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. 

 

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!

bike sprint - PR

This was a hard effort.   Massive PR by 17 sec.   This one will be hard to top.

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 9:21

Avg speed - 14.3 mph

Max HR - 177

HR over 156 - 9:51 (inc 1 min recovery at end)

HR over 170 - 3:53

Avg HR - 166 

I hit the turnaround at 9:56 about 4 sec faster than last PR.

Have been eating more meat (chicken breast) lately.  Weight holding steady in the 142s.  Doing daily strength so seeing a little difference.  

For whatever reason, my MRCP / MRI read may take another week.  I've never known a report to take this long.  I really think this Vanderbilt medical center isn't what it used to be.  When it was a single centralized teaching hospital back in the day, it was top notch.  Now it has taken over numerous other smaller hospitals and facilities, it's losing quality for quantity.  I may look elsewhere in the future.  The Vanderbilt medical name was always very well respected.  Notsomuch now, judging by online reviews.  

The weather has been awesome so far, cool for this time of year but a heat wave hits on Sunday and continues without rain for about 4 days, temperatures in the lower 90ºs... which means near 100º in the cities.  

I expect I'll be swimming and water running everyday beginning Monday.  

Yesterday before my bike climb, I did an 80yd sprint on the track.  It felt ok. Kind of chompin to get back to some limited running.  Maybe do some drills and high knee runs in the heat next week 

Bike sprint, another PR

 Didn't sleep well last night, probably because of that tea I had before bed to ward off munchie cravings.  Probably the caffeine and low blood sugar.  It was 78 when I got up and it's usually higher in the morning.  

Getting lighter.  In the 143s.  I pushed this bike sprint and narrowly set a PR.  

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 9:56

Max HR - 175

HR pretty much stayed around mid-upper 160s to lower 170s the whole time.  I had a similar post sprint HR spike as last time, but a bit different... it occurred 60 sec after the sprint, had just walked upstairs, HR had dropped to 154, in 19 sec it spike to 175 then dropped gradually to 164 over the next 30 sec and continued down.  Nothing like that 190 spike I had last time.  

I know I'm lighter because I got 22 pullups today, I was only getting 18 when I was 4-5 lbs heavier.  

143.2 after workout.  Feel better already.  Still a ways to go. 

-----------

CHART

I found this chart published by a runners magazine compiled with data from Masters rankings and the IAAF.  It confirms that the 62sec 400m I ran in a time trial last Nov. was at elite level, but just barely.  And nearly all my 400m races in my masters career were as well.   The chart doesn't list John Wright's incredible new M65 WR of 54.92 set indoors this yr.

 

Bike climb

 Did the Roark's cove bike climb today, for general fitness, calorie burning and to lose weight.   Was tough since it was warm and humid, heat index around 85º,  and ... yesterday was a hard day, on my feet all day and my back felt it.  Also, I've been at less than 1000 cal/day for the past few days, getting down to optimum weight.  Losing that last 5lbs is the hardest.  

It was a tough slog, was at only 4mph during the hard parts, slow but hard effort as shown by my HR data:

Roark's cove bike climb

Time: 24:11

Avg speed: 5.8 mph

Avg HR: 167

Max HR: 185

HR over 170: 14:00

HR over 180: 2:08

Definitely burning off some of the fat.  My goal is 140 lb daily mean, which means 138.5 ish after workouts.  Today I was 143.1 this afternoon after workout and before any meals.  That means about another 5 lbs or so to go.  That will help the joints when I run, which I'm only doing a little once / week and just hills.  

Our meal yesterday was great.  Sautéed zucchini, tomatoes, onion, garlic, carrot, mushroom, over Lavivia instant Shiritaki low carb rice.  That stuff is awesome, tastes like real rice but has 104 cal per cup cooked, compared with regular rice 240 cal cup and about 1/2 the carbs.  

This very filling meal was less than 400 cal.

After a bad experience with a Oxiline smart scale, I decided to buy a Hume ... because Joe thinks I should constantly weigh, time, and measure myself.  

