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VAP Results Confirm Very High Total Cholesterol. Now What?

Answered on September 12, 2014
Created January 16, 2013 at 7:30 PM

This is working off of my previous question, which was getting rather lengthy: http://paleohacks.com/questions/171923/doctor-wants-to-put-me-on-statins-24-y-o-male-updated-with-vap-results#axzz2I3Y4IL00

My VAP confirms that my total cholesterol and LDL are extremely high at 367 and 279, respectively. Fortunately, HDL and Triglycerides are good, and LDL is mostly the large, buoyant kind. Based on the responses to the previous question, the cause is likely either thyroid issues or familial hypercholesterolemia. I doubt it's FH, since none of my direct family has had a heart attack. However, my TSH level showed to be 2.66 mU/L which I was told seemed a little high.

I was thinking about getting the following labs done:

  • Thyroid Panel (LabCorp): TSH, T3 or free T3, T4 or free T4
  • Thyroid Antibodies (LabCorp)

Do you think these tests would be sufficient in determining whether or not thyroid issues are the cause for the high TC and LDL? Would testing for FH still be worth it? Are there any other options that I should consider? Thanks!

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 07:35 PM

Dan, Really pleased to hear that...I know from personal experience how disconcerting it is to try and improve your health and then get hit with a lipid report like that. Just remember that we are all unique and that there is likely no "perfect" diet that fits everybody. As for the butter, a number of people have reported lipid panel improvements from cutting back on it and cream as well. Good luck and please post back here with any new developments. best

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 07:32 PM

Dan, Really please to hear that....I know fro personal experience how disconcerting it is to try and improve your health and then get his with a lipid report like that. Just try to remember that we are all different and unique and there is likely no "Perfect" diet that fits all people. As for the butter, a number of people have reported lipid panel improvements from cutting back on the utter and cream. Good luck and please post here to let us know how it turns out.

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 03:48 PM

Also, I'm going to test for FH to determine whether or not that can be ruled out.

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 02:49 PM

John, thanks for your response. I do tend to go a little overboard with the butter, so I'll cut back on it for a while and then get retested.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 02:32 PM

We can debate the merits of treating SHT at another time. The important point is that it is extremely unlikely that SHT is producing an LDL of this magnitude. Having his Thyroid values checked in the absence of symptoms runs the very real risk of unnecessary treatment IMO. He needs to change whatever in his diet that likely was responsible for the LDL unless it is hypercholesterolemia which needs to be ruled out since he never had his lipid values checked before.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 02:30 PM

We can debate the merits of treating SHT at another time. The important point is that it is extremely unlikely that SHT is producing and LDL of this magnitude. Having his Thyroid values checked in the absence of symptoms runs the very real risk of unnecessary treatment IMO.

75d65450b6ff0be7b969fb321f1200ac

(2506)

on January 17, 2013
at 12:59 PM

Indeed. Sub-clinical hypothyroidism is usually defined by having a TSH of between 5 and 10, and not having overt hypothyroid symptoms. Doctors are usually reluctant to treat the condition unless there are other factors (eg. anti-thyroid antibodies present). Having said this, since your TSH not ideal it might be worthwhile to get your free T4 and free T3 tested. If the T4/T4 values are low then see your doctor. IMHO, getting one's thyroid checked every five years is probably not a bad thing. (My TSH level is in the 5.x range. However my TC/LDL levels are low.)

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 10:25 AM

There are good research studies on this but for a start guide, see this: "In comparison, large LDL predominate in patients with familial hypercholesterolemia and those consuming high saturated fat diets [16]. Large LDL have higher core cholesterol ester content, potentially delivering more cholesterol per particle to arterial walls [17], a speculation supported by our finding a greater IMT difference for large compared to small LDL on a per particle basis." http://www.athero.org/commentaries/comm564.pdf

61844af1187e745e09bb394cbd28cf23

(11058)

on January 17, 2013
at 04:26 AM

"...people with hypercholesterolemia also have mostly large LDL particles and they often have heart attacks." Where are you getting this information?

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 03:26 AM

You know...the more I think about it, the more I'm beginning to think I have an iodine deficiency. I'm pretty much Perfect Health Diet, except for the sea vegetables, where I only do about a couple pinches of dulse flakes daily. I'm going to try upping it to about a tablespoon per day and see what happens.

