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Cholesterol test--I need some reassurance please

Commented on June 07, 2014
Created May 29, 2014 at 9:28 PM

I apologize in advance that this very likely doubles on some other posts. I just need some of you folks out there who seem so sharp on the science end of things to keep me on the straight and narrow. My doctor called and is very concerned about the spike in my LDL and overall cholesterol. Here are the stats:

LDL = 193

HDL = 62

Overall = 272 (of course they want it under 200. This is the absolute highest I've ever been)

Triglicerides are "wonderful" (his words, no number)

CIP (he said that's inflammation) is VERY LOW.

Plaque is 208 (they want it under 200.)

The inflammation being very LOW is the key here, correct? I'm just a little freaked out because of reading that many people are having such great cholesterol test results and stunning their doctors.

Also, could the fact that I do eat / binge on paleo treats be part of the problem? And not working out like I normally do?

Cf08ad26759fdd206a2c9f9385080a57

(995)

on June 07, 2014
at 04:59 AM

Thomas Dayspring is a good guy to check out too (twitter.com/drlipid.) Attia got a lot of his info by hanging out with Tom.

F291857fa12a0291688ea994343156dc

(720)

on June 07, 2014
at 04:33 AM

Read all Attia's posts on cholesterol... it you can understand them you'll probably understand your situation better than your doctor does.

You're 5' 8" & 130? Unless you're skinny (ie low weight but no muscle) that seems like a pretty healthy height / weight.

(of course, depending on your waist to height ratio).

E32abdc9a483de43def522faf81ed4e9

(0)

on June 05, 2014
at 01:29 PM

So from this it would seem I should absolutely figure out how to lower ApoB?

Cf08ad26759fdd206a2c9f9385080a57

(995)

on June 05, 2014
at 06:54 AM

LDL-P is measured with ApoB. a-4 is associated with apoB, but you might as well just measure the B's and small particles with nuclear magnetic resonance spectroscopy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC330765...

"apoA-IV alters the secretory trafficking of apoB and/or apoB-containing lipoproteins through cellular lipidation compartments, which in turn, enhances particle expansion and, ultimately, TG secretion."

http://en.wikipedia.org/wiki/Apolipoprotein_B#Role...

"in a recent study ApoB was the strongest risk marker for cardiovascular events."

http://www.ncbi.nlm.nih.gov/pubmed/17645591

F291857fa12a0291688ea994343156dc

(720)

on June 05, 2014
at 05:58 AM

Note: the adjective 'former'....

I fired him, he sucked... WAY below average. :(

health is about diet not about pills

No comment on "Most MD don't know squat about cholesterol and diet, pill pushers at best... 25% of American adults should be on statins" ?

Cb9a270955e2c277a02c4a4b5dad10b5

(10989)

on June 04, 2014
at 02:12 PM

I understand, just be careful is all.

Cb9a270955e2c277a02c4a4b5dad10b5

(10989)

on June 04, 2014
at 02:11 PM

"my former GP is a total tub of lard.. I should take his dietary advice?"

No, but you should take his medical advice...

De1095b2ba29c1035f00428cbfe3cc7c

(777)

on June 04, 2014
at 11:37 AM

Thanks for that last link, not that i'm much more informed what to actually do but it's still good to have comparisons side by side like that. The 'five-diets guy' totally messed up all his results by taking statins in my opinion. Seems like ApoE4's should just find a middle ground, eat a bit of everything but not lots of anything, no extremes like vegan or VLC. I feel like forgetting about all this stuff tbh, the stress of thinking about it too much is worse then just eating whatever you enjoy.

F291857fa12a0291688ea994343156dc

(720)

on June 04, 2014
at 04:47 AM

Yeah.... and my former GP is a total tub of lard.. I should take his dietary advice?

Most MD don't know squat about cholesterol and diet, pill pushers at best... 25% of American adults should be on statins?

Read Attia's series on cholesterol, understand it and you'll know more about the topic that 90% of MD's.

http://eatingacademy.com/cholesterol-2/the-straigh...

btw... what you call the guy who graduated dead last in his medical class? Doctor.

