DISCLAIMER
You are reading someone else’s in-depth account/s of nutritional & life intervention/s spanning across ONE YEAR; covering everything from nutrition, psychology, supplementation and fitness training. All intertwined into both socio-economical and self-scientific (explorative) perspective. This is NOT a light reading.

Full Blood Panels ~ why I've been reluctant to share.

Nobody likes sharing blood tests. Ask yourself the same question. An open pit-roast for the Diet-Thought-Police.

I was not aware there is such a thing of "private" blood panel providers until earlier this year . Many years prior saw me spend $80 for a single GP consultation. Only then to be met with "You look fine. I can't allow you to test without a good reason". As I remembered ~ physically walking in & out of a clinic was a Guinness® world record in less than five (5) minutes, whilst parting off $80 for nothing.

Fast forward to now I managed to save however few dollars to share my experiences on various private panel providers. Here are my (3) blood test results from three separate occasions. From (2) private providers (I-medical® and I-screen®).

1/3
Friday 1st of May (end of CKD+IF week)

Sharing a blood test after four years worth of CKD+IF will curl even the toughest of pride and stomach. That is, five Keto/LCIF days on 1600-1800 cals, 2 days of refeeds, occasional periodisation between sat fats MUFAs and PUFAs, and alongside higher daily protein ratios at 35-40%. Only this year I dialled the protein intakes down during the five LCIF days between 20-30%.

This initial test is a general panel plus basic thyroid at an extra / add-on cost. However keeping in mind that this first test (May 1st 2020) was when exercise and training was completely restricted due to COVID19 Gym's lockdowns. In other words, I have not trained "properly" ~ from 21st of March, all the way until Monday 8th of June.

The result are as follows:

1. Fasting glucose : 4.4 MMOL.
   This is about 15 hours of fasting. Due to stress "response" having to calmly and politely explain to the collection nurse why I'm fasting for "so long" ~ that condescendence glare still lingered minutes onwards. Even during the drawing of blood.
2. Vitamin D 25 hydroxy OD :  178 nmOL/L
   ^ yes, very high. This evidently from my daily 5kIU intake. For those who are curious I'm using Doctor's best 5k Vit D. That uses EVOO as its vehicle.
3. Cholesterol (Total): 8.1 MMOL
   1. HDL: 2.6 MMOL ("desirable range": >1.0)
   2. LDL: 5.3 MMOL ("desirable range": <2.5)
   3. Non HDL: 5.5 MMOL
   4. Trigs: 0.5 ("desirable range": <2.0)
   5. LDL/HDL Ratio (risk factor): 2.0
   6. Cholesterol/HDL ratio (Risk factor): 3.1
4. Urea: 8.9 MMOL
   considered high.
5. eGFR: >90
   Determining exactly how high remains unknown. I actually raised this enquiry direct to the provider, only to be met with generic "that's how we usually test this." remark. 
6. Creatine Kinase: 190 U/L (reference range: 40 - 250)
   NOTE: This is on an afternoon AFTER a training day. to be precise third training day of the week.
7. CRP / C reactive protein: 0.1 mg/L (<1.0 = low risk)
8. Thyroid panel
   1. Free T4 = 17.3 pool/L (reference range: 9-20)
   2. TSH = 2.03 mlU/L (reference range: 0.40 - 40)
   3. Free T3 = 4.6 pmol/L. (reference range: 3.5 - 6.5)
9. All liver functions and other blood markers appear right in the middle of reference ranges.

Of course, cholesterol is always the first point of scrutiny. I have recalculated the above into "remnant" cholesterol (TC minus LDL then minus HDL in mg/dl). And got the result of 7.74 MG/DL.

Another noteable concern was the somewhat high urea. Suggesting possible signs of dehydration and/or protein intake.

2/3
Friday 22nd of May (end of CKD+IF week)

So, what to do with the  above (3) main concerns - the high LDL, the urea and the Vitamin D?

I decided to do three (weeks) of "safer fats" CKD+IF cycle. Emphasising on PUFAs N6 first predominantly as Rice Bran oil for the first 1.5 weeks. Then almost exclusively on MUFA coming from EVOOs and Avocadoes (thankfully able to source them shortdated).

