How Keto and Fasting Reversed My Heart Disease PART THREE

Formulating the Plan

Welcome Back! In this third part of a three part series in which I chronicle what I believe I did to reverse my Agatston score from 386 to 355 in 8 months. This may not seem like much of a drop being only 8.2% but the American Heart Association says that a 12-25% increase of calcification annually is to be expected with no known interventions to stop let alone reverse the trend. In Part One dealt with how I discovered that I even had an issue. Then in Part Two went through my details to figure out how to approach possibly reversing my problem by creating an environment in my body that could alleviate the primary driver of my particular type of problem and allow healing to take place. Then now in Part Three I detail some of the things I did that created that environment. 

All the things I do are this:  

• I eat a diet that is ketogenic for me. 70% Fats, 26% Protein, 4% carbs on average. 
• I resistance train, heavy weights, 90 minutes HARD 5x a week. 
• I cycle, paddle and cross-country ski as recreation. 
• I take therapeutic doses of vitamins and minerals beyond recommended levels. 
• I laugh frequently. At myself. My friends. Situations. Inappropriate situations.  

 I will say up front that I have no evidence that can show “x” reduced the calcium burden.  I can only show my correlations and why I made my decisions and then how I verified that things were working.  I have empirical data that my heart improved by reducing its calcium burden- atherosclerosis has reduced and I have also improved blood pumped per stroke. How this occurred will be up to you to decide.

My Nutrition 

As I said in my previous post I eat a ketogenic diet which I started initially for weight loss but then for the many health benefits we( my wife and I) were seeing. Most importantly my wife lost her suicidal tendencies and I was seeing a dramatic increase in my bone mass reversing 15 years of unrelenting osteoporosis and increased disability. Keto was going to be my diet from now on as the health benefits kept rolling in. As I read more and then began traveling the country for science and medical conferences, I found so many other wonderful health recovery stories I realized most of us just should not eat a diet centered around plants and carbohydrates. That it was this Standard American Diet, SAD, that made us ill.  I did not know if ketones provided other health benefits at the time, but I now accepted that by removing the carbohydrates I removed the hyperinsulinemia which was one source of inflammation in my body and this was allowing my body to make “miraculous” healing progress.  

Hyperinsulinemia 

Chronically high insulin leads to heart disease and as I stated in Parts 1 & 2 even on a Ketogenic Diet I saw my insulin levels go down from 9 uIU/ml down to 6 then rocketed top 13!  But investigation showed that the seemingly innocuous sugar-alcohols promoted on some VERY POPULAR Keto sites who’s entire viability and economic success revolves around copious uses of these recipes & desserts, and these are promoted as healthy. While for me it seemed that Keto Desserts and Keto Cookies and Ice Cream might be part of my problem.  Irregardless that the science showed these sugar-alcohols had little impact on glucose or insulin, I had a response.  I cut them out. 

Mostly.

I mean every couple of weeks should be okay, right? Spoiler, so far yes. The problem was daily use and often twice a day. I was no different eating keto cookies than I had been Oreos. Maybe it was everything that went with them blowing open my naturally occurring restricted eating patterns and not the sugar-alcohols themselves. Maybe it was the fibers and fillers along with the sugar alcohols. Didn’t matter.   I cut them out.

It should be noted that my Cronometer Reports DO NOT include supplements. I do not like to confuse my data from what I eat to what I take. Above we can see the last year. I will also tell you I eat to satiety. Some days I am well over 350 G of protein and fat and calories can get past 6000 kcal. I mean this boy can EAT!! Other days 1800 kcal. Though in fasts and my average is pretty much what others eat, about 2500 kcal. As this is a keto diet I should maintain 85% fat and mine was only 71% during this time but my ketones as BHB was an average for the year of 1.58 mmol. Blood Glucose 5.03 mmol. So really with my muscle mass the higher protein and less fat clearly had no impact on my ketone production. For me then this was a ketogenic diet if the definition is “any diet that produces nutritional ketosis”. This for me was a ketogenic diet.

The American Heart Association is very keen on an emphasis on diet as a preventive strategy. Just not a keto diet.

Yet.

