January 2020 Challenge

In this article I share my January 2020 health strategy and get down to some nitty gritty details on the why, what and how. New year, new decade, new body, new you!!

1-Jan 2020, by Lee Sandwith

About my 2020 challenge

In this article I share my January 2020 health strategy and get down to some nitty gritty details on the why, what and how. .

What's it all about

Given my position as one of the founding team members of ingfit, the UAE’s first one stop keto shop, it may appear that I have all of my health and fitness ducks in a row, but in reality, that couldn’t be further from the truth.

I’ve been in a life-long battle with my weight since I was a teenager and for most of my twenties I was uncomfortably overweight. It wasn’t until my early thirties that I finally got a handle on things and got my weight under control.

Almost 15 years later, I still have things under reasonable control but keeping things on the rails is a daily struggle, and one which I’ve started to accept as a perpetual challenge.

Back in 2013, when I really had things dialled in, I managed to get to single digit body fat, which, for a guy at least, is a pretty epic achievement. However, I couldn’t maintain it and have hovered between 10-15% body fat for the last few years.

I think most people in the community know this already, but I didn’t lose weight through keto, I started on my LCHF quest due to all the other attractive side effects, such as better control over glucose and insulin, energy levels, satiety management and, ultimately, the potential longevity benefits.

In terms of weight loss, I’ve always found it extremely difficult to lose weight on keto but I stuck with it as my health and wellness objectives evolved from getting ripped to healthspan and lifespan, or what we like to call longevity.

However, I’m planning on setting a very high bar for myself in 2020 with a target of getting back to 10% body fat. It won’t be easy but I think team ingfit has a well honed protocol which can enable it.

However, it’s not all about the weight loss. At ingfit, although around 99% of our customers are following keto to lose weight, we’re not just about weight management, we also have an eye on the ultimate prize: longevity.

And with that, let me introduce you to my second health challenge, and most definitely the most important one: heart disease.

Most folks in our community recognise me as a bit of an expert in cholesterol. That’s not true, I am, in fact, very much a junior student of the game, but I entered said game as keto sent my cholesterol sky-rocketing.

I’m what’s now known as a cholesterol hyperresponder but I’m not planning on tackling this subject in this article so if this is a topic which interests you, a good starting point would be this article which we published back in 2015.

Having such high cholesterol as a direct result of keto is a scary thing. It’s the type of thing which sends you down the rabbit hole of research and most cholesterol hyperresponders become extremely knowledgeable on the subject and in most cases their knowledge surpasses that of most medical practitioners.

My journey led me to a CT Angiogram and a CAC scan, the former of which directly measures the arteries to determine whether there is any narrowing of the arteries and the latter is a proxy for how much atherosclerosis has been going on.

My CAC score was 59 which puts me in the 90% percentile for my age, meaning that 90% of people in my age group would have seen a lower score. It’s not good. To boot, the CT Angiogram showed a 25% blockage in one of the arteries. In summary, both tests confirmed that I have early onset heart disease.

Despite this diagnosis, and high cholesterol, I refuse to take a statin. In fact, I’m so unconvinced by the research on the efficacy of statins in reducing heart disease that I’m writing a paper on the subject as part of my Masters in Clinical Nutrition.

In reality, both cholesterol and the CAC score can be managed without drugs so for 2020, I’m planning on adding “reduce CAC score” to my health and wellness objectives.

So, after a windy introduction into the “what”, let’s get to the “how”.

Body fat reduction

After what I’ve learned about fasting over the last few years, I would say that the most direct way to 10% body fat would be to simply not eat. But I imagine that such an endeavour wouldn’t be much fun so I’m going to do it through much less painful means.

In fact, I would like to draw up a template that people can adapt for themselves. The idea is to do it in a way which still enables us to completely enjoy eating, making it sustainable for the long-term.

Wholefoods

One of my major downfalls in 2019 was the introduction of too much “non-food”. I’ve always been a wholefoods guy and was the freak in the office who would always bring in his own lunch. I think I missed about two days in ten years so it’s a little bit ironic that since leaving the corporate world I’ve let this slide a bit.

Anyway, it is what it is, but rule #1 will be no “non-food”. If it didn’t previously grow in a field, swim, run or fly, I ain’t eating it.

Time Restricted Feeding & Circadian Rhythm

This is a really simple one but probably one of the most effective weight management strategies that I’ve ever tried. Simply cutting out calories around 4 hours before bed has a massive impact on me personally. It’s not the easiest thing to achieve as it’s at “the witching hour” that you get cravings, but it’s definitely worth it if you can pull it off.

