3

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Hack My Latest Lipid Panel Results: Should I be worried? What should I do differently?

Answered on August 19, 2014
Created October 28, 2011 at 9:32 PM

I'm not really sure what to make of my latest lipid panel results. I was on a standard american diet heavy on grains and processed food when I was tested in April of 2010. I started eating paleo last March, and since then I've lost 30 lbs and feel great. My diet is limited to lots of meat (unfortunately a good portion of it is industrial farmed), lots of vegetables, some berries, some nuts, and (lately) some starchy vegetables (mostly sweet potato). I get some physical activity in each day, mostly walking (4 mile walks), cycling.

So What gives? I expected everything to improve in my latest lipid panel. But my total cholesterol and LDL actually went up!!? I'm confused and disappointed.

I should also add that I have Kaiser insurance, and I can't get the tests that Robb Wolf recommends in The Paleo Solution with them (believe me I have tried).

Should I be worried?

Thoughts? Suggestions?

Thank you all!

10/28/2011

Cholesterol 304 H

LDL Calc 242 H

HDL Chol 42

Triglyceride 100

4/1/2010

Cholesterol 298 H

LDL Calc 187 H

HDL Chol 36 L

Triglyceride 375 H

Edit My doctor also requested this test. I'm not sure if this makes a difference.

Glucose, fasting 92 mg/dL

Da3d4a6835c0f5256b2ef829b3ba3393

on November 12, 2011
at 10:52 PM

Hi, Hans. I took a look at your website. Much of it was lost on me. Perhaps I simply do not understand your message clearly, but I could not glean exactly what you were saying at virtually any point. I certainly do not say this to be a jerk or anything. I simply couldn't follow your writing style very well.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 01, 2011
at 08:58 PM

The study is not reliable becuz it fails to take into account low and upper bounds, where ratios are not meaningful. The problem is your low HDL: Your HDL is low as your TC is 7.2x it. It's not the absolute level but the relative level vs. your TC. However, HDL loses effectiveness starting around 65. Not much improvement in being 65 vs. 125. (Also, at TC < 150, u don't need HDL much higher than 50.) Conclusion: You have low HDL vis-a-vis your TC which puts you at risk, even though your Trigs are low-to-moderate. I would get a particle size test to confirm.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 01, 2011
at 08:52 PM

It's determined by Trig levels from 60 to 150. At 60 or below, you're mostly A; at 150 and above, you're dominated by B. In between, it's a mix and the VAP may give you a better picture. Nothing is 100%. Also, HDL can be elevated due to an infection.

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9 Answers

11
00c8eb3f6e6a1884216044ca29cf868a

on October 28, 2011
at 09:58 PM

First, 298 to 304 isn't significant. It's well within the margin of error.

Second, your LDL is CALCULATED...which means it's baloney. "Calculated LDL" is derived by the Friedewald equation: the reason this baloney number went up is because your TG went down dramatically! https://secure.wikimedia.org/wikipedia/en/wiki/Friedewald_equation

HDL = total Cholesterol - LDL - (0.2 * TG)

Or, solving for LDL: LDL = TC - HDL - (0.2 * TG)

Yes, the best way to lower your "calculated LDL" on a typical "cholesterol test" is to RAISE YOUR TRIGLYCERIDES - in other words, by doing massive damage to your own health. By dropping your triglycerides from 375 to 100, you raised your "calculated LDL" by 55 points!

Note that this is exactly how much your "calculated LDL" went up. This is one reason why the typical test is bunk. Get a VAP cholesterol test if you want to know what's really going on.

JS

4
Medium avatar

on October 28, 2011
at 10:01 PM

The triglycerides you had before were setting you up for a heart attack. It's a good thing you lowered them. That alone probably raised HDL, but more can be done here. HDL should continue to rise as you lower TGs. These factors are generally more important than anything else on the test.

2
03fa485bfd54734522755f47a5e6597e

(3944)

on October 29, 2011
at 01:58 PM

That's a huge improvement in triglycerides. Total cholesterol is basically meaningless, and LDL nearly so if it's not measured (rather than calculated) and split into LDL types. If these are the only tests available, focus on your trigs and HDL, which are pretty good but may look better on a continued paleo diet with some exercise. If you're losing weight, feeling good, and have enough energy to walk 4 miles a day, I'd put a lot more stock in that than in your lipid numbers.

