With permission, I want to share an n=1 story from a very interesting person I have been advising casually. He is young and very active (just ran an ultramarathon for the second time).
He sent me this email about a year ago:
"I recently read about your research on the keto diet. I just lost a close family member to cancer and dementia and have a family history of heart disease, diabetes, cancer and dementia...
"I recently read about your research on the keto diet. I just lost a close family member to cancer and dementia and have a family history of heart disease, diabetes, cancer and dementia...
...As such I've been trying to do anything I can to hedge my bets. I have been on a ketogenic diet for about 18 months and feel great but have had a spike in my LDL that is concerning"
He sent me his labs at that time showing what had happened to his lipid profile when going on keto 
When we spoke last fall, I made some suggestions. I don't even recall really what I said but it did not appear to be very helpful
At this point, I guess he'd be classified as a lean-mass hyper-responder as per @DaveKeto. Anyway, around this time, I started to get very interested in what would happen to these people if you replaced the majority of their SFA intake with MUFA and predominantly n3 PUFA
He was doing full on keto with heavy cream in the coffee, butter on everything, lots of meat, cheese etc. So I suggested that maybe he try replacing much of the SFA with UFA. Practically, this meant adopting mostly a plant and fish-based diet
So he told me he actually loved fish and preferred to eat it. As an aside I do think many people doing keto diets think there is only one way to do it. So he replaced most of the meat with fish and butter with olive oil. He uses hemp milk and avocado oil in his coffee...
He feels great and remains in ketosis. He says he just shaved 40 minutes off his last ultramarathon time. And so what happened with his lipids? Well, here is the latest
What are my key takeaways?
1. There are many ways to do keto & it is possible to do it with mostly plants and fish (or even just plants)
2. His reason to do it was not weight loss but to optimize cardiovascular health. He reached out to me because he was concerned about his LDL
1. There are many ways to do keto & it is possible to do it with mostly plants and fish (or even just plants)
2. His reason to do it was not weight loss but to optimize cardiovascular health. He reached out to me because he was concerned about his LDL
3. He found a diet that made him feel and perform better than he ever had and not only abrogated the significant increase in LDLc he had seen with conventional keto, but reduced it to as low as it had ever been
4. This forms the rationale for developing what we are calling Key Eats which is a mostly plant and fish (or all plant) based keto diet that we recently released at @GetKeyto. Would love to hear from people about what they think
5. Lastly, we plan to study this formally @GetKeyto soon with a real prospective RCT looking at what happens to people just like this when they are randomized to a plant and fish based keto diet. As always, there is so much more to learn!
@GetKeyto I'm getting lots of questions about specifics of the diet. I will try to put together something that fits on Twitter. In the meantime, we have a lot of resources and many are freely available to download. Also there is a lot of free content on the app: shop.getkeyto.com/pages/key-eats
Also, in my interview with Ron Krauss (episode 2), we spent a lot of time discussing this (toward the end). Check it out if curious...
getkeyto.com/blog/best-know…
getkeyto.com/blog/best-know…
And the plant-based resources @cadiulus discussed with @TheVeggieMD here (podcasts.apple.com/us/podcast/nut… ) can be found here: shop.getkeyto.com/pages/key-eats…
