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Hack My Friend's (CRAZY!) Cholesterol Results...

Answered on August 19, 2014
Created February 22, 2013 at 7:14 PM

I recently convinced a friend to give paleo a try. He's been all on board for about a month now, and he got his blood checked to see if everything is going alright... he made sure to check the particle size, as well. Well, things don't seem so good, even by paleo standards. But I don't know much about interpreting blood test results. Can the more informed members here tell me whether these are as bad as they look? There is some strangeness, I think, in the fact that his LDL-P is so high, but his triglycerides are so low. (I thought this is usually not the case...). Any thoughts here? Thanks!

LDL-P: 2284 nmol/L

LDL-C: 174 mg/dL

HDL-C: 45 mg/dL

TRIGLYCERIDES: 58 mg/dL

TOTAL CHOLESTEROL: 231 mg/dL

HDL-P (total): 24 mmol/L

SMALL LDL-P: 842 nmol/L

LDL SIZE: 21 nm

LARGE VLDL-P: 0.7 nmol/L

SMALL LDL-P: 842 nmol/L

LARGE HDL-P: 3.8 mmol/L

VLDL SIZE: 36.5 nm

LDL SIZE: 21 nm

HDL SIZE: 8.5 nm

LP-IR SCORE: 43

EDIT: The most concerning part, I think, is the LDL-P numbers, which are off the charts high... this seems like it might necessitate some sort of immediate intervention (unless I'm misunderstanding what that number means... I thought it indicated many little nasty dense LDL particles...)

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 25, 2013
at 05:55 PM

Given what you report, especially the alcoholism and tremors, he should be medically evaluated. This is not something to deal with on an Internet forum.As for the dietary advice, I am not sure about the basis for this and, anyway, this can be taken up after a medical evaluation.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 24, 2013
at 06:06 PM

For now, I advised him to get checked for congenital conditions that might cause hypercholesterolemia. Also, he had been eating a fair amount of carbs from fruit and starchy veggies. Following Chris Kresser, I advised him to eat fewer carbs and focus on fattier meats. Basically, fatty meat and non-starchy veggies, very low carb paleo. Try this for about three months and then get his blood rechecked. Does that seem like reasonable advice, given the little you know from his blood results? Thanks for the advice!

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 24, 2013
at 06:00 PM

Thank you for your detailed response. I don't know the rest of his medical info, but I can tell you that he is around 38 years old and has always tended to be rather skinny. He certainly has not lost a lot of weight since beginning to eat paleo. I actually suspect he might have some hyperthyroidism (he is very high strung, big appetite although skinny, tremors in his hands, and often has trouble sleeping). Another big factor is that before going paleo, he was a BIG drinker, like a (functional) alcoholic. He has stopped drinking since going paleo a month ago... (cont.)

Bcb2f5436d11467e89123680c046b858

(1356)

on February 23, 2013
at 02:16 PM

Actually it's HYPOthyroid that could possibly contribute to high LDL. See http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/ or Chris Kresser for more info on this.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on February 22, 2013
at 09:27 PM

The numbers don't mean anything as they are just one measure. Did he have one before paleo? If not then file away and see where he is in 6 months.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 22, 2013
at 08:16 PM

I see... for some reason, though, I had it in my head that LDL-P numbers over 2000 were dangerous enough that they might necessitate a immediate intervention (I think I heard that on Robb Wolf's podcast?), or it might indicate a different underlying problem (hyperthyroidism?). In any event, thank you for your advice. I'm doing my best not panic, or have my friend panic. He suggested that he might just need grains in his diet - but I managed to persuade him that grains would not help anything.

3491e51730101b18724dc57c86601173

(8395)

on February 22, 2013
at 07:55 PM

Yes, the LDL-P is high, but what Greymouser pointed out is you don't have any data about what his LDL-P was BEFORE he started paleo. For all you know, it could be coming down from a much higher level before he started paleo. The test should be repeated in 3 - 6 months to see which way it's trending. Meanwhile, don't panic.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 22, 2013
at 07:45 PM

Do you have any thoughts on the LDL-P numbers? That's what's concerning. They seem to be literally off the charts high, which I thought might be cause for immediate intervention of some sort (even if the paleo diet did not cause these numbers...)

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6 Answers

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1
Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 24, 2013
at 11:37 AM

You can't evaluate a lipid panel in the absence of much more information about the person than that provided here. That said:

1) Its not at all strange that your friend's Triglycerides are low and his LDL high. In fact, this has been reported here and discussed many many times. Often, variations of a very low carb/higher fat diet seem to trigger this pattern.

2) His LDL-P is very high and, in fact, higher than his LDL-C would suggest. This is called "discordance" See:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070150/

Discordance is strongly associated with metabolic syndrome but as noted, without more information (blood pressure, glucose levels, waist measurements, etc), its not possible to know if MetSyn is a factor here.

3) You say referring to LDL-P " I thought it indicated many little nasty dense LDL particles...)"

Actually LDL-P refers only to the number of particles irrespective of particle size.