Bike sprints, diet and disease

Yesterday did the bike sprint intervals.  Today did the 2.5 mile sprint with hills.   Both hard.  I'm thinking these types of workouts plus strength are probably better than these 25 min hill climbs where my HR is over 170 for 15-16 minutes, over 180 for 2-3 min.  I still push it to the 170s but just for short duration.   Maybe do a hill climb once a month or so.  

Bike sprint intervals  - 4 x 400m w/ 2:30 rest  

max speed: 28.4, 27.5, 28.4, 28.5

Max HR - 173

 

------------------------------------- 

Bike sprint - 2.5 miles on Laurel Branch Trl

total time - 10:18 (tied PR)

Max HR - 179 

HR over 170 - 5:18 

Avg HR - 165

 

Going for a blood draw again this week.  Kidney function tests and week after, followup with my PCP, and will press him for an angiography.  

Diet and heart disease

My brother's latest determination of celiac artery blockage was called into question by one of his Drs because it was ultrasound based, so he's pressing for a more definitive test, a CT w/ contrast.

His Dr., a DO, is one of these Keto diet guys.  I'm all for low carb low sugar diet but to be extreme about it is not particularly sensible to me.   I get the low carb thing, carb = sugar. These keto bros / carnivores are totally into this idea that you can eat unlimited fat as long as you eat zero carbs and sugar. The fact is that it does work to lose weight, but for some people, this keto diet will cause heart disease if you’re a “responder” to dietary fat.  And you don't know if you are unless you test prolifically.  Not just standard lipid panels, but more advanced tests like lipid fractionation, apolipo ratios, Lp(a), inflammation, imaging like angiography, etc... CACs are good but not enough, same with lipid panels, and it's ridiculous to draw any conclusions from the once per year lipid panel... but better than nothing. Lipid panels are cheap. Just $23 at Ulta.  

The problem with tests like LDL or Lp(a)  - these are a few of many factors that *may* contribute to heart disease / atherosclerosis. The development of CVD is a very complex and individual process, as we can see with the wide range of anecdotal experiences.   Some have established heart disease yet live long lives. Some are affected by disease from lifestyle factors like diet, yet some aren't. Medical science observes general trends among the population, but there are always a lot of outliers on each end of the bell curve.  You can definitely lose weight on carnivore / keto,  usually by replacing carbs/sugar with protein and fat. Much of the confounding and conflicting data on the subject ignores the fact that there is no general rule for all people on affect of dietary fat. Different people are affected differently by dietary cholesterol as the process for atherosclerosis is complex and dependent on many factors -including genetic disposition. Frankly, looking at it any other way is tantamount to pushing an agenda, a hasty generalization, overly simplistic, or plain disingenuous.   Not much long term data on the results of carnivore / keto diets.  

Anecdotally, I've learned I am a dietary 'responder' to animal fat intake as I learned in 2021 on my brief 'egg diet.'   My brother and I are an interesting case study, albeit ... anecdotal.

A lot of this carnivore / keto diet stuff coming from social media influencers - some professionals - seems to follow the trend of the "RFK Jr - MAGA - bro-science - pseudo-masculine - vaccine science deniers" ... long on anecdotal trends and short term results, short on science and long term studies, and certainly not looking out for individual susceptibilities, and tailoring diet to the individuals based on known vulnerabilities.  They certainly push a lot of generalizations, questionable cherry picked "science," and not much info on longevity and long lived cultures - none of which are carnivore / keto.  I also think diet can be adjusted for athletic goals and training, and can vary and be optimized according to physical needs, time of year, activity level, and body type, etc...

Morning bike sprint, tests

Didn't do much today, just some pullups, and a morning bike sprint on my 2.5 mile course with hills.  Super beautiful here.  Best time of year.

2.5 mile bike sprint - Laurel Branch Trl

PR - 10:18

I went to my final appt with the oncologist that my PCP sent me to.  I did so mainly to get another free set of tests.  He basically said I don't have cancer and so long as I'm getting followup on my cysts, I don't need to see him.  He noted the genetic test had not produced risk factors (nor did the Grail test).  

I had the same tests I had 2 weeks ago and they were worse.  Not surprising because I let my diet go since Roya has left.  Instead of fresh vegetables and salads, been eating more fat like nuts, sunflower butter, chocolate, more sugars like fruit preserves on crackers and Royo bread.   

