Recently I had a bunch of blood tests done including an NMR lipid panel. Everything is great except for one number. The problem is that some people say that's the only number that matters.
The number is LDL-P, the number of LDL particles, which is 1905. That's officially considered to be "a lot" and puts me somewhere above the 95% percentile. I am aware that there are other people (like Jimmy Moore of the Livin' La Vida Low Carb fame) in the same situation with even worse numbers.
Other things are good: TG 51, HDL-C 80, LDL pattern A, small LDL-P is only 149, HDL-P is 37.1.
LDL-C is 160 which actually seems lowish for the particle number of 1900. My ApoB is 120 which also seems lowish for that LDL-P since each LDL particle has exactly one ApoB molecule. TC is 250.
I am eating nonspecific paleo-style, low-carb (but not VLC, I'm not usually in ketosis). My thyroid panel is normal, TSH is 1.2, free T3 is 3.3. My inflammation markers are low, CRP is 0.47. I don't have glucose problems, HbA1C is 4.9% and the NMR panel gave me the insulin resistance score of 6. I'm not actively losing weight. I doubt I'm copper-deficient as my Ceruloplasmin is 18 which is well within normal range.
So all in all I'm not terribly worried, but I still don't like that LDL particle number. Recent studies like MESA point to the LDL-P being a better predictor of CVD to the extent that once you account for it, other common predictors (like LDL cholesterol, LDL-C, or particle size) become insignificant.
So what's the paleohack wisdom on the subject?
asked byLumifer (10)
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on July 19, 2013
at 04:46 PM
OK, I did a re-test recently. It's interesting partially because I had lipid panels done at two different places from the same blood sample (well, different vials but drawn at the same time). This way we have three different sets of numbers. The numbers tagged NMR-Jan are from the first test discussed in the OP. The numbers tagged NMR-Jun are from a recent re-test, same lab (Liposcience). And the numbers tagged BHL-Jun are from the same re-test, but coming from the Berkeley Heart Lab.
Tot-C: 250 (NMR-Jan), 205 (NMR-Jun), 227 (BHL-Jun). LDL-C: 160 (NMR-Jan), 124 (NMR-Jun), 144 (BHL-Jun). HDL-C: 80 (NMR-Jan), 69 (NMR-Jun), 68 (BHL-Jun). Trigs: 51 (NMR-Jan), 60 (NMR-Jun), 73 (BHL-Jun). LDL-P: 1905 (NMR-Jan), 1611 (NMR-Jun). HDL-P: 37.1 (NMR-Jan), 31.7 (NMR-Jun). Small LDL-P: 149 (NMR-Jan), 608 (NMR-Jun). ApoB: 120 (Jan), 107 (Jun), 94 (BHL-Jun). In both cases pronounced LDL pattern A (large & fluffy).
What changed besides time? My diet changed a bit (not hugely), in the direction of less saturated fat and more MUFA and more carbs. A fair chunk of that additional carbs was fruits, so fructose.
The direction of lipid changes is a bit of a trade-off. Certainly LDL went down a noticeable amount. But HDL went down as well and trigs went up. Not up into worrisome territory, but still up.
The spike in small LDL-P is puzzling. It may be an error as the LDL size profile from Berkeley Heart Labs says that only 11% of my LDL particles are small and dense. Yes, I know that the definitions of what's "small" do not match -- I'll look into it further.
Still haven't done ApoE testing, but at the moment it does seem that my LDL is sensitive to the amount of saturated fat in my diet. N=1, of course.
on March 08, 2013
at 05:43 PM
I had a high-ish LDL-P (1567) too, but my other numbers looked great. I'm going to repeat the test in 6 months to see which way it's trending. For all I know it may be on its way down, as it was my first NMR.
There's no data on whether higher LDL-P might be a natural healthy response to lower carb diets, or how it correlates to risk in people following a low carb diet. I'm not necessarily taking comfort in that fact because we just don't know. But I'm not ready to panic yet, either. If I'm trending downward at 6 months that's good, but if its going up I'll have a lot to consider.
on March 08, 2013
at 03:36 PM
(sorry, too new here to be allowed comments :-/)
I haven't had any bloodwork done for years and years and this is my first lipid panel ever. All tests were done from blood samples taken at the same time.
The non-NMR part of bloodwork didn't mention any cholesterol numbers, but measured ApoA (205, out of the reference range, consistent with my high HDL), ApoB, and Lp(a) which was 4.
on March 08, 2013
at 03:50 PM
I just had an MNR panel as well with some similar numbers to you, with my LDL-P at 2251. My TG 31, HDL 55, LDL pattern A, small LDL-P 445 and HDL-P 31.2. LDL-C 179 and ApoB 127. C-reactive protein 1.5 mg/L. I've been Paleo about 2 years.
My doctor who I got off the Paleo physicians network suggested I take Niacin to address some of the cholesterol issues.