1

votes

Hack my NMR please!

Answered on August 19, 2014
Created April 03, 2013 at 7:47 PM

I'm 5'11", 175 lbs, physically active (walk and lift regularly) and primal. Diet is mainly eggs, fish, vegetables, fruit, dairy, nuts, and saturated fats. No grains, no vegetable oils, no sugar except in fruit and dark chocolate. Non-smoker, rarely drink.

Doc is a little concerned about my LDL-P and small LDL.

LDL 126 LDL-P 1641 Small LDL 701 Large LDL 5.5 Large VLDL <.7 total chol 188 particle size 21.1 Trigs 87 HDL 45 LP insulin resistance score 24

He's not too worried overall, but suggested reducing egg consumption (I eat 2-3/day now), but that seems contraindicated by the latest studies on PubMed.

Any advice from cholesterol experts?

Thanks!

Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 04, 2013
at 10:34 PM

I think it depends on the person. It helps if there a multiple data points to know where to move to improve. It sounds like you're pretty low carb and active and high fat with high LDL-P, so it might be interesting to increase starchy carb, reduce sat fat and check the change. Some people have better lipids with this approach. Maintaining similar calories shouldn't affect weight and many people improve weight with more carbs, less fat. There doesn't seem to be a one-diet-fits-all.

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 04, 2013
at 04:21 PM

Is it that starchy carbs lower LDL-P or merely that they are a replacement for saturated fats? Are you saying saturated fats may be responsible for my LDL-P or small particle number? I worry about weight gain with starchy carbs, don't really need to lose much weight (dropping 5 pounds of body fat would be nice), but definitely don't want to gain it!

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 04, 2013
at 04:17 PM

My insulin resistance is great. It's 24 and should be under 45. My macros are 60% fat, 20% protein, 20% carbs (mostly from fruit, some from non-starchy vegetables). What's the best strategy for reducing small LDL-P in light of how I already eat?

336c383a3c4d28652d7ab888c79108a3

(614)

on April 04, 2013
at 12:12 AM

what are your dietary % of fat, carbs and protein? The small LDL-P is something to be VERY CONCERNED about. What is the reference range for the Insulin resistance score? Does it show that you ARE IR? If you cannot reduce the small LDL-P you may have to consider VERY low dose statin - you may not have a choice

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 03, 2013
at 09:10 PM

The effect of diet on lipid markers varies. Some people said that dairy spikes their LDL, some people said that any kind of saturated fat drives LDL, some people said that excess carbs raise LDL, etc. If you care enough, change your diet noticeably enough, then re-test...

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 03, 2013
at 09:04 PM

Yeah, I had already decided I wouldn't be taking a statin before I walked in the front door. I would get a CIMT before I would take any Rx, and even then would further investigate dietary changes first. I'm left wondering if I need to do anything different at all. What about reducing down fruit consumption (fructose)? I eat 3-4 servings/day now.

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 03, 2013
at 08:11 PM

@PrimalGuy Mine did suggest statins. But that's OK since he can take NO for an answer :-)

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on April 03, 2013
at 08:07 PM

In those who see an effect.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on April 03, 2013
at 08:07 PM

And from what I understand, increased dietary cholesterol generally just increases the cholesterol content of the LDL particle meaning it increases LDL-C and particle size but not LDL-P.

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 03, 2013
at 08:02 PM

To his credit, he did NOT recommend that I start statins! It's part of the reason he's still my doc.

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2 Answers

1
Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 03, 2013
at 11:53 PM

Chris Kresser's High Cholesterol Action Plan indicates LDL-P should be <1000. There seems to be individual variation and experimentation helps. One experiment might be to increase starchy carbs and reduce saturated fat and monitor the changes.

LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study - Implications for LDL Management

"Event-free survival was clearly worse for discordant individuals with low LDL-C and high LDL-P than for the group with high LDL-C and low LDL-P."

hack-my-nmr-please!

Figure 2

Event-free survival among participants with LDL cholesterol (LDL-C) and LDL particle number (LDL-P) above or below the median. Median values were 131 mg/dL for LDL-C and 1414 nmol/L for LDL-P.

Cbdc8318738324492f2d5918868ce4c9

(1211)

on April 04, 2013
at 10:34 PM

I think it depends on the person. It helps if there a multiple data points to know where to move to improve. It sounds like you're pretty low carb and active and high fat with high LDL-P, so it might be interesting to increase starchy carb, reduce sat fat and check the change. Some people have better lipids with this approach. Maintaining similar calories shouldn't affect weight and many people improve weight with more carbs, less fat. There doesn't seem to be a one-diet-fits-all.

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 04, 2013
at 04:21 PM

Is it that starchy carbs lower LDL-P or merely that they are a replacement for saturated fats? Are you saying saturated fats may be responsible for my LDL-P or small particle number? I worry about weight gain with starchy carbs, don't really need to lose much weight (dropping 5 pounds of body fat would be nice), but definitely don't want to gain it!

1
800e726cb5dff569fd8edf604c3e2793

on April 03, 2013
at 07:57 PM

Looks reasonable. My LDL-P is worse, but trigs and HDL are better (http://paleohacks.com/questions/184018/weird-lipid-panel-nmr-advice) and I don't think contemporary medicine has anything close to consensus on how the interplay of all these lipid markers works -- other than EVERYONE NEEDS STATINS, of course.

My doc also spoke of reducing eggs which is weird since not that many people are hyper-responders to dietary cholesterol. I suspect it's just default meaningless advice along the lines of "eat more vegetables"...

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on April 03, 2013
at 08:07 PM

In those who see an effect.

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 03, 2013
at 08:02 PM

To his credit, he did NOT recommend that I start statins! It's part of the reason he's still my doc.

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 03, 2013
at 08:11 PM

@PrimalGuy Mine did suggest statins. But that's OK since he can take NO for an answer :-)

800e726cb5dff569fd8edf604c3e2793

(1655)

on April 03, 2013
at 09:10 PM

The effect of diet on lipid markers varies. Some people said that dairy spikes their LDL, some people said that any kind of saturated fat drives LDL, some people said that excess carbs raise LDL, etc. If you care enough, change your diet noticeably enough, then re-test...

7199db7c352bd70e8c6fe631b43a2ec2

(5)

on April 03, 2013
at 09:04 PM

Yeah, I had already decided I wouldn't be taking a statin before I walked in the front door. I would get a CIMT before I would take any Rx, and even then would further investigate dietary changes first. I'm left wondering if I need to do anything different at all. What about reducing down fruit consumption (fructose)? I eat 3-4 servings/day now.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on April 03, 2013
at 08:07 PM

And from what I understand, increased dietary cholesterol generally just increases the cholesterol content of the LDL particle meaning it increases LDL-C and particle size but not LDL-P.

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