Conversing diet with the science deniers

I joined a large FB group called "The Great Cholesterol Conspiracy" ... wow.   I really am at a loss as to why in this day of the internet and easily searchable medical research via AI, people cling to these pseudo-scientific notions as widely represented by recent diet fads like carnivore, keto, etc...   You look at these individual's pages, they are a mix of FB influencer followers, conspiracy theorists, they are often research and scientifically challenged, are often people who have "turned their life around" with a new short term diet, and often fall into the anti-vax - RFK Jr. - MAHA - MAGA groups.  Their most common conspiracies are about vaccines, "Big Pharma", and generally mainstream science research ... often asserting they've been "lied to" or "victimized" in some way... by the gov't, drug industry, Fauci, etc... you name it, you get the idea.  

From what I've been able to discern from the "advice" they give me, is that their entire concept hinges around these assumed "truths":

If the Triglyceride / HDL ratio is favorable (low) it negates all other potential cardio vascular risk

This is what Claude AI says:  

If someone has a high LDL particle count (high ApoB or LDL-P) but a "good" TG/HDL ratio, that combination should not be read as low risk. Most lipidologists would treat the ApoB/LDL-P number as the dominant driver of atherosclerotic risk in that scenario and would not consider a favorable TG/HDL ratio reassuring enough to offset it. This is part of why ApoB (or LDL particle number via NMR) is increasingly recommended as a primary risk marker over ratios like TG/HDL, especially when the two disagree... No major RCT has shown that deliberately improving the TG/HDL ratio, in isolation, causally prevents CVD.

However, an unfavorable Triglyceride / HDL ratio can predict disease.  That doesn't mean a favorable TriG/HDL ratio can prevent heart disease in the presence of high LDL particle burden.  

The other thing is the idea that one diet - their carnivore / keto diet - benefits all people.   The dietary affect on blood lipids is highly individual and this statement is clearly false.  And the development of CVD is multi factored, involving inflammation, innate blood chemistry, and numerous risk factors (polygenic tendencies, Lp(a), etc..).   It is not solely diet.  

My general anecdotal observation - most people touting the carnivore diet are not 'athletic fit-for-life’ types.  They are formerly obese types that have ‘turned their life around.’    These are not people who have always maintained a life long normal BMI.  Very few of them have actually had CAC scans or advanced lipid profile testing.  The vast number of carnivore adherents been doing it less than 10 yrs, most less than 5 yrs.   It's clear, carnivore can be therapeutic in the short term and an effective way to lose weight. The success stories are mostly because of what meat replaces in the diet, rather than the meat / animal fat itself. 

The Mediterranean diet has by far the strongest, most direct random controlled trial evidence of any dietary pattern for cardiovascular prevention and longevity. The PREDIMED is a real, large-scale, multi-year randomized controlled trial with hard clinical endpoints (actual heart attacks, strokes, deaths) — not surrogate markers, not observational association, not mouse data. It's frequently cited alongside the older Lyon Diet Heart Study as the gold-standard evidence for any dietary cardiovascular intervention. This is a substantially stronger evidence base than exists for keto.   Some of longest lived cultures in the world eat a mediterranean diet and that is not anecdotal. Carnivore is a fad.  The longterm evidence on longevity and disease for keto diets is thin.  https://pmc.ncbi.nlm.nih.gov/articles/PMC12845189/

Claude AI:

Recently, a meta-analysis covering over 100 peer-reviewed studies found associations between keto diets and increased risk of heart disease, elevated LDL cholesterol, kidney problems, Alzheimer's disease, diabetes, cancer, worsened outcomes for people with existing chronic kidney disease due to the high protein load. .... The honest state of the science is: short-to-medium term (up to a few years) data is reasonably reassuring for most people regarding cardiac health, but a meaningful and growing body of peer review-level and mechanistic evidence — including new animal studies — raises real questions about longer-term effects on the liver, kidneys, bone, and lipid profile. This is a diet where individual lipid response varies enormously, so, checking your ApoB/lipid panel would be genuinely informative a risk picture on a keto diet... there's no randomized trial evidence showing that lowering the ratio (e.g., by raising HDL specifically) reduces cardiovascular events.           

https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.702802/full

So no, eating lots of animal fat to boost HDL isn't doesn't generally seem to prevent heart disease. 

 

Water running, swim, bike sprint trial w/ the offloader

 Two days ago, I hit the lake and did a set of water running, and a swim.  Pretty good workout.

