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My Three Day Water Fast

Aug 24, 2018 at 12am

Three days. No food. Only water. Whoa. This was the adventure that I embarked on from August 18, 2018 until August 21.

But why, you ask? Primarily to lose a few stubborn final pounds. At that point I had lost about 19 pounds in 2018, but I still had seven pounds to go to hit my goal. I had been stalled for a couple of months and I was looking for something new to get me across the finish line.

I never would have tried a three day water fast unless I had heard about it on Kevin Rose's podcast. The idea of fasting always seemed attractive to me, but not eating anything for three days seemed pretty dangerous. After I heard Kevin introduce it as a thing that people did though, that lead me to do some research, and finally convinced me to go for it. In addition to the weight loss possibilities, I was also attracted by the concept of autophagy (which seems valid, but then again, what do I know).

Below is a hodgepodge of thoughts from my experience.

  • Mild initial panic on Day 1. After about 18 hours or so or not eating, realizing that I had another 50+ hours to go I did feel a low-level sense of initial panic. This didn't last long and was very manageable, but if I hadn't done some research before starting I would have probably bailed at this point, fearing that I was about to do some serious harm to myself. Other than this issue though, Day 1 was pretty easy.
     
  • Smooth sailing on Day 2. This was far and away the easiest and best day. I had no mild panic, completely manageable hunger pangs, and an overall sense of "hey, look at me, I'm doing it!". It definitely helped that I dropped three pounds by Day 2.

  • Feeling poopy on Day 3. By the third day I felt pretty bad. When I woke up in the morning I felt weak and light headed, and it was difficult to pay attention to multiple things at the same time (more on this later). It helped though that I was now down five total pounds (in less than three days). On my way to work, with 12 hours still left to go, I definitely considered bailing and calling it quits. Then however, I realized that I hadn't had any water since the night before. As soon as I slammed some water down my throat, I felt better -- not great, but mangeably better. Even so, by around 5pm I had a splitting headache and I was ready for it to all be over.

  • Fast Breaking Meal: I had done a good bit of research about what food to eat when breaking a fast. There was lots of competing advice but I ended up going with fruit and rice cakes. I went to Whole Foods right after work to grab the food and I started eating it before checking out. I probably had about 900 calories and I felt 100% better immediately.

  • Overall it wasn't that bad. The whole process wasn't nearly as bad as you'd think. There were many times when I felt great, in fact -- better than normal. While I found that it was hard to context switch or multi-task (e.g., I had a hard time talking to someone and typing at the same time), I found it easier than normal to deep focus on one particular task. Also, one thing worth noting is that by Day 3 I felt pretty sore inside my stomach and chest -- similar to if I had done a ton of sit ups (that feeling went away within 36 hours of breaking the fast).

  • Final weight loss results: I lost almost exactly five pounds in three days. I'm typing this now four days after the fast ended, and the scale says that I've added back 1.5 of those pounds. As a result then, I probably legitimately lost 3.5 pounds in three days. That may not sound like much, but if you've ever done serious dieting (where "aggressive" means losing two pounds in a week), these results are phenomenal.

    Update (September 3rd, 2019): It's roughly two weeks later now and I'm back down to a full five pound loss from the water fast. Since I broke the fast I've eaten mostly low calorie (though I've had some cheat days). Point being: I think I really did lose (and keep off) a full five pounds from the fast!

  • I'd do it again. Aside from Day 3, the process was pretty darn easy. I do think that I'd do another three day water fast in the future, and next time be more strategic about drinking water as soon as I wake up (and maybe even once during the night). Or, I might only fast for two days next time. Overall though, the whole adventure was mostly postive and worth repeating.
More Posts About... diet / fasting / health

CalorieCalc

May 21, 2018 at 12am

I finally found a calorie counting iOS app that I like. It's called CalorieCalc.

It's crazy dead simple, which is what I prefer. Don't give me a giant food database to pull from, don't try to track my exercise, and don't ask me to care about micro-nutrients. Just let me tell you my calorie limit for the day and then allow me to burn down from that limit by manually entering calories for each meal/snack.

