Ketones, Inflammation, and Some Thoughts on Cholestrol

http://www.sciencedaily.com/releases/2015/02/150216131146.htm

The article linked above is kind of important.  One of the points I make repeatedly in my manifesto is that in regard to the ketogenic diet, we are still in uncharted territory as there are still a lot of questions that need to be answered and there is a lot of important science that still has not been done.  (Even worse, there is a lot of science that has been done that just hasn't hit the mainstream as well though, too.  Check this book out to see a collection of it.)

In a part of the manifesto I spoke briefly on reduced inflammation with the ketogenic diet, I think with regard specifically to more and healthier mitochondria, but I remember I also linked out to the /r/keto subreddit, stating that reduced inflammation is one of the most common side effects brought up by new dieters.  Browse /r/keto for a while and you will see it come up in so many different ways it is astounding.

The ketogenic diet is being studied as a new possibility for the treatment of many diseases, mostly inflammation based, all the way from acne to arthritis, bipolar disorder to Alzheimers, and diabetes to atherosclerosis.  The link above says that Yale University has discovered a direct link between Beta-Hydroxybuterate, one of the prevalent ketone bodies, and inhibition of one of the components of what they call the "inflammasome."  Please take time to read the article at the link above.

This would explain a lot.

We have known for decades that the ketogenic diet is often effective in treating epilepsy.  Heck, even back to biblical times we knew that just not eating could cure a person of "demons."  Nothing brings about high ketone levels like fasting.  Beta-Hydroxybuterate has also been tied to anti-aging, which makes sense when you consider the direct implications for fighting inflammation.

I am curious though, if this might also be at the heart of our scientific disagreements regarding cholesterol numbers and their relevance to heart disease.

My cholesterol went up to above 500 the first time I was tested after starting on the ketogenic diet.  I am not sure what it was before the diet, but I am pretty sure that was an increase as it is incredibly high.  An increase is often reported by people new to keto, but usually it calms down after a while. There are also a few other things I was doing that might have helped it go that high as well.  You see, there is a theory that excess ketones can enter the cholesterol synthesis pathway, which would be the reason that cholesterol goes up in new converts to paleo or keto and then often eventually goes down as our bodies become more efficient at absorbing them and using them for fuel.  This is evidenced by increased ketones in the urine.  Eventually, when fat-adapted for long enough, we don't create excess ketones and we have to use blood monitoring to detect ketones as they won't show in urine samples.

I was running pretty hard at the time.  Ketones tend to test higher after a run.   I apparently had not reached that point yet the first time I was tested.  Also, there is a chance I am just a hyper-responder to saturated fats, which might be genetic.

I had been warned once in a forum on reddit that drinking saturated fats is not a good idea, especially if you are having a sedentary day, as it causes those fats to be quickly processed by the liver.  Add MCT's like coconut oil, and you have a cocktail for high ketones, and possibly high LDL particle count as well.  If you are looking to raise your cholesterol, I have to recommend my routine of fasted running in the morning followed by coffee with butter, heavy cream and coconut oil.  Yikes!

Taking a look at Dr Attia's "Straight Dope on Cholesterol" or Ash Simmonds fantastic summary here, we see that the correlation of cholesterol levels to heart disease is all over the place, with the only significant strong correlation being with particle count when the dust finally settles...

but then here, we have a heart doctor who questions even that.  He claims that even with high particle count after switching to paleo, his heart disease showed a reversal according to scans.  The significance there is that he was looking at actual disease rather than risk factors.  He hypothesizes that maybe the reduced inflammation associated with paleo makes even particle count lose it's correlation with heart disease.

Then we have this interview with Loren Cordain.  In it he states that even the Inuit had signs of atherosclerosis, but that without the inflammation from eating carbohydrate they would most likely not have had heart attacks.  A heart attack requires inflammation to rupture any build-up that might be present.  Dr Kummerow at this link explains it very well, as he fought the system over it for decades.

Of course, it gets even more complicated.

Next we have to look at things like the phenomena of endurance runners having heart attacks due to undetected calcification of arteries when they otherwise seem ultra-healthy.  Mark Sisson at Mark's Daily Apple warns against chronic cardio often.  He insists this is why we should exercise intermittently, keeping our cardio low-intensity and mixing in some form of short burst sprinting. Chronic cardio might be providing even some of us fat-adapted athletes with too much repetitive inflammation. There are so many variables it is hard to keep track.  Would marathon runners not have this issue if they ate a ketogenic diet?  Who knows? Ugh... it is such a puzzle.

So the question still remains that needs to be answered with more science:  "are low carb dieters somehow immune to heart disease in spite of the possibility of higher cholesterol and increased saturated fat intake?"

It seems like a silly question, but it is one that has been asked repeatedly.  With the new finding at Yale, I would think that we need to get NUSI on the job as it might be a much more relevant possibility.  In the paper cited above where it is implied that excess ketones can enter the cholesterol synthesis pathway, he insists that it would be stupid for low-carb dieters to just not worry about their high cholesterol and assume they are somehow specially exempt.  He even suggests adding some carbs back into the diet just to help this level off.  So then we are left wondering: is the high cholesterol more of a risk factor than the inflammation we would get by adding the carbs and reducing the ketones?

I lean toward inflammation being worse than particle count, but I would rather let scientists duke it out as opposed to just going with my gut feeling. I plan to stay low carb and keep eating my saturated fats, but without the bulletproof coffee, without chronic cardio (keeping the running at around three miles if I run at all,) and hanging on to my sprinting with USRPT and short workouts as the majority of my exercise.

and oh yeah... I am going to make a gamble that dark chocolate and red wine will help too, because if eating those every night is wrong, I don't want to be right.