Water running

60 (R/L) steps x 6 w/ 1 min rest

Max HR 158

Avg HR 129

Lake swim -  340 yds

I was happy to have the lake by myself. ... since a casual visitor to the lake who would see me water running might think I was struggling, maybe drowning. lol

This morning I tried 'strict' pullups - all from full extension, only 18.  Definitely different than the 'near full extension' pullups I normally do.

Today, I got the DonJoy OA Nano offloader brace today, free with my insurance.  I looked it up, it generally sells for over $600 new.  I tried it out on a bike sprint with some brief standing hills.  Yea, it works.  It seems to prevent 180º full extension - maybe allowing up to just few degrees short of full extension, and corrects the valgus/varus angle, shifting load off the vulnerable compartment.  It has to be worn tight or it doesn't work.  Unlike the Ossur offloader, this one seems pretty solid and doesn't slip.  I think it could even be affixed more securely with K-tape.  Not really super comfortable to be worn for hours.  

I did the usual bike sprint and even though I didn't time it or measure HR, that first hill where I'm standing for 30 - 35 R/L strokes is FAR more engaging to the cardio vascular system than anything I could do in a similar stretch sitting on the saddle.  (True, Joe).  Knee felt great afterward, but I'm not going to dive into standing bike sprints right away.  A little at a time.  

The pretty young nurse that fitted me with the brace just graduated from Auburn and is a friend of  Ja'Kobe Tharp, new world record holder in the 110H, and Adidas track pro.  It was fun talking track.  

I'm definitely eventually going to try running with this thing at some point.  

Still really light, mid 141s this morning.  Meeting postponed so my next blood work postponed til Mon.  

I joined this popular FB group called the "Great Cholesterol Conspiracy" and wow, the debate continues.   Seems to me when you have research tools like Claude AI,  people shouldn't have so much belief in unscientific notions.  More on that next post.  

Bike sprint, resistance, diet, life change

Doing bike sprints while seated is really a difficult thing, to not stand and engage the glutes, strongest muscles in the body.  Much more of a quad workout. However, that's what I'm doing during this healing phase of my workouts.  Still doing daily resistance, 24 pullups this morning.  Becoming routine.  Situps, ab wheel, pushups, dumbells, hanging abs are my routine.  Stopped doing the slant board squats for a while.  The 2.5 mile bike sprint was a 'seated' PR.  Almost a minute slower than my regular PR. 

2.5 mile seated mountain bike sprint - Laurel Branch Trl

Time - 10:09

Avg speed - 12.8 mph

Max HR - 165

HR over 156 - 4:07

Avg HR - 150 (inc 1 min recovery at end)

Decent workout but not the real max HR sweat dripper that I'm used to.  Really helps to have the glutes to get to that intensity.

Had a swim yesterday at Scott's party.  Also ate some party food like chips and brownies, ice cream, but not a lot.  Still 142.7 for today's weigh in.  

I feel like my life has entered a major transition as I've now committed to playing full solo concerts starting in Oct.  The lifestyle of a musician that I led for so many yrs is quite different than the lifestyle I led after the pandemic pushing toward athletic championships.  It actually got a bit unhealthy during the peak as a performer in my early 40s.  Was probably 10-12+ lbs heavier, didn't watch my diet as much, exercise wasn't a priority, occasionally ate poorly, spent a lot of time sitting and practicing, up late at night and drinking too much tea and coffee, even beer, occasional light use of cannabis - (which actually is proven helpful in the interpretive and creative process).  Also, performing itself is quite stressful.  When you say you're a guitarist, usually the next question is, 'are you in a band?'   There is no more difficult, challenging, and stressful situation for a guitarist than doing hour long SOLO classical concerts in an academic or concert series situation.  Period.  

I did find a shirtless photo of myself from that era before athletics when my life was only guitar.  I looked somewhat lean, but weak.   

This is about 24-25 yrs ago, (about age 41-42ish).   I was doing some very serious hiking then, so I wasn't by any means significantly overweight.  This photo was during a boat trip with Lisa at Fontana.  At one point, we did a 25 mile day hike with a nearly 5000' vertical climb, as well as a 16 miler with a 3300' climb in the same few day trip.   I couldn't come close to doing that today.  Only maybe if my life depended on it.  

The parallels between training as a sprinter and as a concert musician are really remarkable … “trust the process” as they say.  I haven’t played a full hour solo program in almost 8 yrs I think. (Shorter programs yes).  Now concerned with hand health, but that is generally ok.   Where athletics and music training differ is in time spent. Physical adaptations for the hands seem to take more daily time than relatively brief intense track workouts, because a lot of the practice is slow and methodical, and it’s every day.  Both are long term commitments taking months, not only in learning to execute, but doing it on the spot in a performance, which is more the mental aspect.    Not that it's impossible to do both as I did in 2015, but my 2015 tour was in the fall - off season for track.

