Likely ALL of that is (poor) diet related. High carb high sugar diet brought back the weight, made you insulin resistant, and is likely the cause in the rise of your triglycerides. Your eGFR indicates you are on the cusp of Stage 3a Chronic Kidney Disease. You had success before on a keto-carnivore diet, and you can have success again. I would make returning to and sticking to a proper human diet (carnivore or carnivore-centric keto/ketovore) your primary goal. Yes, cholesterol may go up. We do not worry about that. Trigs usually drop dramatically, but in my case they actually went up because of my kidney disease. I no longer recommend fenofibrate. I was on it for a year, and it tanked my kidneys, and I was deep into stage 5 renal failure for a while. I am currently reversing the damage done. If you remain on fenofibrate, get blood labs regularly and watch that creatinine and eGFR. If creatinine rises and eGFR comes down, get off if it immediately. Those trigs might go up during active weight loss but will eventually come down when you reach a goal weight and remain weight stable for several months. Omega-3 supplementation (fish oil) has been known to help lower trigs. I should have recognized the adverse effects of fenofibrates such as muscle twitching, late night leg cramps, and more, but I passed it off as an electrolyte imbalance due to my kidneys. I don't take fenofibrate nor any electrolytes anymore and I am fine. But you want to eat fatty meat, not lean meat. In the absence of carbs, fat is your energy, and your goal is to become fat adapted. The vegetables are optional. Either eliminate them altogether or only eat the low carb cruciferous kind while weight loss and healing are your goals. Later in life you can occasionally treat yourself/toy with a few more single-ingredient plants or fruits, but you have goals to reach first and one of them is getting the addiction to carbs and sweet tasting things under control. So my experience with fenofibrate ended in a nightmare. There is a part of me that wants to take the video down, but at the same time the explanation of what's happening in the body and everything else is still good information. Now I would do diet first. Today I only take meds for blood pressure and that's it. My LDL varies between 200 and 300 and I am not worried. My trigs were up to 2887 at their highest as you know from the video. Fenofribrate brought them down to about 555. And believe it or not, I just tested again 2 days ago after being off fenofibrate since last November (6 months now) and my trigs were 222, proving they would have come down on their own eventually (I do take fish oil). Yes, they say high trigs increases your "risk" of heart disease, but I am still alive and well. "Risk" is relative and so much goes into "risk". Most people who have high trigs eat candy, cakes, cookies, pies, chips, donuts, and other high carb junk foods. But that's not me. My trigs are high for an entirely different reason (most likely that I spill lipoprotein lipase in my urine due to my CKD). So were my trigs still a relative higher "risk". Maybe. I'm not so sure. Now with that said, I know people who take fenofibrate with no issues at all, such as my father. And I know doctors who take statins. For example, Dr. Ford Brewer takes a very low dose rosuvastatin, not for it's LDL lowering effects, but because it helps keep down inflammation. Sure there is a time and a place for these things, but I personally believe that most medications should be temporary, not lifelong, and one's goal is to get to the root cause and fix the issue, which is usually diet and nutrition.
This is an interesting video. Nicholas Norwitz performed an experiment on himself, demonstrating that adding carbs to an otherwise ketogenic diet would lower LDL better than Statin therapy. He changed nothing about his normal daily diet, except for adding a bunch of cookies to his daily regimen.
Paper link: https://www.mdpi.com/2218-1989/14/1/73
Aim: To tested the prediction -- consistent with the Lipid Energy Model (below) -- that adding carbohydrates (in the form of Oreo cookies) to an LMHR on a ketogenic diet would reduce LDL-C levels by a similar, or greater, magnitude than high-intensity statin therapy.
Findings: Oreo supplementation (12 cookies/d) lowered LDL-C by 71% (273 mg/dl) in just 16 days. Rosuvastatin (20 mg/d) lowered LDL-C by 32.5% (137 mg/dl). Thus, Oreos were ~2X as potent as high-intensity statin therapy for LDL cholesterol lowering in this LMHR subject.
The Why: The LMHR phenotype has much to teach us about human metabolism, and cardiovascular disease pathophysiology. It's a new frontier that deserves further study, for the sake of the patients with this phenotype and for pure scientific curiosity! This experiment will serve as 'productive provocation,' a form of 'legit-bait' that will hopefully help prompt discussions and larger-scale experiments that need to happen.
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