My lipid panel before adopting a paleo-style diet:
- HDL 40.6
- LDL 110
- Tryglicerides 39
After my two-months paleo:
- HDL 65.6
- LDL 318
- Tryglicerides 68
Now, I know that LDL isn't the most precise indicator of CVD risk, but, anyways, could this be normal? My diet consisted mainly of conventionally raised meat (beef, pork), eggs ("free-range"), fish, butter & veggies, few fruits or other kind of dairy.
Could this be from too much saturated fat or animal protein? Is there something to worry with my lipid panel?
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The most important thing to know in trying to answer this is 'what were you eating before?'. The most surprising thing is the very low triglycerides previously, increasing significantly, but still low. Increased carbohydrate is one of the main drivers of increasing triglycerides, so it's a surprising result, since most people eat fewer carbs on a paleo diet (unless you were VLC beforehand). Alternatively, were you eating large amounts of omega-3, perhaps from flaxseed, previously, since this would depress triglyceride and cholesterol levels?
HDL increasing with increased saturated fat intake is unsurprising and a good thing. This just leaves increasing LDL as the surprising factor. A few possibilities present themselves. Had you had more normal (higher) triglyceride levels beforehad, I would wonder whether you're getting a misleadingly high LDL measurement due to the friedwald equation, which over-estimates LDL when subjects have unusually low triglycerides (as with low carb eating). Another possibility, is whether you were eating more cholesterol-reducing foods before you went paleo? It's possible that increased omega-6 decreases cholesterol, ditto plant sterols, increased soluble fibre etc could all artificially lower cholesterol. There's no reason to assume this is a good thing, indeed in the case of o-6, it is at least in part a bad thing, through increased oxidation of LDL.
I'm willing to be corrected, but I'm not aware of any hard links between animal protein and cholesterol (aside from tenuous associations at the population level). Animal products seem to have gotten associated with cholesterol in the minds of nutritionists on the basis of their SFA, but I don't know of the protein itself being significant.
It's possible that consumption of eggs could influence your cholesterol profile. While it is correct to note that the body easily adapts its cholesterol levels to increased dietary intake (it simply decreases its production of cholesterol, which far outweights dietary intake), there is some evidence that dietary intake increases the ratio of total cholesterol to HDL cholesterol. Thus, it might negatively offset the gains you get from increased SFA intake, in terms of higher HDL.
Another possibility is simply that something else has changed in your lifestyle since changing to paleo (less sleep, more stress, less exercise, for example). Cholesterol is a tool that your body uses to perform certain functions, not just an isolated consequence of our diet; if your body is damaged in some way it may well increase cholesterol to repair the damage. My own view is that cholesterol itself is just a marker for other things going on in the body and thus not worth worrying about in itself, reducing cholesterol artificially is unlikely to be a good thing.
Kurt Harris: "If you don't believe the lipid (diet/heart) hypothesis (I don't), why are you having your total cholesterol even measured more than once? [...] As long as trigs are low and HDL is high, they indicate you are eating plenty of good fat but are otherwise fairly meaningless."
Harris has said however that a total cholesterol of 300 is a good upper limit for "normal," which means that if it is significantly above that you could have FH (familial hypercholesterolemia) or thyroid issues. I would guess you would first have to find the proper formula (Iranian?) for calculating LDL and total (I don't know how this works, to be honest, I haven't done it yet). But anyhow there are a lot of insights on this old thread from the PaNu forum, particularly Dr. Harris's October 15th response on the thread. Keep in mind of course that nothing on any of these websites counts as medical advice, etc., etc. And this material is from some time back; Dr. H's most recent blog post is on cholesterol, and it's an excellent read. Anyhow, all of this can give you some valuable perspective.
2 words: lab error
It's highly unlikely that a paleo lifestyle would increase your LDL by nearly 200%. Either the first or the second test result is probably wrong--or maybe they're both wrong, and your LDL is somewhere in the middle. A third test (by a different laboratory) will cast the deciding vote.
If the second test is wrong, then you have nothing to worry about.
If the first test is wrong, then I would get your LDL sub-fractions tested ( http://www.abclab.com/newsletter/LDL%20Newsletter%20Insert.pdf ). A paleo lifestyle usually favors large, fluffy LDL (low risk) vs. small, dense LDL (higher risk).
Also, I would get your thyroid levels (TSH, FT4, FT3) checked, and make sure you're getting enough iodine. It is rare for triglycerides to go up after adopting a paleo diet, so there may be something else going on, like decreased thyroid function.
I'm going to go with Robb Wolf here and say that grass-fed meat IS significantly different and perhaps we don't know all the ways it is yet. CLA differences, for example, are a relatively recent discovery.
I almost never eat factory farmed meat and here I am typing this as a young woman with normal LDL.
