All life is an experiment. The more experiments you make the better.Ralph Waldo Emerson
LONG OVERDUE UPDATE: The experiment has been (and will continue to be) on hold while I am in school and/or until the weight-loss journey I am on is complete, until which point there will most likely be lipolysis confounding the test results. Until then…
Tl;dr? (Wanna skip to the nitty gritty? Click here.)
This experiment is the result of a nearly five-year journey.
For much of my adult life — basically up through my late-30’s — I was stuck in the Matrix when it came to diet and my health. I ate a “standard American diet”. I ate for fun. I was into food — meaning I liked to cook and explore new restaurants and cuisines — but beyond that, I gave very little serious thought to what was going in my body. If I did think about it, I either felt mild guilt, as on some level I knew I was eating too much of the wrong things, or I blew it off: I was young, life was a party, and everything would be ok. But it wasn’t. Living with little concern for what I consumed left me in the same boat as so many others today: metabolically deranged, out-of-shape, and longing for a way out.
In February 2009, my out finally came. I dropped many of the rocks that were holding me back, woke up, and I began on a new course. I finally took the red pill, so to speak.
When you make a major life change in one specific area, there’s a tendency to think everything is going to magically change by association. I woke up every morning for a while assuming one day I would find myself back to my college weight. It didn’t happen. You can’t just “quit” eating. I had to become aware in this arena as well, and do the work.
Over the next three years, I began reading. Exploring. Learning. I worked my way through hundreds of nutritional blogs and websites. I tried on different “dietary frameworks”. When I lived in San Diego I had a friend who was a raw vegan, and she always seemed to be in great health and have more energy than any of us knew what to do with, so I began to focus there. I watched videos by Dan “The Life Regenerator” McDonald. He was fired up. I got fired up. I bought in. I got a juicer. I ate a lot of salads and did a juice fast. I was friends with Kale before he became famous. I lost a few pounds and kinda felt like I was on crack a lot. I started reading more vegan blogs. I watched a really maniacal couple get fired up about eating 40 bananas a day, and nothing more. They preached the One True Way. I saw people not doing well and being told they were “doing it wrong”. I grew up Catholic. I recognized dogma. Something didn’t seem right.
While I was reading through some forum posts on one of the more popular vegan sites at that time, I read a comment by someone named Denise Minger. She mentioned she had started a new blog that would focus on some of the flaws in the vegan diet. I was curious. She was a good writer. At some point, she made reference to “paleo.” I had no idea what she was talking about.
Denise would go on to write a rather infamous rebuttal to the China Study. I would go on to explore Paleo. And I liked what I found. Instead of anecdotal references to detoxing, living enzymes and “Kirlian light auras”, I found hard references to Pubmed studies. Instead of blogs written by people who had layman experience coupled with a strong ethical bent, I found articles written by MDs with degrees from Stanford working in major hospitals. The lay people who were writing were focused mostly on breaking down the science — their opinions were a side note. With all due respect to those in the vegan community, the science appealed to me more than promises of karmic righteousness. (That being said, I also soon found the paleo dogma and the paleo crazy. Crazy knows no bounds.)
In the end, I tried to assimilate it all. I started in the middle. Where the circles convened. What I found there was wheat. It was bad. The Vegans and the Paleos agreed. I stopped eating it. Everyone was in agreement about a variety of vegetables, so I ate more. I had to pick a side about meat, and in this case I chose to side with paleo, and hence “became” Paleo. I stopped the rabid research, stopped being the person who couldn’t talk to his friends about anything besides food, and I just quietly eased into my decision.
Over the next year, I was only about 80% compliant. But like Pareto predicts, it was enough to do the trick: During that time I lost about 50 pounds. I got into tracking metrics, and kept daily logs of things I could measure — weight, BP, temperature, hours of sleep. I learned there was a whole “quantified self” movement, and read stuff by Seth Roberts and Tim Ferriss. I had my partial genome tested through 23andme.com. I had a doctor appointment where the nurse casually said “It would be good if we knew what your pressure was this morning”, and I casually told her what my pressure was that morning. She looked at me like I was nuts. Maybe so. Crazy knows no bounds.