The good: my liver enzymes were fine, ALT, AST = 17, 20; glucose 86.  The bad:  My CA 19-9 was up 10 points to 64,  my eGFR was down 12 points to 58, my creatinine was borderline high (1.25), and my protein (6.2) and globulin (2.0) were low, chloride was high (108).  My albumin and everything else was normal, as was my CBC.   Dr. told me not to worry about the CA 19-9 unless it sky rockets into the hundreds.  The other seems to point to slow kidney function.  These eGFR readings are on the low side of typical for me however.  AI said my most significant reading is the low eGFR, and that the elevated CA 19-9 could be related to my reduced kidney function.

CMPs are cheap, $23.  CA19-9 are $45.  I'll test again at some point during my travels to ATL.  

Probably would be good to do another 60 hr fast at some point.  

Best time of year because I'm looking at the longest vacation time coming up.  Weather has been great. 

 

casual biking, resistance, food

Peak color today, perfect weather, high temp of 73º today.  Set out on my bike, stopped briefly at the college football game (Sewanee lost 28-0), then to the weight room to do a brief weight workout.

Hard to believe that by tomorrow night it will be freezing, and will remain below freezing for 30 hrs through Monday to Tues morning.  Bike tomorrow, track Tuesday in the cold.  Winterized the boat, partially, will put heaters in for safety as well.

I also completed my last obligation (the last $25) for my $250 wellness incentive by conversing with a 'health coach' for 20 min.  She turned out to have no significant training aside from a psychology degree (from Sewanee!) 21 yrs ago.  I ended up coaching her on her health and orthopedic problems. 

Some photos of this incredible day. 

 

Food.

I recently got a craving for sushi so I ate some regular brown rice sushi.  2c cooked is about enough for 3 sushi rolls, about 18 pieces.  That much rice has 600 cal, 140 g carb.   Tonight I tried the dried konjac rice and it was great!  Honestly could not tell the difference with this brand and regular white rice, however, it is ridiculously expensive.  About 8x as expensive as regular rice.  $9 for 2c cooked rice!   

The difference is 2c of this rice cooked has 232 cal and 48 g carb.  About 1/3 the cal and carb.   I'm going to try the Livivia brand which is essentially the same nutritional values and ingredients (konjac and rice flour) but a bit cheaper.  Much prefer the dried konjac rice to the wet packets that smell wierd.   

These rolls were sardine, avocado, cucumber, carrot, sweet red pepper sesame seed.  

CV Study - dietary LDL / carb intake

This is an odd one.   Purely an anecdotal case study, but references a cohort study on a subclass of individuals who are “Lean Mass Hyper-Responders” (LMHR):  

A recent cohort study of 548 persons on carbohydrate-restricted diets (CRDs) revealed inverse associations between triglyceride/HDL-C ratio (TG/HDL-C) and LDL-C change, and between BMI and LDL-C change, on CRD. This means leaner persons with lower TG/HDL-C ratios generally exhibit larger increases in LDL-C on CRD. Individuals with a particularly pronounced high LDL-C, high HDL-C, low TG ratio are termed "Lean Mass Hyper-Responders." This report provides a clinical vignette of a patient who exhibits the Lean Mass Hyper-Responder phenotype, with LDL-C as high as 545 mg/dl, despite normal pre-CRD LDL-C of 95 mg/dl and consuming a CRD with a high unsaturated/saturated fat ratio. Coronary CT angiography conducted after 2.5 years of extremely elevated LDL-C reveals no detectable plaque development.

This seems to correspond to the time when I was on the zero carb 'egg diet'. Although I didn't exactly meet the criteria for this phenotype -  LDL-C ≥ 200, HDL-C ≥ 80, and TG ≤ 70 mg/dl, I was close:

March '21 - mean body weight about 138.5 lbs, likely about 9-10% body fat, LDL - 203, HDL -59, TriG - 71.   Never had my HDL been that high at the same time my TriG were that low.   My Trig/HDL was never better.  