I suspect that I'm in the vast minority in wanting such a limited calorie counting app.

More Posts About... diet / ios / app / health

An Epic Saga: My Giant LDL Spike 🚀 from a 3.5-Month Low Carb/High Fat+Intermittent Fasting Diet

Jul 25, 1999 at 12pm

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.

Chapter 1: Rapid Weight Loss

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:

  • Low-Carb High Fat (LCHF): I ate roughly between 30-75 carbs per day. My diet mostly consisted of meat, cheese, eggs, and other high protein and high fat foods. I think there was one week where I ate a 12-ounce steak three days for dinner. I also got addicted to Enlightened's Keto Ice Cream product (which I ate a pint of 2-3 times per week). Note that many of the flavors of this ice cream have a whopping 40 grams per pint of saturated fat (and remember that I'd be eating steak and other fat before eating the ice cream) -- that means the ice cream alone was pushing me far, far past the recommended saturated fat intake per day
  • Intermittment Fasting (IF): I would only allow myself to eat after 4pm each day. This usually meant that I would fast for between 14 to 21 hours per day (depending on how early/late I ate the previous day). On most days I used the Zero app to track my fasts. 

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.

Chapter 2: Blood Test #1

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)?

Chapter 3: Research

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:

  • Years ago, Dave Feldman went through a situation very similar to me: he lost a bunch of weight on a low-carb diet and saw a giant spike in LDL (I think Dave's LDL count was even larger than mine, as I recall him mentioning his LDL number in a video; unfortunatley though, I can't remember which video that was to adequatley source this claim). As explained in his research, I came to appreciate the following: (a) there are a not-insignificant number of people who have seen and/or experienced large LDL spikes due to a LCHF diet, and that these people are called "hyper-responders" (or "lean mass hyper-reponders"); (b) this phonenomenon is not well understood nor accepted (or even known about) within the medical community; (c) there was a chance that I was a "standard" (versus lean-mean) hyper-responder (I based this belief on many factors, including my results from Dave's calculator, which are shown below).



  • There were a bunch of really smart and qualified people (see the list above) who were challenging the traditional lipid hypothesis. Virtually none of these people were brazenly suggesting that having an elevated LDL wasn't a cause for concern -- rather, I would summarize that this group was collectively proposing the following: (a) the problem at hand is not as simple as a "high LDL = bad vs. low LDL = good"; (b) if you have a high LDL number, that should trigger you to do significantly more blood work (and other tests) to identify if you indeed have a problem on your hand that requires action, and (c) in some (though certainly not all) situations, having a high LDL may not play a negative role in constructing your overall health profile.

  • To dig deeper into your personal LDL situation, you must collect a bunch of additional data. I would bucket each data point that you need to collect into one of two categories:

    • Data Points You Can Collect Yourself, Without Additional Lab Tests:

    • Data Points that You Need a Doctor Help You Collect, By Ordering Additional Lab Tests:

      • What is your c-reactive protein (hs-CRP) level? As explained by the Mayo Clinic (in the article just linked to), "A high level of hs-CRP in the blood has been linked to an increased risk of heart attacks." This is a routine blood test.

      • What is your ApoB level? As explained by Dr. Bret Scher (in the article just linked to), "ApoB and LDL-P are likely better markers than LDL cholesterol level for predicting cardiovascular-disease risk. [...] Also, many experts believe ApoB is likely a better marker than LDL-P since it includes VLDL and IDL in the count." This is a routine blood test.