With the following more notes in mind:

• Still absolutely no resistance training / training at all. Except resistance bands exercises at home. Also throughout these three weeks I experimented with cold showers. 
• Low to very low  SAT FAT Intakes. Bye bye butter, creams, and beloved desiccated coconut / pumpkin cream puree desserts. The only allowed sat fat source is the meagre amounts of cheese.
• Absolutely No Vitamin D intakes. The overly high Vit D made me think twice about Vit D supplementation. Hence I willingly spent three weeks absolutely WITHOUT any Vitamin D supplementations. 
• Low(er) protein intakes. adhering back to the stricter 70/20/10 as closely as possible consistently on all LCIF days.
• VERY HIGH psyllium husk supplementation amidst low carb desserts AND on feature meal. I'm talking about tablespoons amount per any given day.
• The First and half week of CKD+IF ~ PUFA N6 from the RBO (rice bran oil) was emphasized on first and only solid largest meal during LCIF 4-5 hour feeding window, Monday-Friday. Then the remainder incorporating high MUFA intakes from EVOO, and avocados.
• Weekend Refeedings were still NOT exactly 2 days full. On Saturdays = less than 3500 cals. Followed by another 16:8 feeding window on Sunday equating to less than 2600 cals.
• Supplementation on minerals remains more or less the same - magnesiums, zinc, etc. However Vitamin E is more frequently used during these interventions considering the high PUFA+MUFA intakes.

...And here is the result, same CKD+IF 5-6 days 19:5 / 20:4 formatting. With reduced carbohydrate refeeding windows to effectively just 1.5 days:

1. Fasting glucose : 5.1 MMOL.
   Higher than expected. I have always been under (institutionalised dogmas~ here, here, and here) that either PUFA or MUFA should technically produce lower glucose readings. But my experiences have been somewhat inconsistent. 
2. Vitamin D 25 hydroxy OD : 132 nmol/L
   (last time = 178)
3. Cholesterol (Total): 6.1 MMOL (Previously= 8.1)
   • HDL: 2.3 MMOL ("desirable range": >1.0)
     Previously= 2.6
   • LDL: 3.6 MMOL ("desirable range": <2.5)
     Previously= 5.3
   • Non HDL: 3.8 MMOL
     Previously = 5.5
   • Trigs: 0.5
     Previously = same.
4. Urea: 7.2 MMOL
   Previously = 8.9
5. eGFR: >90
   same as previous however again, how high or low of a difference? Is not shown....
6. Creatine Kinase: 179 u/L
   Previously = 190 U/L
7. CRP / C reactive protein: <1 mg/L
   Previously = 0.1 unfortunately this provider (I-screen) does not show exactly how low.
8. THYROID PANEL: <did not test because couldn't afford another $65 at the time>
9. All liver functions and other blood markers appear right in the middle of reference ranges.

As one can see, there is marked improvement on lipids over the previous. But still high on LDL. The remnants cholesterol as I calculated came to 7.729 MG/DL compared to 7.74 last time.

However, how exactly do I feel throughout these intervention going back to the strict classic 70/20/10 format on high amounts of PUFAs and MUFAs? ...Well, not exactly "good".

Some days = Absolutely rock bottom.
Most days = More lingering hunger.
Some days = More constipated.

Motivation and outlook on daily life wise appeared more or less "worser" than before.

My optimism* on fibre thus far, seems increasingly misplaced. When others rave for it as bulking agent, for me it seems to stagnates satiety and worsen constipation. Despite copious vegetables back to my "classic" high fibre intake Standard Keto (up to 250g worth of uncooked content, enough to fill a 2L cake mixing bowl). Together with almost up to 2 tablespoons-full worth of psyllium husk daily including on desserts ~ did not seem to improve. I was also noticing markedly more random gases.

Hard to explain, but consider this metaphor. If you are hungry, yet if Fibres supposedly "delays" every nutrient partitioning that much longer, then what happens? One may likely "stays" even more hungrier. That much longer. 

*I am not a phD nor am I "decorated" with degrees. But I speak based on the language & perspective of N=1 conviction. Absolutely by no means this will constitute the same response to another individual. Hence, all mileages and experiences vary.

Low protein / less than 100g per day = never a good idea.

At first ~ Low protein intakes early on during the 3 weeks of strict 70/25/5 intervention was actually okay. It was tolerable. Passable. But later on? Signs of "adaptations" (or what I'd rather call it "Understanding") inevitably showed their ugly colours. Lingering hunger pangs.

Soon after the second blood test I immediately tried raising more protein (at least 130-150g of protein intake on 20:4 IF weekdays), sat fats, cheese intakes alongside Vitamin D and K2MK7. By the next two or three days ~ I slowly returned feeling back to my previous homeostasis.