There is substantial evidence to support this strategy and I first became aware of the science after listening to Dr. Satchin Panda on Dr.Rhonda Patrick’s podcast. If this is a new concept to you then a good place to start would be this video:

Fasting

Fasting needs no introduction really as it’s something that we discuss in our group often. Most people are either doing Intermittent Fasting (IF) on a daily basis and have experimented with longer fasts.

2019 was the year that I really got into prolonged fasts having completed a couple of 72 hours fasts and one 5 day fast. Within the month of January, I will definitely build in at least one 48 hour fast and maybe even a longer one.

Low Carb High Fat, Paleo, Keto

When I first discovered keto, I maintained a strict keto diet for around two years but more recently I’ve started to follow a slightly high carb diet, a bit higher in protein and lower in fat. I mainly switched from strict keto due to the effect the diet had on my cholesterol which I’ll discuss a bit later.

I’m very low carb at the best of times but I do include some occasional high carb foods, especially sourdough bread, and more liberal helpings of vegetables and even some fruits. I’ll develop a broad meal plan which will cut across keto, paleo and LCHF which I’ll share throughout the month.

Exercise

I’m generally extremely active but I was hampered somewhat in 2019 by a shoulder injury. Ideally I’ll be doing a combination of cardio (squash, HIIT & swimming) and strength and conditioning training with a mix of yoga and resistance training. I won’t be sharing too much on my exercise program as 80% of the work will be done in the kitchen.

Things to exclude

You may have noticed that the core protocol includes ADDING things to my lifestyle, not removing, however, there are a few things which I will be excluding.

The first and most obvious is sugar, however, I think this is a moot point for me as my diet has been pretty much void of added sugar for the last 15 years. The one thing I used to do when I first started out was cheating with sugary treats (cakes, cookies, chocolate etc). I still do that now but my cheat treats are always from the keto / low-carb range of which there are ample options now available in the UAE.

That said, for the entire month of January I will be cutting out all snacks and treats, whether keto or not keto to comply with my first objective of consuming only wholefoods.

For general health reasons, I never consume anything which includes vegetable oils. Those of you who have been involved in our community for some time will take this as a given but for anyone unsure as to why this is so important, you may wish to check out the below short video:

 

Last but definitely not least, I will not be consuming any alcohol. Alcohol is probably my biggest downfall when it comes to keeping things on the rails. I’ve published on this subject before so if that’s something that interests you check out this article.

Heart disease

My protocol for heart disease will be to attempt to tackle two of the main risk factors for heart disease: cholesterol and my CAC score.

The objective of reducing cholesterol may come as a surprise for some of you as many keto personalities are down-playing the risk of high cholesterol in relation to heart disease risk. Personally, I am keeping an open mind on this as even though there are studies emerging which suggest there is no association, there are a plethora of studies that do suggest an association including several meta-analyses (1,2,3).

Without going into too much detail, there are many heart disease risk factors, one of which is cholesterol. Total cholesterol (Total-C) is not too much of a concern but advanced metrics such as ApoB, Lp(a), LDL particle size and ratios (especially HDL/TG) are, and these are the ones which I’ll be focussing on trying to control. More info on these metrics can be found in this article.

Diet

If I just wanted to reduce my cholesterol into the normal range, the most direct way to reaching that goal would be to switch to a high carb diet. I’ve tested this strategy multiple times and the result is always the same: keto = high cholesterol, high carb = “normal” cholesterol.

However, given that a big part of the heart disease story is inflammation, glucose and insulin control (4), my preference is to stay low-carb despite the potential increase in heart disease risk. To minimise the hyperresponder effect I’ll be keeping saturated fats quite low and keeping carbs within the 50-100g range.

For most people, this would probably be a bit too high to maintain a state of nutritional ketosis but I should at least be in mild ketosis at these levels. This is because I’ve been experimenting with a ketogenic diet for many years and I have become what they call fat adapted. I’m also extremely active so any glucose that does enter my system is burned off pretty quickly which induces ketosis.

Coffee

Coffee, unfortunately, may well increase LDL levels. This is not due to the caffeine content but due to coffee oils called diterpenes which are thought to impact the body’s ability to metabolize and regulate cholesterol (5).  

That said, a brief search of the literature on this reveals mixed results with some studies showing an association but others not (6, 7, 8). Interestingly, though, one meta-analysis showed that LDL could increase as high as 45 mg/dl in some people (9) so this is definitely a lever worth looking at, especially given that my daily coffee consumption is towards the high end.