Most doctors never read any research papers, probably cannot design a proper experiment nor correctly interpret the results.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on June 04, 2014
at 04:21 AM

Oh I totally agree. Do not disregard doctor's advice for the chatter of the internet rabble. I do not give medical advice but rather scientific opinions based on cherry picked data I've come across on the internet.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on May 31, 2014
at 10:00 PM

I have no idea though if the lines are real or not. You can add a trendline to a graph, it doesn't mean it's significant though. :P

618fc5298c4a96b817c4918c795a875f

(1217)

on May 31, 2014
at 08:21 PM

I like this big confusing graph! Thank you!

E32abdc9a483de43def522faf81ed4e9

(0)

on May 31, 2014
at 02:14 PM

I will indeed. Last time my LDL were large, so that was also good. Everyone has their cross to bear in health but this one at least might not be an issue for me. Fingers crossed :-) You've all been so helpful.

3491e51730101b18724dc57c86601173

(8395)

on May 30, 2014
at 10:20 PM

Your doctor and most of the medical establishment will not agree that high LDL is OK. They are certain that it's a heart attack waiting to happen. But as far as I can see, that's based on drug company literature, not hard science. 50% of the people who have a heart attack or stroke have LOW LDL. With the rest of your great numbers, chances are your LDL are nice and big and fluffy. But don't take my word for it--do the research yourself.

E32abdc9a483de43def522faf81ed4e9

(0)

on May 30, 2014
at 09:49 PM

Typical diet is hard for me since I'm a melancholy sort, every day can be different. I gravitate toward meats(not lean)eggs (but 2 regular eggs and 1 with just one yolk ratio), beef, bacon, lamb, pork, fish (I guess try for more fish? I just don't get full on it!).Lots of spinach, kale, asparagus, broccoli, olives. Cooking with olive oil, coconut oil, ghee, butter, bacon grease. LOTS of water w/ lemon.Trying hard to avoid paleo snacks-doing a reset on that.But when I binge it's big. Binging can happen once a week or three times a week or every other week (my guess is this does my numbers in.)

E32abdc9a483de43def522faf81ed4e9

(0)

on May 30, 2014
at 09:45 PM

The ratio you're mentioning is interesting, mine is almost exactly 4:1 (LDL:HDL). Still safe but go no higher, eh? I do take fish oil, usually 4000mg daily. I think I need to figure out some satisfying fat not saturated sources that aren't nuts or olive oil (due to the O6 factor.) I hate avocado!

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on May 30, 2014
at 01:31 AM

your trigs are probably 85 mg/dL

Not a doctor, but you may want to reduce your LDL

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9 Answers

0
E32abdc9a483de43def522faf81ed4e9

on June 04, 2014
at 01:51 PM

@Stephen 4 I understand where you're coming from. My language can be pretty general, I definitely plan to continue my research. My questioning of "OK" pertains to the general " Paleo" opinions at large, not their opinions ruling my life choices. I am a researcher at heart, always. I exercise regularly (brisk walking and some weights), I'm 5'8" and 130lbs, so weight isn't an issue. and there is zero history of heart issues in myfamily. There's a first for everything though, I realize! The only thing on my charts that is "alarming" by traditional standards is the LDL and the a-4 in the ApoA.To @BobK 's point, I'd bet money that many of the people with moderate or low LDL and high inflammation are the ones with the heart attacks. Also @BobK, my triglycerides are 51, very low. To @paleot my ApoA is separated into 5 types, The a-1, a-3, and PreB-1 are all Optimal, the a-2 is borderline, and the a-4 is High risk. So that's the one I need to "nail" down.

Cb9a270955e2c277a02c4a4b5dad10b5

(10989)

on June 04, 2014
at 02:12 PM

I understand, just be careful is all.

Cf08ad26759fdd206a2c9f9385080a57

(995)

on June 05, 2014
at 06:54 AM

LDL-P is measured with ApoB. a-4 is associated with apoB, but you might as well just measure the B's and small particles with nuclear magnetic resonance spectroscopy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC330765...

