1

votes

Hack My Blood Work. Doc is Freaking

Answered on September 12, 2014
Created January 16, 2013 at 4:31 PM

Military Doctor who knows nothing about Paleo is flipping out at my Cholesterol numbers. Help me know how I'm really doing.

Total Cholesterol: 435 LDL: 362 VLDL: 10.6 HDL: 62 Glucose: 101 Triglyceride: 53

I'll admit I'm a little concerned about Total and LDL.

Any help interpreting is appreciated.

BTW, they can't test for big vs small LDL.

Medium avatar

(10601)

on July 30, 2013
at 07:24 PM

Pile on all the risk factors you can...great N=1 experiment...

Medium avatar

(10601)

on July 30, 2013
at 07:19 PM

Is everyone giving blood today or something? One zombie blood test after another.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 27, 2013
at 12:15 PM

JB Primal, you are continuing to fall back on the "fluffy" LDL meme. Please see my comments below on this subject. Ditto for the Trig/HDL ratio. I understand the urge to look for solace in the face of this kind of lipid report, but there is no need to make the issue so complex. You changed your diet and your LDL went way up so change it again if you want it to go down. End of story.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on January 26, 2013
at 09:20 PM

Hello trollie...

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on January 26, 2013
at 03:17 PM

High cholesterol is a symptom, not a risk. The risk factor is what's causing the high cholesterol, who knows what that is though. But assuming everything else is ok with you, then time is on your side.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 03:31 AM

The Fluffy test is not very accurate either. You want to get your LDL down idf possible. Also HDL is not that high. Are you working out much?

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 03:29 AM

JB Primal. Be sure to read Travis's response in the link I added to my post. You might want to cut out cream and butter for a month and re-test. You should get a second test anyways.

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 02:26 AM

Fascinating, upvoted.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 12:45 AM

Read Travis's response here: http://paleohacks.com/questions/91329/perfect-health-diet-tweaks#axzz2IBmVVgRi

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 16, 2013
at 09:26 PM

You're right, it is something to be worried about. However, trying to lower cholesterol directly by doing something like lowering butter intake, which would likely work, is not looking at it in a way much different than deciding to take statins. There's some other reason for the high cholesterol.

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 09:15 PM

Meat and fat. Under 75 carbs per day. IF most days until around 5 PM, then a high fat, moderate protein dinner with some veggies about 4 times per week. Fruit about 3 times per week. Dark chocolate (72% or higher) once or twice per week. Heavy cream in my coffee in the morning. I'm not too concerned, as my Triglyceride/HDL numbers are .84 (Under 2 is good), but the high total is a bit of a shock. I read somewhere earlier that if your triglycerides are under about 75, your LDL is likely all fluffy type A, rather than dense type B.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on January 16, 2013
at 08:18 PM

I agree HDL/trig is good, but there's still something amiss with LDL that high. High LDL is a symptom of something else going wrong, a warning sign.

D8612a7c536e74f9855b70d8e97919b5

(1042)

on January 16, 2013
at 07:25 PM

That 3 part series from Kresser and Masterjohn is really good info. My total cholesterol was a little over 300 6 months ago. After hearing Masterjohn talk about the importance of selenium and iodine and their effect on thyroid function, I started eating a brazil nut each day and eating some kombu/kelp most weeks. Six months later and my total is down to 260-ish, almost totally from LDL reduction. My doctor still wants me to take a statin, but I am no longer considering it. TLDR; Before you think about statins, check your thyroid.

Ebb10603524dd22621c1155dd7ddf106

(19150)

on January 16, 2013
at 06:56 PM

*Might attempt to quit the tobacco* **Might?!**

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 06:27 PM

No. No family history

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 06:26 PM

Yes, about an 8 hour fast.

61844af1187e745e09bb394cbd28cf23

(11048)

on January 16, 2013
at 05:47 PM

Is the glucose a fasting number?

244dca88091fa349a77379b1629d0b25

(255)

on January 16, 2013
at 05:33 PM

Even that trigs are on 'great' range, LDL is still to high for the dense/fluffy to matter. There are just too many LDL particles floating around and that's an issue. So there may be a need to check other things - hsCRP, thyroid, micro-element deficiencies. Maybe to the actual check for blocked arteries - carotid intima-media thickness, etc.

