Todd Allen

Mccoy, if you go back and listen to Dr. Attia closely his position is high LDL-p is problematic in the context of compromised endothelium but high LDL does not cause the compromised endothelium. Since evaluating endothelial health accurately is not currently possible short of an autopsy he believes it is prudent to maintain low LDL as that is something we can readily track.

Mike, one must read a study to make an informed judgement of its worth. Here's a link to the full paper: http://sci-hub.tw/https://doi.org/10.1093/eurheartj/ehz174 Here are a few of the study's weaknesses as identified by the authors. Studies based on epidemiological data are notoriously weak and inconsistent. In the intro and discussion they point out other studies of this type with conflicting findings. This study based on admittedly inaccurate data focused on dietary composition of carbohydrates versus non-carbohydrates. They lump fiber in with carbohydrates as if there was no difference between fiber and sugar. Most consider fiber healthy and refined sugar unhealthy, including the authors. Regardless of where one stands on the question of the healthfulness of fiber and sugar there is no questioning that fiber by definition is complex carbohydrates that we do not directly digest. Our digestion of fiber is mostly limited to fermentation by gut microbes resulting in short chain fatty acids such as acetate, butyrate and propionate. Equally stupid is lumping everything non-carbohydrate together. Proteins and fats have very different properties and roles in a thoughtful diet. There doesn't appear to be any consideration given to dietary quality, to how food was produced, processed or prepared, or to whether diets were nutritionally complete. This study's cohort are not practicing caloric restriction. They aren't attempting to optimize nutrition for longevity or any other purpose. I fail to see how it has any relevance to myself or any other person who prioritizes health when choosing what to eat. This is a study for people who think taking a daily multivitamin is a good alternative to a nutritionally complete diet.

I ate all of those foods today. And it was damn good, it was mostly fat and I'm deep in ketosis. My meal was a salad with red leaf lettuce, kale, spinach, avocado, eggplant sauteed in EVOO, sous vide beef heart, parmesan cheese, broccoli sprouts, fenugreek sprouts, olives, black bean natto, pecans, sunflower seeds, almond butter, tahini, dried tomatos, ACV, ground flax, garlic, mustard, cumin, seaweed and salt followed by a desert of kefir'd heavy cream and chia, a raw egg and topped with cacao nibs and shredded coconut.

Mccoy, thanks for the interesting video from Jerry Brainum. It was good to hear him discuss how widespread the use of low carb dieting was in the early days of body building. Vince Gironda made claims that he had influenced many to try it and it was widely adopted because many struggled to achieve in any other way the ridiculously low body fat percentages that had become essential to be competitive in the sport. I was hesistant to bring up Gironda's claims that extreme carb restriction was common because I thought it might be self promotion. I've found some examples such as Larry Scott but I've also found high carbers from that era. And few consistently stick to a single diet for long periods. Here's an excerpt starting at roughly 13 minutes into Jerry's video: Jerry has it significantly confused. The chain of causality is severe carbohydrate restriction (or fasting) causes a drop in basal insulin which leads to a greater excretion of electrolytes, especially sodium. In addition salt intake tends to drop when people cut carbohydrates because they are cutting breads, crackers and a whole range of processed foods that are high in salt. As sodium depletes we excrete more water to maintain blood electrolyte concentration. As the body dehydrates it becomes harder to rebuild and maintain glycogen stores. Loss of sodium leads to increased potassium excretion to maintain balance and the loss of potassium eventually impacts maintaining nitrogen balance in muscle but that is a slower later process than glycogen depletion. The rapid severe muscle wasting Jerry encountered was a loss of muscle glycogen. People today who take care to get enough sodium eating low carb or even zero carb, 5 grams daily is typical, and adequate intake of the other electrolytes don't experience the acute glycogen loss, fatigue, feeling like crap or muscle wasting. This is discussed in detail in several places throughout this book: (search for "sodium" to find relevant passages) The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable

Typically ketogenic diets dramatically lower triglycerides, moderately increase LDL-C and are neutral on LDL-P though there are cases both sharply up and down. They also raise HDL somewhat correlated to the amount of saturated fat. This was the pattern in the lipid data of the Wilson study of resistance trained men though due to the short duration the figures hadn't adjusted as much as people see after a year or two. Here's a presentation by Dr. Ronald Krauss where he goes into some detail on these factors and the decrease in risk of CVD.

A presentation on the US Major League Soccer team Columbus Crew SC and their increasingly positive experience over the past 4 seasons since adopting a LCHF team diet. While not RCT quality evidence it does suggest like other anecdotal evidence that it takes time to adapt to this dietary approach and if there was funding for longer RCTs they might show more impressive results. One might say soccer is a lesser sport to diminish the significance of this case but I'd suggest if one looks closely they might see soccer can be as physically demanding as real sports...

