started a new diet, which revolved around the following parameters:
The weight came off extremly quickly. I weighed myself each day using the Withings scale, which produces great charts like the one below:
Point 1 in the graph is my weight on March 14, 2022, when I started the diet -- my weight was 183.2. Point 2 is June 22, 2022, the day of my blood test -- my weight was 157.8. Between these two days, exactly (and concidently) 100 days had past, which is 14.29 weeks. I had lost 25.4 pounds in 100 days, at a rate of 0.25 pounds per day, or 1.77 pounds per week.
At the time I did not have a primary care provider (PCP), but I knew that I wanted to get a blood test nonetheless. It had been decades since I had last seen a doctor and done a comprehensive blood panel, and I felt like now was the perfect time since I had recently lost a bunch 'o weight. As a result, I ordered a Comprehensive Health Profile from Quest Diagnostics. I took the test on June 22, 2022, and recieved my results on June 28th, 2022.
I was shocked and terrified by the results. Below are screenshots of the Heart Health portion of my result report:
At this point I had basically no understanding of what cholesterol is or how to interpret these results -- after a few quick Google searches I simply knew that an LDL of 221 is astronomically high. I began to panic, not only because the numbers was so large but because I had no idea how long my LDL number had been so elevated. Had I been developing heart diseases for 20 years? Did I have familial hypercholesterolemia (FH)?
And so I did what anyone would do: Scour the internet for information to try and understand what was going on. I was not only searching for information to better understand cholesterol at a general level, but also to understand how diet -- and specifically a combination of LCHF+IF -- can affect cholesterol levels.
Before long I came across the following voices:
And so what did I learn from all of this? So much! Here's a quick summary:
As this point my main goal was simply: Lower my LDL. A lot.
It's important to remember that, for me, I had no pre-weight-loss LDL baseline to refer to. As a result, I had no idea whether or not my LDL had been massively elevated for decades, or if my LDL had spiked due to my LCHF+IF diet. As a result, my primary goal was to determine what my LDL was outside the context of a LCHF+IF diet.
As a result, I dropped LCHF+IF and pivoted to a diet that consisted of the following daily macronutrient composition:
Concidently, however, right before I recieved by blood work (which showed the elevated LDL count) I had started using a continious glucose monitor (CGM) from Levels. If you're not familar with CGMs, they are medical devices (long used by diabetics) which track your blood glucose levels. You insert a CGM into your arm using a tiny (and 100% painless) needle, and the device stays attached to you for 14 days -- after which point you replace it with a new one. You scan the device with your phone every few hours to see and track your glucose levels through out the day, especially after meals. CGMs can help you understand how insulin sensitive you are, whether you are possibly on the road to prediabetes or even diabetes, and what specific foods spike you the most (as each person is different here).
You're probably wondering: What the heck does a CGM have to do with my persuit of a lower LDL count? The answer: Nothing. Or least, the two aren't direclty related. That said, another major goal that I had was to not gain back any of the weight I had recently lost. A secondary goal was to ensure that I was eating foods that were healthy for me from an insulin resitatance standpoint. If you've read Jason Fung's The Obesity Code, you understand the importance of controlling and minimizing the level of insulin in your blood throughout the day, as a mean by which you control weight gain and insulin insenstivity. As a result, a CGM helped me achieve these goals. I only ate food that: (a) didn't spike me past 140 (but ideally less than 120), and (b) didn't keep my blood glucose level above 100 for more than a few hours (allowing me to maintain an average daily glucose of 95 or lower). I was also very carefuly about when and how often I ate. To keep your blood glucose low, it's best to only eat during defined meal times, and not at all during non-meals times -- this allows you to go long stretches of time without seeing any food induced glucose spikes. I ate breakfast in the morning and then nothing until dinner that night -- these were the only two times I consumed calories (
I also made a few other dietary tweaks:
Cronometer became an invalueable tool for me. Nothing went into my stomach without being track in Cronometer. Below are a couple of screenshots from this tool of one of my typical days. Using this data I was able to identify precisely how I was doing with respect to each macronutrient goal.
A problem that I ran into right away was that I couldn't stop losing weight. This was likely because it's very hard to get to 2,000 calories a day if you apply the macronutrient limits that I mentioned earlier. As a result, on average I ate only about 1,700 calories per day, plus (as will explained below) I was exercising at least 150 calories away per day as well. Between my first blood test (on June 28th, 2022) and my second blood test (which will be explained later in this blog post), I lost an additional 3 or pounds. Why is that a bad thing? Because I found a fair amount of research suggesting that -- even outside of a LCHF diet -- rapid weight loss on its down can temporarily spike LDL, and that the spike may not disipate until after weight loss stablizes. I did my best each day to construct a diet that got me the maximum amount of calories possible (within my macronutrient constraints), but this wasn't easy.