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 05:06 PM

Sorry, I don't have reference numbers or previous numbers. It's a military clinic so they aren't exactly customer service oriented.

63f2e1f026317464d8553801ea5fe495

(314)

on January 16, 2013
at 04:41 PM

Can you also add in the reference ranges? Those should have been supplied to you on the lab paperwork. And do you have any previous blood work that you can use to compare these numbers to?

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13 Answers

4
D60a36346ff1078f083edcdfbf199ab9

on January 16, 2013
at 10:32 PM

Your cholesterol is way too high. I don't care if you have "fluffy" LDL or whatever.

4
7bf306ada57db47547e9da39a415edf6

(11214)

on January 16, 2013
at 07:07 PM

Yep, those cholesterol numbers are high. I wouldn't take the drugs, and I probably wouldn't change my diet (assuming you eat like I do), but my numbers are super awesome, and I bet I'd be a little worried if I did have you numbers, so the first thing you need is good info:

Chris Kresser and Chris Masterjohn talk about cholesterol and heart disease, part 2, part 3.

I've listened to this stuff, but I tend to forget stuff that isn't directly relevant to me.
It is worth remembering statins are a class of drug, and if you did ever decide to go that route, it would be a good idea to see which ones had the best history- least side effects, fewest deaths, been around long enough for you to have a rough idea of what to expect...

D8612a7c536e74f9855b70d8e97919b5

(1042)

on January 16, 2013
at 07:25 PM

That 3 part series from Kresser and Masterjohn is really good info. My total cholesterol was a little over 300 6 months ago. After hearing Masterjohn talk about the importance of selenium and iodine and their effect on thyroid function, I started eating a brazil nut each day and eating some kombu/kelp most weeks. Six months later and my total is down to 260-ish, almost totally from LDL reduction. My doctor still wants me to take a statin, but I am no longer considering it. TLDR; Before you think about statins, check your thyroid.

3
1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 16, 2013
at 09:08 PM

According to Chris Kresser those numbers are high enough to be concerned. You might try eliminating butter as that has worked for some Paleo hackers. Also can you list your diet?

Refer to the accepted answer to the following question: http://paleohacks.com/questions/91329/perfect-health-diet-tweaks#axzz2IBmVVgRi

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 16, 2013
at 09:26 PM

You're right, it is something to be worried about. However, trying to lower cholesterol directly by doing something like lowering butter intake, which would likely work, is not looking at it in a way much different than deciding to take statins. There's some other reason for the high cholesterol.

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 09:15 PM

Meat and fat. Under 75 carbs per day. IF most days until around 5 PM, then a high fat, moderate protein dinner with some veggies about 4 times per week. Fruit about 3 times per week. Dark chocolate (72% or higher) once or twice per week. Heavy cream in my coffee in the morning. I'm not too concerned, as my Triglyceride/HDL numbers are .84 (Under 2 is good), but the high total is a bit of a shock. I read somewhere earlier that if your triglycerides are under about 75, your LDL is likely all fluffy type A, rather than dense type B.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 12:45 AM

Read Travis's response here: http://paleohacks.com/questions/91329/perfect-health-diet-tweaks#axzz2IBmVVgRi

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 02:26 AM

Fascinating, upvoted.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 03:29 AM

JB Primal. Be sure to read Travis's response in the link I added to my post. You might want to cut out cream and butter for a month and re-test. You should get a second test anyways.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on January 17, 2013
at 03:31 AM

The Fluffy test is not very accurate either. You want to get your LDL down idf possible. Also HDL is not that high. Are you working out much?

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 27, 2013
at 12:15 PM

JB Primal, you are continuing to fall back on the "fluffy" LDL meme. Please see my comments below on this subject. Ditto for the Trig/HDL ratio. I understand the urge to look for solace in the face of this kind of lipid report, but there is no need to make the issue so complex. You changed your diet and your LDL went way up so change it again if you want it to go down. End of story.

2
Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 26, 2013
at 03:04 PM

1) I think you may be being a bit hard on your doctor. Just because he doesn't know anything about paleo does not mean he is not competent (its not really a mainstream medical subject after all) and how many people here who are giving advice have anything close to a medical education?