If you can't afford to buy grass-fed meat, Robb Wolf suggests going for leaner cuts and supplementing with fish oil. My own advice would be lean cuts + invest in GOOD grassfed butter/ghee/olive oil/lard to cook it in. Cut out factory-farmed pork entirely, lamb and beef are the least affected by poor feeding practices.
My LDL went from 90 to 101 when I increased my pork consumption. HDL also increased too though. n=1, but whatever.
Eventually I hope someone will study the differences between paleos eating grass-fed and those not. I suspect us grass-feds have better numbers.
First as Ed says it is possible for it to be an error in your lab test. However I will assume this is not the cause. The ldl number is probably not very precise as the standard equations do not work well with low tryglicerides, however I suspect your ldl will still be very high however it is calculated.
You were eating a low fat high carb diet and you have switched to what looks like a diet high in fat. A low fat diet can have a detrimental effect on cholesterol levels in some people. This does not seem to be the case with you as your first profile looked ok.
You will now be eating a lot more satruated fat, I think this is the most likely reason for your sudden rise in Ldl cholesterol. Individuals vary a great deal in their cholesterol response to dietary saturated fats and also dietary cholesterol. Many people will see little change or even a reduction in cholesterol levels after increasing fat and animal products and big improvements in Hdl. A few others such as yourself respond with large increases in Ldl cholesterol.
People will argue about wether high Ldl cholesterol is harmful or not and about particle size. I think it is a risk factor but only one among several other factors. The fact that members of traditional hunter-gatherer societies had lower cholesterol levels than average modern people leads me to suspect than a diet that raises cholesterol further above high western levels is not replicating an ancestral diet.
If you want to lower your Ldl it would probably not be to hard. A paleo style diet does not have to be low carb and high in saturated fat. You could eat more green and starchy vegetables, fruits and nuts. Soluble fibre found in these is common in paleo diets and also lowers cholesterol. Just eat a moderate amount of saturated fat. Use olive oil for some of your fat and less butter. Animal protein does not raise your cholesterol. Eat less of the very fatty conventionally raised meats.
Of course you can also ignore it and choose to believe that high ldl cholesterol levels are totally harmless
Of more concern to me is the increase in Triglycerides - although thankfully this is still very low. Definitely worthwhile getting another test (direct measurement) in a few months and looking again.
The cholesterol numbers you have reported do not tell the entire picture. Is your LDL the small, dense type (bad) or large, fluffy type (good)? With higher HDL and low triglycerides, the LDL is probably large and fluffy which does no harm. I would ask for the VAP cholesterol test which will give you much more information about what is really happening. Since LDL is calculated, you might also want to use the Iranian formula (easily found with google) and see what the numbers actually are.
A fatty liver could be right-sizing, thereby releasing lipids into the bloodstream.
"Is your LDL the small, dense type (bad) or large, fluffy type (good)? With higher HDL and low triglycerides, the LDL is probably large and fluffy which does no harm."
Where is everybody who says this getting this information? I believe that an LDL of 318 is always going to be a concern no matter if it's fluffy or pellet-like or anything else. Maybe I'm wrong? I would urge you to consider everything that is said here and to seek other information as well. Take care and keep us updated!
The following is just my experience and probably not an answer to your question. I am 24 male. Before starting Paleo, I realized I have high cholesterol, especially high LDL around 150. It looks somewhat genetic. As usual most of the people on the net say fat has nothing to do with cho blah blah but I did a low sat fat diet and my LDL dropped. Then I introduced eggs (not the free range though) and ate 3 per day for two months. Guess what, my cho was back to being high. So I found a direct correlation between my sat fat intake and cho levels. Now note that people here will tell you sat fat is good as long as they are healthy, so take all the advices with a pinch of salt and do some independent research and 'listen to your body'.
I am somewhat scared how my numbers would be now after more than a month of Paleo.
Are you perchance female and relatively young? My LDL is crazy high(didn't check it pre-paleo though) and I've done some looking around... I've met a surprising number of women in the paleo blogosphere with very high LDL. Considering that young, healthy women probably rarely get their cholesterol checked, I'm starting to wonder if it's actually normal for us to have higher LDL. Or maybe there are underlying inflammation issues, I dunno. Anyway, see my answer on this thread: http://paleohacks.com/questions/3906/very-high-total-cholesterol/3912#3912
ETA: VERY interesting blog post by Chris Masterjohn on this. It's possibly that your lipids could (hopefully temporarily) increase while your body heals itself of fatty liver disease.
If by conventionally raised meats you are meaning regular supermarket meat, fed corn and antibiotics then this is not surprising at all. Most of the fat you are taking in from that is polyunsaturated omega 6 which is not the type of fat that is considered good for you on a paleo diet.
You should either switch to 100% grass-fed meat, or at the very least only buy the leanest cuts of conventional and supplement with copious amounts of fish oil.
Same goes for your butter and dairy, if its cheap butter, its not going to do you much good.