Avoiding Weight Regain, Sodium and Breastmilk, Keto and High LDL | THRR041

Should I Give Up Keto if it Skyrockets my LDL?, 5-2 Fasting, Avoiding weight regain after losses, LMNT/Sodium and Breast Milk Production, Low T3 Levels after long term keto adaptation

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Show Notes: ---- News topic du jour:

Hit or miss: the new cholesterol targets "Setting targets for 'bad' (LDL) cholesterol levels to ward off heart disease and death in those at risk might seem intuitive, but decades of research have failed to show any consistent benefit for this approach, reveals an analysis of the available data, published online in BMJ Evidence Based Medicine." "Their analysis showed that over three quarters of all the trials reported no positive impact on the risk of death and nearly half reported no positive impact on risk of future cardiovascular disease. And the amount of LDL cholesterol reduction achieved didn't correspond to the size of the resulting benefits, with even very small changes in LDL cholesterol sometimes associated with larger reductions in risk of death or cardiovascular 'events,' and vice versa. "Thirteen of the clinical trials met the LDL cholesterol reduction target, but only one reported a positive impact on risk of death… "Considering that dozens of [randomised controlled trials] of LDL-cholesterol reduction have failed to demonstrate a consistent benefit, we should question the validity of this theory." "In most fields of science the existence of contradictory evidence usually leads to a paradigm shift or modification of the theory in question, but in this case the contradictory evidence has been largely ignored, simply because it doesn't fit the prevailing paradigm." "Moreover, consider that the Minnesota Coronary Experiment, a 4-year long RCT [randomised controlled trial] of a low-fat diet involving 9423 subjects, actually reported an increase in mortality and cardiovascular events despite a 13% reduction in total cholesterol." https://drmalcolmkendrick.org/2020/08/05/cholesterol-lowering-has-no-impact/

1. Should I Give Up Keto if it Skyrockets my LDL? [18:11]

Charlie says:

Hi Rob and Nicki,

Big fan of the show. After learning about the many health and longevity benefits of keto from folks like yourself, Dr. Peter Attia, and Dom D'Agostino, I gave it a go for 4 months. I followed a clean, dairy-free version with loads of greens and cruciferous veggies, a variety of meat and fish, avocados, olive oil, nuts and coconut, you get the idea. I confirmed ketosis regularly with a blood meter. I felt great during the four months, and by the end even started making gains again with my kettlebells and barbell. The diet wasn't a huge adjustment for me since I was already essentially paleo.

After the four months, I got my bloodwork to compare to my baseline. My triglycerides and HDL remained excellent, but my LDL-C skyrocketed, and my LDL-P is fairly elevated. I am so bummed out and discouraged because I was so excited about all the longevity benefits of ketosis, but my PCP told me to go back to my previous eating habits. Here's my question: do you have any ideas for ways I can achieve some of the benefits from ketones (BHB) while mitigating my LDL going haywire? Maybe intermittent fasting? Cyclic keto? Exogenous ketones?

While the high LDL numbers scare me, I know from listening to your podcast as well as Dave Feldman that LDL isn't the end-all be-all for cardiovascular risk. I find solace with my HDL and triglyceride levels, also my fasting glucose is very low, and my LP-IR score is below the low range, indicating I'm highly insulin sensitive. Any advice you have for me regarding my path forward with keto is greatly appreciated. Thanks guys. For context, I'm a lean, active 34-year old male.

2. 5-2 Fasting [29:09]

Devon says:

Hi! I was wondering if you had any good resources, guidance, recommendations or considerations (basically anything) about 5-2 intermittent fasting. It is difficult to sift through all the crap on the internet

3. Avoiding weight regain after losses [34:29]

Sarah says:

Hey Robb & Nicki!

