UPDATE; Nov 26, 2016
This is one of the most shared blogs I have done, because cholesterol is a huge concern for people when I start talking about eating bacon, eggs, cheese and all these other foods that were vilified for so long by the 'low-fat' police. 
I have been eating OFM for 3 years and 8 months. Last week I had my cholesterol measured again, almost exactly 3 years after the most recent numbers in the original blog and the results were not that surprising to me. But those who are worried about the long-term effects of OFM might find them interesting.
Total Cholesterol; 217 (no change)
Triglycerides; 79 (+6)
HDL: 73 (+3 improvement in 'good cholesterol')
LDL; 128 (-4 decrease in 'bad cholesterol')
VLDL: 16 (+1)
These results, combined with the fact that I have been able to keep my weight in check for over 3 years- despite greatly reduced physical activity- only makes me want to share this lifestyle with more people. 
​

ORIGINAL POST: Cholesterol might be one of the most misunderstood of all things you hear about on your annual Dr's visit. This is a complex subject so there are going to be a lot of words and not many pictures (don't worry, the next post is on my Greece trip and has lots of pics).

When I got my first checkup after starting OFM the following were my cholesterol numbers were as follows. 

The first number was on my normal high carb diet; the second number is 8 months into OFM. (My numbers have remained relatively close to the second numbers since)
​​Total Cholesterol: 196-217
Triglycerides: 135-73
HDL: 61-70
LDL: 108-132
VLDL: 27-15

Of course I wanted to know what the heck all these numbers meant, and most importantly, was I going to die from high cholesterol that day. I don't want to ruin the suspense....but clearly I didn't. Anyway, I did a little research and asked some health professionals.

The basic cholesterol equation is below, The Friedewald Equation . Using this we can solve for any missing variable if we have the other variables- or at least that is what my HS math teacher taught me. If you are not good at math there is a Friedewald calculator on the internet!

Total Cholesterol = LDL + HDL + (Triglycerides/5)

Here is what the Mayo Clinic Website has to say about each cholesterol number:

Triglycerides: A type of fat (lipid) found in your blood. When you eat, your body converts any calories it doesn't need to use right away into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals.

• Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)
• Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
• High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)
• Very high — 500 mg/dL or above (5.7 mmol/L or above)

Mine dropped from 135 to 73! Yes! One tick in the not going to die column.

HDL (high-density lipoprotein), often called "good cholesterol". They act as cholesterol scavengers, picking up excess cholesterol in your blood and taking it back to your liver where it's broken down. 
Men, At risk=Less than 40 mg/dL; Desirable=60 mg/dL or above.
Women, At risk=less than 50 mg/dL; Desirable=60 mg/dL or above
Mine went up from 61 to 70. Another "not going to die" tick.

LDL (low-density lipoprotein), often called "bad cholesterol". These lipoproteins carry cholesterol throughout your body, delivering it to different organs and tissues. But if your body has more cholesterol than it needs, the excess keeps circulating in your blood. Over time, circulating LDL cholesterol can enter your blood vessel walls and start to build up under the vessel lining. Deposits of LDL cholesterol particles within the vessel walls are called plaques, and they begin to narrow your blood vessels.

• Less than 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease (those with metabolic syndrome)
• Less than 100 mg/dL for high risk patients (for example: some patients who have diabetes or multiple heart disease risk factors)
• Less than 130 mg/dL otherwise
• Note: LDL guidelines are currently a topic of much medical discussion and will be covered later.

Mine went from 108 to 132. Oh shit, I'm over 130...mark one in the going to die column. (Keep in mind I'm still alive, so keep reading)

VLDL (Very low-density lipoprotein), at present there is no simple, direct way of measuring VLDL cholesterol. It is usually estimated as a percentage of your triglyceride value. An elevated VLDL cholesterol level is more than 30 milligrams per deciliter (.77 millimole/liter).
Mine went down from 27 to 15. Feeling better about this....

Simple right? No. I still had no idea what was going on with my numbers or how they were measured. I find out they probably only really measure a few things, total cholesterol, HDL and triglycerides and then use formulas for the rest. But my 'bad cholesterol', LDL, was over the recommended level and my total was over 200! Am I totally #@%#^#$^ed?!?! I panicked, then emailed some actual Dr's.  One who knew what diet I was on and the other who did not. 