4) "this seems like it might necessitate some sort of immediate intervention"

A high LDL-P is not something that is going to kill a person or cause vast immediate damage but it is a risk marker. Since we don't have any solid idea about what high LDL-P means for people on the kinds of diets discussed here, it would seem prudent for your friend to keep an eye on this situation. If it were me and my LDL-P was already this high, I would start to think about modifying my diet immediately so as not to risk this process going much further. If your friend wants to wait some months to check again, that of course is his choice.

I can;t say more without additional information about your friend and his health status/markers.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 24, 2013
at 06:06 PM

For now, I advised him to get checked for congenital conditions that might cause hypercholesterolemia. Also, he had been eating a fair amount of carbs from fruit and starchy veggies. Following Chris Kresser, I advised him to eat fewer carbs and focus on fattier meats. Basically, fatty meat and non-starchy veggies, very low carb paleo. Try this for about three months and then get his blood rechecked. Does that seem like reasonable advice, given the little you know from his blood results? Thanks for the advice!

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 24, 2013
at 06:00 PM

Thank you for your detailed response. I don't know the rest of his medical info, but I can tell you that he is around 38 years old and has always tended to be rather skinny. He certainly has not lost a lot of weight since beginning to eat paleo. I actually suspect he might have some hyperthyroidism (he is very high strung, big appetite although skinny, tremors in his hands, and often has trouble sleeping). Another big factor is that before going paleo, he was a BIG drinker, like a (functional) alcoholic. He has stopped drinking since going paleo a month ago... (cont.)

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 25, 2013
at 05:55 PM

Given what you report, especially the alcoholism and tremors, he should be medically evaluated. This is not something to deal with on an Internet forum.As for the dietary advice, I am not sure about the basis for this and, anyway, this can be taken up after a medical evaluation.

5
Ebb10603524dd22621c1155dd7ddf106

(19150)

on February 22, 2013
at 07:33 PM

... and what did his numbers look like before he began to have a paleo inspired diet? If this is one month in, we don't know if he's already getting better or worse!

In general, I would say Trigs are pretty darn good, but total cholesterol is somewhat off from great -- LDL could be lower as well as HDL being higher (yes, both).

Since it's only one month in, I would take these are your beginning numbers, and get retested in 6 months or a full year.

3491e51730101b18724dc57c86601173

(8395)

on February 22, 2013
at 07:55 PM

Yes, the LDL-P is high, but what Greymouser pointed out is you don't have any data about what his LDL-P was BEFORE he started paleo. For all you know, it could be coming down from a much higher level before he started paleo. The test should be repeated in 3 - 6 months to see which way it's trending. Meanwhile, don't panic.

Bcb2f5436d11467e89123680c046b858

(1356)

on February 23, 2013
at 02:16 PM

Actually it's HYPOthyroid that could possibly contribute to high LDL. See http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/ or Chris Kresser for more info on this.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on February 22, 2013
at 09:27 PM

The numbers don't mean anything as they are just one measure. Did he have one before paleo? If not then file away and see where he is in 6 months.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 22, 2013
at 08:16 PM

I see... for some reason, though, I had it in my head that LDL-P numbers over 2000 were dangerous enough that they might necessitate a immediate intervention (I think I heard that on Robb Wolf's podcast?), or it might indicate a different underlying problem (hyperthyroidism?). In any event, thank you for your advice. I'm doing my best not panic, or have my friend panic. He suggested that he might just need grains in his diet - but I managed to persuade him that grains would not help anything.

6da7ce6a4a250c46a6e78b5b4e22da83

(987)

on February 22, 2013
at 07:45 PM

Do you have any thoughts on the LDL-P numbers? That's what's concerning. They seem to be literally off the charts high, which I thought might be cause for immediate intervention of some sort (even if the paleo diet did not cause these numbers...)

1
32652cb696b75182cb121009ee4edea3

(5802)

on February 24, 2013
at 03:47 PM

Mark Sisson did a good article on this. One of the takeaway points was that when you start paleo, if you are losing weight, your body is dumping fat into your bloodstream. If you take a "snapshot" at this point, your cholesterol numbers are going to look high. Better to wait until weight loss has stabilized and retest.

https://www.marksdailyapple.com/why-did-my-cholesterol-go-up-after-going-primal/

0
Cfec3fb17e6d06f984ffedc2aae54920

(150)

on February 23, 2013
at 04:06 AM

Has your friend dropped weight? If so, how much and what does he weigh now? Let's assume his levels were higher before he went paleo.

0
D7cc4049bef85d1979efbd853dc07c8e

(4029)

on February 22, 2013
at 10:14 PM

The numbers are just markers. There could be a problem with LDL uptake by cells leaving LDL particles around the blood stream. So knows, there could be some other infection your friend is dealing with.

You've probably heard that Thyroid hormone is involved with LDL uptake, so maybe dealing with angle could help. You know, getting selenium and iodine up, that kind of thing. Vanadium also seems to be involved in thyroid health, maybe supplementing a chromium-vanadium supplement would help it.

0
8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on February 22, 2013
at 08:55 PM

His numbers seem pretty good. It would likely be beneficial if he raised his HDL level by eating plenty of saturated fat. Evidence shows that a total cholesterol between 200 and 260 correlates strongly with the lowest rates of mortality.

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