Vitamin K2

Vitamin K comes in two broad forms: vitamin K1 (phylloquinone) which mainly comes from plant sources such as leafy green vegetables and vitamin K2 (menaquinones) which mainly comes from animal foods and fermented foods such as cheese and natto.

Vitamin K2 is the form that we’re interested in from a heart disease perspective as there is a wide body of evidence to suggest that it plays an important role in CVD risk reduction. In fact, it appears that low vitamin K2 status can actually increase CVD risk (10) and diets high in vitamin K2 can actually slow down and even reverse calcification of the arteries (11).

This latter point is what interests me most given that my primary objective is to try to tackle my CAC issue. One slight concern on this, though, is that some experts in the field have suggested that removing calcification may actually do more harm than good. Without going too deep, a CAC score above 0 confirms that some sort of arterial damage has occurred in the past but the calcification is indicates that this damage has been managed and stabalised.

The issue is that removing this calcium from the artery wall may actually destabalise the plaque which would lead to a cardiac event. Personally, I think adding K2 makes sense so I’m not going to worry about that risk too much and I’ll mainly get getting my RDA from food so that’s an intuitively safe thing to do.

A further complication with vitamin K2 is that it comes in various sub-forms, namely MK4 through MK14, although it appears that MK4 and MK7 are the main ones. The best resource that I’ve come across on K2 is Chris Masterjohn’s ultimate guide; it’s written in a very simplistic manner to make it easy for anyone to understand and there’s lots of technical detail for the nerds among us who want to go that little bit deeper.

To summarise the key points from Chris’ guide, from an application standpoint, K2 works by preventing calcium from getting to all of the wrong places, such as the kidneys and blood vessels, and by making sure calcium gets into all of the right places, such as the bones and teeth.

Not only does K2 have a positive impact on CVD risk, it’s also associated with a plethora of other health benefits such as improved insulin sensitivity, metabolic health, exercise performance, sexual health and cancer prevention.

In terms of dosage, it seems that the sweet spot might be around 100-200μg per day, ideally splitting this across MK4 and MK7. From food sources, MK7 is most abundantly found in Natto which provides a whopping 900μg per 100g, and MK4 is most abundantly found in Goose Liver (Fois Gras) which provides around 350μg per 100g.

Given that Vitamin K2 is a fat soluble vitamin, it should be consumed in conjunction with fat and Chris recommends around 35g fat per meal, preferably from saturated or monounsaturated fats, not poly unsaturated fats.

My plan is to consume around 40g natto per day but supplement with 100μg of MK4 given that I have a slight issue with how goose liver is produced. I’ll share details on the products and recipes as we go through the month.

Vitamin D

It’s widely accepted that Vitamin D and K are thought to work together in combination to ensure calcium gets into all of the right places

Personally, I’ve never been a fan of supplementing with Vitamin D as I try to get plenty of sunshine and I’ve had multiple blood tests which showed Vitamin D always on the high side.

That said, I do like to ensure all of my bases are covered so on days which I don’t get so much sun exposure I’ll probably supplement with a small dose of Vitamin D3, like 400 IUs.

Omega 3

Omega-3 should not need any introduction to the health conscious as it’s been widely advocated for its health benefits, especially in relation to heart disease risk.

It seems that the RDA for anyone with heart disease is around 1,000mg per day through combined EPA & DHA. The good news is that this is easily achievable through food.

For more information on the best sources, and information on the difference between Omega 3 obtained from plant and animal sources, check out this article.

In summary, the active, bio available EPA & DHA can only be obtained directly from animal sources, making them superior. Plant sources contain only ALA which the body has to then convert into EPA & DHA, and there is no guarantee that this pathway is functioning optimally in every body.

Here are the top sources:

Food

Approx. Omega-3 content

Serving

Mackerel

5,000 mg (EPA & DHA)

100g

Salmon

2,250 mg (EPA & DHA)

100g

Sardines

1,500 mg (EPA & DHA)

100g

Flax Seed

2,350 mg (ALA)

1 tbsp (10g)

Chia Seeds

5,000 mg (ALA)

28g

Walnuts

2,500 mg (ALA)

28g

 

I’ll be building a meal plan which incorporates some of these foods every day, and on low days I may cover all of my bases with an Omega-3 supplement. My go to brand for fish oil has always been Carlson’s which you can find in some pharmacies in the UAE and definitely on iHerb.