Dr. with no prior knowledge of my diet when I sent my numbers:

• Dr: Did the Triglycerides go from 135 to 73? Or was that supposed to be 173?
• Zane: 135 to 73
• Dr: Then your numbers are great. The bump in total cholesterol is mostly from the bump in HDL (which is good). The LDL is a calculated number, and as the triglycerides go down, that number will go up based purely on the calculation.

Dr. with in-depth knowledge of diet and the fact that I was on it:
"You experienced the classic TG [Dr talk for Triglycerides] lowering and HDL boost.  The total cholesterol and LDL-C response is more variable but a small increase as you experienced is not uncommon.  Given the drop in TG it is almost certain the increase was due to larger LDL particles, which are not as atherogenic [I googled this, it means:tending to promote the formation of fatty plaques in the arteries] as the smaller one.  Those likely went down."​

The good news- I wasn't going to die that day from cholesterol. Bad news- this is some complex shit! Now we are talking about the size of LDL particles....and atherogenic particles. (I just had to use that word again to sound smart). So I emailed Dr. Volek to get some more info, since he is one of the world's experts in this area. Here is what I found in his response that might help us understand a small portion of this.

• My results overall were pretty close to what was observed in scientific tests. Although results are very individual and can vary widely.
• Small LDL particles are atherogenic (BAM!) and probably not good for you. ""We need to remember cholesterol does not cause problems in the circulation, it’s only when it gets into the arterial walls. We have come to appreciate that LDL particles vary in size, and it is the smaller particles that are most likely to get into arteries." -Dr. Volek
• A very low carb diet study saw a 106% increase in large LDL particles and a 78% decrease in small LDL particles. When compared to the low fat study it became clear larger LDL particle size is closely related to increased CHO (carb) intake
• Remember the old The Friedewald Equation (Total Cholesterol = LDL + HDL + (Triglycerides/5)? It turns out this could be complete crap. "When serum TG is low [under 100, like the fine piece of meat typing this] and total cholesterol high, the equation over-estimates LDL-C!" More good news for me
• (TG/HDL)<3.5 indicates that you probably have...a predominance of small LDL particles, and there’s a good chance you may also have insulin resistance. For me this is 73/70=1.04. More good news!

Bottom line: "The cholesterol response [to a low carb/high fat diet] can be quite variable, especially the LDL. The question still remains should we be concerned if it [LDL] goes up? We have a 2 year research project ongoing that will address that question." -Dr. Volek

So that was a lot of words and you probably stopped reading right after the Friedewald Equation....I know I would have. Every person's body is going to react differently to a OFM type, low carb diet. The key is to know what your baseline was before you started the diet and then get another test after several months (over 6) on the diet.  Then you can use the information above to decipher all those numbers. 

If you are dying for more cholesterol talk (I mean, really, who isn't!?!). Just click here to see a lot of videos by Dr. Volek discussing the subject.

As I watch people run around in circles for 24 hrs, something I actually enjoy, I thought I’d catch up on a well-overdue story.  More than anything else I've ever done, I get questions about my weight loss journey. For years, my weight was right around 190 lbs, but around 4 years ago, it just started to sneak up a little at a time to peak around 230lbs.  No matter how much I ran, it would only make me hungrier and make me want to eat more.  I’ll be the first to admit I satisfied my hunger fully, and usually with pizza and beer.  I’m not good at being hungry….to put it lightly!  Being hungry is not fun!  I could handle being hungry for a few days, maybe even a week, but in the end, a buffet or pizza would always be needed to satisfy my hunger.  This continued until my flight suit was being pushed to the limits and I was struggling to run a 5K, let alone a 50-mile race.

Then, just after St. Patrick’s Day 2013, I got a note from Mike Morton that he was having some folks come to Ft. Bragg to talk about the diet he was on, and he invited me to attend.  At that time, Mike was having an amazing run of winning the 24-hr World Championships and crushing 100-miler after 100-miler.  But I respect Mike more for what he has done in the military than running and am always willing to consider his perspective.  So I showed up for this presentation with a bunch of doctors getting ready to talk about a low-carb diet.  In my mind, I was a carb-loading runner, so I sat wondering, “What do these guys know?”  I listened to the presentation by Dr. Phinney, Dr. Volek and Peter Defty about changing my body from a carb-burner to a fat-burner, but was still in disbelief.  And I wasn't the only one in the crowd.  In the end, someone finally said they didn’t think it would work for ‘real’ military athletes.  At that point Mike stated something like, “If I had known about this diet 10 years ago, I would have been on it then and would have been better at my job.”  Like I said, I trust Mike.   So I decided to spend the rest of the day with these folks and Mike.  As we were touring the facilities we passed the DXA scanner (super precise body-fat measurement machine) and they proceeded to talk me into getting scanned and asked me to bring the results to dinner that night.