However, as they continue to recommend a low-fat diet which naturally then must become higher in carbohydrates not only has heart disease continued to rise, but so has Type 2 Diabetes, obesity, Alzheimer’s, which incidentally I accept to be Type 3 diabetes and many other diseases of the so called First World. So perhaps their guidance is wrong in this aspect. Indeed, a new study as part of CARDIOPREV  shows a Mediterranean higher fat diet outperforms a low fat diet when it comes to slowing atherosclerosis. Perhaps a higher fat diet such as keto would do even better? In any case here is a breakdown of my fats for the last year averaged out. My cholesterol on my last report 346 mg/dl and my Trigs were high and my HDL was low. I suspect I will return to my normal Trig/HDL ratio of 1< September 2 on my next test.  I did little to change how I ate other than I removed sugar-alcohols and increased actual cod-livers…to be addressed in supplements. 

Fasting My preferred fast is 5 days coffee and water only. I follow the protocols of Dr. Jason Fung and Megan Ramos and at one time helped administrate on Facebook, The Jason Fung Fan Club a 150,000-member page. I accept that turning off the insulin switch allows for deep cellular repair via autophagy  to the point that I took a three-month course with Dr. Yoshinori Ohsumi for his discoveries of mechanisms for autophagy. 

Later I changed this up to be an alternative day fasting regime that lasted over 100 days and again. The schedule was either do not eat for 36-42 hours, then eat the rest of the day and repeat.  The Green Bay Packers were once again in the playoffs and as an OWNER I liked watching my games with food. This meant breaking protocol. So I developed a 2 X 2 fasting protocol. Don’t eat Monday and Tuesday. Eat Wednesday and don’t eat again Thursday and Friday and enjoy Saturday and Sunday as eating days but still keto! I lost a good amount of body fat but threw it all back on inadvertently and I talk about that here :https://ketopd.com/2021/03/14/unhealthy-panic/ . 

I believe that fasting is great for heart health as it raises ketones and the American College of Cardiology says ketones should be an effective treatment for heart disease  and the American Heart Association says that a heart in failure can ONLY fuel on Ketones . Not only is this evidence that a Ketogenic Diet is  great for the heart it also implies that fasting which is the quickest way to raise your ketones will supercharge your heart with fueld and cellular repair! Lose Fat AND get healthy? I am in! Sign Me up! 

My Exercise 

I have swung back and forth with being fat and being athletic. the pictures are Age 21, 26, 47 and 57. I believe a program developed around a resistance training model is superior in every way to a cardio workout. I used to run marathons and 100-mile weeks. No I lift more frequently and leave the cardio to recreational activities.  I am constantly trying to improve my aesthetic, add muscle, lose body fat. We do know that sarcopenia is associated with worsening outcomes of health whether by injury or frailty and up to a four times mortality. So the more muscle the better. Unless you once again listen to my cardiologist who reminds me high BMI also leads to mortality and I should lose weight. “What? make muscle but not too much?” I ask?  It is impossible for Body Mass Index or BMI studies to account for the muscle mass of subjects as BMI is calculated as weight in kilograms divided by the square of height in meters (kg/m2 ) and as such is a poor surrogate to understand body size and mortality.  It would be best to know body composition. But even that focuses on body fat and rising comorbidities. As such it is almost impossible to make a judgement on mortality and  greater lean mass. But in this I will have you consider this: “Moreover, lean body mass was inversely associated with mortality in men and women. One SD increase of lean body mass was associated with 31% and 19% decreased risk of mortality in men and women, respectively (P < 0.01).” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348595/). 

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My cardio is then opposite of what my cardiologists wants. I do cardio as recreation and not exercise. I will bike 20-30 miles 1-2x a week. Kayak on Geneva Lake or a larger river, my favorite being the Wisconsin between Boscobel and the Mississippi and in winter cross-country ski.

I am slightly disappointed that I let my stomach flab continue for yet another summer but I was focused on recovery from the PE and my heart. I should be ecstatic that I have done both of these goals but ya know, I am the type of guy that always wants one more thing. That’s the next 180 day project along with continued repair.

 

Supplements

After my pulmonary embolism and AFIB episodes back in April I was given Eliquis 2 x daily at 5mg each as well as diltazem 360 timed release. If you think an anticoagulant that works on the Xa receptor and a calcium channel blocker had this effect I would love to see your evidence. I do not believe either of these recent additions to my regimen added OR subtracted from my goals.

This is what everyone wants to know.  But I caution you, there is no proof this is what helped me and it might be that it helped me because of it being in conjunction with my exercise and nutritional practices along with my particular heart issues and my epigenetics. If you feel you wish to emulate do so at your own risk. I advise nothing. 