      • What is your calcium score, as measured by a coronary artery calcium (CAC) scan? As Peter Attia says (in the article just linked to), "When I talk about CAC, I often use an analogy of atherosclerosis as a crime scene involving breaking, entering, and vandalizing. A criminal went into your house while you were on vacation and did some damage to your home, damage that was somewhat irreparable in that you couldn’t repair your home back to a state where you never would’ve known there was a break-in. Holes in the walls of your home needed to spackle to patch them up. The repair work left clues of damage. In the case of atherosclerosis, a lesion is a damaged artery, and the calcium deposits are a sign of repair to the artery." The bottom-line with a CAC scan is, if you have a score over zero, you want to know that, and factor that into your decision on how to treat your elevated LDL count. This is a completly painless CT scan that takes less than 10 minutes and requires no preperation.

      •  Is your LDL count comprised of mostly large/fluffy LDL particles or small/dense LDL particles? As explained (in the article just linked to), "Over the past two decades, it has become apparent that LDL particle size plays a very important role in determining the risk of [Congenital Heart Disease]. As shown below in Figure 1, people with LDLs that are primarily small and dense face a much greater risk of CHD than people with LDLs that are larger and less dense. In other words, two people with the same elevated LDL value might actually be at very different levels of risk!"

Chapter 4: Diet & Exercise

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:

  • 150 grams of protein
  • 150 grams of complex carbs (including at least 60 grams of fiber)
  • 86 grams of fat (of which only 15 grams could be saturated fat)

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:

  • I stopped drinking any coffee. While I don't think there is conclusive evidience that coffee increases LDL counts, I found enough studies that made me give it up trying this period of my life.
  • I gave up virtually all animal products (except low-fat cottage cheese -- which I realize is an odd thing to hold on to, but it gave me something to spread on bread).
  • I started taking roughly four pills a day of CholestOff.

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:

Chapter 5: Doctor Visits

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):

  • "That's a very high and potentially dangerous LDL count. Let's try lowering it with diet and exercise for 90 days, then let's retest."

  • "If the number is still above 190 after 90 days, you need to be on a statin."

  • "Your LDL spike could have been due to LCHF+IF, or it could have always been this high. I'm not sure. I don't have any experience in that domain."

  • "I'm happy to order an advanced lipid panel for you (to see if you have large/fluffy LDL particles or small/dense LDL particles), but if you're above 190, the results of that test won't change my decision to recommend a statin."

  • "You are too young to benefit from a coronary artery calcium (CAC) scan, as you may have plaque that hasn't yet calcified. Even if your score is zero, that test won't change my decision to recommend a statin."

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:

  • As I had hoped, she had a strong clinical and literature-based understand of not only cholesterol in general, but the potential (and highly indivudalized) effect of LCHF+IF on cholesterol. She talked with about other patients she had worked with who had seen large LDL spikes due to LCHF and rapid weight loss in general (which was high encouraging). 

  • Unlike the PCPs I had seen, she spent 80 minutes with me. (To be fair to the PCPs, I paid out-of-pocket to meet with this third doctor. It's not realistic for non-concigere PCPs to spend this much time with each patient.)
  • She had a highly actionable and data-driven approach to handling patients with high LDL numbers. She recommended the following:

    • Right away, take two additional tests: (1) coronary artery calcium (CAC) scan; (2) another basic cholesterol panel (I had now spent 20+ days off of LCHF+IF, and she wanted to see if my cholesterol numbers had changed at all during this time).

    • Wait another 65 or so days, and then take the following tests: ApoB, c-reactive protein (hs-CRP), advanced lipid panel (to determine the composition of my LDL particules, in order to determine if htey were large/fluffy/safer versus small/dense/more harmful).

    • As the PCPs had suggested, she said that if my LDL was still >190 after 65 days, I needed to be on a statin. That said, if it was <190 but still >130, then she would use all of the data listed above to help me decide whether a statin was appropriate or not.

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!)

Chapter 6: Additional Lab Tests

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):

  • Total Cholesterol: 279 to 161 (73% drop)
  • LDL-C: 221 to 105 (52.49% drop)
  • HDL-C: 38 to 42 (11% increase)
  • Triglycerides: 86 to 62 (28% drop)
  • Non-HDL Cholesterol: 241 to 119 (51% drop)
More Posts About... health / cholesterol

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