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.