Thread by @ethanjweiss

As some of you may know and some of you may wish not to know, I started a little experiment about 10 months ago and began eating a low-carb and high fat diet for the first time in my life. I have not been tracking macros specifically but I can say a few things:

1) I have been in nutritional ketosis pretty much every day (as measured by countless ways) save a few days here and there where I accidentally or intentionally slipped

2) I have eaten between 20 and 75g of carbs/day (estimated)

3) I have tried to keep my protein intake about the same

4) Since, as I am fond of saying, nutrition is zero-sum, I increased my intake of fats. Here, I tried to keep SFA intake about the same as it was and tried to boost intake of MUFA

I have chronicled the effects on my wardrobe and belt before so why the update? Well, I finally decided to look at my lipids. But 1st, a refresher on what has happened to my body in 10 months. As an aside, I feel as good as I ever have but I can’t quantitatively prove that (yet)

Here are data from my “smart” scale. It’s an older Withings Body scale for those who care. Here is my weight over the past year. Since March, I am down about 18 pounds

Whatever you think about bioimpedance as a method, it is hard to argue that there has also been a change in my body composition. At one point, I think I calculated that I lost 15 pounds of fat

And finally, here is my BMI. I’ll write more about this later, but I was not overweight when I started & did not intend to lose weight. I was concerned about some metabolic red flags (my fasting glucose was 113 mg/dL). More later but suffice it to say that is not true today

So what about my lipids? Well it may surprise some of you that as a preventive cardiologist, I don’t really pay much attention to them. In fact, the last time I had checked was when I did my Theranos experiment in 2015 and then it was just a plain fasting lipid profile (I had 3)

I’ve never done advanced lipids before & no, I’ve never done a calcium scan. Here are my baseline lipids. For what they are, they were good. At this time, I was 46 & my 10 year ASCVD risk was 1.4%. I did not then & do not now take any medication or supplement

Here is the update from a week or two ago. This time I did do advance lipids (the CardioIQ + inflammation from Quest). Here are just the basics. The changes are mostly what you’d expect. My TG went down and the HDLc went up and the LDLc is about the same

FWIW my ASCVD risk is now 1.8% but I went and calculated what it would have been today with exactly the same lipid profile I had back in December 2015 (above) and it would have been 2.2%

Because I was curious (I am still sorting out the clinical utility - with apologies to @Drlipid), I also did advanced lipids (again apologies to Tom, but it was just easier to do Quest)

Here they are. I won’t comment too much on them because I don’t have baseline, but again there are few surprises here. I’ll be sure to write more about this later but my intention in doing this was to determine whether anything bad happened when I changed my diet

I think the answer to that is a pretty clear no. If anything, my numbers are slightly improved and since I feel as good as I ever have and the effects on my metabolic health (more later) and my body have been so good, I see no reason to stop. Will I do it forever, who knows?

Again, this is not meant to be taken as n=1 this is going to change the world though it has certainly gotten me thinking and has changed my life in many many ways. But really, I did want to know if I was doing something risky

I can’t say anything about long term risk but the effects on this set of biomarkers is very reassuring to me & I thought it was an interesting little dataset so hence why I am sharing today...

And finally, thanks for bearing with me on this (@adamfeuerstein muted me long ago)

A few updates in response to ?'s I've gotten today:
1) I stopped drinking beer but I continue to have ~2 glasses of red wine each evening almost without fail
2) I have always wished I exercised more. That has not changed. I still try to work out in some way a few times/week

3) I have not gotten a calcium scan and as I said, I take no medicines or supplements. I suppose I might sometime, but right now can't really see why with my risk as low as it is