Skip to main content

ASCVD: My Personal Case

Atherosclerotic Cardiovascular Disease. A mouthful.

The following is from a journal entry - Sunday, December 26, 2021.

Email this morning from Peter Attia. Opened and clicked a generic “Nutrition” link. One article was entitled “Ketogenic Diets: Not For Everyone?” and started reading. As suspected. In many people the lipids blow up.

So I did more homework. Searched Promethease and discovered the culprit in my SNPs. Note the images (markup mine):

From Peter Attia, M.D.:

So this is the major concern. ApoB is atherogenic; the tiny particle can lodge in the artery, trigger an immune response, and incite inflammation and macrophage activity, resulting in plaque. This is apparently why I did not have a clean calcium score.

From Peter Attia, M.D.:

Note the subject circled: Male, 52 years. Close to me in age. What’s up with TG on low fat? My guess is other variables.

From my genetic data, parsed with Promethease:

The culprit: rs693(T:T) single nucleotide polymorphism. Key is that it increases susceptibility. Couple that with the normal ApoE variant I have (2/3), is it not possible that the unfavorable variant expresses under high fat diet conditions, and not under low fat? Seems plausible to me. See next image.

From SNPedia:

That belongs to me. Elevated lipids.

From Wikipedia:

Clearly from this article, even with a normal phenotype (Apo e2/e3), there is still the unfavorable allele present, which has a poor binding capacity to receptors. Poor binding means challenged uptake into cells, meaning poor clearance from circulation. This is my problem without question. 

My theory is that the high fat diet perturbs the lipid clearance process so badly for me that the apoB cannot clear circulation while on the diet, and takes a long time to recover after the cessation of the diet. I think blood tests demonstrate this.

My hunch for the solution? Keep dietary fat well below 100 grams per day. Preferably around 60 grams on a more sedentary day and no more than 100 on a very active day. If I am exercising a lot, the extra dietary glucose (and/or protein gluconeogenesis) will not become a problem. It is a matter of tweaking and testing at this point. 

Does this mean I can never have beef again? Certainly not. Beef may even be preferable, so long as it is low fat. 

There is still a lot of work and a long way to go on this. But I am learning every day.


Popular posts from this blog


Lately I have started paying more attention to the work of Michael Easter. He is not a stranger to many of you, as he's authored books such as The Comfort Crisis and Scarcity Brain . Among the insights of his that most stick with me are these: First, the tribes he lived with in Bolivia, and their diet — and lack of chronic illness. Secondly, that we are filling ourselves with the plenty that is characteristic of this and the latter centuries — and we are dying for it. It's the issue of plenty I'm rambling on about here. HOW MUCH IS ENOUGH? My Aunt Pauline wrote her memoirs, entitled " Lolly-Gaggin' All the Way " back in the 1970s, about growing up in a tiny rural Tennessee town. What comes away as most striking to me in this little book is the absence of pictures . The reader must depend on that wonderful human attribute of imagination . With that human feature comes individualization, as no two readers will imagine with the same perspective nor imagery. Whe


The most recent episode of the Huberman Labs podcast puts this into laser focus. The guest is David Goggins.  The central takeaway is that there is nothing but the doing . Nothing else matters. As David said, there will come a day when his body say, "No more running." Until then, there is only running. The post title comes from Star Wars. Yoda tells young Luke, "Do or do not. There is no try." Fear of failure is not uncommon. I believe it is connected with expectations, be it ours, or those of others. We expect that we should achieve and succeed, and that means we have a goal and we are determined to perfect it — often right out of the gate. We leave no room for doing without expectations. There is no time for deliberation. There is only do, or not do. EXPOSURE THERAPY In time we adapt. This is one of the best things about the human condition. Our bodies work hard to adjust and get used to things. But they also thrive on challenge. PUSH Without challenge, there is t