Berberine

Berberine is a chemical found in several plants and is thought to be effective in the treatment of diabetes and cholesterol levels. Its potential for lowering LDL cholesterol has been corroborated through at least one meta-analysis which concluded that berberine could “significantly reduce total cholesterol and low-density lipoprotein levels and elevate the high density lipoprotein levels” (12).

In terms of dosage, around 1-1.5g per day seems to be recommended but for cost purposes I’ll be taking 1g per day. My berberine of choice is Thorne 500mg caps, also available on iHerb.

Gut Health

So much research has been published on gut health over the last few years that it probably doesn’t come as much of a surprise that having a healthy microbiome may well influence LDL (13). Although I couldn’t find any solid papers on this in humans (there are plenty on mice), I think given the plethora of health issues associated with an unhealthy gut microbiome, I think this is one thing to consider in the overall picture.

My strategy for this will be to include a couple of healthy gut promoting food items into my diet. This will largely be covered off by a daily helping of natto, however, I’ll also be adding sauerkraut and laban to this.

I also considered a supplement a new supplement called Seed which is touted as one of the best available and supported by the likes of Ben Greenfield. However, I’m trying to minimise the number of supplements I take so I decided to park this one for now.

Dietary Fibre

Many studies have shown how dietary fibre might play a role in the reduction of cholesterol (14, 15, 16), however, this may pose a slight problem for anyone following a LCHF diet as dietary fibre intake can be lower than a higher carb diet.

A potential solution for this is the use of a fibre supplement such as psyllium husk which has been shown to support in reducing cholesterol levels (17). It seems that the target dosage should be around 10g per day so I’ll be adding this to my protocol.

Apple Cider Vinegar

Apple Cider Vinegar (ACV) falls into a similar camp to Gut Health for me when it comes to heart disease risk. There is some noise about the potential to lower LDL but not many studies in humans to back this up. That said, there is very little downside to adding ACV to your daily routine and given the number of health benefits associated with AVC, it’s worth a shot.

Measuring success

If you don't measure it, you don't know it

_ me.

The weight loss / body fat objective is pretty straightforward so I don’t feel the need to share anything on that.

The most interesting part will be to see whether my heart disease protocol has any impact on my heart disease risk.

This time, due to the costs involved for all of the blood work, my intention is to only test after the month is completed, specifically looking at advanced cholesterol measures.

In addition, I plan on continuing the protocol until later in the year when I’ll schedule another CT Angiogram and CAC scan to see if there is any progression or regression of the disease.

Read Next

Eu omnium laoreet nominati mel, id vis dolore utroque

Blood work

Standard Cholesterol Panel

When we talk about a standard lipid panel, we're talking about Total-C, LDL, HDL, Triglycerides.

Although there are more advanced tests (which I'll cover in the next section) you can actually learn a lot form the standard test.

I’ll be looking mainly at my LDL-C and the TG/HDL ratio which should be less than 2. 

Biomarker

Target

Last test

Total C

Not relevant

253 (Medium High)

LDL-C

>130 mg/dl

169 (High)

HDL-C

60 or above

81 (Optimal)

Triglycerides

<150 mg/dl

51 (Optimal

TG / HDL ratio

<2

0.63 (Excellent)

 

Advanced Cholesterol Panel

There are now more advanced tests which can look at particle number, LDL particle size and oxidised LDL, all of which are much more pertinent when it comes to CVD risk. I've written about this extensively in the past so if you'd like to know more about why these tests are important check out this article.

Here's a summary of what I'll be looking for:

Biomarker

Target

Last test

ApoB

<80 mg/dl

110 (Medium high)

ApoA1

>131 mg/dl

172 (Excellent)

ApoB to A1 ratio

<0.92

0.64 (Excellent)

Lp(a)

<30 mg/dl

3.3 (Excellent)

LDL pattern B

<6 mg/dl

40 (Unclear)

Oxidised LDL

TBC

Never measured

 

Atherosclerosis markers

Two biomarkers which I’ve recently become aware of are LP PLA2 and Myeloperoxidase. I’m not sure exactly whether these tests are available in the UAE but I will be doing some further research during the course of the year.

Non-cholesterol biomarkers

  • Haemaglobin A1C
  • Oral glucose tolerance test with insulin
  • CRP
  • Testosterone
  • Uric Acid

What next

If you're interested in following my progress, I'll be posting regularly in our Facebook group and you could always follow me on Instagram.

Think I've missed something? Any areas that you feel I may improve? Please leave a comment or reach out to me on social media

Lee Sandwith

Leave a comment