"apoA-IV alters the secretory trafficking of apoB and/or apoB-containing lipoproteins through cellular lipidation compartments, which in turn, enhances particle expansion and, ultimately, TG secretion."

http://en.wikipedia.org/wiki/Apolipoprotein_B#Role...

"in a recent study ApoB was the strongest risk marker for cardiovascular events."

http://www.ncbi.nlm.nih.gov/pubmed/17645591

F291857fa12a0291688ea994343156dc

(720)

on June 07, 2014
at 04:33 AM

Read all Attia's posts on cholesterol... it you can understand them you'll probably understand your situation better than your doctor does.

You're 5' 8" & 130? Unless you're skinny (ie low weight but no muscle) that seems like a pretty healthy height / weight.

(of course, depending on your waist to height ratio).

0
Cb9a270955e2c277a02c4a4b5dad10b5

(10989)

on June 04, 2014
at 04:00 AM

No, it is not okay. Your doctor just told you that you have a medical condition and you are turning to a bunch of random people on the internet to reassure yourself that you shouldn't listen to someone who attended over 8 extra years of schooling. This is insane.

You're cholesterol numbers are almost in the 300's, if you're not going to take the medicine then at least talk to a doctor about exercise routines that might help lower your LDL. But please don't blow off an MDs advice at the whim of a few fancy graphs (sorry @Matt 11) and forum goers. We are not qualified to tell you to ignore your doc's diagnosis and recommendations.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on June 04, 2014
at 04:21 AM

Oh I totally agree. Do not disregard doctor's advice for the chatter of the internet rabble. I do not give medical advice but rather scientific opinions based on cherry picked data I've come across on the internet.

0
F291857fa12a0291688ea994343156dc

(720)

on May 31, 2014
at 08:35 PM

Get the trig number, actually get a copy of the report.

If you want a super detailed look into cholesterol, Dr. Peter Attia has written eight (?) blog posts and I think he's not done yet.... it's a bit too biochem for me since that's that my background.

http://eatingacademy.com/cholesterol-2/the-straigh...

Read the entire series before you take the numbers too seriously.

SInce I've cleaned up my eating...'m down from 220 to 190 (6') & I've lost ~3" on my waist.

My internist liked my recent lab numbers so much (Trig was 80, but TC was high?...250 ) that she emailed me.... "keep doing what you're doing, keep the weight off.... see you in a year.

>>>I do eat / binge on paleo treats<<<<

Knock it off... I gave up the whole paleo treat, modern junk made paleo because it's too easy to over consume them.

0
Cf08ad26759fdd206a2c9f9385080a57

(995)

on May 31, 2014
at 07:57 PM

I would be curious what the LDL-P is, and your APOE status. Your particle count is the key there, as well as the amount of small LDL-P nmol/L.

http://www.youtube.com/watch?v=LUlJE2Rqs0w

https://www.youtube.com/watch?v=dAWdHYSrh7M

http://chriskresser.com/the-diet-heart-myth-why-ev...

http://apoe4.info/MWiki/index.php?title=Biomarkers...

De1095b2ba29c1035f00428cbfe3cc7c

(777)

on June 04, 2014
at 11:37 AM

Thanks for that last link, not that i'm much more informed what to actually do but it's still good to have comparisons side by side like that. The 'five-diets guy' totally messed up all his results by taking statins in my opinion. Seems like ApoE4's should just find a middle ground, eat a bit of everything but not lots of anything, no extremes like vegan or VLC. I feel like forgetting about all this stuff tbh, the stress of thinking about it too much is worse then just eating whatever you enjoy.

0
32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on May 31, 2014
at 03:32 PM

Here's a big confusing graph:

Total cholesterol is across the bottom, mortality is vertical. Results are in men, but the results are similar in women. Shows that all cause mortality is lowest around 220 mg/dL total cholesterol. Though CVD mortality is lowest around 200-210 mg/dL. Slightly faulty due to the "3rd world" countries lower cholesterol (via lower nutrition) and their correlation with lots of other causes of death, but the general trend is observed in developed counties as well. In women, the high cholesterol side doesn't increase as much as in men.

