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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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January 02, 2017

Dear Mark: Raising HDL Particle Number, Who Should Try Ketones, and Where’s My Keto Energy?

By Mark Sisson
25 Comments

detail of blood screening results prinitng with focus on cholesterolFor today’s edition of Dear Mark, I’m answering three questions from readers. First up, what’s the best way to increase your HDL particle count? There are dozens of articles explaining how to reduce LDL-P, but what about HDL-P? Second, are ketones right—or necessary—for everyone? The final question comes from a reader who, despite sticking with the diet for four months, hasn’t felt the fabled “keto energy.” Should she try ketone supplements, give it more time, or what?

Let’s go:

Any ideas of what might increase hdl-p? There is surprisingly little information that i can find. So far the only thing i’ve found is that resistant starch raises it in pigs fed a western diet .https://www.ncbi.nlm.nih.gov/labs/articles/27653386/

That’s certainly one route—via eating more resistant starch. I’d also guess that eating more prebiotic substrate in general will have favorable effects on HDL-P.

Exercise is a big one.

In patients with rheumatoid arthritis, exercise predicts rises in HDL-P. The largest increases are in smaller, denser HDL particles, which tend to have more antioxidative (protective) potential than larger, fluffier HDL particles.

Endurance exercise also increases HDL-P in healthy overweight middle aged adults, albeit somewhat differently than in rheumatoid arthritis. Instead of increasing smaller, denser HDL-P, exercise in this group increases larger, more buoyant HDL-P (less protective).

Before you assume exercise is good in RA patients but bad in overweight older adults, think about it like this. Rheumatoid arthritis patients bear a large inflammatory burden. They’re under a lot of oxidative stress. In that situation, an increase in the types of HDL particles that protect against inflammation is probably a good thing—it indicates help is on the way.

Meanwhile, in basically healthy older adults, inflammation is somewhat low. Endurance exercise supports and enhances this low inflammatory burden—as indicated by the increase in buoyant HDL-P. When inflammation is low, your body has no need to boost production of the ultra-protective small dense HDL-P.

We see evidence of this in another study (PDF) where overweight older men with elevated cardiovascular disease risk factors went on a short-term diet and exercise regimen. Although their HDL particles lost density, the overall profile grew anti-inflammatory and protective.

Olive and thyme polyphenols seem to decrease LDL-P/HDL-P ratio, which either means reduced LDL-P, increased HDL-P, or both. Either way, it’s a positive development. Polyphenols from other foods and spices probably have similar effects.

Eating dairy fat rich in natural trans-fats like CLA increases HDL-P, at least in guinea pigs. Seeing as how pastured dairy fat does seem to improve cardiovascular health in humans, I’d wager it’s increasing HDL-P as well.

What else?

I admit I had no idea what this article was going on about and had to do a bit of research. Now a question: Are exogenous ketone supplements something that would benefit everybody, including people who are NOT athletes, or is this just the latest “in” performance enhancer? I just want to be able to maintain sufficient fitness for an active, pain-free lifestyle as I continue to get older.

Athletes, especially endurance athletes (but likely everyone who does anything with even a modicum of aerobic activity, which is most) can benefit. I explained why and how in this post.

Older people suffering cognitive decline. The evidence is growing, from the MCTs in coconut turning into ketones and improving Alzheimer’s outcomes to outright supplementation with ketone esters improving cognition in an Alzheimer’s patient.

Patients with treatment-resistant epilepsy. The ketogenic diet is often the best treatment available for epilepsy—it just plain works—but it’s not the easiest diet to follow. It might be easy for the people crazy enough to read a daily health science blog and willing to comb through the hundreds of references it contains, but many “normals” have trouble even identifying “carbs.” That’s where exogenous ketones could help. They certainly help in epileptic rodents.

But for everyone? Ketone supplements are too expensive for most people to mess around with. Ketone supplements can rapidly spike blood ketones to levels shown to be protective against Alzheimer’s, Parkinson’s, and epilepsy, but they have a half life of 1-2 hours, so if you’re taking them for cognitive decline or epilepsy, you’d have to frequently re-dose. 

We’ll see how things go.

Are these products really necessary? How much do they really help? I have yet to find the energy everyone is talking about and I’ve been keto for four months. Give it more time?

They aren’t necessary for most people. Or anyone, yet. It’s a very young industry, and the science is developing.

They help me with energy and endurance during my weekly Ultimate Frisbee games. That’s worth it for me, but it might not justify ketone supplementation for anyone else.

You’d just have to try. If you can eat $15, try a sample pack. The financial investment isn’t that large, and you’ll stop wondering if they work or not.

Another thing to consider: keto may not be the right diet for you. And that’s fine. But I suspect you might be looking for something that’ll never be realized.

Ketogenic enthusiasts oversell the diet. Heck, the same goes for any dietary enthusiast, whether vegan, vegetarian, paleo, or macrobiotic. Every diet is “the best thing ever” and grants adherents “unlimited power and boundless energy.”

