Friday, March 27, 2020

Retrospective #405: LDL-C and TGL while Fasting

One of the speakers at Keto Fest in New London July 2017 was Dave Feldman, a self-described “engineer, software developer and entrepreneur.” Compared to the other presentations at Keto Fest, Dave made a rather geeky presentation about his high LDL-C hypothesis. These notes are taken from his talk:
“LDL-C has many jobs.” “Its primary job is to distribute energy from fat” (triglycerides or TGL). “MULTI-DAY FASTING BEFORE A CHOLESTEROL TEST WILL LIKELY SPIKE YOUR LDL-C.” That last sentence got my attention.
Then I saw that both Michael Eades ( and Jason Fung ( had also credited Feldman on this hypothesis. It turns out he’s attracted a lot of attention in the Low Carb/High Fat and fasting communities. Here’s a related sample from Feldman’s website,
“There’s just a few of us that think the same thing as I do. That cholesterol is the red herring. That mostly, this is due to higher demand for fat-based energy coming from storage in the form of triglycerides being carried by VLDLs. The cholesterol being measured resides in those VLDL-originating LDL particles, which is why its quantity is inverted from the total amount of dietary fat I eat.
More fat in my low carb diet? Less need for fat-based energy from storage, less VLDLs mobilized, less cholesterol riding along with it. Lower cholesterol score.
Less fat in my low carb diet? More need for fat-based energy from storage, more VLDLs mobilized, more cholesterol riding along with it. Higher cholesterol score.
My doctor’s appointment is typically on a Tuesday, and I generally don’t fast on weekends, but I often do on Monday. So, I made a mental note to be sure to eat fat on any fasting Monday before an appointment. Check!
I should also note that Dave Feldman is also what is known in lipidology medicine as a “hyper-responder.” “The term, ‘hyper-responder,’” Feldman says, “has been used within the ketogenic/low carb, high fat (keto/LCHF) community to describe those who have a very dramatic increase in their cholesterol after adopting a low carb diet.” This is not common, but occurred to Feldman and is the reason he began his investigations and developed “The Feldman Protocol,” a hypothesis to explain this “inverse correlation.”
Dave’s Protocol is much too complex for this blog, but if you happen to be one of the few to whom this has occurred, I strongly encourage you to check out his website and delve into or even participate in his experiments.
For my part, eating just Very Low Carb (without fasting), before I started the occasional use of Extended Full-day Fasting, my LDLs and TGLs have all been very good. I wrote about them a few years ago in Retrospectives #281, #282 and#283. By just eating a strict Very Low Carb diet, my TGLs dropped about 2/3rds and HDL more than doubled.
I also recently did a 14-year TGL average of 50 tests, beginning 1 year after I started VLC, and the result was 54mg/dl. My average of 15 TGL tests in the early years of eating Very Low Carb was 49mg/dl.
Since starting full-day fasting, my Total Cholesterol has gone from 198 to 201 and then 196. My HDL-C has gone from 85 to 74 and 74. My LDL-D has gone from 101 to 114 to 100; my TGLs have gone from 60 to 67 to 108. Hmmm.
Also, my blood pressure has gone from 130/80 to 125/70 and 120/80. And my A1c has gone from 5.8 to 5.3 and 5.2. These improvements in the lipid panel are the “expected” response to switching from the low-fat, very high carb Standard American Diet to a Low-Carb/High-fat diet. Dave Feldman’s hyper-responder response is not typical, but his work on investigating the mechanism is very interesting and may prove useful in explaining these (and my) anomalies, e.g. that unexpected 108 TGL on my most recent lab. I must have fasted on the Monday before the test.

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