What does this mean? Your TC is still a tad high, but you're not going to do too much better in terms of mortality rates if you decrease it.

618fc5298c4a96b817c4918c795a875f

(1217)

on May 31, 2014
at 08:21 PM

I like this big confusing graph! Thank you!

0
E32abdc9a483de43def522faf81ed4e9

on May 30, 2014
at 09:35 PM

I got the result about the trilglycerides and they are indeed low at 51 :-) That's encouraging, right?! And @Girlgenius was correct, the nurse is going to send the results to me in the mail But I was really glad that triglycerides were low. As for the saturated fat--I confess to plenty of eggs and a decent amount of bacon. But if inflammation is low, triglycerides low, etc. but LDL super high, that's still OK, right?

3491e51730101b18724dc57c86601173

(8395)

on May 30, 2014
at 10:20 PM

Your doctor and most of the medical establishment will not agree that high LDL is OK. They are certain that it's a heart attack waiting to happen. But as far as I can see, that's based on drug company literature, not hard science. 50% of the people who have a heart attack or stroke have LOW LDL. With the rest of your great numbers, chances are your LDL are nice and big and fluffy. But don't take my word for it--do the research yourself.

0
Medium avatar

on May 30, 2014
at 09:16 PM

Hi fellow fab female! Be reassured that you're on the right track, but of course the devil is always in the details. The nurse will probably forward you a copy of your blood test in the mail if you ask her by phone. So you'll have your numbers. I also don't play a doctor on the internet (what a great phrase, I'm stealing it!!), but I don't have much choice in my diet. I have to eat fat or I get nasty neurological problems. So I've found that Udo Erasmus has some good books on the subject of fat specifically. However... and this is a BIG however... he doesn't always come to the same conclusion I do. So if you read his books and I hope you do, verify what he says and stop to think about his conclusions. Sometimes he tells you that something that deactivates omega-6 is bad, for example. It's because he was writing before all this omega-3/6 ratio was known.

Anyway the point is, different fats are different. I didn't totally kill inflammation until I got some beef trimmings and rendered them down to tallow for use in whatever I am making, mostly cooking, but I'm bold enough to create fat bombs with it. But I'm old, maybe others don't need such serious measures. Tallow has an interesting property in that it turns off your body's ability to use omega-6 for a while. I got that from Udo Erasmus, but he says it's a bad thing.

In general, as long as

1. your blood sugar is low 70-90

2. you're not eating a lot of concentrated carbs

3. inflammation is down (whether you use fish oil, tallow, aspirin, or all of these to achieve this

... chances are low that you will develop heart disease. There simply isn't anything there to form AGEs and denature the fats so they can't attach to your blood vessels... at least as far as I understand the theory.

I haven't looked into it myself but some places I have heard can tell you whether the LDL particles are small or large. The small ones are dangerous, the large ones are not as dangerous unless you have high blood sugar and inflammation, in which case, any fat in your blood is in danger all the time.

About binge-ing, treats, and exercise: When you're in any diet transition, your body will probably feel odd and it takes more effort to exercise or avoid treats. Think about your ancestors who didn't have more than a bicycle to make travel easier, yet still had to show up for work every day. And if they got a cold and had to go home, they had to ride home sick before they could collapse into a comfy bed. Thoughts like that make me realize how easy my life is now, and I think that's part of my problem. It's too easy to chicken out for me, and if you suspect you're developing the same pattern of excuse making as I am, you might want to get tough on that attitude. Or at least do the exercise out of respect for your ancestors. Depends what kind of mental trick will work for you.

Hunger: You can temporarily use HFLC to kill your hunger, but it takes more creativity in the kitchen than straight Paleo, so time may be an issue. If time is a factor, then just try to reduce carbs as much as possible and add Coconut oil or refined MCT oil to your plan. That will bump you over to ketosis and stop hunger. If you get too extreme with it though, having fat bombs for every meal... then you might want to really look into ketogenic diet and what to do to mitigate the risks (baking soda, potassium citrate, etc...).