I read Patrick Theut’s Cardiac Manifesto with great interest. I decided that since I knew my Vitamin D has been low my entire life even though I am outside at least 2 hours daily and more on the weekends, the sun just did not make enough in my body…for whatever reason. I tested in 2019 and again was low at 22 ng/mL. Again by 4/27/2020 at 35.5 ng/mL so I began to take drops. Vitamin D along other things helps transport calcium in the body. Perhaps in dealing with my osteoporosis I did not have enough D to help move the extra out? MAybe I parked the extra calcium in my heart? Who knows. Couple this with my current lack of great amounts of leafy matter decided that I was likely deficient in Vit K, especially K2.  Grace Alessi MD says  

“Vitamin K helps the body use calcium by shuttling it to your bones. Increasing one’s intake of  vitamin D without enough vitamin K can cause an increase in calcium levels without the ability  to use it effectively, which raises the risk of depositing calcium in arteries and soft tissue. This is  dangerous because it can lead to heart disease, heart attack and even stroke. It’s crucial that  these vitamins be taken together because supplementing vitamin K with D helps the body use  calcium properly to build bone instead of depositing it dangerously in arteries and soft tissue.  Vitamin K actually has a protective effect on arteries, preventing buildup and therefore  protecting against cardiovascular disease” 

Furthermore: Epidemiology – cardiovascular outcomes reported that “The tendency to slow the progression of CACS was noticed in patients treated with vitamin K2 particularly in those with less advanced vessel calcification at baseline. The mechanisms by which vitamin K2 exerts a protective role on the progression of vascular damage may be connected with its impact on MGP, OC and OPG secretion. “ (https://academic.oup.com/ndt/article/28/suppl_1/i352/1838602?login=true).  These fat soluble vitamins made my list. 

A friend, Tom Seest pointed out to me that CoQ10 is a known preventative prescribed at some levels by most cardiologists. In looking about for that information I uncovered this gem First drug to significantly improve heart failure mortality in over a decade and the best form of CoQ10 for me appeared to be Ubiquinol as it has ”significant increase in plasma CoQ10 status observed after the 2-week supplementation suggested that ubiquinol appeared to be a better supplemental form to enhance the CoQ10 status than ubiquinone in older men. Neither ubiquinol nor ubiquinone supplement affected the measured biomarkers of oxidative stress.  

My cardiologist Dr. Peter Diamond suggested quercetin for lowering CRP inflammation. I went from 3.3 to 1.1 in a couple months. I added berberine was shown to be as effective for lowering heart rates as some calcium channel blockers as well as lowering insulin something I already saw as a problem in me. Double WIN!! 

I increased my pink salt intake. I really do not want to tackle the benefits here of an adequate salt intake but I doubled mine to about 6-10G daily of REAL SALT (https://redmond.life/pages/realsalt) for its ability to help regulate electrolytes, especially magnesium and potassium as well as iodine. 

Patty Gilfeather Hecht whom has been Keto for a couple decades and runs along with other sites, The Ketogenic Heart ( https://www.facebook.com/groups/1971999876396327 ) on Facebook. She introduced me to Dr Sinatra who said “People with heart disease often exhibit CoQ10, L-carnitine, D-ribose, and/or magnesium deficiencies.” (https://heartmdinstitute.com/diet-nutrition/the-awesome-foursome/). I had already been taking magnesium but I upped my game and included a very broad spectrum of common magnesium but also throate, malate and orotate some of which are thought to be superior to heart health as it helps in particular the left ventricle ( https://pubmed.ncbi.nlm.nih.gov/19367681/) and (https://www.phlabs.com/if-you-have-hypertension-you-need-to-know-about-magnesium-orotate) So the salt helps balance my electrolytes and then I added D-ribose because WTF, why not? I mean it’s a carbohydrate but it hasn’t really hurt my ketones and it should help fuel ATP mitochondria. I lift like a maniac so it will not harm me and should help if nothing else my Krebs cycle. You may have heard the term WINNING used by some politicians but THIS is what SO MUCH WINNING looks like. 

Most of us have read about fish and especially fish oils being heart healthy. I have found little to contradict this and as my trigs are perennially high and my HDL low I sought to exchange the ratio of these two and mostly I succeed. I take Carlson’s Super Elite DHA and then at least once a week if not more I eat Cod Livers & sardines.  Because I like the taste and texture. I shake liberally RealSalt on the dish and find it immensely satisfying however I will caution you…one tin is a shiton of fat. 74G of fat. No carbs, no protein. Fat.  Or as a Keto Dude says “ FffffffaaaaaaaaaaaaaT!” When I do this my trigs to HDL ration is 0.6 and <1.0 is considered insulin sensitive and heart healthy, yah me. 