Another downside of low protein intake is that at LOW calorie daily targets ~ the stringent 70/25/5 ratio becomes very difficult, if not impossible to maintain. Imagine eating 1500 cals or under when you're already lean and consider the volumous fitness training involved. On sub 1500 cals on 70/25/10 ratio that only leaves 80 to 90g of protein intake. That is downright starvation. Even with weekend refeeds ~ digestive supports (Betaine HCL+Pepsins) will prove necessary. You can thank me later.

The "only" good thing from almost all MUFA exclusive days? I get to enjoy that peanut butter by the jar.

...Even though that made me insatiably thirsty afterwards. If it fits ketogenic macros of meeting net carbohydrates less than 50g, then why not? Semanticism have no place in one's own self-authenticating in the name of "Science".

3/3
Thursday 29th October

Many months passed, I decided to do another test. This time with the following changes as follows:

1. (Major) reintroducing exercise / volume training 4-day week rituals. There were CLEARLY struggles early on. But eventually LBM / lean body mass was regained. Thereby raising weight from 62.5kg to 67.5kg-68kg. This took almost an entire month of CKD+IF cycle with surplus on LCIF days around 1900kcals. Then also putting in back full two day-refeeds. However, see point #9. 
2. Macro composition wise ~ back to occasional higher protein intakes. But generally still hovering - on average on most KetoIF days ~ around 60-65%F, and 10-15% carbs (total not net carbs counted) the rest as protein.
3. PUFA N6 intakes reduced again. Almost none throughout August through to late October. These include absolutely not nuts intakes throughout entire August and September.
4. MUFA heavy intake days however, still remains occasional. About two but no more than three days per week. These are usually the main meal themselves as EVOO or (very rare / few intakes of avos) with PUFA based condiments  mayo, garlic aioli etc. nothing else.
5. Vegetable intakes back to habitual defaults on feature first solid weekday meal. 100 -150g amounts. There are few days I tinkered with less carb days <25g total.
6. Began tinkering and experimenting with Vitamin C. chewables, and effeversescents. High dose (up to 4 grams) low dose (<500mg). Before sleep. As intra exercise mix. Even tried one or two during fasting windows to see if it affects my daily glucose test. So far - hard to tell almost miniscule of an effect. 
7. Last but most notable ~ supplementing back Vitamin D. Daily dose vary between 5k to 10k iu. I also tinkered with 15k IU per day, but mostly only in presence of refeeds or full days of eating. 
8. 2 Weekly Refeed days gradually condensed. As explained previously for digestive comfort, I've occasionally turned 2x full day of refeeds to just one full day (saturday) then followed by HC+IF days 16:8 formatting on sunday. I maintained these throughout Sep & Oct.
9. I am introducing back casein. It has been almost months or perhaps years but this I believe helped with the lean mass retention, and also as plus do contribute to better satiety.
10. Minor but nonetheless a personal note to my own self ~ I was in the middle of scrutinising different effects on why: some particular coffee brands and differing types: standard premium crema, blends, vs espresso = have curious upsetting / unsettling effects during fasting windows.

So what is the result?

1. Fasting glucose : 5.5 MMOL.
   Higher than expected. Although keeping in mind this is tested much earlier in the morning (<12 hours).
2. <Vitamin D 25 hydroxy OD : did not test because couldn't afford the extra $50 at the time.>
3. Cholesterol (Total): 8.6 MMOL (Previously= 8.1)
   1. HDL: 2.8 MMOL ("desirable range": >1.0)
      Previously= 2.3
   2. LDL: 5.5 MMOL ("desirable range": <2.5)
      Previously= 3.6
   3. Non HDL: 5.8 MMOL
      Previously = 3.8
   4. Trigs: 0.7 MMOL
      Previously = 0.5 MMOL
4. Urea: 8.0 MMOL
   Previously = 7.2
5. eGFR: >88ml/min
   Previously = >90
6. Creatine Kinase: 357 u/L
   This is quite surprisingly high given it's after a rest day.
   Previously = 179 U/L
7. CRP / C reactive protein: <1 mg/L
   Previously = 0.1 unfortunately this provider (I-screen) does not show exactly how low.
8. THYROID PANEL: <did not test because couldn't afford another $65 at the time>
9. All liver functions and other blood markers appear right in the middle of reference ranges.

As one can see, does not look good on "paper".