I didn't bring up Larry Scott as an example of an ideal longevity approach but rather to counter the notion that ketogenic diets inherently produce muscle wasting. And if one considers the numerous early deaths of high carbohydrate bodybuilders it doesn't suggest carbohydrates = longevity.

Perhaps this is your reason for thinking eating keto causes wasting? I've looked but never seen anything anywhere that gives me that impression. I have seen cases where protein restriction is extreme and this can occur such as when taking it too far for too long as in the case of pursuing very high ketone levels to manage medical conditions such as epilepsy, cancer and some metabolic/neurological diseases. As for bodybuilding I see evidence of ketosis being employed with advantageous purpose, not just for cutting but for building muscle while staying lean, since the earliest days. In the book Unleashing the Wild Physique by Vince Gironda he states: "Personally, I prefer to use fats over carbohydrates as energy sources" He lists several sample diets for different purposes, maintenance, weight gain, high definition (before competitions), ovo-lacto vegetarian reset, etc. They are all low carb, mostly keto though some include fruit as the last item without specifying the fruit or quantities. The vegetables he recommends are the same as recommended today for keto, nothing starchy like potatoes or even onions. His weight gaining diet includes 2 slices of toast at breakfast and allows for a cup of milk although he says he drank cream. He claims to have coached many other body builders who followed his dietary advice with good results. Here's an article on Larry Scott who Gironda says he coached and the diet sounds much like one of Gironda's and is so low carb he was undoubtedly keto despite the high protein. scans of pages to show I'm not making this up:

I guess we each see things through different lenses. When I hear Valter and others speak about keto I tend to see them critical of things that fall into the realm of keto just as others can be critical of things vegan, such as Twinkies, but yet I see the acknowledgement keto encompasses wide ranges of possibilities with redeeming aspects: https://www.youtube.com/watch?v=zz4ZzNik1Y4 at time 17:40 Mark Hyman: so there's a bunch of things you threw in there like a ketogenic diet and intermittent fasting, there's this whole field out there that's moving in this direction of a fasting mimicking approach, right, not your fasting mimicking diet, but a ketogenic diet in a way sort of mimicks fasting and may activate a lot of the same mechanisms ... a little talking over each other ... a ketogenic diet is the latest hot thing but your saying it's not necessary 19:12 Valter Longo: I don't want, even though I could get more benefits from a lower more ketogenic diet, a lower carbohydrate diet, I don't want to do that. Why don't I want to do that? Because I don't want people to go back and forth in this yo-yo manner to very low carb, very high carb, because I'm worried that's going to stimulate too many variations in the program and some of them are going to have detrimental effects. So we're not used to this back and forth and so I don't want to introduce this. I'd rather have a very potent effecct but not as potent as I could. Because we always get asked why don't you reduce the carbohydrate in the FMD and that's on purpose because we don't want to push you to the edges. Mark Hyman: But it's not starch, right, it's vegetables. Valter Longo: It's not starch, it's all vegetables. 38:15 Valter Longo: for specific uses I think that the ketogenic diet can be more extreme if you have someone that is overweight, obese, has all kinds of problems, yeah that's where I see that a much higher fat level, a much lower carbohydrate level being very useful to get the person to where they need to be Mark Hyman: that's over 2 billion people on the planet Valter Longo: exactly, exactly

You make a declarative unsupported statement that a keto diet causes muscle wasting. I post a study that shows a change in resistance trained athletes of muscle thickness from 5.25 to 5.50 cm in 10 weeks on a keto diet vs 5.0 to 5.18 cm on a standard diet. Those on the keto diet did not have wasting but rather gained 1.39 times MORE than the standard diet. And after a week of glycogen recompensation the keto group increases another 0.2 cm for a net result that is 2.65 times better growth in muscle thickness. And your conclusion is the results are unimpressive and we've gone OT...

In my case free T is up modestly as SHBG rose strongly. But albumin is also up a lot which significantly increased bioavailable T. My average protein intake is not particularly high due to cycling between a week of aggressive caloric restriction and fasting (averaging 30 g protein/day) followed by a month of modest caloric excess (90-100 g protein/day). I've never taken exogenous ketones. My ketone level is high during restriction phases and liberal use of coconut oil and sometimes MCT oil is sufficient to offset the ketone lowering effect of the added protein during my anabolic phases. Here's another presentation that at 21:50 shows greater skeletal muscle mass after a long term ketogenic diet vs a standard high carb diet without any carb loading. I previously posted a link to a paper by Jon Ramsey on this research. This is on mice fed a standard research diet with the low carb and keto groups swapping lard for carbohydrates. The keto mice getting most of their calories from lard live longer and they had much lower markers of inflammation, stayed stronger, faster, better endurance, smarter, better memory, better insulin sensitivity, and greatly reduced tumors and cancer.