The Cholesterol Issue
From that spring of 2009 until February of 2013, I didn’t really have any lab work done, and I wasn’t seeing doctors on a regular basis (the incident mentioned above happened during one of maybe three visits.) But I had lost the weight and outside of a bout of Cedar allergy-induced pneumonia in early 2012, I was feeling great. My only knowledge of my cholesterol levels came after a few various blood donations, where I would check my total number online. It would usually hover around 200. I had no idea about my LDL or HDL levels. This didn’t give my any pause. As a paleo I rejected the Cholesterol Hypothesis. I was sure that by keeping sugar low, eating healthy fats and decent meat, my body would self-regulate cholesterol levels to where it needed them to be. And by keeping inflammation low, cholesterol was a non-issue anyway. In keeping any serious critical examination or even consideration of my cholesterol numbers at arm’s length, I was ignoring a few things:
- Since 2009 I had made quite a few lifestyle changes besides diet, but quitting smoking was not one of them. If anything, I was smoking more than ever. Maybe not a lot compared to full-time smoker norms like one or two packs a day, but certainly enough to hurt — between one or two packs a week. Any inflammation I was keeping at bay through diet I was more than making up for with smoke and nicotine.
- My Dad, who it’s apparent at first glance I got most of my physical genetics from, had elevated cholesterol throughout much of his adult life, and had a triple bypass at age 67. The rub is that he spent the vast majority of his life eating a de-facto paleo diet. He grew up on a farm. Yes, he ate grain, but the bread was handmade and there was little to no processed food. It was Idaho, so the starch was potato. The fats came from dairy cows, not a plastic bottle. The meat was local. Breakfast was eggs. I don’t know what he ate for lunch at work when I was growing up, but dinner was broiled chicken and vegetables. We weren’t a pasta or cake family.
- Between statins and a significantly-altered diet (much lower in saturated fat), my Dad’s cholesterol numbers are radically lower, and his three bypasses have remained clear of obstruction for over ten years. By some (Paleo) standards, his cholesterol numbers could be considered too low, yet his health is currently great — his cardiologist sometimes thinks he has the wrong chart because he’s sure he must be younger.
By this point, I had read many posts on Paleo message boards and blog comments that resembled the following:
I’ve been eating strict Paleo for [x] years. You say my cholesterol should be self-regulating, but my total number is 567 and my LDL is 323 and my HDL is -79. My doctor is tripping balls. He wants me to go on a statin, but of course I refused because if there’s one thing that everyone who’s locked into an alternative dietary framework agrees on besides the horror of gluten, it’s that mainstream medications are always bad bad bad. So what should I do? P.S. Please don’t say statins or a diet modification or anything that would potentially point to any flaws in our universally perfect for everyone dietary framework pls tks
The answers, of course, usually stuck to the party line: Keep trudging ahead. Don’t sweat the numbers. They’ll level out. Or: Cholesterol doesn’t matter. Or worse: You’re doing it wrong. You’re only 80/20 paleo? You need to be 95/5. You’re already 95/5? Then it’s that cookie you had six months ago. None of this seemed helpful.
In my mind, there were to major questions to be sorted out:
- Is high cholesterol truly problematic, regardless of diet?
- Is there such a thing as doing it wrong? Or is every person unique enough that any given dietary framework can be a total success for one person yet a total disaster (and totally contraindicated from the get-go) for another?
I wanted to know more.
The Cholesterol Issue Refined: Is high cholesterol universally problematic? The importance of LDL Particle Counts
In early 2013, I stumbled onto the work of Dr. Peter Attia and his ten-part series on cholesterol (actually nine-part, the final chapter remains mythically unwritten). It’s long, dense, and probably the most thorough explanation of cholesterol and how it functions and malfunctions within the human body that you could ever possibly read. There are many, many takeaways, but one is most relevant here:
If you were only ‘allowed’ to know one metric to understand your risk of heart disease it would be the number of apoB [containing] particles (90-95% of which are LDLs) in your plasma. If you want to stop atherosclerosis, you must lower the LDL particle number [emphasis mine]Dr. Peter Attia, The Straight Dope on Cholesterol, Part IV
If you want to understand why (or if you disagree, at least what Dr. Attia’s line of reasoning is), I would highly suggest reading the series. In any event, I wanted to know what my particle number was. At the time (February 2013) I still didn’t have a primary doctor, and probably wouldn’t have been able to convince them to order this test for me anyways, so I used Directlabs.com to obtain the following:
My particle count was 2264. My LDL was 169 and I had an HDL that was barely above 40. I was concerned. But was there anything I could do? Was this a result of Paleo? Was it because of the cheats? Because if I was really honest, my diet had started to like 60/40 at best. But even so:
Eating cholesterol has very little impact on the cholesterol levels in your body. This is a fact, not my opinion. Anyone who tells you different is, at best, ignorant of this topic. At worst, they are a deliberate charlatan.Dr. Peter Attia, The Straight Dope on Cholesterol, Part I
If this is is case, then what is going on? Though I didn’t have any sort of pre-paleo numbers to look back on for comparison, why was I, along with a certain percentage of people on high-fat paleo diets seeing universal increases? If your body is self-regulating, why was my cholesterol so high, while my sister, who ostensibly has similar genetics and eats a diet much further to the low-fat vegetarian end of the spectrum, has low-to-normal levels? How were my Dad’s levels driven so high?