The case study "LM" was only in his 20s, but after having a LDL reading as high as 545, after two+ yrs on the diet, angiography showed he had accumulated zero plaque or heart disease.  

Back to square one.  It's all very individual and complex.  

Life change and test results

It will be end of coming week before I hear anything from Dr. LaPrade.  He will have both my Xrays and MRI arriving before he comes in on Jan. 2.   

Previously with my other knee injury, I trained on it for almost 2 months before surgery but not this time.  I'm doing nothing really except pullups, pushups, rubber tubing shoulder rotations, weighted bicycle crunches, ab wheel, but nothing to raise the heart rate near max and run the engine hot.  I fear it may affect my CV health and promote faster aging.  The best thing to do would be to get into the pool but it's closed til 1/13.   I could probably bike or row with no pain but I don't want to make my meniscus worse.  It will be already a difficult enough repair, assuming it can be.

During my normal lifestyle when training, so many things are centered around this.  What and when I eat, when I go to the bathroom, the weather (wind direction, rain, etc...), what type of workout I will do, what my goals for the session are, etc... It is a total life change.  It has brought me back strongly to guitar practicing where I'm playing so much more.  I played a community concert in FL on xmas night with a guitar I purchased and had sent to my parents house.  It turned out to be a spectacular guitar, a 48 yr old Takamine C136s in near mint condition, worth 3 or 4x the $500 I paid for it.  Definitely among the best guitars I own.  Astonishingly loud and easy to play.  

LIPID Blood work

I had the blood drawn for 4 lipid tests and I have results of 3 of them:  Apolipoprotein B1/A ratio, standard lipid panel, and MMR Lipid fractionation.   (They screwed up and didn't take enough blood for the Lipid ion mobility fractionation test).

Results were generally ok, some good and bad.   It had only been 8 weeks since my previous blood draw and I tried 3 things:  500mg niacin, bergamot juice and capsules, and cutting down on espresso coffee.  

Here is the standard lipid panel - first number Oct 18 blood draw, second - Dec 12.

Total Cholesterol: 215 - 169 

Triglycerides: 152 - 107 

LDL: 158 - 113 

HDL: 42 - 35 

Ratio: 5.17 - 4.8 

Slight improvement, but the HDL dropped with the LDL, which always has been a problem.   Overall, improvement, showing the supplement regime working.  Odd that all three indicators:  Total Chol, LDL, and TriG all dropped by the same exact amount, 45-46 points, which is significant - especially in just 8 weeks.   

My Apolipoprotein B/A1 ratio came in at 1.05. B was 104 - considered borderline high, A1 was 99 considered too low (under 120). Any ratio over 0.9 is considered higher risk (Mayo C).   Pretty much confirms the bad ratios I've always had, around the borderline risk area.   

A study showing this as the best prognosticator of CVD risk: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC8277048/

The lipid fractionation MMR came in with mixed results, but mostly that I have more small dense LDL and less large molecule HDL.   

Confusing because the small LDL-P came in at 853 nmol/L which is high risk, however, the overall LDL size was in the normal range - 20.9 nm (over 20.5 is good).   

HDL-P, Large HDL-P came in low, which is considered high risk,  especially the Large HDL-P.  The overall HDL size was just into the high risk level (8.4 nm, anything under 8.7 is high risk) 

My most anomalous reading was VLDL-P (Large VLDL particles).   Elevated levels of large VLDL particles is bad.  Anything under 3.7 nmol/L is considered optimal, mine was off the charts low, listed as <1.5 nmol/L ...  which is very good.  My overall VLDL was also good, anything under 47.1 nm is optimal, mine was 43.8 nm, also good.  

Very hard to understand what all this means.  It's a very complex science, a lot of intangibles.

I also found another interesting food supplement I'm going to try.  It's called mangosteen juice.  I read some studies on it and heard some anecdotal testimonies from someone I know that it is has strong anti-malignancy and anti-inflammatory properties.  Recent study on that: https://www.sciencedirect.com/science/article/pii/S104366182200576X 

  

I met up with my friend Jeff for dinner, a multi-millionaire physician.  We again went to his facility and looked at our carotid arteries with the ultrasound, we both were clear.  No sign of calcium on the walls of the artery, just a tiny amount on the outside.   He and another physician friend of mine are really against statins for non obese people.  He insists that it won't do much to extend life.  But I think it has for my parents.  