Yes, LDL going up is fairly common. The ones where it goes up dramatically tend to be people who engage more heavily in exercise and achieve low levels of body fat. I’m trending toward that pattern though not quite there yet. My LDL ~190, HDL & TG both ~75, but I’m still roughly 20% bodyfat. I expect to be a full fledged member of the group by the time I hit my goal of 12%. Low markers of inflammation are also typical for this group. I’m already there for ESR, hsCRP, GGT, ferritin, fibrinogen and WBCs. Some are concerned about high LDL, but there is growing evidence of decreased severity of numerous neuromuscular diseases with high LDL and I find it curious that myalgia and/or myopathy are side effects of all drugs that lower LDL: statins, fibrates, cholestyramine and even the new pcsk9 inhibitors. Here’s an interesting recent interview with Dr. Ron Krauss where he admits how little is known about the impacts on lipids and cardiovascular risk of high fat carbohydrate restricted diets and his interest in studying the healthfulness of this pattern of high cholesterol and low triglycerides. And he repeatedly mentions problems of high carbohydrate diets... Here’s a paper by Eric Verdin and John Newman of the Buck Institute on actions of ketone bodies including suppression of the NLRP3 inflammasome. A more recent presentation on this research: John Newman - Ketone Bodies As Signaling Molecules Another presentation of this and related research: Steve Phinney - Inflammation, Nutritional Ketosis, and Metabolic Syndrome Here are research papers suggesting the opposite of your beliefs with respect to keto and muscle: The Effects of Ketogenic Dieting on Body Composition, Strength, Power, and Hormonal Profiles in Resistance Training Males CONCLUSIONS: The KD can be used in combination with resistance training to cause favorable changes in body composition, performance and hormonal profiles in resistance-trained males. The effects of ketogenic dieting on skeletal muscle and fat mass A presentation by one of the authors: Metabolic Health Summit: Jacob Wilson, Ph.D. | The Muscle PHD A website for keto bodybuilders. As for testosterone mine has been climbing sharply since going keto and pulsing heavier protein intake along with intense resistance training and extreme thermal stress: most recently 1950, ref. range 250-1100. It used to concern me as testosterone has been shown to be an essential driving factor of my disease pathology and some take testosterone blocking drugs to slow disease with the most extreme case I know of is a man who opted for sex change as this disease barely affects females. But my IGF-1 is also up strongly which I think may be protecting me from the adverse consequences of high testosterone: Insulinlike Growth Factor (IGF)-1 Administration Ameliorates Disease Manifestations in a Mouse Model of Spinal and Bulbar Muscular Atrophy I like feeling like I'm 18 again since going keto and my wife is pleased with my decision to remain male.

https://med.stanford.edu/news/all-news/2018/07/diabetic-level-glucose-spikes-seen-in-healthy-people.html High blood sugar is getting a lot of attention because it is an issue for the MAJORITY of adults, at least in the US: diabetics age 45-64 17.0%, 65+ 25.2% prediabetics age 45-64 40.9%, 65+ 48.3% TOTALS age 45-64 57.9%, 65+ 73.5% statistics taken from: https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed.html https://www.cdc.gov/diabetes/data/statistics-report/prevalence.html So roughly 3/4s of seniors are prediabetic and the report I posted from the endocrinologists society finds increased risk of CVD from hyperglycemia begins below the criteria for prediabetes and many with normal blood sugar have diabetic spikes after a bowl of cornflakes... Study after study finds improved cholesterol profiles of people on ketogenic diets. HDL up strongly, triglycerides down strongly, LDL sometimes up sometimes down but consistently a better profile - larger particle size, reduced oxidation. Markers of inflammation such as hs-CRP also consistently improve. These factors more strongly correlate with cardiovascular risk than the calculated LDL-C of a standard lipid panel and well formulated ketogenic diets are widely recognized to potently reduce CVD risk. As in fasting aggressive carbohydrate restriction produces a short term insulin resistance in muscle to spare glucose for the central nervous system. This is a healthy, essential process that lowers the need for protein sourced gluconeogenesis sparing muscle tissue the largest reservoir of protein. After a day or two of glycogen repletion this glucose sparing mechanism shuts down. Ketogenic diets, especially when unhealthy refined vegetable oils are excluded, dramatically improve insulin sensitivity and glucose tolerance. There are studies showing problems with "high fat diets" usually in inbred mice fed highly unnatural diets of sucrose, inflammatory casein for protein and refined soy or corn oil. Note, HFDs are typically only 40-45% fat and still 40%+ carbs often half or more being sugar. In such cases feeding them more starch instead of toxic vegetable oils would be healthier though I bet a more natural mouse diet of fatty grubs, nuts and seeds would produce health instead of disease.

Tahini, ground sesame paste, is great in dressings and is probably more healthful than sesame oil which loses the fiber and desirable phytochemicals in the extraction and refining processes. I prefer raw vs roasted tahini and store it refrigerated to minimize rancidity. Grinding or mashing it yourself from whole fresh seed might be best but premade still ought to be better healthwise than oil.