Fasting BG of 92 is maybe slightly high, but it's just one test and it's still in the normal range. If you can beg/borrow a BG tester, you might want to check yourself in the mornings and 1 and 2 hours after meals for a few days, and see if you're handling glucose properly both fasting and post-meal. If you tend to be up over 90 fasted in the mornings, that can be a sign of developing insulin problems.

2
9bb33374b7e0eb1208920486d445c818

on October 29, 2011
at 09:02 AM

Add 2-4 tablespoons of coconut oil to your diet. It will drastically improve both HDL and TC/HDL ratio. It's possible your thyroid isn't ideal, dieting of any kind can lead to slight hypothyroidism. I would suggest eating around 100g of carbs everyday (mostly starch). Increase overall intake too by eating more fat.

2
13a44ea00b0c9af0b6d0f3d5f5c2cfca

(7223)

on October 28, 2011
at 10:00 PM

Well, your HDL and triglycerides did improve. You may just need to give it more time.

1
Cdb9e467dac06a12c515ddfd18a4cdda

(140)

on November 12, 2011
at 06:50 AM

I really think that this whole ignore your cholesterol level and focus on particle size and profile pattern has been overexaggerated. things like total cholesterol levels, LDL and stuff do count and are actually quite important in my opinion. Sure the ratio is important and what not but if we think about this systematically in terms of risk stratification it may be more prudent to think of TC levels and LDL levels in levels of 3 and within each level you have then stratify by ratios and patterns. In this case the lower levels would be lower risk.

I recently wrote a couple posts on this issue at my blog: http://hanswuhealth.blogspot.com/2011/11/paleo-folk-beware-of-your-cholesterol.html this is the link to my most recent post with some mechanistic speculation. However my previous posts delineate why I think higher cholesterol levels are probably more detrimental. Hope this helps. If you disagree with me that is fine, everyone can see the same data differently.

Da3d4a6835c0f5256b2ef829b3ba3393

on November 12, 2011
at 10:52 PM

Hi, Hans. I took a look at your website. Much of it was lost on me. Perhaps I simply do not understand your message clearly, but I could not glean exactly what you were saying at virtually any point. I certainly do not say this to be a jerk or anything. I simply couldn't follow your writing style very well.

1
7cf45aaa9478fcef7dd16914088ce480

on November 01, 2011
at 07:07 PM

Thank you all for your help!

I came across an interesting study that was posted in the comments section on one of Chris Kresser's posts.

In short, the study indicated that you can determine your pattern of LDL particle size by dividing your triglyceride by your HDL number. Anything less than 3.8 indicates Pattern A (large, buoyant LDL cholesterol particles).

Does anyone know more about this study? If it holds water I might be in better health than I thought.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 01, 2011
at 08:52 PM

It's determined by Trig levels from 60 to 150. At 60 or below, you're mostly A; at 150 and above, you're dominated by B. In between, it's a mix and the VAP may give you a better picture. Nothing is 100%. Also, HDL can be elevated due to an infection.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on November 01, 2011
at 08:58 PM

The study is not reliable becuz it fails to take into account low and upper bounds, where ratios are not meaningful. The problem is your low HDL: Your HDL is low as your TC is 7.2x it. It's not the absolute level but the relative level vs. your TC. However, HDL loses effectiveness starting around 65. Not much improvement in being 65 vs. 125. (Also, at TC < 150, u don't need HDL much higher than 50.) Conclusion: You have low HDL vis-a-vis your TC which puts you at risk, even though your Trigs are low-to-moderate. I would get a particle size test to confirm.

1
Da3d4a6835c0f5256b2ef829b3ba3393

on October 28, 2011
at 09:41 PM

You might try to lower carbs and cut the starchy carbs just to see what happens.

Congrats on feeling so great and dropping the weight!

0
38fca13acabddf7b9c54098507e4041a

on October 29, 2011
at 02:10 AM

On going discussion on many forums. Blood type Os I've read naturally have higher cholesterol numbers. A good ratio of HDL to LDL is important. I would look more at triglycerides and fasting insulin as well as body fat % too. And overall lifestyle-- ask yourself how you feel,etc. If you feel OK why worry?

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