I also started seriously exercising, essentially for the first time in my life. The connection between exercise and LDL seems to be somewhat unclear. I found some studies suggesting that exercise may reduce LDL, while I found others declaring that exercise is unlikely to affect LDL. Nonetheless, it's hard to argue that -- even outside the consideration of cholesterol -- regular exercise is something that I should be doing. As a result, between my two blood tests I complete the following runs on a treadmill:
As mentioned earlier, I did not have a primary care provider (PCP). Nonetheless, I knew that I needed to see a doctor quickly to review my blood test results with them.
I essentially found the first available PCP from Houston's best medical system (Houston Methodist) and went in for an appointment. The MD that I saw was very nice and patient with me -- she let me explain my entire situation, without rushing me or interupting. When I finally showed her my blood work and LDL count, her reaction was as expected (my quotes below represent paraphrasing; they are not direct quotes):
Let me be very clear: I found everything that she said above to be entirely fair and reasonable. In fact, after all of the research that I have done since this appointment, I share her opinion: If your LDL is above >190 after three months of trying to lower it with diet and exercise, I believe that you should be on a statin, regardless of any other data point. While there are strong arguments/studies that high LDL counts often don't correlate with atherosclerosis, I find that there are equaly strong arguments/studies to the contrary.
I left this appointment quite scared. I think I was unconsioculsy hoping the doctor's reaction was going to be something like, "Oh yeah, this is from LCHF+IF! There's nothing to worry about here, I see this all of the time. Give it three months and it will come back down." Instead, I felt like I had the same experience that George from "Seinfeld" did when he saw a doctor about a "slight discoloration" on his lip. I wanted the doctor to say, "Come on, get outta here -- you're fine!" But that is, of course, naive on my part. The doctor reacted exactly as she should have.
Nonetheless, I wanted a second opinion. Well, not really a second opinion (since I didn't disagree with the first opinion) -- rather, I just wanted to see an MD that better understood the connection between LCHF+IF and LDL spikes. As a result, I found a second PCP (this time from UTHealth). This MD told me almost exactly the same thing -- he essentially said, "I don't have any experience with LCHF+IF, so let's get you on a mederterain diet for 8 weeks, and then re-test. Don't worry about a statin right now, we'll cross that bridge if and when we get there."
I felt a little better that two doctors had given me the exact same advice -- at least I had consensus on next steps. That said, I was discouraged that I couldn't find a doctor who had any experience with LCHF+IF.
Then, out of the blue one day, my wife said, "You know, I work with someone who's wife is a nutrionist. You should see her to figure out what you should be eating to lower your cholesterol." I thought it was a decent enough idea, so I started looking into it. I was super pumped to see that this person wasn't only a nutrionist, but was actually a full MD who had completed her residency in Internal Medicine through Harvard Medical School at Massachusetts General Hospital. Even better, she operated her own private practice right next to my house. Best of all even, it looked like she focused (or at least, often recommended) LCHF diets. Perfect!
When I finally saw this doctor, things really started moving in the right direction. Here's how my meeting with her went:
I left this meeting very encouraged! I immediatley made scheduled the two additional tests I was to take right away.
(Note: I'm hesistant to list this doctor's specific name/practice, only because I'm summarizing her findings above in my own words, without first giving her the chance to review and modify them. If anyone wants her name, please DM me via Twitter and I'd be happy to give you her name. She is excellent!)
First I did my coronary artery calcium (CAC) scan. It took less than 20 minutes total (including my time in the waiting room) and was completly painless. Here's a video showing what the testing process entails.
While taking the test was easy, waiting for the results was horrible -- and I only had to wait about 16 total hours. At my age (40), finding out you have any calcium (that is, a score of anything other than zero) indicates that you have (in Peter Attia's words) a "four alarm fire" on your hands. As a result, I was (if I'm being honest) beside myself with fear of getting back a positive score. When I got my results (shown below), I was relieved, to say the least:
It's important to note that most doctors believe that a negative scan doesn't necessarily mean you're 100% healthy and free of any risk if you are under 50 (again, here's Peter Attia on this topic). For my personal situation, since I had no pre-LCHF+IF cholesterol baseline, I was using a CAC test to evaluate whether or not I had had severly elevated and untreated LDL counts since I was a child, in which case the calcification process may indeed have already started over the course of 30+ years. Receiving a score of zero was not defintinve proof that I didn't need to be on a statin -- it was simply an encouraging data point that I didn't (yet) have ragging heart disease.
Next, I took another basic cholesterol test. I spent a lot of time mentally preparing myself to see no significant changes in my LDL count from this test, since it had only been exactly 20 days since my first test. My hope, however, was that I would see a move in the direction -- I would have been over-the-moon with a 5% to 10% drop in my LDL count.
When I got my results (again less 24 hours after taking the test), I was... Shocked.
To my utter amazement, my LDL count had dropped a whopping 52% in 20 days.
Below is the actual result report from this blood test:
And here's a full before/after comparison between the two bloods tests (again, 20 days passed between the two tests):