Melatonin at 3mg as recommended by Doris Loh http://www.melatonin-research.net/index.php/MR/article/view/86 and I added 5HTP for serotonin uptake. I do feel better rested. I take B-12 just in case and Niacin.  I might just start Niacin Flushes. I didn’t want to add too much at one time and get very confusing results. September I begin Carnivore for some practical reasons to help my wife’s autoimmune problems, but we can talk about that in upcoming blogs, so I could add a niacin flush then. 

Vitamin C.  

Which brings us to vitamin C. The ideas around Vitamin C are very controversial but here is the deal. I think little could be lost by trying it and much to gain.  Papers go back to at least 1955 talking about Vitamin C supplementation and plaque reduction ( as well as Niacin) To my thinking the arterial wall material is made mostly of collagen proteins. Vitamin C, Lysine and Proline are all crucial in the function of healthy collagen. Thus, making sure the basic building blocks are there should help regulate healthy arteries. It could be an error in my thinking, a false conclusion but if the arterial wall is damaged, perhaps you need excess building blocks to instigate repair.  In this line then if Vitamin C is water soluble and easily excreted with almost no repercussions, then a dose of 2G> every few hours should help. That’s my operating principle. Basically, if I am right, I help myself. If I am wrong, I do not create a worse situation.  

To further illustrate this, the interplay between endothelial single layer of the artery and the actual structure is poorly understood. Most of the medical world assumes the damage to the artery comes from inside where the blood flows. Professor Subbotin  hypothesizes that LDL in an effort to eliminate some inflammatory event comes from OUTSIDE the arterial wall which explains why we see Atherosclerosis develop midway in the wall. Personally, from a mechanical point of view this is a very rational explanation and one I accept. 

Doris Loh whom I met in The Ketogenic Heart Facebook Group has quite a bit to say about Vitamin C and melatonin. It is worth watching: Ancient Molecules for Healthy Hearts  –  Doris Loh (Sept 2020) . then there are the disputed findings of Dr. Linus Pauling and Dr. Tim Rath. One has to take this stuff with a very skeptical eye, and I admit some of this sounds like quackery. But as I said earlier if it cannot hurt me or interfere with any other potential treatments, well, why not?

 

Going Forward 

In none of this do I account for Lp(a) and ApoA1 or ApoB as all are leading theories that it is these that create plaque burden. That the apolipoprotein B molecule initiates atherosclerosis which, in advanced stages, when localized to coronary, cerebral and peripheral arteries, leads to heart attacks, strokes, angina, and claudication.  I have tracked lp(a) for 2 years and have halved it as of last lab. I recently learned of ApoB and will have my first test September 2 in an effort to create a baseline.  

I will remain with a good exercise program. First-off I enjoy lifting heavy, it brings great satisfaction to be strong and I also enjoy being seen at my age as being in “great shape”. The bedrock of resistance training and health however is nutrition and therapeutic levels of vitamins and minerals would continue to be my course going forward. I would avoid statins and other pharmaceutical “solutions” until I had proven that my efforts were either valid or fruitless. Fortunately, as I have shared the markers I looked at in my scans, EKG, blood pressure and blood labs all moved in a direction that could only be seen as remarkable. To prevent my wishful thinking an overinflation of what I had accomplished I maintained an excellent communication with Dr. Peter Diamond who as a cardiologist was skeptical of my methods. As I shared in Part One after seeing my results and testing me himself, he has told me to continue my protocol as the results “are intriguing.” I am absolutely fine with that. I want to say “reversed” and he is more reserved, as he should be.  What could convince him? More evidence. To that end I will continue these efforts. 

The coming months I will make some alterations. To aid my wife’s own health journey I am going full animal sourced food, no plants. We can discuss the reasoning in a future post however my carnivore lifestyle for 90 days or more will be documented with labs and other tests. I have two carpal tunnel surgeries coming. This will dent my efforts towards exercise. I might add a niacin flush during this time to see if that speeds up the process of reducing the size of the calcium burden. 

If you have made it this far. WOW! Thanks for reading. Sorry it took longer than the initial timeline I posted but gathering links and resources and then selecting which ones to share is a daunting. Next post, the Carnivore Experiment!