I visited my parents in FL last week.  I did gain a few lbs but by today I was back just under 141 lbs.  The worst thing I ate was a cannoli.  I snacked mostly on fruits and nuts besides my one meal / day.  

I think my parents look great.  Mom will be 83 in a month, dad 85 in April.  My dad is 25 lbs lighter than last yr at this time, weighing about 205 lbs.  My mother is definitely a bit overweight at 5'4" 140+ lbs.  My parents... they eat steak and potatoes, processed food like store-bought cookies and pies (with mile-long lists of ingredients), artificially flavored and chemically sweetened beverages and foods, they don’t read food labels, they eat butter, eggs, ice cream …. all the stuff I would never eat.  My mother at least eats vegetables, my father eats nothing really that is healthy.  He hates all the good stuff, berries, cruciferous vegetables, greens.   They are both on statins, my dad had a CAC scan Agatston score of over 1200 12+ yrs ago, they both have had a stent installed. Me, age 64, no beef or pork in 33 yrs, Mediterranean diet, only organic chicken and wild caught seafood, organic produce. I try to get my parents to eat better, but they say…"But we’re 85."   What can you say to that? 

We celebrated their 65th anniversary day after Christmas.  They were married Dec 26, 1959.   My mother was a month away from her 18th birthday, and my dad was to turn 20 that April.  Growing up in a hurry.

2x300,200,100 tempo

Back on the track for the first time since Tues.  3 days with not much training due to the tooth infection and end of school.  A little weak perhaps, have not slept the entire night through in 3 days.  Tooth infection seems to be slowly improving.  My friend Dr. Scott seemed incredulous that I'm not on antibiotics.  It only seems bad at night, jaw hurts, can't open mouth fully (maybe a good thing?)  

Sunny, N breeze, 48º, not bad training weather.  But the workout sucked.  No speed.  I need to get back to short speed training, form, strength.  Just generally lame today.  

Hoka trainers on

stretches, drills, bands, 100m

100m stride - 16.7

Hoka rocket x2s on

2x300, 200, 100m w/ 3 min rest - 51.79, 54.56, 38.11, 14.44

If I had gutted out the final 300, it probably would have been 56+.   Here's the HR data:

300m - HR peak 176, recovered to 133

300m - HR peak 185, recovered to 145

200m - HR peak 170, recovered to 147

100m - HR peak 164, recovered to 142 in 1:30

138.4 lbs after workout.  Lightest this season.   Didn't help me run fast though.  

Planning on being back out on Monday, late afternoon, maybe just do some 50s and 100s. 

Made some cookies this evening out of oat bran and protein powder with walnuts and chocolate chips.  So far that's all I've eaten today as of 8pm (not good).   I need to eat more and better.  Thinking about eating more varied whole grains for carbs instead of just oat bran, like barley and quinoa.  

UPDATE:

I put a call into Dr Scott, I'll be on Augmentin antibiotic tomorrow, I'm afraid this infection isn't done yet.

Bike climb

Wanted to burn a few calories yesterday so I did a relaxed bike climb, keeping my HR relatively low. 

Roark's cove bike climb - 26min

Avg HR - 150

Max HR - 178

HR over 170 - 5:17

Avg speed - 5.35 mph

Time for yearly blood work again Thurs morning so eating super clean and small.  Would like to get down to 140 by Thurs.  

Tomorrow, running on turf.  Foot improving slightly.  

Eating basically Mediterranean diet every day, thanks to Roya.  Now, without the snacking on nuts, fruit, and chocolate. 

 

bike, swim, run

 Saturday, I did a hard bike up the mountain.  I started fast and maintained a high HR throughout although it was 15 sec slower than my previous. 

Roark's Cove Rd bike climb - 22:12

Avg HR - 170

Max HR - 186

HR over 170 - 14:24

Avg speed - 6.33 mph

I also had a HR over 180 for somewhere around 4 min total, that's a long time.  I think these sessions are good for overall strength and calorie burning, but I don't think they do much for my long sprint endurance, speed, and only marginally helps my V02max.   Nothing like running.  Probably should do sprint intervals on the bike instead.