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 16, 2013
at 08:17 PM

CD, (1) No, I have always been pretty lean. (2) No, this was the first time. (3) I have gone back to school, away from my doctor. I thought it would be simpler than going to another doctor. (4) Not really, my diet is pretty much Perfect Health Diet.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 16, 2013
at 08:11 PM

(4) Are you low carb?

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 16, 2013
at 08:09 PM

Dan, couple of questions: (1) Are you actively losing weight? (2) Do you have any cholesterol numbers from a couple of years ago? (3) Why are you, and not your doctor, ordering the Thyroid Panel?

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4 Answers

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3
Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 12:20 AM

First, you should realize there in the last year or so, there has been an avalanche of reports of skyrocketing LDL on various forms of the paleo diet. The most common advice given is :

A. Don't worry if you have "large, buoyant LDL", ignoring the fact that people with hypercholesterolemia also have mostly large LDL particles and they often have heart attacks.

B. Get an NMR to see what LDL-P number is although it would be pretty much impossible to have a "good " LDL-P number with an LDL of 279. That's because with such a high LDL number, you undoubtably just have a lot of particles.

C. Don't worry because the LDL-C calculation isn't completely accurate with somebody who has low TG's even though the alternative calculation isn't going to result in a vastly lower number and nobody has ever explained what other kind of cholesterol is represented in the missing fraction (probably IDL which isn't going to help).

D. Get your Thyroid checked even though if you didn't have Thyroid issues before you changed your diet and you aren't Very Low Carb, its not a likely explanation. It just is not plausible that so many people suddenly have Thyroid problems when their LDL numbers were much lower pre-Paleo unless we believe that Paleo diets cause Thyroid issues. (It can't hurt to get tested but you will still need help to evaluate the results.)

I have no idea why people can't get their head around the idea that the increase in LDL after you changed your diet likely happened, well, duhhhhh......because you changed your diet. I know what I am talking about because my LDL went as high as 330 on a low carb and then Paleo diet. After two years and a diet that now includes potatoes, bananas, sourdough bread, etc, it has come down to 180 and I am guessing my LDL-P is under 1600 but I have to check that. Oh yeah, I should mention that my Thyroid has alway tested in the normal range.

So, based on my experience and what I have learned, here is what I suggest:

1) Stop listening to the Internet voices who, for the most part, have no idea what they are talking about.

2) Make a decision, you can either wait for a while to see if the number comes down over time like happened to me or you can change your diet again. 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. I am curious to see what my next test shows.

3) 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 at such a young age?

4) Also, go ahead and get Chris Kresser's series on high cholesterol. Its pretty good and you will learn a lot but it would also be good to work with a sympathetic physician. Good luck on that.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 10:25 AM

There are good research studies on this but for a start guide, see this: "In comparison, large LDL predominate in patients with familial hypercholesterolemia and those consuming high saturated fat diets [16]. Large LDL have higher core cholesterol ester content, potentially delivering more cholesterol per particle to arterial walls [17], a speculation supported by our finding a greater IMT difference for large compared to small LDL on a per particle basis." http://www.athero.org/commentaries/comm564.pdf

61844af1187e745e09bb394cbd28cf23

(11058)

on January 17, 2013
at 04:26 AM

"...people with hypercholesterolemia also have mostly large LDL particles and they often have heart attacks." Where are you getting this information?

1
Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 11:20 AM

Dan,

I will make one more try to get you to look at this whole matter differently. You really have no reason to think that you have an iodine deficiency. In order for your greatly elevated LDL to result from resulting hypothyroidism, you would have to be sub-clinically hypothyroid (SHT) unless you are having symptoms which you are not reporting. 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 even a significant relationship between SHT and LDL for the male subjects. Not only that, while your TSH as reported on your other post (as I remember 2.5 or so) might be considered high by some, in the above study 3.5 was used as a cutoff so you wouldn't even make it into the SHT group by that standard. Finally, the very, very high LDL that you have (and I don't think hypercholesterolemia was ruled out?) would make it unlikely to result from SHT.

This whole idea that the many, many people on Paleo diets who have soaring LDL have Thyroid problems makes very little sense as I have already written and is a concept that certain bloggers have come up with but has no scientific validation as far as I know. As I have also already said, using Occam's Razor, the simplest explanation is that you changed your diet and as a result your LDL went way up. I realize from personal experience that this might be hard to swallow (no pun intended) since the last thing you wanted was to possibly risk your health by adopting what you see as a "Perfect health Diet" but that is why we have science to try and arrive at a more objective view of how the world works.