Anyway, since I started this blog 15 yrs ago, it's going to remain about training, fitness, wellness, etc... and I'm going to begin at some point, moving my discussions on music to my somewhat neglected other blog which I started nearly 20 yrs as mostly an adventure, outdoors, travel, music, and photography blog.  https://tnparadise.blogspot.com/

I'm really liking my life right now.  Have settled into a pleasant routine where I stay up late and practice, sometimes go to the cathedral, wake up early and go back to sleep, usually getting out of bed by 9 or 10am, do a few scales on the guitar, do my pullups, pushups, a brief walk, weigh in on my scale, drink a liter of water, sit in the hot tub, get out and start my daily practicing ... which will go for hours.  I have my first coffee about noon and a light snack, usually Wasa crackers with fig jam mixed with psyllium husk.  I eat my main meal which is a large salad sometimes with fish, or chick peas.  Sometimes a vegetable stew with zucchini, cabbage, tomatoes, onions, garlic, basil from my small basil tree, and whatever other vegetables I have available.   Really low carb.    These types of main meals don't have enough calories to make it and I've been snacking on walnuts and blueberries, occasionally Wasa crackers of Royo bread with sunflower butter, and dried cranberries.   When I do eat meat, it's usually flounder, salmon, organic chicken breast.  I will also occasionally eat other types of fish like cod, shrimp.  So with a relatively narrow diet, it's not out of the possibility that I may have a folate or Vit B deficiency so I'm testing for that on Friday.  Easy to remedy.  Due to my CKD, I was told to be cautious with Vit C, and I did see my collagen supplement had 100mg of Vit C.  Should be ok.  

Living in nature and getting most of my vegetables from the local organic market, the low stress job, the commitment to health and fitness I have now should help make a healthier transition back into concert performance.  Older and wiser.  

seated biking, resistance, tests

Been doing daily resistance work and my weight has been good, in the 142s last few days.  In an effort to allow my knee to recover, I've eliminated hard standing bike sprints and hill climbs.  But, I've been doing the same biking but seated and not as much.  I do think this is compromising my V02 max but at least I'm pretty strong, yesterday another PR pullup set - 26 although the last one was a bit of a kip cheater.  The remarkable thing is that I have gained a bit of lean muscle mass without eating much protein.  

The last two 2.5 mile bike sprints in which I've stayed seated have been more than a minute off my PR of 9:21 for all out standing sprints.  The first one wasn't a strong effort.

Aug 1 (seated) bike sprint:

Time - 10:48

Avg speed - 12.5 mph

Max HR - 156

Avg HR - 143

Aug 4 (seated) bike sprint:

Time - 10:32

Avg speed - 13 mph

Max HR - 172 (178 spike 50 sec afterward)

Avg HR - 161

I had that weird spike after finishing this run, (178).  I think it's actually a sign of losing fitness.  

I only plan on doing such rides 2 or max 3x / week.  Really focusing on the rest and healing of my knee.  I am getting an off-loader brace and may experiment with using it on the bike, rower, hiking, stairmaster, etc...

I was at a conference today and a music colleague asked me if I was retired from track I said probably but haven't made the decision 100% yet.   As I become more involved with preparing myself to play concerts again, I find the decision to walk away from track a bit easier.  It always tugs on me when I see colleagues racing but I am enjoying getting up in the morning with no knee pain, walking, and climbing stairs also with no pain.  If I do test the waters and try to run a little, it won't be for at least 5 to 8 weeks (late Sept/ Oct.).  I went to the track today and just stretched, no drills.  Avoided the temptation to run, although I felt I could have. 

As I am officially elderly now, I am most concerned with staying alive, well, and disease free.   Speaking of that, I had a major round of tests and with the help of Claude AI, I was able to refine some of my issues.  

Testing / wellness

I think the tests I had were a bit skewed by 2 consecutive meals of this high fiber protein fortified pasta I had not eaten previously - most affecting kidney and TriG readings.    Regarding the tests, I had the usual moderately high small molecule lipids: LDL (147), Triglycerides (162), ApoB (130), and too little HDL (40).   oxLDL was high (83), and kidney function low - GFR (58) due to high creatinine (1.36).  Also homocysteine was high (16.2).   AI suggests testing for folate and B12 insufficiency, which I plan to do next week.  That would explain these readings and be an easy fix.  I'm also going to repeat cystatin-C.  