Don’t fall into this trape. Don’t chase the keto high. Are you getting your work done? Are your workouts going well? Are you reasonably engaged with your life and the people in it?

If the answers are yes, you’re fine. If the answers are no, try something different.

Bottom line: ketone supplements may assist with energy, but they’re too expensive for everyday use for most people. If full-blown ketosis isn’t doing much for you, throwing in some ketone supplements won’t, either.

Thanks for reading, everyone! Take care, and if you’ve got anything to add, be sure to help out with the reader questions down below.

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25 Comments on "Dear Mark: Raising HDL Particle Number, Who Should Try Ketones, and Where’s My Keto Energy?"

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Elizabeth Resnick
3 months 25 days ago
Wow, these are all great questions. I’d have to ask the person saying they have been keto for four months and still don’t feel the energy everyone claims if they are getting enough sleep. This is such a simple thing that we all tend to overlook (especially me). I have not gone keto, but have definitely found that the more fat I consume the better (and more stable) my energy levels are. At some point I might experiment and go full blown keto. For now, I feel good doing what I’m doing. Other things that really keep my energy up… Read more »
Susan
3 months 25 days ago

In regards to having amazing energy when I am in ketosis, it happens but only if everything else is optimal: B12, iron stores, cortisol and thyroid. It really is a constant balancing act!

Shary
Shary
3 months 25 days ago
I tried a medical ketogenic diet on myself prior to putting my son on it (for a seizure disorder).I noticed a sense of greater wellbeing, but I can’t claim that I had any more energy than usual. As Elizabeth pointed out, this could have been due to other factors. I was working shifts at the time and never got enough sleep. My son did not have seizures while being on this diet for the recommended year; however, he did require some medication again after going off the diet. I’ve been told that a ketogenic diet for seizure control works better… Read more »
Clay
Clay
3 months 25 days ago

For increasing HDL and decreasing LDL, I’ve noticed that eating lots of eggs (plus eating a bit of coconut oil and dark chocolate) and getting plenty of soluble fiber (beans and oats are excellent) pulls those two numbers in the opposite direction. I seem to have naturally excellent lipid profiles, and exercise plenty, but I’ve been able to manipulate those numbers pretty easily with simple and relatively minor dietary changes. Your mileage may differ though.

Chris
Chris
3 months 25 days ago

Curious what your lipid profile is. I tend to get high HDL (80+), low triglycerides and moderate LDL after shifting to a primal-focused diet (total cholesterol always seems to hover between 210-220).

Clay
Clay
3 months 25 days ago
Here’s my numbers spread over three years ( see below). My goal after my first lipid panel ( the first one I’ve ever taken in my life at age 47 when I had my first physical) was to boost HDL and lower TG without bringing up LDL. The food in parentheses is what changed. My diet is pretty static and vegetable centered overall. I gave up oatmeal because it was making me nauseous and sluggish for hours afterward. Then I intentionally upped the eggs, and saturated fat from coconut oil and dark chocolate as well as boosted fish oil. It’s… Read more »
Clay
Clay
3 months 25 days ago

In tried to post my numbers but it’s been flagged for moderation. Probably because lots of numbers and abbreviations look spammy. If it doesn’t get approved I’ll try again later.

Will Wilkin
3 months 25 days ago

My comment here is also “awaiting moderation” –something I’ve never seen here before. And I have zero numbers in it….

Clay
Clay
3 months 25 days ago
One more try…. Here’s my numbers spread over three years ( see below). My goal after my first lipid panel ( the first one I’ve ever taken in my life at age 47 when I had my first physical) was to boost HDL and lower TG without bringing up LDL. The food in parentheses is what changed. My diet is pretty static and vegetable centered overall. I gave up oatmeal because it was making me nauseous and sluggish for hours afterward. Then I intentionally upped the eggs, and saturated fat from coconut oil and dark chocolate as well as boosted… Read more »
JJill
3 months 25 days ago

I had HDL that ranged from 42 to 48 all my life. Eating primal way improved my fasting glucose and triglycerides. It didn’t change my LDL or HDL ratios much. Then last year my HDL went to 60 – a level I hadn’t seen ever. The only two changes I made were more sunbathing and increasing my exercise from about 2 hours a week to 4 to 6.

HealthyHombre
HealthyHombre
3 months 25 days ago

Good information JJ! You got me curious so I just looked it up, at my last checkup my total cholesterol was 158, HDL 64, triglycerides 58, overall ratio chol/HDL ratio 2.5 … FWIW. OK for an old guy I guess. 🙂

Clay
Clay
3 months 25 days ago

It’s all about the ratios.

My latest (Cholesterol to HDL Ratio 2.0)

Total Cholesterol 213, TG 40, HDL 107, LDL 98.