1/2 Creatine kinase seemed really high

To the point of being odd to me. Considering this was taken on a day after a Wednesday rest day ~ I felt truly at ease. Research suggests that even just 24 hours after one (1) bout of heavy training, CK can skyrocket up to 30 times than reference ranges. That review finds that at least three days is required to decrease CK by 70%.

Below is what appears to be a listing of (some) things that can contribute to a raise in CK:

• Endocrine disorders (Hyperthyroidism, Hypothyroidism, hyper PTH.)
• Metabolic disturbances (Hyponatremia, Hypokalemia. Hypophosphatemia),
• Muscle trauma (Strenuous exercise, Intramuscular injections, Needle electromyography, Seizures)
• Medications (Statins, Fibrates, Antiretrovirals, Beta-blockers, Hydroxychoroquine...)
• Others (Celiac disease, Malignancy, Pregnancy, CKD/Kidney, Surgery...)

...In other words, more or less contributed by any other "mortality" risk factors.

2/3
LDL increase again.

I recalculated the above "remnant" cholesterol (TC minus LDL then minus HDL). And got the result of 11.61 MG/DL. Which was an increase. Not good also.

Indeed sooner or later I surrender to the fact I will likely need to transition back towards a bias towards MUFA intakes.

However, whether or not these imply faith for the "conforming" to reference ranges remains yet another "challenge". Because the following lists my convictions, nearing five years thus far:

• MUFA or PUFA heavy intakes = paradoxically made me more hungrier.
  This has now occurred to me as a convincing, general pattern. All my significantly higher LCIF calorie days (1900+) more often correlated with HIGHER MUFA intakes. Saturated Fats on the other hand frequently satiates. Research suggests Linoleic Acid may be the culprit . Likewise, here is  an interesting study finding, thanks to Peter from Hyperlipid. By no means MUFA or PUFA however is to be condemned. They (in food sources) have inherent flavours ~ nuts, avocados, EVOOs, etc which I still yearn occasionally. Also not forgetting the importance of marine Omega N3s. 
• MUFA or PUFA heavy intakes =  "phlegmy" / mucus heavy almost immediately post-prandial.
  I  did an exclusively almost all PUFA N6 (the supposed "666" of healthy oil) intakes. That did not make me feel consistently "good". Despite many of the great tasting low cost condiments are sadly derived from PUFA N6 rich sources ~ think sunflower, cottonseeds, etc, relying on them as "sole" source of fats to me, so far do not seem to be productive.
• Low Vitamin D intake = worser general malaise.
  It is probably safe to say that Vitamin D affects everything. COVID19 related or not ~ more compelling research now amounts their essentiality. Alas, I believe it as "magic" pill. But I can only say from my own N=1 that somehow, without Vitamin D supplementation ~ I am not within my own surrogate markers of "wellness".  At the very least objectively for sure - without it - I simply feel somehow worse. Again, very difficult to explain, yet intuitively felt. 
• Higher protein = for overall sanity and satiety.
  The very word "Protein" itself means "first" and "prime importance". Unless if one is in very specific clinical compromise/s to protein handling & partitioning ~ restricting overall intakes seems highly unwise for general livelihood (see here, here and here).
• Less overall fibre intake = less gas, less "cumbersome".
  Need not be said. Less fibre intake = I felt generally more better. Although I must admit - that having fibre just for the sake for the food "to settle" indeed at times brings relief. Yet somehow, it did not satiate me. Once again, this may yet be a matter of individual variability, responses and reactions. 

With the above convincing traits I picked up (for myself, for scientific authenticating N=1) along these five long years ~ were these to be disrupted altogether remains a very difficult calling.

3/3
Despite looking "bad" on paper, I slowly reclaimed "myself" again.

Increased protein intakes, full day refeeds, Vitamin D, and sat fats.

Yes, I felt injurious at times during training after COVID19 lockdown lift. Yes, I felt lingering pressure of daily motions. Yes it took a long time reclaiming my maintenance training record being 12+ exercise per training day, 250+ rep volume depletion.

But of all things? I reclaimed what I lost. But at what cost? More statistical coercions upon "guilty" diagnosis, it seems.

In spite of all the above signs of decline. I nevertheless aims to finish this year with yet one more, though may yet not be the last ~ concluding contemplative remarks.

End part 2 of 3.

To be continued part 3.

TLDR as hint; we have to work "with" nature. Not "against" it. That includes cholesterol, for life's sake.