So, while it can't hurt to eat more sea vegetables, I hate to see you go down the route of speculation, unnecessary and costly medical testing, and endless rounds of experimentation and advice. So, please give what I wrote above some thought and think about modifying your diet. You don't have to abandon most of it; just consider modifying the amount and kinds of fat you are eating.

And I should add that I also tried the Kelp tablets, seaweed, etc with no change at all.

75d65450b6ff0be7b969fb321f1200ac

(2506)

on January 17, 2013
at 12:59 PM

Indeed. Sub-clinical hypothyroidism is usually defined by having a TSH of between 5 and 10, and not having overt hypothyroid symptoms. Doctors are usually reluctant to treat the condition unless there are other factors (eg. anti-thyroid antibodies present). Having said this, since your TSH not ideal it might be worthwhile to get your free T4 and free T3 tested. If the T4/T4 values are low then see your doctor. IMHO, getting one's thyroid checked every five years is probably not a bad thing. (My TSH level is in the 5.x range. However my TC/LDL levels are low.)

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 02:32 PM

We can debate the merits of treating SHT at another time. The important point is that it is extremely unlikely that SHT is producing an LDL of this magnitude. Having his Thyroid values checked in the absence of symptoms runs the very real risk of unnecessary treatment IMO. He needs to change whatever in his diet that likely was responsible for the LDL unless it is hypercholesterolemia which needs to be ruled out since he never had his lipid values checked before.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 02:30 PM

We can debate the merits of treating SHT at another time. The important point is that it is extremely unlikely that SHT is producing and LDL of this magnitude. Having his Thyroid values checked in the absence of symptoms runs the very real risk of unnecessary treatment IMO.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 07:35 PM

Dan, Really pleased to hear that...I know from personal experience how disconcerting it is to try and improve your health and then get hit with a lipid report like that. Just remember that we are all unique and that there is likely no "perfect" diet that fits everybody. As for the butter, a number of people have reported lipid panel improvements from cutting back on it and cream as well. Good luck and please post back here with any new developments. best

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 02:49 PM

John, thanks for your response. I do tend to go a little overboard with the butter, so I'll cut back on it for a while and then get retested.

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 03:48 PM

Also, I'm going to test for FH to determine whether or not that can be ruled out.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 17, 2013
at 07:32 PM

Dan, Really please to hear that....I know fro personal experience how disconcerting it is to try and improve your health and then get his with a lipid report like that. Just try to remember that we are all different and unique and there is likely no "Perfect" diet that fits all people. As for the butter, a number of people have reported lipid panel improvements from cutting back on the utter and cream. Good luck and please post here to let us know how it turns out.

1
74075df7b66e81e049783e8bbfb46bc0

on January 17, 2013
at 12:49 AM

Paul Jaminet, who co-authored the Perfect Health Diet and is pro-paleo, gives the most plausible explanation I???ve seen of this phenomenon. He says the answer is likely either hypothyroidism or a micronutrient deficiency:

First, he explains that contrary to the dismissive attitude of some people, high LDL is truly a cause for concern:

???Poisonguy???s comment assumes that the LDL number is not a symptom of trouble. Is it? I think so???.Now this is not the ???lipid hypothesis.??? Compare the two views:

??? The lipid hypothesis: LDL cholesterol causes vascular injury.

??? My view: LDL cholesterol is the ambulance crew that arrives at the scene of the crime to help the victims. The lipid hypothesis is the view that ambulance drivers should be arrested for homicide because they are commonly found at murder scenes.

So, to Poisonguy, on my view high LDL numbers are a symptom of vascular injury and are a cause for concern.???

He goes on to detail what micronutrients you should try supplementing with to eliminate possible deficiencies. Reference: http://perfecthealthdiet.com/2011/03/answer-day-what-causes-high-ldl-on-low-carb-paleo/

In a later post, he talks about the thyroid issues: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

8f2d9842fdfec224a425c0f77c4ee34d

(1241)

on January 17, 2013
at 03:26 AM

You know...the more I think about it, the more I'm beginning to think I have an iodine deficiency. I'm pretty much Perfect Health Diet, except for the sea vegetables, where I only do about a couple pinches of dulse flakes daily. I'm going to try upping it to about a tablespoon per day and see what happens.

1
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 16, 2013
at 08:24 PM

I would go with the Thyroid Panel first. I cannot tell from LabCorp's site, but you want to make sure you get a direct measure of T3, T4, and rT3 (in addition to the TSH test).

Once you get your results you can determine whether you need to take the antibodies test.

Good luck!

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