Thread by @nicknorwitz

🚨 #LeanMassHyperResponder lowers LDL 🚨
#LEM #LMHR

1/ First off, this thread is long with lots of nuance.

But here’s the bottom line:

👉 I dropped my #LDL by over 400 mg/dL
👉 Previously ~500
👉 Now it is under 100

(Yes, you read that correctly)

Here’s how I did it…

2/ The method was quite simple:

Add in some carbs.

This shouldn’t be a news flash for anyone following our work on the Lipid Energy Model

We published on this intervention with the #LMHRpaper case series here: doi.org/10.1093/cdn/nz…

3/ I’m an example of an LMHR that eats a relatively low saturated fat diet at baseline. Even when >80% of my fat intake is MUFA/PUFA, my LDL can run >500. Thus, it’s not simply the sat fat. Even when fiber intake has been >30g with net carbs <30g, my LDL can easily run >350

4/ What recently changed is, following a fermented foods protocol in which I titrated up my intake of kimchi/sauerkraut, then natto and kefir, and prebiotics, I became able 2tolerant a greater variety of foods

5/ However, past experimentation with higher carb food have strongly suggested I still require therapeutic ketosis to keep my colitis in remission, as each time I’ve exited ketosis, I’ve begun to flare but otherwise have remained in remission for years.

6/ So, here’s what I did: I supplemented with high-dose BHB ketone ester (@geoffreywoo) and a butyrate supplement to maintain ketosis and boost exogenous SCFA levels to replace endogenous ketosis, while increasing carbs 15+g/week for a month until my intake 80-100g/d

7/ Notably, throughout this timeframe, I did not decrease saturated fat intake and, incidentally, actually increased it a bit (decreased seafood intake b/c of a slightly high mercury test at 13, and exchanged for increased pork, eggs, yogurt, and cheese).

8/ As predicted by the #LEM, my LDL dropped. I was surprised to see it dropped to 70 on the CardioChek (my lowest prior to keto was 95), and this may be because my fiber intake was higher than prior to keto.

Now, I will reflect on the implications...

9/ For myself, I’m not sure this approach is sustainable. The ketone ester costs >$130/d and tastes horrible (was able 2do this experiment bc I had a stash fr Oxford) and standard market ketone supplements aren’t currently powerful enough 2maintain high-level prolonged ketosis.

10/ Also, and apologies if this is TMI for some people, but my bathroom time has increased, and this might create conflict with my forced lifestyle during my medical training. You may laugh, but I’m quite serious.

11/ IF I could persist like this, I would. I personally have no issues have a sweet potato or banana in my diet. I’m not religiously wed to keto, but medically so. And I know other patients with similarly complex issues, which is one reason I was compelled to post this thread.

12/ Now for the juiciest bits. The big take aways:

(i) The LMHR profile is not simply about the saturated fat. Can saturated fat move the needle, sure. Is it the primary determinant? I highly doubt it.

cholesterolcode.com/lean-mass-hype…

13/ (ii) Carb reintroduction appears to be effective for lowering LDL in LMHR as an isolated intervention. Again, we have also shown this in the case series.
academic.oup.com/cdn/article/6/…

14/ (iii) Responses of myself and others are consistent with #LEM, which stands as the only complete explanation 4the phenotypes/patterns we are observing (by which I mean othr explanations can't easily explain the inverse BMI-LDL relationship, triad, etc)
mdpi.com/2218-1989/12/5…

15/ (iv) This is a SERIOUS matter. IMHO, if you are LMHR and have the luxury of simply adding back carbs, rather than gambling on your heart, why not go for it? The “cost” to you is basically a couple bananas or a sweet potato.

BUT...

16/ (v) But some #LMHR don’t have that simply luxury, and the decision becomes a more complicated calculus. For example, in #LMHR children with epilepsy, lowering LDL with diet change appears a zero sum game with seizures.

17/ It is not the place of social media influencers to try to reduce those decisions down to oversimplifications or stereotypes

Doing so is not only hurtful to patients, but disruptive of productive scientific and biomedical dialogue. And, quite honestly, I'm getting sick of it.

18/ (vi) Finally, as is nearly always the closing point, MORE RESEARCH IS NEEDED!

Thankfully, it’s coming… but it's hard work and slow going... and we could use more support…

19/ I realize this thread might stir emotions. In a sense, I suppose it's intended 2be provocative but that doesn't mean I'm trying to encourage polarization. Instead, I want us to try to think deeply and come together. And your responses determine whether I succeeded. 🙏