A dumb doctor would be pushing statins because I’m “borderline” in total cholesterol. A smart doctor goes “holy cow, great job!”

HealthyHombre
HealthyHombre
3 months 25 days ago

Awesome biometrics Clay!

Clay
Clay
3 months 25 days ago
Thanks! I told my latest doctor (my other one moved away) that I was experimenting with my diet to see how high I can get my HDL while keeping my LDL and TG low. He said if you want to do it to amuse yourself go right ahead, but you’re there already. You’re not going to get even more heart protective at this point. He suspects that some of it is just genetic. Probably true, but I can still manipulate my numbers is fairly predictable ways. Eggs, exercise and saturated fat tend to raise HDL, while soluble fiber tends to… Read more »
Will Wilkin
3 months 25 days ago

To me, ketone supplements seem a little like cheating, or at least seem unnecessary when the body makes the ketones if you just eat the right diet to produce them. And, again, for me, being in ketosis gives me a great feeling of well-being and energy and mental clarity. Of course, often I only assume I’m still in ketosis, or that I can tell when I am because when I fell off the wagon I noticed the sugar crash even just from a brief foray amounting to a cookie and a chocolate and maybe too much fruit….

HealthyHombre
HealthyHombre
3 months 25 days ago
Just ordered some Macadamia Sea Salt Bars Mark, they better be good. 😉 A question I have that maybe Mark can address sometime if he already has not done so is PSA metrics. Since I went from vegetarian paleo a few years ago (I know, kind of an oxymoron, right?) to “regular” paleo my PSA has gone from 1.1 (where it stayed at for years) to 1.4 and last year to 1.7. May just be a coincidence, but I’ve decided to eliminate eggs and dairy and cut back on meat consumption somewhat, replace my whey protein with plant-based protein for… Read more »
Clay
Clay
3 months 25 days ago
I’m 50 and I had my first PSA done in April. It was 0.44 ng/mL. So nice and low. Like you I was primal/vegetarian until about three months ago when i started eating meat again for the first time in 30 years. However I’ve always eaten a lot of eggs (4-8 a day my whole life), dairy, plenty of whey protein and lots of green tea, tomatoes and cruciferous veggies. And nuts with just about every meal. My PSA numbers are under that diet minus the meat which is very recent. No real lesson from this, just sharing some stats… Read more »
HealthyHombre
HealthyHombre
3 months 25 days ago

Wow Clay that’s a reading to die for … or more accurately not to die from …

Vicki
Vicki
3 months 23 days ago

Clay you are making me curious about why you decided to start eating meat after so many years. Just being nosy!

Clay
Clay
3 months 23 days ago
It’s a really long story but I’ll try to shorten it. Here’s my 10 Step Program. 1.I became and vegetarian initially because I noticed a pattern of heartburn after eating meat and I didn’t want heartburn anymore. 2.I failed on my first attempt a vegetarianism in 1984. I was 17 and still as senior in high school. I failed because I did what a lot of first time vegetarians do, I ate the the same way minus the meat. You can only eat so many cheese and peanut butter sandwiches before you throw in the towel. In Arizona there was… Read more »
Dondo
3 months 25 days ago
After reading Mark’s post last week on exogenous ketones, I ordered some and was able to use them to immediately and painlessly “clean up” my diet and get back on a healthy primal/paleo diet that includes prolonged periods of ketosis and all the health benefits that come along with that. In the past I’ve had a very hard time making the transition from a SAD, glucose-centric diet and then maintaining for an extended period of time – lots of reasons for this that I won’t go into – even though I am so much happier and healthier on a paleo… Read more »
Starmice
Starmice
3 months 24 days ago

I do the same – I use it as a ‘soft landing’ for when I go completely off the wagon for the holidays and eat crap, and then return to a paleo/keto diet. It helps with the low carb flu a lot! I also use it as insurance if I have a non-paleo meal or a beer or something like that. Not sure if that works or not, but I do it anyway.

Jack Lea Mason
3 months 25 days ago

When I’m in ketosis it usually takes about three days of less than 50 grams of only berries for mycarbs each day. Then I crave Brie cheese. It’s almost like brie, establishes my ketogenic sweet spot?

Matt
Matt
3 months 23 days ago

Mark, it’s interesting that you use ketone supplements for your Ultimate Frisbee games. Does ketone supplementation only help with short bursts of speed or can it also help with endurance sports? I’m a mountain biker who does 30 – 50 mile XC races. These usually require 3 – 5 hours of hard effort from me. I already eat primally and am getting better at being fat adapted. Would ketone supplements help with this type of racing?

Amy
3 months 16 days ago

Could you please address the carageenan controversy? I’ve read that it has been shown to cause cancer (in laboratory rats), that it is a generally harmless natural additive, and that it may not be a good idea to eat too much of it, but there isn’t really any definitive information that it causes harm. I’m so confused!

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