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LOW CARB PALEO & INTERMITTENT FASTING - LIPID CREATION or CLEARANCE?

Answered on August 19, 2014
Created July 02, 2012 at 7:25 PM

FACTS:
Male, white, 52 5-7 170lbs approx. 130lbs fat-free mass Bodyfat: approx. 19%

GOAL: <10% bf using a LC PaIeo diet combined with Intermittent Fasting which means I must lose at least 17lbs of bf, both subcutaneous and visceral.

Resistance train 4xs/week Cardio interval train 2-3xs/week

I was dx'd via ultrasound with non-alcoholic fatty liver disease (NAFLD) two years ago. It is indeterminate how long I've had it. Liver enzymes continue to remain within normal range and I notice no symptoms

I am hypothyroid and have been taking 75mcg of sustained-release T3. My latest thyroid numbers are posted in the link below [p2, 3, 10].

TSH has improvement over last labs. Both T4 and T3 show depressed, however, I was fasting for nearly 20 hours on the first day. rT3 is less this time, which is a good thing.

Have been on LC Paleo diet for last three months and doing between a Lean Gains [ http://www.leangains.com/2010/04/leangains-guide.html ] 16/8 IF protocol to as much as 20/4 IF protocol. I do mini-carb refeeds (about 50-60g) on my workout days only. If I increase carbs more than this, my post-prandial BG will exceed 125.

What's freaking me out are my latest lipid tests. I had the top three done in a matter of two consecutive days [p2, 5, 11-14].

LATEST LABS: http://s57.photobucket.com/albums/g207/CS2006/LABCORP%2006-19-12%20and%2006-20-12%20LABS/

If we???re clearing lipids from the liver, then this is a good thing, but HOW CAN I DETERMINE THAT IT'S THIS AND NOT FROM THE DIET ITSELF?

In other words, is the increase due to CREATION or CLEARANCE (resolution of NAFLD)?

I have not changed any macros in my diet, maybe slightly more lean grass-fed animal protein, but saturated fat intake has remained constant throughout. And most of the saturated fat is drained because I steam all my meats, so how can it be CREATION?

The only other fats I eat with frequency are O3s (2-4g), coconut, flax, macadamia and olive oil.

What evidence supports this unconventional theory?

I understand that one of the key problems with fatty liver disease is that the lipids get stuck in the liver and they???re not being released into the bloodstream.

How could this be the case when taking liver support supplements like milk thistle, dessicated liver, choline, lecithin, etc.? Why wouldn't such intervention spur on the purge also?

Why wouldn't free fatty acids (FFAs) from stored subcutaneous fat be released into the bloodstream as well?

Could this explanation be the mechanism behind the clearance of FFAs: During fasting or starvation, free-fatty-acids are released during lipolysis into the liver and muscles to be burned as energy, this is called fat-oxidation. During the fed-state and especially while eating a starch-based-diet, fat-oxidation is inhibited and replaced with carbohydrate-oxidation, insulin is what mediates this shift. When carbohydrate-oxidation is taking place, fatty-acids are shuttled back and "locked away" in adipose-tissue... where they belong.

In addition to LC Paleo/IF, I also began taking 1g of choline nearly a month before the labs + 3mg methylfolate/day to help with a genetic methylation defect.

Could the above combination have created a mega-purge?

Could the answer be that the best predictor of fatty liver is obesity and insulin resistance?

Another thing: I have been on warfarin for 3 months and must remain on it for another 3 months. This was the only thing I could find on warfarin and its effects on blood lipids:

Coumadin binds to bile acids in the intestine leading to increased excretion of bile acid in the feces leading to increased oxidation of cholesterol to bile acids resulting in increased numbers of low density lipoprotein receptors with increased hepatic uptake of LDL and lower serum cholesterol levels source: http://www.flash-med.com/Side_Effects_Coumadin.asp

Anomalies to purge theory:

Why the decreased HDL when I was making nice progress before?

Lastly, I had been fasting for 18-20 hrs prior to my blood being drawn. My fasting insulin was only 5.2. Then why an elevation in HbA1c (5.8) and FBG (95)? Should've been in the low 80s, especially when fasting for LONGER periods AND on LC Paleo.

This even when on a broad range of BG-lowering natural agents including corosilic acid, chromium, cinammon, etc.

So, why is my insulin sensitivity is taking a nosedive during this so-called healing crisis as well [see Insulin Resistance Score - p12, 14]?

