Meet Mark

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

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  1. 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 (and are compatible with keto) are consuming organ meats and just doing things that make me happy. I’m always energized after a fun lunch with a friend or a brisk walk with my feisty little dog. And you’re right, Mark…everyone claims their diet is the best. That’s why we all need to experiment a bit and find out what works best for us.

  2. 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!

    1. 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 for children, and he was already a young adult when he tried it.

      The medical version is incredibly strict. You not only need to eliminate ALL starchy carbs, you also need to weigh everything you eat according to a specific formula. Portions are small and the diet is difficult to stick with, although the vastly increased amount of fat does keep one from being hungry. His diet was supervised by Children’s Hospital 20 or so years ago. It may have been revised by now.

      My son’s seizures are completely controlled. He hasn’t had one in over 8 years (knock on wood), although he no longer avoids carbs. I think it may be partly because he did spend a year in ketosis.

  3. 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.

    1. 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).

      1. 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 pretty clear that my LDL tends to drift up along with my HDL when I’m intentionally trying to raise it, but my TG goes down with this diet. My ratios stay excellent and I think soluble fiber from beans or oatmeal is the strongest predictor of where my LDL drifts.

        I started eating meat three months ago after being a vegetarian for 30 years. So we’ll see how that changes things, if at all, on my next test in a couple months.

        9-28-2013 (big bowl of oatmeal, 4 eggs per day, 1 tsp fish oil)

        Total Cholesterol: 181, TG 52, HDL 94, LDL 77. VLDL 10

        7-06-2015 (dropped oatmeal, added a little sweet potato, lowered carbs, 6 eggs per day, 2 tsp fish oil, some coconut oil and dark chocolate)

        Total Cholesterol: 235, TG 46, HDL 110, LDL 116. VLDL 9

        4-19-2016 (1-2 cups black beans, 6-8 eggs per day, 2 tsp fish oil, some coconut oil, and dark chocolate)

        Total Cholesterol: 213, TG 40, HDL 107, LDL 98. VLDL 8

      2. 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.

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

          1. 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 fish oil.

            It’s pretty clear that my LDL tends to drift up along with my HDL when I’m intentionally trying to raise it, but my TG goes down with this diet. My ratios stay excellent and I think soluble fiber from beans or oatmeal is the strongest predictor of where my LDL drifts.

            I started eating meat three months ago after being a vegetarian for 30 years. So we’ll see how that changes things, if at all, on my next test in a couple months.

            9-28-2013 (big bowl of oatmeal, 4 eggs per day, 1 tsp fish oil)

            Total Cholesterol: 181, TG 52, HDL 94, LDL 77. VLDL 10

            7-06-2015 (dropped oatmeal, added a little sweet potato, lowered carbs, 6 eggs per day, 2 tsp fish oil, some coconut oil and dark chocolate)

            Total Cholesterol: 235, TG 46, HDL 110, LDL 116. VLDL 9

            4-19-2016 (1-2 cups black beans, 6-8 eggs per day, 2 tsp fish oil, some coconut oil, and dark chocolate)

            Total Cholesterol: 213, TG 40, HDL 107, LDL 98. VLDL 8

  4. 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.

    1. 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. 🙂

      1. 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!”

          1. 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 lower LDL and fish oil and avoiding sugar/fructose does wonders for your TG.

  5. 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….

  6. 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 my nightly protein drink just to see what happens. I’m also upping consumption of green tea, curcumin / tumeric, tomato-based food and cruciferous veggies … along with corresponding supplements of the same. I’m anticipating my PSA to go down at my next annual physical. I’ve done a ton of research and do not side with the PSA naysayers, IMO men ignore their rising PSA at thier own risk. BTW I’m the same age as Mark so I’m not getting any younger LOL (sorry Mark)! – George B aka HealthyHombre

    1. 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 from someone who historically probably eats pretty close to you.

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

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

        1. 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 zero resources and support for what I was trying to do.

          3.Two years later, when I was nineteen, I was now living in Santa Rosa, California. I had a job at an art framing shop and my co-worker was a classic 1980’s Sonoma county, back to earth liberal. He didn’t own a car, rode his bike to work, packed a home made lunch in a paper bag that he re-used until it fell apart. He co-slept with his toddler and wife (who was Honduran I believe) on a futon on the floor. And of course he hated Ronald Regan. He told me where the natural foods co-ops were, where the organic sprouted grain bakery outlet was, schooled me on workers rights and militarism – It was a crash course in all things progressive.

          It was through his example and conversations that I learned about the wide world of options besides meat – lentils, black beans, tofu, temphe, exotic veggies, exotic sprouted grains – all the stuff that is now pretty mainstream. I also got introduced to the politics of meat, industrial farming and animal welfare.

          4. A decade or so into being a vegetarian, I tried being a vegan. But without my eggs and dairy I felt weak, hungry, unsatisfied and irritable. That pretty much convinced me that my friends, who loved meat, were telling the truth about how they felt when they were deprived of their favorite protein source (meat).

          5. Decades pass by and I learn more an more about ancestral diets, the important role of fats and cholesterol in the diet, DHA, EPA, etc. I cut out all the junk ( cookies, cakes, crackers, etc). I start adding fish oil to my diet. Then I start adding collagen hydrolysate to my whey protein shakes to round out my amino acids balance. I experiment with going low carb. Find out what my limit is, then bring them back up a little. More learnin’ as a read studies about the symbiotic relationship with pasture and ruminants, nutrition, exercise, positive and harmful stressors, inflammation, etc.

          6. A couple months ago I went to pick up some soup at Staff of Life after my acupuncture appointment (yes, I know that sounds totally cliche and made up) . Anyway, I passed some buffalo jerky on one isle and my body said to eat it. So I did. It was delicious and I felt great afterwards.

          7. Fast forward two or three weeks and I’m loving smoked turkey and black forest ham. Then I had pork ribs and chicken at my brothers house (he’s a chef). Delicious. Slept like a baby.

          8. But before trying meat I had retired my vegetarian identity. Meaning, I ate vegetarian, but it was no longer part of my identity. I was already in a kind of grey area with fish oil supplements and collagen. I think my body changing, and no longer feeling obligated to maintain a specific diet, made it easy to follow my instincts without guilt or a feeling that I had betrayed myself. So I followed what my body said.

          9. I’m grateful for my years of vegetarianism. Being a vegetarian for so long really opened my eyes to the all the possibilities out there. So my diet and tastes are very wide and varied due to having to explore non-meat options for decades.

          10. I still eat like that, and I eat way more veggies than most vegetarian and vegans, but now I just added meat back in. And honestly, the variety of options I have now is liberating. No more struggling at pot lucks, dinners at friend’s houses, or restaurants while traveling.

  7. 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 diet with an emphasis on healthy fats.
    Based on my experience over the past few days, I’m optimistic that exogenous ketones are the tool I’ve been missing to maintain a great diet and lifestyle. If you’ve had similar challenges in the past, I’d recommend giving them a try.

    1. 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.

  8. 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?

  9. 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?

  10. 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!