Sunday was swimming.   Did a casual swim of about 400m and then did water running 4x70 sec w/ 45 sec rest (120 strides).  

Monday, first running in almost two weeks and was able to tolerate 600m of sprints, and it was brutal.  Conditions were rough, heat index 90º and the plastic smell of the new track and turf was pretty nasty.  Happy that the lacrosse netting was not up so I put out the cones for some 150s on turf.  

Stretches, drills, bands, 2x100m

2x150m on turf w/ 30 sec rest - 22.45, 24.98

12 min rest

2x150m on turf w/ 30 sec rest - 24.40, 26.09

It was tough.  I ran the first one pretty fast for my present shape at the end of #2, my HR hit a max of 189!  After one minute it came down to 170.   Took 3 min to come down to 135 but soon as I stood up, it went back to mid 140s.  During the 12 min rest between sets it only fell to 128.  I started the las set at close to 150 and hit 174 on 1st rep, 186 on second.   Not much sprinting but hard in the heat and me in poor condition.  These are the type of workouts that are effective, time efficient, and a place to begin ramping up from.

I've been able to bring my weight down a little,  142.5 lbs after workout.   With Roya here, I eat better.  Grilled chicken, salad, melon, fruit, nuts and of course.... cappuccinos.  

 

Back in TN on the bike, possible genetic related heart issues

 Was harder today with the extra weight I've gained.  Warm, in the 80ºs but not hot.  A pretty hard effort with a high HR.

Roark's cove bike climb 

23:05 min

Avg HR - 173

Max HR - 189

HR over 170 - 17:14

Avg speed - 6.10 mph 

Second highest max HR I've recorded.  It felt ok.  I had pushed hard early and hit 170 before the big hill and started the steep at 163.  I hit 180 with 250m to go.  So it was a solid effort.  

-----

Heart health and family history are a cause for concern.  I have a history of high LDL and so does my family.  I have never had any heart issues to my knowledge, chest pain, or shortness of breath.

Both my parents have been treated with statins and BP medication for many years.  Both have cardiac stents.  Neither has had a bypass and both seem ok at age 82 and 84.

My brother was recently diagnosed with a rare spinal stroke, (originally misdiagnosed with demyelinating disease), resulting in MS type symptoms.   According to specialists, this is a clear cardiac related issue.   Having the same genes as my brother, it's certainly a cause for concern.  He was hospitalized with chest pain last night and BP fluctuating to high levels.    Hard to know what the exact cause of such problems are, but genetics certainly play a role.  Also, lifestyle, I have to think, is also a factor.  My brother, like the rest of my family, is not a 'label reader' when it comes to food, and is almost totally without conscience or education in regard to eating, and clearly has dad's 'sense of entitlement' when it comes to food.   Despite my occasional binges, I always snap back before I become overweight.  My brother has been into the overweight BMI range, weighing as much as in the 190s at 5'9", but often fluctuating widely.  Even 175 lbs for a 5'9" person is BMI overweight, which I think has been the low end of his weight range.   My dad has held an obese level of BMI for most of the past 2 decades although recently graduated to merely 'overweight' (below 209 lbs.).  I've never been BMI overweight, except for a few brief periods 20 yrs ago where I once reached 160.  

The thing with my brother is that he hasn't had even the first frontline image test on his heart, a coronary calcium scan.  My dad has, and it was astonishingly bad.  I can't remember the score but I'm sure it was over 1000, and that was 10+ yrs ago.  The fact is, you can have plaque, but if it's not in the wrong place, you can live with it.  Just like you can have high LDL, but if it doesn't 'stick', then you're ok.  

My genome test said I have a very high susceptibility to high Apolipoprotein B level  - which is related to high LDL.  However, the Genome test has been a bit underwhelming, delivering conflicting results, etc...  But I take this as a warning, nevertheless: 

LDL cholesterol, the “bad” cholesterol, relies on transport by apolipoprotein B (apoB). As a result of this connection, elevated levels of apolipoprotein B are linked to elevated LDL cholesterol and an increased risk of coronary heart disease.

