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High LDL, Low triglycerides, high ferritan iron loading

Answered on August 19, 2014
Created February 14, 2013 at 11:36 AM

First of all, I am 28 years old, 83kgs, fit, lift weights, do karate, sleep well, rest lots, have a hungry apetite to improve my life even though I already consider it to be pretty sweet.

So I went and got my first ever blood test (fasted) after being Paleo for 6 months (would have been nice to get it before I went Paleo but Paleo introduced me to the idea of getting this stuff done). My results came in as:

TC - 375 HDL - 58 LDL - 244 Tri - 62

Also my blood glucose levels were fine, my inflammation was not detected, my thyroid panel was also ok but it didn't show exact measures of T3 (my metabolism is good). Also I tested on the low end for testosterone and my Vitamin D and cortisol was good. Oh and I haven't had any traumas or legions or anything that would cause my cholesterol to get to work fixing things up.

Needless to say my dr freaked out, said its the highest she has ever seen and wants me to start treatment on statins, eat a low-fat diet and cut back on my consumption of butter, red meat and eggs. You can read more about this experience here.

I have listened to episode 151 of Paleo Solution with Robb Wolf and Chris Kresser and also read alot of articles on high LDL, low carb paleo, and the relationship between Tri/HDL as an indicator of LDL(b). My ratio is 1.03 which according to Chris Kresser means I could be at low risk but that I should still take an NMR lipopanel test for particle size of my LDL. SO I am going to get this test done in the next week.

My first thought though is, I am a young strong fit male so what is sending my LDL up? Seeings as my Dr didn't bother to read the other results of my blood test I decided I would. So one thing that stands out is that my iron loading through serum ferritin is maxed out at 347 ug/L. This study seems to suggest that further studies are required to prove if there is a relationship between iron and LDL.

So my question, what the fudge could be going on? I am running out of ideas. I guess I need to get the NMR but in the meantime it is hard not to stress about this stuff considering the solution of 'eat more butter and eggs' doesn't go down well with the people who love you and don't want you to die.

Any guidance would be greatly appreciated.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 05:12 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a rare doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is. That why doctors won't be impressed by CRP results at your age. Heart disease develops over a long period normally.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 12:52 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a record doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is. That why doctors won't be impressed by CRP results at your age. Heart disease develops over a long period normally.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 12:45 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a record doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is.

0ea747d651c21d4028eafd3e12e302f5

on February 15, 2013
at 11:00 PM

John! Thank you! This is great info. I guess the main thing I am trying to get my head around is the underlying cause of it all if it is 'bad'. I think it may come down to going too low carb. I'll make a few changes and see how I go. I am going back to a well regarded Dr on Monday so hopefully she just says 'you're young, lets retest later, in the meantime try this...' as opposed to just 'X>Y=Drugs'. Thanks again. I did listen to the episode of Chris Kresser and John Masterjohn talking about hyper responders. This may also be an underlying condition of mine...anyway. Thanks again.

0ea747d651c21d4028eafd3e12e302f5

on February 15, 2013
at 12:57 AM

Hi diabeticbinger thanks for the favourite and some of your thoughts. I have found out at this stage that Australia doens't have the labs to do the NMR test so I will have to try some other way to do a lipid panel that includes particle size of LDL(b). My other alternative is to just accept that saturated fat increases LDL in the short term but that this normalises over time. It is hard to do this though when your loved one's just connect 'satured fat is full of cholesterol so is raising your cholesterol'...

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Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 15, 2013
at 05:07 AM

You should know that this is an experience often reported here so you are not alone by any means. That said a couple of points:

1) Forget whatever you have heard or will be told about "particle size". Its an older idea but once all relevant factors were accounted for, it turns out that particle number (LDL-P or apo-b) is the risk marker to watch. It is also not true that large LDL-P particles are somehow magically "projective" since people with familial hypercholesterolemia have lots of large particles and they also get heart diseases.

2) You don't need an NMR, neither for particle size which is irrelevant nor for LDL-P since with an LDL that high, its certain that it will come back high.

3) I am not sure what you mean by "the relationship between Tri/HDL as an indicator of LDL(b)" but probably you are referring to the Tri/HDL ratio as a risk marker. Having a low Tri/HDL ratio is very common with people on a paleo diet and probably just means that your insulin sensitivity is good. Either that or you are heating low carb and high saturated fat :). In any event, it does not somehow cancel out an LDL that high.

4) Yes, your ferritin is at the high end of the range but there is nothing to suggest that this is behind the high LDL. Go ahead an donate blood because its a good thing to do and won't hurt but don't expect that to be the miracle.