2) Speaking of advice, you are getting some of the standard "wisdom" common in these circles but beware:

A. Any assertion that "large, fluffy" LDL is somehow protective is ill-advised. At best, there is a notion that small, dense LDL is more arthrogenic however the new studies that control for confounding variables suggest that its the number of particles (LDL-P) irrespective of size that is the risk marker. No where has it ever been credibly said that large (fluffy) LDL particles are some how positive.

B. The above is related to the also common advice that if your triglyceride level is low or if you have a good HDL/Trig ratio, you are out of the woods somehow. However, the HDL/Trig ratio is really a marker for insulin resistance but insulin resistance, and its relationship to metabolic syndrome, only represent one cluster of risk for heart disease. Another cluster is familial hypercholesterolemia and those folks have loads of "large fluffy" LDL particles but they still get heart problems. Bottom line, you may in the clear for insulin resistance but that does NOT mean you have no risk of heart disease.

C. Another common idea is that sky-high LDL is a sign of Thyroid disorder but assuming you have no symptoms of hypothyroidism, it would have to be subclinical (SHT). In the research I looked at, this for example:

"In the follow-up study, where we looked specific-ally at those with SHT, the serum TC and LDL-C levels were significantly higher in the females in the SHT group than in the controls. The serum TC and LDL-C levels were also higher in the males SHT subjects, but the difference did not reach statistical significance."

http://www.ncbi.nlm.nih.gov/pubmed/16789979 (paywall)

there wasn't a significant relationship between SHT and LDL for the male subjects. So, it seems unlikely that SHT would produce an LDL of your magnitude or even have any impact at all. People who report lowering their LDL through various self-experimentation (Brazil nuts, iodine, etc) have no clue if the result was from what they did or from time alone (assuming that its even an accurate report).

So where does that leave us. The reality is that you have very high LDL and the only question for you is what does that mean and what are you going to do about it. You still may want to have a physician try to rule out familial hypercholesterolemia and assuming its not that and also assuming you have no symptoms of any kind, the only reasonable conclusion is that your LDL went way up because you changed your diet. That has happened to scores of people myself included and as I see it and based on my experience, here is what I suggest:

1) Stop listening to the many Internet voices who, for the most part, have no idea what they are talking about (except this one of course :)

2) You can also decide to forget about the whole issue but you should realize that nobody has the slightest idea what the future holds for Paleo eaters with high LDL over time. Do you really want to experiment on yourself in this manner?

2) You can wait for a while to see if the number comes down over time. I have no idea how long is reasonable to wait so that would be up to you.

3) You can combine waiting with some dietary changes. Some people just seem to be "hyper responders" to saturated fat so you can cut down somewhat on that. I have been using more olive oil for cooking, some lard at times (half monounsaturated fat), and cut back on butter, cream (I use half and half), and I don't drink fat bomb smoothies or "Bulletproof coffee" anymore. If you are VLC, then I would also suggest eating a reasonable amount of carbs. I started with bananas and potatoes but I do now eat a slice of good sourdough bread most days and not to mention fruit and some other carbs. I have pretty much lost my "carbaphobia" but I don't go overboard either.

4) You might want to get Chris Kresser's series on high cholesterol. Its pretty good and you will learn a lot although I am not sure about his supplement programs. It would also be good to work with a sympathetic physician. Good luck on that.

5) Also, if that is your fasting blood glucose, I would keep an eye on that as its getting up there. If it goes up from there, it would definitely be worth trying to understand why.

Oh yes I forgot to say that my LDL went as high as 330 but after about 18 months, it started coming down and about two months ago it was 189 and I suspect my LDL-P is even lower. That reduction occurred BEFORE I started changing my fat intake and about a year after I started adding carbs. I will be interested in seeing my next report. I can't really say if it was time or the added carbs that made the difference.

I apologize if some of this repeats what I wrote in a response to your subsequent post but I wanted to address some of these other issues here.)

1
0deb5ec945725477d56eaeb3d245ae92

on January 16, 2013
at 06:30 PM

Funny, I just got my cholesterol checked too. Off the top of my head, my numbers are: 460 Overall, LDL is mid 300's, HDL is 64, Triglycerides is 104. My doctor freaked and wanted me to get on statin drugs. When I flatly refused to do so, he asserted I was going to have a heart attack any day now. (Btw, 6'2", 178lbs, BP 120/80, resting pulse 60).