I just don't know how lifestyle factors are going to help or hurt.  I do remember times at dinner when I looked at what my brother was eating with a bit of disdain, and he'd alway look at me and smirk, saying, "what's it going to do to me, Bill?"  Maybe these recent health issues with my brother are a manifestation?  Who knows?  He's always been a big meat, carb, and sugar eater, habitually eating large bowls of popcorn with butter before bed.  Maybe there's something to be learned here.  I hope he is ok and perhaps he can improve his longevity with medication and improved lifestyle choices.  Medication has seemed to have served my parents well.  

As for me, so far so good.  No issues.

Bike climb, moving forward

Still planning to write more on Penn, but first... 

Did a bike climb today, didn't work too hard except for the final sprint.  Got it done in about 22 min.  

I did reach a new max HR of 186 at the top.  9:10 min over 170, 15 min over 164.  

It was really beautiful.  The forest canopy is in and the wisteria and lilacs are blooming.  It was like a tunnel of green and purple.  Love Sewanee in the spring. 

 

HR Data:

 

Foot is finally starting to feel ok.  Planning on hitting the track tomorrow for a conditioning workout, but nothing too serious.  If I race again this summer, it will probably be a 100m or 200m.  I want to really start working on my top speed and strength.  

My diet has tanked in the past few days.  I made traditional kataifi pistachio pastry today.  But my weight hasn't yet gotten out of control.  

143 ish

Tea and pastry at sunset.  Life is good.  

 

Gym

 In the gym last night for some resistance and intervals on the rower.  Roya joined me.

Stretches

4 x 500m w/ 1 min rest - 2:08, 2:04, 2:02, 2:02

Hip flexors, abs, adductors, chest machines

Pretty good session, not full effort but peaked my HR at 170.  Nice having Roya here. 

Injury still there but steady improvement.  Will try to run a little by this weekend.  Maybe start with some hills.

I was incredibly disciplined with my diet in the month pre Nationals.  Wonder if I got too light?  I had bought 5 lbs of my favorite chocolate in early March and just opened it for the first time this week.  Ate at the campus buffet last night so a lb heavier this morning at 141.5.  

interview and new food item review

Larry Sorensen's youtube interview with me last week. - 

https://youtu.be/vMPG9YyAdvs?si=7fBOl4UYXI2_W9w2

------------------------------------------------------------------------

New Food Item:

Royo bread and bagels.

https://eatroyo.com/

I ordered their starter pack of 3 bags of bagels (plain, raisin, and everything) and one loaf of bread.  It was my first venture into low carb low calorie bread.   Like other low carb foods, I wasn't expecting it to taste anything like 'real bread' but I was happily mistaken.   Unlike say, shiritake noodles, the low carb bread actually tasted pretty good.  

The Royo plain bagels have 70 cal, 'everything' and 'raisin bagels' are 80 cal.   Compare to regular bagels that can be 300-400+ cal.  (Panera's cinnamon crunch bagels are 430 cal).   Royo bread slices have 30 calories although are pretty small.  

The ingredient that jumps out is 'resistant wheat starch'.   This is apparently a starch that is non digestible in the small intestine and helps the gut biome in the large intestine.  So, it is essentially fiber.  This bread is very high fiber but still contains protein and some carb.  

Pros: 

1/3 the calories of regular bread, high fiber.  It toasts well and tastes very good.  Gives the feeling of fullness, satisfies appetite.  It is claimed to ease insulin sensitivity, inflammation, and boost gut health.

Cons: 

Expensive, about $2 a bagel.  Digests more slowly, probably contributing to the fullness feeling.

More on resistant wheat starch:

https://www.webmd.com/diet/what-to-know-resistant-starches

https://eatroyo.com/blogs/the-toast/what-is-resistant-wheat-starch-and-why-is-it-the-hottest-new-ingredient-in-the-baking-world

Because of Royo, tea and toast is back as a comfort food for me.   When I eat regular carbs like toast, granola, cereals... I find them addictive, hard to stop eating them.  This type of Royo bread feels different.  It's simply more filling.  