4) Bottom line is that you have very high LDL and no matter what people may tell you, its not all clear what this means for people on a pale/low carb diet. Until such time that more is known, it would seem prudent to try and address this issue since as a young person, I don;'t think you want to experiment with many, many years of LDL at that level. So what to do?

5) Instead of going down the road of ever more esoteric theories and solutions, you need to realize that the one thing that all the people here who report high LDL have in common is that they changed their diet. You say that "saturated fat increases LDL in the short term but that this normalises over time" but I am not aware of any actual research that says this is true. Some people here report instead even higher LDL levels and I have seen numbers in the 400's. You really don't want that.

6) So, the logical thing to try is to change your diet again. It doesn't mean you have to abandon what you are doing completely but its worth making some modifications in two areas.

7) First, if you are going very low carb (VLC), you should think about adding back a reasonable level from sources such as potatoes or other tubers, bananas, starchy vegetables and grains such as rice or even (gasp) wheat if you are not truly gluten intolerant.Some people's metabolism just seem to respond to VLC as if they were starving which is a well known cause of high LDL.

8) Second, try changing the level and kinds of fats you are eating as opposed to "eating more butter and eggs." Some people are "hyper responders" to cholesterol and/ or saturated fat so if you are dumping loads of it on your food stop (no Bulletproof Coffee) and try substituting monounsaturated oils such as Olive Oil for cooking ignore what you are told about Olive Oil and oxidation while cooking; its a myth).

It may turn out that time is the answer but while waiting, it can't hurt to give what I have suggested a try. Let us know how it works out.

0ea747d651c21d4028eafd3e12e302f5

on February 15, 2013
at 11:00 PM

John! Thank you! This is great info. I guess the main thing I am trying to get my head around is the underlying cause of it all if it is 'bad'. I think it may come down to going too low carb. I'll make a few changes and see how I go. I am going back to a well regarded Dr on Monday so hopefully she just says 'you're young, lets retest later, in the meantime try this...' as opposed to just 'X>Y=Drugs'. Thanks again. I did listen to the episode of Chris Kresser and John Masterjohn talking about hyper responders. This may also be an underlying condition of mine...anyway. Thanks again.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 12:45 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a record doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 05:12 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a rare doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is. That why doctors won't be impressed by CRP results at your age. Heart disease develops over a long period normally.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on February 16, 2013
at 12:52 PM

Glad it was helpful. BTW, I edited the above to say you have "very high" LDL instead of "extremely high" because I have seen others with much higher. I wish you good luck with your doctors and maybe she will want to retest in case of error but it would be a record doctor who would say "just wait and see", especially because you are young. The thinking is that the more years of high LDL concentrations, the worse it is. That why doctors won't be impressed by CRP results at your age. Heart disease develops over a long period normally.

0
Cbdc8318738324492f2d5918868ce4c9

(1211)

on February 16, 2013
at 02:16 PM

John has some good suggestions.

Re: ferritin

High ferritin may not be the cause of high LDL, but also consider the association between iron overload and increased CVD.

http://www.ncbi.nlm.nih.gov/pubmed/21128934

CONCLUSIONS: IO patients presented not only insulin resistance but also metabolic alterations that were related to elevated iron stores and are associated with high risk of cardiovascular disease.

Paul Jaminet suggests 50-100 range:
http://perfecthealthdiet.com/recommended-supplements/comment-page-14/#comment-92995

Usually ferritin should be in the 50-100 range and other iron tests should be normal

and gives blood every two months:
http://perfecthealthdiet.com/2012/04/roast-beef-beets-and-potatoes/comment-page-1/#comment-124945

I give blood every two months. I think it is good to have ferritin relatively low, but not in anemia territory. My ferritin gets down in the mid-30s after blood donation and rises through the two months.

0
24c27817ad9ac518946dda4a131737b5

on February 14, 2013
at 01:29 PM

Favorited this post.

In many ways, Paleo is still an experimental diet (in its modern incarnation).

Personally, I wonder if Paleo will ultimately turn out to be compatible with 100% of the population in such things as arterial health. Would not surprise me if a minority have to change meat intake in type and quantity.

0ea747d651c21d4028eafd3e12e302f5

on February 15, 2013
at 12:57 AM

Hi diabeticbinger thanks for the favourite and some of your thoughts. I have found out at this stage that Australia doens't have the labs to do the NMR test so I will have to try some other way to do a lipid panel that includes particle size of LDL(b). My other alternative is to just accept that saturated fat increases LDL in the short term but that this normalises over time. It is hard to do this though when your loved one's just connect 'satured fat is full of cholesterol so is raising your cholesterol'...

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