I was wondering if you two could have a nice discussion about the optimal way to avoid gaining back the weight you've lost while dieting. There's a lot of talk about the best way to lose weight, but not enough on what happens after. I know you'd say that to lose weight, to try a low carb diet with adequate protein and electrolytes and exercise, using fat as a lever, and everything will work itself out. However, during the pandemic, I ended up doing a VLCD, and I lost about 42 lbs from mid March to mid May. You'd likely agree that this rapid weight loss is problematic because of lean tissue loss. I'll tell you right now, I wasn't eating adequate protein. The food I ate was primarily protein, but it wasn't much, some days a few meatballs... Also I chose not to exercise during this time. I'm sure I'm not the only one out there who gets impatient and isn't satisfied with losing .5 lbs per week even though it's the most sustainable way to lose.

So anyway, I did some research (lost job because of Covid, no kids, lots of time on my hands), and I wrote it all down in a comprehensive plan to avoid gaining the weight back in the summer and moving forward. I was wondering if you might like to consider taking a look? And perhaps bringing some criticism/comments/tips for the the other five listeners on what we can do to stabilize after weight loss.

(I'm a woman, 37, currently 208 lbs, besides obesity, all healthy biomarkers, I normally enjoy crossfit style workouts, once a week or less - not hardcore enough to build lots of muscle, and mini-triathlons in the summer)

Thanks!!

Notes:

Conclusion: A diet consisting of high levels of animal-based protein combined with a lifestyle of consistent strength training should go a long way to help the dieter not regain the fat mass that they have lost. A general recommendation is to eat a diet of 35% protein, 15% carbohydrate and 55% fat. The carbohydrate and fat can be adjusted based on how addicted a person is to certain foods, and how they see their body responding during refeeding. An app like MyFitnessPal can calculate the percentage of macronutrients you are consuming.

4. LMNT/Sodium and Breast Milk Production [44:47]

Hey Robb and Nicki!

My partner Garrett and I have been huge followers of you since the beginning of our relationship, 11 years ago!

We just welcomed our second daughter about two months ago. I'm exclusively breastfeeding and I've noticed an increase in milk supply while drinking LMNT. Is it safe to drink it more than once a day or is that not recommended?

Thanks,

Margo

5. Low T3 Levels after long term keto adaptation [49:24]

Diva says:

Hello Rob and Nikki,

First of all, thank you so much for the wonderful work that you two do!

I would like to know what are your thoughts on low T3 levels after long term Keto adaptations. According to Phinney's work, amongst other evidences, it seems that it is physiological normal for Keto adapted people to no longer require high free T3 levels, according to standard recommendations.

I am a 44 year old athlete. I have been Keto adapted for over 12 years. I was diagnosed with hashimoto hypothyroidism 25 years ago. My antibodies have been under control since after starting a Keto Paleo lifestyle and I've able to reduce my T4 dose considerably as well. However, my free T3 levels are very low, below the standard recommendations of 2.0 I am COMPLETELY asymptomatic though. My body composition is great, I'm very muscular and carry 9% body fat effortlessly throughout the years. Despite knowing about the T3 efficiency that Keto adapted people acquire, about two years ago I decided to experiment with adding exogenous T3 to my T4 dose. I noticed no difference on energy levels but I did notice that I started losing muscle mass! Which makes sense because one of the reasons that T3 may be lower on Keto is due to muscle sparring. I stopped taking T3 about one year ago and have gone back to T4 only since then. But one trend that I noticed is that my fasting insulin has increased a little. Nothing much. It used to be around 3 and now its 5.3. This started happening after I added T3 to the mix. I have since stopped taking T3 but my insulin has not gone back to levels that it used to be before taking it. I know that artificially raising T3 levels may raise insulin but shouldn't it have gone back down after stopping the med?

I wear a CGM and my blood sugar control is stellar! I can handle carbs very well, I've been testing with that, and even after eating tons of carbs, like 200g at one seating, my blood sugar didn't move past 13 points. The maximum increase was 105. And I'm not kicked out of ketosis. Other than that my average blood glucose is about 85. The only times that it goes up is after high intensity exercise, then it goes above 150, 170 sometimes! But I know that this is physiologically normal so it doesn't concern me.

My question is: what are your thoughts on the T3 efficiency after being Keto for so long? Should we try to artificially push up FT3 levels despite having no symptoms? And should I worry about a fasting insulin of 5.3 despite obviously being super insulin sensitive??

Thank you so much for your insights to this matter!

Diva.

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