Thumbs up.

stadium stairs, new shoes, food sweetener

Yesterday morning at the MTSU stadium stairs.  It was one of my worst sessions on the stairs.  This 40m stair sprint is one that I've done 30x in a session (10 yrs ago).  Usually try to get 20.  Today, only could do 12, and took generous rest between the final 3.   2 yrs ago about this time I did 16, then a week later, 19.  I'm really out of shape.   By the end of these last stair sprints I was not even getting off the ground between the last few steps due to fatigue.   A reminder that it goes away fast.  I'm sore today.

I had my blood drawn on Thursday morning.  I tested my blood twice that morning.  Blood glucose was 77 and an hour later, 79.   I was up early on not a great night sleep to take my car in for some tire work.  Then had my blood drawn.  Was tired.  I'll bet my T-level will be low.  I think my T and my glucose was higher last time because I did some squats in the morning before my test.  Not really interested in T level, just want to be under 100 for glucose to get the wellness rebate.  After my blood test, I had a sandwich and some sweet coffee and tested it again a bit later, it was 140.  

 

Hoka trainers on 

stretches

12 x stadium stair sprints

141.0  lbs after workout.

I heard recently of a study linking zero calorie sweetener erythritol to negative health effects due to excessive platelet activation which can cause blood clotting which could lead to heart attack and stroke.  Not sure if this would show up in a blood test as an increase in platelets, or if it just enhances the clotting of platelets at a normal level.   Erythritol is in both sweeteners I use - a blend containing stevia and monkfruit.  Still preferred above sucralose and acesulfame potassium, but I'm going to do what I had been doing before, mixing it half and half with raw sugar, reducing my use of both.   Disappointing for sure.  

I got the Hoka Rocket X2s in today.  They are 6.7 oz, almost an ounce heavier than the Vaporflys.  Still very light, comparable to the Rincons.    Just tried them on, will probably not run until Monday if I'm smart.  The feel and fit is really different from the Nikes.   First impression is that the Nike Vaporflys are 'plastic-y' in the upper and non-flexible, like the Maxflys.  The Hokas in comparison are 'rubbery' in the upper and have a stretchy snug fit, a lot like my Adidas Prime SP2 racing spikes, and like the Adidas Takumi Sen 8s.  Not really easy to get on, but still quite comfortable on first impression.   Just walking around the house, these Hokas feel like no other shoe.  Very hard to describe except I feel tall and springy.

Planning to up my running workouts to 2x week - Mon/Fri.  

.

300s

Happy to have the facility to myself today in Sewanee.  First time on the track in a while.   Wanted to run some long sprints and wow, am I out of shape.  

Hoka trainers on

stretches, drills, bands, 100m, 50m

100m - 14.47

Adidas trainers on

300m - 45.31

Hoka trainers on

300m - 47.79

Yea, that first 300m wasted me.  I should have known it would be tough after a mere 100m in 14 got my heart racing to near 150.   The first 300m pushed my heart rate to 160.   Heart rate was just below 130 several minutes later when I ran the second one. 

The key to doing track workouts is to stay off my feet as much as possible the day of and the day before my workout.   The foot hurts afterward but there has never been any swelling or sign of trauma.

I've gained about 4 lbs of fat.  Was 143ish after the workout.  I want to reduce this week in prep for my blood work and physical... to get that refund.  Good motivator.   I ate very little today but did have a piece of keylime pie at the cafeteria.  Should be pretty light tomorrow.   It's probably like a difference between being 9% bodyfat during competition and 12-13% now.  Still generally fit, but not 400m fit. Even now I think I could still run my age in an all out time trial, maybe even 62. 

Fitness, V02 max, muscle tone..... it goes away fast.  

Fat, it accumulates fast.

Still thinking about trying some more padded shoes as my Hoka Rincons are getting old.  Looking at the Hoka Rocket X2 and the Nike Vaporfly 2 and 3.   There are good deals on the Nike V2 as the V3 is now out.  Both X2 and V3 are super high priced, $250.

UPDATE:  

Went with the Hoka Rocket X2s.   Can return them if I don't like em