So for dinner I chose one of my favorite places just to see if I could eat like these ‘strange’ people.  And I brought black and white proof of how obese I was (the DXA photo here is not mine, let's just say mine was much fatter).  Turns out eating with these guys wasn’t so bad and after looking at my body fat (34.9%) I decided it couldn’t possible hurt me to try this for 2 months.  So I stated I was starting the diet that night.  Of course, Dr. Phinney asked if I had read their books, and I didn’t even know there were books.  He handed me The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance and suggested I read them.  I had the premise, cut my carbs to 50 grams a day and fill 60-70% of my calories with fat….easy day right? 

Well, it is easy unless your diet up until that point had consisted basically of pizza (carbs), beer (carbs), pasta (carbs), and potatoes (carbs).  Needless to say the transition was a little rough for my body.  When I cut the carbs to 50 grams a day, it went into full on revolt.  I didn’t want to get out of bed, I was falling asleep at work, and running was nearly impossible.  This lasted about 2 weeks.  At that point something strange began to happen.  I started to have not just more energy, but more than I had two weeks prior.  Within a month, I was running better than I ever had and was down over 10 lbs after my initial water weight loss (carbs hold a lot of water in your body so you lose that first 5lbs pretty quick).  Something was happening and I kind of liked it.  I was eating eggs and bacon in the morning, a salad with sour cream and cheese at lunch and then a dinner of ribeye and veggies in heavy cream, butter, and cheese. I was never hungry, eating full fatty food and losing weight....rewind the tape…..I was never hungry, eating full fat food and losing weight.

I went in for another DXA scan 43 days after my first humiliating scan.  I had dropped 10 lbs of pure fat and was down to 32% body fat.  On top of that, a few weeks later I completed a 40-mile mountain race in West Virginia (barely making the cutoff).  My fat pants were starting to get loose and it was getting a lot easier to tie my shoes.  Maybe there was something to this diet.  A little concerned about my cholesterol levels due to the amount of saturated fat I had been consuming, I had a full profile done along with my annual physical in October (7 months after starting the diet).  My triglycerides had dropped from 135-73, HDL went from 61-70, and VLDL had gone from 27-15.  Not only were my numbers not getting worse, they were actually improving!

Later that summer, I made an attempt at the Leadville 100.  While I fell short of completing it, I took almost 2 hours off of my 40-mile split, compared to my race in West Virginia in the spring.  Why had someone not told me about this eating plan sooner?  I gave up most of my beer and pizza but my performance was increasing rapidly, I was eating like a bear, I had more energy than I had ever had before and my blood work was improving.  Of course at this point people started to really take note that I was thinning down.  This is the only time when someone asking you if you are sick is actually a compliment!  I was heathier than I had been in years!

In November 2013 (almost exactly 8 months after starting), I went in for another DXA.  This time I was down 31 lbs of pure fat and my body fat was down to 24%.  The best thing, I was weighing in under 190 lbs for the first time in a long time and could break out some clothes that I had not been able to fit in years.  I even thought I saw an abdominal muscle one time when the light was just right!  If I had not before, at this point I saw no reason to change something that was working so well.  That fall I did the JFK 50-miler.  After my failure at Leadville, I ran most of the race very conservatively.  I only took in about 500-1000 calories during that race but my energy levels were high.  With 4 miles left, I realized I could finish under the cut-off even if everything went to hell so I just started running as fast as I could.  Turns out I could run pretty fast (for me) and I kept getting faster the more I ran.  Now that I look for it, I see OFM athletes getting strong in comparison to high-carb athletes as races progress, but that was a first for me. 

Now I am coming up on two years of low carb/high fat eating (and as any of my friends will tell you, I mean EATING!).  I have not gone hungry since March of 2012 and don’t ever plan on it again.  My weight has been as low as 180 lbs when I was running 70-mile weeks and as high as 190 lbs when I was running 0 miles per week for a few months.  In the past two years, I have introduced dozens of normal people and athletes to this plan with great success.  And although it certainly is not for everyone, it is for me!