I've been eating Primal for the past 10 months. Another way of determining your risk for heart disease is Triglycerides divided by HDL. The ratio should be under 2. Yours is excellent.

I eat mostly fat and protein. No grains, sugars, artificial sweeteners, legumes, starchy vegetables, or alcohol. I do use tobacco and caffeine though. Not sure why my numbers are so elevated, but I'm not changing my diet. (Might attempt to quit the tobacco).

There's a lot of conflicting information out there regarding cholesterol generally, but one thing I've figured out is that what matters most is particle size. For that you need an advanced test like an NMR or a VAP - I haven't got one yet.

As for Uzito's comment about too much dense/fluffy LDL, well, can there be too much fluffy? Anyway, low triglycerides and high HDL is indicative that it's mostly large fluffy and not small dense.

Ebb10603524dd22621c1155dd7ddf106

(19150)

on January 16, 2013
at 06:56 PM

*Might attempt to quit the tobacco* **Might?!**

Medium avatar

(10601)

on July 30, 2013
at 07:24 PM

Pile on all the risk factors you can...great N=1 experiment...

1
956408f7e0581013adcc54b3f10a5e9e

on January 16, 2013
at 05:16 PM

Your triglyceride numbers are great which makes your cholesterol less of an issue. How is your stress level, how are you sleeping? A very high cholesterol reading like that makes me think of some inflammation issues.

244dca88091fa349a77379b1629d0b25

(255)

on January 16, 2013
at 05:33 PM

Even that trigs are on 'great' range, LDL is still to high for the dense/fluffy to matter. There are just too many LDL particles floating around and that's an issue. So there may be a need to check other things - hsCRP, thyroid, micro-element deficiencies. Maybe to the actual check for blocked arteries - carotid intima-media thickness, etc.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on January 16, 2013
at 08:18 PM

I agree HDL/trig is good, but there's still something amiss with LDL that high. High LDL is a symptom of something else going wrong, a warning sign.

0
8d3cb0be5f31c75a05f853cb3b5c245a

(1601)

on July 30, 2013
at 06:48 PM

how is this going? Did you ever resolve your issue? I'm curious if you have a copper issue, or selenium, iodine, or other issue (like say Manganese, etc.). Did you see this: http://perfecthealthdiet.com/2011/03/answer-day-what-causes-high-ldl-on-low-carb-paleo/

The article is really interesting, and the commenters noted that not only copper, but also

"hypothyroidism and elevated LDL. As one cause of hypothyroidism is iodine or selenium deficiency, this is another pathway by which mineral deficiencies can elevate LDL."

0
34cf7065a6c94062c711eb16c0f6adc3

on January 17, 2013
at 04:49 AM

Yes, everybody is right, your Cholesterol is too high.

Check out the following article at PerfectHealthDiet. http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

Read Gregory Barton's experiments and experiences while reducing his cholesterol. You might not have that hard a time :-).

0
336c383a3c4d28652d7ab888c79108a3

on January 16, 2013
at 10:29 PM

Try to get an NMR test to see your total particle count - large vs small

What is your daily diet like - what do you eat in an average day?

Can you post the full results of your blood work?

0
06bf7b92d77f1ac1d8e3dc9d539d8254

on January 16, 2013
at 07:40 PM

There is a likely explanation as described here: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

I would definitely address that if I were you. Not with statins of course.

0
D8d3320bb17b9f7b9af83cf1ad21c426

(100)

on January 16, 2013
at 06:09 PM

Is there a history of Hypercholesterolemia in your family?

6bce08b072e3cea49b292658b9d5d197

(1144)

on January 16, 2013
at 06:27 PM

No. No family history

-1
2564c814ad9931c834ae092e1ef069fb

on July 30, 2013
at 08:24 PM

Whatever you do, do not cut back on butter or eggs!

-1
44d244d6254dc133df6234cfb616a7d1

on January 26, 2013
at 08:46 PM

High Cholesterol (Need): Thyroid, sugar, protein, coconut oil

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on January 26, 2013
at 09:20 PM

Hello trollie...

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