The Cholesterol Issue Refined Further: Is your diet contraindicated? Enter genetic testing and APOE4
After getting my 23andMe results in 2012, I learned that I was genetically at-risk for two major issues: Heart disease and Alzheimer’s. My grandma was taken by Alzheimer’s, so along with my Dad’s history, neither of these was a big surprise. According to the information 23andMe presented, the Alzheimer’s risk is due to a particular variants in one’s two Apolipoprotein B, or “APOE” genes. In my case, one of the genes was APOE variant E4, making me what is called Heterogeneous APOE4 (i.e., I have one copy):
Studies have shown that the odds of developing Alzheimer’s increases with each copy of the ε4 variant of APOE. Carrying a single copy of the ε4 variant is associated with about 1.5 to two times increased odds of developing Alzheimer’s and having two copies is associated with about 9 times increased odds in populations of European ancestry, compared to average.23 and Me, Technical Report on APOE and Alzheimer’s
What my 23andMe report doesn’t mention (the risk as reported comes from another set of genes) is that the same APOE4 variant, whose effect on cholesterol transport and blood plasma clearance is what causes the brain issues, can also — despite Dr. Attia’s statement — alter how cholesterol and fat is absorbed through the intestine, alter cholesterol lipid levels, and therefore, can be risk factor for heart disease:
The Apo E gene polymorphism has been well documented to interact with diet affecting individual lipid responsiveness.Berkeley Heart Lab, Apolipoprotein E Genotype and Cardiovascular Disease Management
This APOE4 variant, in its combined heterogeneous (E3/E4) and homogeneous (E4/E4) occurs in approximately 25% of the human population.
The Berkeley Heart Lab paper goes into significant detail about the effect APOE4 variants have on the cause, prevention, and differing treatments of cardiovascular disease, but much of it is summarized in the following chart:
If this information was correct, it meant that the Paleo diet — or any diet that utilized fat for fuel — seemed to be seriously contraindicated for not just me, but the 25% of the population who was APOE4. But at the end of the day, risk factors are one thing; actual evidence of harm is another. Had my lifetime of questionable consumption, with an extra focus on fat consumption over the prior three years — actually done hard damage?
In July 2013 I had a CT scan of my chest after an isolated incident of stomach pain. The results showed my GI tract to be fine. But the radiologist made a note that was missed (or ignored) by the GI docs, and that I found when reviewing the results myself: Patient has visible calcification of the coronary arteries. Not only did this make a case that one has to do their own due-diligence after every medical interaction, but when I brought it to my (now established) primary doc, she made a case for me seeing a cardiologist. I was hooked up with Dr. Eugene Lozner, who helped keep my Dad alive for the past decade, and after a more specific heart CT scan and a nuclear stress-test, we found the following:
- My exercised cardiac blood flow and EKG response was nominal. However:
- My cardiac arteries were approximately 10% calcified, with a calcium score of 94. Nothing to be super-concerned about overall, but enough to put me near the wrong end of the bell curve for my (still young and awesome) age.
Combining these results with my family history, it doesn’t take much of a leap to figure what came next:
- A prescription for a low-sodium, low-fat, limited-animal product diet (a.k.a., low-fat vegan), and
- A prescription for a statin (which given the circumstances, I agree with)
The theoretical had become real, and I had some choices to make. But before I did, I wanted just a little more information first. Information that couldn’t come from anywhere except an experiment on myself. N=1, baby.
The Experiment, Explained (Finally)
I learned that self-experimentation can be used by non-experts to a) see if the experts are right and b) learn something they don’t know.Dr. Seth Roberts, Professor Emeritus of Psychology, UC Berkeley
Before making a radical (and most-likely permanent) departure from the way I’ve been eating for the past three years, and back to one that I have tried only briefly before, and didn’t have the greatest of luck with (and which my mind, with years of Paleo ingrained, still wants to reject), I wanted to know exactly what the specific impact a given diet — paleo, vegan, or otherwise — would be on my blood lipids. To do this, I would have to deliberately, consistently, and accurately eat according to the given diet’s generally accepted framework of macronutrient ratios and generally-accepted as healthy foods, do it without exception, do blood tests afterward, and I would have to do it before starting on the statin.
I decided that for five separate three-week periods, I would rotate through the following five diets, starting with where I mostly already was:
- A Low-Carb Paleo Diet: Not 80/20, but a 100%, good old-fashioned Paleo diet, circa 2010.