On the plus side, my inflammation markers, and glucose / insulin handling is very good.   Both my inflammation markers hsCRP and IL-6 were optimal - below the minimum reference level - too low to measure.  Fasting glucose good (92), fasting insulin optimal (4.2), and HbA1c 5.5 - normal. 

Also, the innate lipid particle Lp(a) is optimal for me, below minimum reference level. 

So in general, a mixed bag.  I also found from my genome through Nebula Genomics, that I have a maximum (100%) polygenic tendency to develop high Apolipoprotein B.   This makes sense and is confirmed by numerous relatives with heart disease.   All of my testing, in particular my lipid fractionation tests, point to a very high risk assessment of cardio vascular disease, but fortunately not compounded by other factors such as inflammation, Lp(a), and high HbA1c.... not to mention no alcohol, no smoking, normal BP, low fat low carb diet etc...  It is very clear that animal fat is not the only issue in developing heart disease, it also is caused by sugar and carbs.  (Roya's younger brother is a vegan and had to have his heart stented due to heart disease).   

It is very likely that my 400m training over the past decade+ has kept me relatively disease free, not to mention the low carb diet.  Compared to the avg American, my diet is ridiculously clean.  About the worst things I eat are high fiber Wasa crackers with fig preserves which I mix with psyllium husk fiber, and Royo high carb bread (30 cal a slice).  Also occasional bowls of blueberries. I have a pretty big list of things I almost never eat... including common foods like pizza, chips, potatoes, butter, eggs, margarine, high fat dairy, fried food, boxed cereals, regular bread, regular rice, cookies, pies, baked goods, no beef or pork in 35 yrs.   I replaced skim milk with unsweetened almond milk.   The only fats I eat are small amounts of olive oil, walnuts, and sunflower seeds.  I use the allulose/monkfruit sweetener.  I even started filtering my espresso through paper to eliminate LDL increasing compounds like cafestol.  Low protein and occasional fish / chicken.  Sometimes go a week + vegan.  Somtetimes I will eat canned skinless boneless sardines in water.  

I will likely consider preventative medication, especially if I can get a CCTA scan to test for soft plaque and it is positive.  That is the goal of my next appt.  To make the case for a CCTA scan.  I have been resistant to drugs up until now, but now may be the time to consider it - considering my small molecule particle burden as shown by my Apolipoprotein B1/A ratio.

I'm really digging the incredible self pay pricing on Goodlabs.com test broker.   

To good health!

Routine, 2 month Hume scale report

 In Atlanta, doing a daily routine of exercises when I get up:

22x pullups

25x ab wheel

35x pushups

15x slant board squats / 10x step downs

15x dumbell runners/ curls / 10x press

Yesterday I did a very brief seated bike climb.   Thurs was Roya's 65th and we did a long walk around Centennial Park in ATL.

HUME SCALE

So, after 2 months with the Hume body pod, my results are in the right direction.  Interestingly, I've made some fairly significant changes in body composition without much change in weight.  My weight has settled at about 143ish, about the same weight as I was in HS.

May 26 - July 25:

Body fat: 13.4% to 12.3%

Body fat mass: 19.2 lbs to 17.6 lbs

Subcutaneous fat mass: 16.7 lbs to 15.3 lbs

Subcutaneous fat %:  11.6% to 10.7%

Skeletal muscle mass: 76.9 lb to 77.9 lbs

Lean mass %: 80.7% to 81.9%

BMI: 23.3 to 23.2

Basic Metabolic Rate: 1472 cal to 1475 cal 

Changes come slowly and are best plotted over time, not day to day.   Also, depends greatly on when reading is taken.  After last night's party, I weight 146.8 lbs, at noon today I was 143.1.   The scale is not that accurate and may be off up to 2% on most readings.  People who get a DEXA scan say it overestimates fat % by 1-2%.  I'm thinking it's pretty accurate.  

 

Dr. visit, long swim, police

I prepared a lot for the Dr's visit and it was pretty short and inconsequential.  Drove 95 min, he was nearly 90 min late, had to cancel my blood work appt.  He spent maybe 10 min with me.  Despite coming with pre and post op MRI reports, surgical report, laptop with images, he blew all that off and I had to get radiated again with their Xrays.  The ones I had from just weeks ago, they couldn't download.  