Most people get good hunger control from just upping the fat and lowering the carbs a little more though, if that's not enough, taking some Chromax or chromium picolinate (500 or more mg/day for a week or so) will help with sugary/carby cravings. Take it for a week and then think back whether it has helped you, it should work fast, within a few hours to make you more sensitive to insulin. The cravings are a matter of metabolism and it took me over a year to lose the carb cravings on a high fat diet that is nearly totally ketogenic (I take breaks if I sense acidosis coming on because I'm very strict with ketosis in my diet, but you might not need to be so strict). Ideally, you won't have to wait a year, or use chromium picolinate, or do more than cut carbs a little more and up the fat a little more... but the reality is not always the same for every person,

I hope that helped and wasn't TMI...

0
7904c7276d7e48f1be887fabd263bfd9

(300)

on May 30, 2014
at 04:33 AM

Should probably include your general diet as well.

While I have no clue about anything, I get the impression that different paleo fats can affect your cholesterol differently. For example if you're eating a dozon eggs a day or a bunch of damaged fats it may affect you in a negative way. ( Or a bunch of paleo snacks! )

Source: I don't even know where I am.

E32abdc9a483de43def522faf81ed4e9

(0)

on May 30, 2014
at 09:49 PM

Typical diet is hard for me since I'm a melancholy sort, every day can be different. I gravitate toward meats(not lean)eggs (but 2 regular eggs and 1 with just one yolk ratio), beef, bacon, lamb, pork, fish (I guess try for more fish? I just don't get full on it!).Lots of spinach, kale, asparagus, broccoli, olives. Cooking with olive oil, coconut oil, ghee, butter, bacon grease. LOTS of water w/ lemon.Trying hard to avoid paleo snacks-doing a reset on that.But when I binge it's big. Binging can happen once a week or three times a week or every other week (my guess is this does my numbers in.)

0
3491e51730101b18724dc57c86601173

(8395)

on May 29, 2014
at 10:23 PM

I'm not a doctor and I don't play one on the internet, but a few things to think about.

1. You need to know your triglyceride number. Doctor's tend to think it's unimportant, but it's probably one of the most important numbers. They think anything below 150 is great, it should be far below 100. Mine are 55. When Triglycerides are under 100, the method for calculating LDL is inaccurate, so I wouldn't worry too much about LDL's, especially if you are well below 100 on triglycerides. You want to look at your ratio of total to triglyceride. Triglycerides should be less than 50% of total cholesterol. Triglycerides go up if you eat too many carbs.

2. If you are a female, you could do better in the HDL's--mine is 100. The ratio of total to HDL should be below 4--mine is less than 1. Are you getting Omega 3's? Fish oil is a good way to improve that number.

3. Low CRP (inflammation) is great! That's a good sign. But you should know the number--this is YOUR health, you should take charge. That way you will know how it's trending next time you have the test. It should be below 3.

4. Women with higher LDL live longer and have lower rates of cancer and infection than women with low LDL.

5. There is no correlation between total cholesterol or LDL cholesterol and heart attacks or stroke. About 50% of people who have heart attacks or stroke have LOW cholesterol.

How do they measure plaque through a blood test???

If you add saturated fat to your diet (i.e. BPC) on a regular basis, you might cut down on added fat to bring your numbers down a little into what your doctor feels better about. Also, check your thyroid function (again, get the actual numerical results, don't let someone tell you your numbers are "normal") if you are concerned, a sluggish thyroid can cause increased LDL and total.

E32abdc9a483de43def522faf81ed4e9

(0)

on May 30, 2014
at 09:45 PM

The ratio you're mentioning is interesting, mine is almost exactly 4:1 (LDL:HDL). Still safe but go no higher, eh? I do take fish oil, usually 4000mg daily. I think I need to figure out some satisfying fat not saturated sources that aren't nuts or olive oil (due to the O6 factor.) I hate avocado!

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