Can someone please interpret my lipid profiles, especially the NMR LipoProfile and tell me what is going on?

3864f9a2af09b1b447c7963058650a34

(3703)

on July 03, 2012
at 12:47 PM

Low thyroid function increases LDL... Which is likely triggered by starvation modesas seen in IF models.

3864f9a2af09b1b447c7963058650a34

(3703)

on July 03, 2012
at 12:44 PM

You've certainly covered the b vitamins! Has the reason for the clot been discovered? What you say about purging fatty acids makes no sense... Where are you getting the info? The low insulin is a result of IF and low carb. It fails to measure directly insulin resistance at the peripheral tissue and cellular level. The fact that you no longer burn fat reflects it clinically. Your current results are textbook...

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5 Answers

1
3864f9a2af09b1b447c7963058650a34

(3703)

on July 03, 2012
at 03:43 AM

I'd concur with Knox. Too much stressors include IF. Though the cortisol reported was decent it doesn't show the response or hour to hour pattern. One value is almost meaningless. Here we discussed earlier how IF causes pseudo diabetes....

http://paleohacks.com/questions/14320/fasting-blood-glucose-increase-while-intermittent-fasting/14342#14342

You should consider with your practitioner:

--possibly too much pre-formed vitamin A from liver or desiccated liver supps which is liver toxic and may contribute to insulin resistance

--insulin resistance and poor thyroid functioning from excessive stressors, fasting, ketosis and possible adrenal dysfunction. Insulin resistance also maybe a result of toxins, hormonal dysregulation and intestinal permeability. The high hgba1c, small particle sizes, and high TG to low HDL ratio is the metric that often reveals.

--you imho do not appear yet to be an effective fat burner (insulin sensitive) yet

--if undermethylating consider ALL the activated and methylated spectrum of B vitamins not just methyl folate alone. Cyanocobalamin does NOT exist in the natural world! I like this one: http://www.iherb.com/Thorne-Research-Basic-B-Complex-60-Veggie-Caps/18791

--potential magnesium and zinc deficiency which inhibit fat burning, anabolic activity, thyroid and adrenal proper functioning

--dangerously lowering BG by COMBINED IF and taking supp insulin sensitizers--- this is very stressful for both thyroid and adrenal function to maintains optimum BG LEVELS, especially given the intensity and freq of all that glucose-intensive anaerobic activity!

I believe you are correct that NAFLD is a function of insulin resistance at the liver level, which may or may not incl obesity. I know a ton of skinny men and women who have it! They consume way way way too much n6 pufa oils and are omega3 deficient. NAFLD is easy to reverse and it mirrors improved insulin sensitivity well from my observations.

Good luck and look forward to your progress

1
F0a3e3f17d9a740810ac37ff2353a9f3

(3804)

on July 02, 2012
at 08:58 PM

Mark,

I'm hypothyroid, as well, and I would be happy with those thyroid numbers, especially after a 20 hr. fast.

Otherwise, even if I knew enough about blood lipids to offer an opinion, there's so much going on, with supplements, eating patterns, macro intake, that it would be extremely difficult to discern a cause for the rising numbers.

I will say that there appears to be a connection between stress and elevated blood lipids, and your diet and exercise regimen seems ungodly stressful. Why not just follow a simple, low-carb Paleo diet and hit the gym 2-3 times a week? That should control blood sugar and help you shed a few pounds, and it doesn't take much resistance training to maintain lean body mass.

It's not my place to tell you what your priorities should be, but you seem to have some fairly serious health issues. Maybe you should see what you can do to address them with diet and then go for the ripped abs.

0
72cd359efb959175e2c7786ea0450879

on July 03, 2012
at 06:10 PM

Also - low T3/T4 during fasting is only a concern when you exceed about 24 hours which does not apply to me.

0
72cd359efb959175e2c7786ea0450879

on July 03, 2012
at 06:07 PM

I suspect the clot was from the MTHFR mutation causing elevated homocysteine, but no way to know for sure.

The purge is based on this:

In this link, Chris Kresser had Chris Masterjohn covered reasons why cholesterol would increase after going paleo, and why it may not be bad:

http://chriskresser.com/chris-masterjohn-on-cholesterol-and-heart-disease-part-3

Masterjohn mentioned that a transitory increased blood lipids could be a sign that fatty liver disease is being reversed.