The only thing he looked at was the surgical report, he commented that "Justin's work is amazing" and this repair was far more involved than the LaPrade repair on my right, which I knew, but he emphasized it.  He said I had some arthritis and due to my bow legged alignment / running form, running L turns, etc... my medial side is susceptible and he showed me xrays that showed 1/2 the joint space on the medial vs the lateral knee compartment.   It was still not bone on bone.  Bottom line, he thinks there is a chance to recover the knee with the goal of limited running, and seemed more than happy to do injections as needed, which I would only do as last resort.   I got measured for an offloader brace which will help recovery.  He seemed to think that biking, rowing, and weights were ok.  I'm not so sure, but will return to seated only biking.  Generally, not a great impression, and a guy I will likely not see again. 

So, I got home after meeting with a contractor at my house and took a brief nap.  Got on the motorcycle and went to the lake.   Just as I crossed the lake, I looked back to the opposite shore and saw 3 police trucks and a small swarm of uniformed police standing around my motorcycle.  I took off and swam a half mile down the lake.  Back stroke, I can swim forever.  When I was out of sight, I came ashore and and walked to the near shore opposite of the bank where I parked.  I was thinking they'd just get tired of waiting and leave.  They didn't leave.  I reasoned that I'd better not keep them waiting any longer and swam back to face the music.  

Well, it went ok.  I just had happened to go around the gate when Nate the forestry chief was driving by.  Just bad luck.   He was there with a couple cops.   The old cop gave me a stern warning and asserted the strict no motor vehicle policy on Sewanee protected areas.    I told them I had been doing this for more than a decade and several times just this past week, and I how I've cleaned up this place and picked up garbage.  It was fine.  No citation.   I could have been cited for multiple things - bike hasn't been registered in 6 yrs, uninsured, violation of protected property, etc... since it's a small friendly town, we just chatted.... about how great this place is, about motorcycles, E-bikes, etc... Nate knew my name and that I'm a professor.  This is really the end of an era, I've been doing this more than a decade without any issues.  It is literally the only place I ever go with my motorcycles.  So it's quite significant.   I wish I had thought to have gotten a group photo before I drove off.   They did bring up an interesting issue... very gray area between an electric motorcycle and an electric bike.  (E-bikes are ok on trail but must be below a certain wattage)
. 

water running, guitar

4th day in a row at the lake.  After dodging strong storms all day that kept the temperature just perfect, there was an evening break and the lake was surreal, quiet, smooth.

Did a set of water running but no significant swimming, as the thunder was rumbling in the distance.   I really needed to burn some calories.  My diet has been bad.  Yesterday, just wasa crackers, fig jam, a banana sandwich and tea.  Today only slightly better, sardines, spring mix lettuce, wasa crackers, Royo bagel w/ almond butter and honey.  

Water running

6 x 60 strides with 1 min rest

Max HR 143

Spent 80 min at the cathedral practicing after midnight.  It was actually pretty taxing.  Got home, fell asleep in a chair and slept straight until 8 am.  Got up, did my usual bedtime regime and went back to bed for 90 min. 

I love the sound and the feel of playing music but, to pull off a concert of virtuoso repertoire, it takes an enormous amount of time and commitment, and even then, rarely is a performance perfect.  Not to mention the stress involved.  At this stage of my career, there actually seems to be more to lose than gain in some ways.   The stress involved, the risk of a substandard performance.   I never perform 'badly' but sometimes have had mistakes, memory slips, etc... and like a car wreck in an auto race, that's what people remember the most.  That's why I wonder sometimes if I should even do it.   Some of my colleagues have stopped or scaled back performing.   Years past there were rewards involving academic standing, tenure, money, career, etc... but now none of those things are at stake or an issue.  It's all personal.  Making video recordings for Youtube is actually a better way to reach the public instead of giving a guitar recital.  Rarely have I played a guitar recital for more than 80 people or so, typically it's like 40-50.  Social media reaches so many more.  But, to be a teacher and proponent of the rare art of solo classical guitar performance, since I can do it, I should do it.  I need to set an example and attempt to inspire students.  20+ yrs ago, I inspired a bright kid from East TN who was a heavy metal shredder.   Years later he was performing in Carnegie Hall and playing for ambassadors, now recognized as one of the best guitarists in the world. 

Been working on the Rameau variations again.   No one in the world played this piece but me until just the last few yrs, now a few have. Probably the single most important and unique piece I've ever played, but I stopped playing it in concerts about 15 yrs ago because of the difficulty.   I'm fairly sure I will perform it this fall.  Taking a fresh look at it.  Fingers are still working.  

Like racing a 400m... we do these things, not because they are easy, but because they are hard.   Beautiful and expressive as well.  

Back to the cathedral tonight.