- A Potato Monodiet: This diet was essentially born in the wake of a self-experiment by Chris Voigt in 2010, and was further popularized by long-time blogger Richard Nikoley at FreetheAnimal.com, broken-down scientifically by Petro Dobromylskyj of Hyperlipid, Dr. Stephan Guyenet and others, and discussed ad-infinitum in the forums at Mark’s Daily Apple.
- The Mediterranean Diet: Considered by the mainstream to be the epitome of heart-healthy diets.
- A Protein-Sparing Modified Fast (PSMF): Born in bariatric wards of the 70’s and 80’s, it was essentially re-engineered by Lyle McDonald as a way for bodybuilders to safely “cut” as rapidly as possible, while still maintaining lean-body mass.
- The Low-Fat Vegan Diet: The doctor’s prescription, Berkeley Heart Lab’s recommended diet for anyone APOE4, and based upon all other pre-experiment evidence, where I will most likely end up.
With the Paleo diet, based on the majority hypotheses of optimal diet for ApoE4, we’re looking to see just how bad this diet is. With the LF Vegan diet, based on the majority hypotheses of optimal diet for ApoE4, we’re looking for the opposite — to see just how good this diet is. The Mediterranean diet is included since it basically falls in the middle of the fat/animal-protein spectrum between Paleo and Vegan, so we’re looking to see if it’s good or bad without a specific hypothesis. The Potato Diet is included as an extreme, non-sustainable version of LF Vegan, and the PSMF is included as a counterpart to the Potato diet. Both the Potato diet and PSMF have the additional expected benefit of accelerated weight loss. Neither is a contender for long-term, post-experiment implementation.
My primary goal is to determine a diet that will be in the best interest of my personal cardiovascular and overall health as someone with an APOE4 allele. My secondary goals are:
- To promote the idea that there is no “one correct diet”, or best set of macronutrient ratios, for all people. It’s not the “best diet” because it worked for your friend, or worse, just because they said so.
- To show that a group of sexy hot Vegans, or a group of sexy hot Paleos, is nothing more than a group of sexy hot people who most likely lucked into falling into the middle of a given bell curve. Just to camera left in those sexy group photos (the big cement gym seems to be the new photo studio) is a group of lethargic and ill Paleos or Vegans who are gonna keep trying their best, but won’t make next month’s FB photo post either.
- To add to a growing body of self-experimentation, and maybe provide a framework someone else could base their own experiment around, and therefore
- Promote self-experimentation in general, and
- Have fun during the process, get smarter, and get healthier.
I also wouldn’t mind ending up with a like-minded community while I’m at it — made up of self-experimenters, genetic testers, APOE4s — but mostly those of us who’ve been around the map with eating and dietary frameworks, and like the idea of really being able to figure one out for themselves.
For each diet, I will do my best to control for all variables outside of the varying macronutrient ratios, namely:
- Keeping calorie intake consistent within each diet, in the range of 1400-1700 each day
- Keeping calorie intake consistent across diets — i.e., if the number of calories consumed on the third day of Diet #1 were 1700, then I will consume 1700 calories on the third day of the remaining four diets. In this sense, the calorie record of the first diet maps out the intake for diets two through five.
- In order to avoid metabolism stasis, on Sundays, calorie consumption will be bumped up to 1700-2500 calories.
- The mono and fast diets (#2 and #4) will most likely come in lower, around 700-1100 calories per day
- The vegan diet (#5) will most likely come in higher, around 2500 calories per day
- Exercise will be kept consistent across diets, and will be generally limited — 30 minutes of dog walking, and 15-20 minutes of bodyweight exercises.
- Intake will be limited to diet-specific/generally accepted as healthy foods, i.e., no alcohol, cheat foods, etc.
- There will be no wheat or gluten consumed during any of the five diets.
- Getting consistent sleep
- Keeping all medication and supplementation consistent across diets
- Diet #1: Low-Carb Paleo09/28/2013 – 10/18/2013
- Diet #2: Potato Monodiet01/06/2014 – 01/26/2014
- Diet #3: Mediterranean Diet02/06/2015 – 02/26/2015
- Diet #4: Protein-Sparing Modified Fast (PSMF)02/27/2015 – 03/19/2015
- Diet #5: Low-Fat Raw Vegan Diet03/20/2015 – 04/09/2015
At the end of each three-week period, I will utilize the NMR® Lipoprofile test to reassess my LDL particle count, along with the standard total, LDL, and HDC-C counts. I will also obtain a standard metabolic profile. Results will be posted in the specific pages for each diet.
If anyone has made it this far, and has any thoughts, helpful input or comments, or if you’re APOE4 and you think this experiment will be helpful, I’d love to hear from you.