0
72cd359efb959175e2c7786ea0450879

on July 03, 2012
at 09:18 AM

Appreciate the feedback thus far, however, IF, if anything, relieves the burden of digestion as well as resets leptin and insulin. Perhaps I should stick to a longer refeed window like 16/8, but I feel no worse extending it. So far, I feel better and get a better workout during fasting. It may sound stressful, but no complaints with the exception of these labs. Actually, I do take a good size portion of aminos to avoid catabolism, so at least it's something as opposed to a strict fast. Just no carbs before, only after. Training during fasting oxidizes fat more than in a fed state (no good). I have no hunger or symptoms of any kind during this time. Following training comes a sizeable refeed, largely of lean animal protein, fresh veggies, and a mini-carb refeed.

If I had leptin and insulin resistance, then why is my fasting insulin and leptin so low? That's what doesn't make sense.

I am not diabetic. My FBG ranges from the mid-80s-high 90s; postprandial BGs hover between 105-115 with no carbs and between 115-130 w/ smart safe carbs and in the 50-75g range in one meal. I rarely ever go above a 30 pt. rise postprandial. I can also control the level with an ounce or two of apple cider vinegar. It works!

The elevated vit A is simply from supplementation saturation (cod liver oil) and is what my doc wanted. Now, time to drop dose back. Too little A is worse for thyroid! I takes tons of zinc and mg daily and my past levels are optimal.

My O3 to O6 ratio is the opposite of everyone else's: like 6:1 in favor of O3s which is too much O3 and not enough O6! So I am taking more O6s now to rebalance and get closer to 1:1.

I am on warfarin for a DVT (clot) I had in my left leg in March. My guess is that it was caused most likely from the MTHFR mutation I just discovered I had which can cause hyperhomocysteinemia (elevated homocysteine) which can lead to clots. I am taking a comprehensive methylation regimen of methylfolate, methylB12, P5P, R5P, NAC, TMG, DMG, SAMe, taurine, etc.

I am on the standard 6-month anticoagulant prophylaxis protocol. I have two more mos. and I'm done. Still, I wonder what effects warfarin has had, as it has definitely decreased my Vit K level on my lab which affects the protein responsible for procoagulation which affect, hello, LIPIDS: http://atvb.ahajournals.org/content/14/11/1737.short

To what extent, I don't know, does anyone?

I am upping my carb intake on my workout days to help offset the potential stress from chronic ketosis. BUT I STILL AM UNABLE TO SHED MORE BODYFAT! I WAS making progress (19% down from 24%, but have another 10% to go to reach my goals), and then it seems to have stopped. No, it would seem I am definitely NOT an efficient fat burner! If I am at 19% and have NAFLD still, I need to be IFing and doing paleo I would think!

By the way, this is not my typical lipid profile. Here are my last three lipid and glucose tests:

PRIOR TO LC PALEO & IF: 06-14-11: TC: 163 LDL:92 HDL:42 TRIG: 147 HGBA1C: 5.6 INSULIN: 2.3

AFTER STARTING LC PALEO: 10-20-11: TC: 214 LDL: 144 HDL: 47 TRIG: 113 HGBA1C: 5.3 INSULIN: <2.0

AFTER STARTING LC PALEO/JUST STARTED IF: 03-08-12: TC: 197 LDL: 132 HDL: 43 TRIG: 108 HGBA1C: 5.0 INSULIN:<2.0

With all the anecdotal threads on paleo temporarily causing elevated LDL [http://paleohacks.com/questions/96588/clinical-question-about-cholesterol-and-paleo-diet#axzz1ypfg6I2f], especially when one has fatty liver, I would guess I fall into that category hands down. During a purge caused by LC Paleo/IF, free fatty acids are released into the bloodstream. But with so much going on here it is not an easy, slam-dunk answer. As I said, I haven't altered my diet, increased my IF from 16 to 20 hrs.

With all that I have tried and already done, I am leaning (and hoping) towards this anomaly being resolution of fatty liver.

Thanks again.

3864f9a2af09b1b447c7963058650a34

(3703)

on July 03, 2012
at 12:44 PM

You've certainly covered the b vitamins! Has the reason for the clot been discovered? What you say about purging fatty acids makes no sense... Where are you getting the info? The low insulin is a result of IF and low carb. It fails to measure directly insulin resistance at the peripheral tissue and cellular level. The fact that you no longer burn fat reflects it clinically. Your current results are textbook...

3864f9a2af09b1b447c7963058650a34

(3703)

on July 03, 2012
at 12:47 PM

Low thyroid function increases LDL... Which is likely triggered by starvation modesas seen in IF models.

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