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Is High LDL-P NORMAL for a low carb diet?

Commented on August 11, 2013
Created April 13, 2013 at 1:28 AM

Questions for the group

From Dr. Peter Attia's website - in the comments section

http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-v

Thomas Dayspring aka "Dr Lipid" May 26, 2012

Well the 50th percentile cutpoint is not normal if one is trying to prevent atherosclerosis. The 20th percentile cutpoint would be considered desirable: that is 80 mg/dL for apoB and < 1000 nmol/L for LDL-P

Barkeater May 31, 2012

Thanks for replying and thanks for this series.

I am anxious for the grand train wreck that comes when Dr. A tells Jimmy Moore and the low-carb/ paleo crowd that have achieved > 2000 LDL-Ps (yes, I am in that club, thanks to FH) that they have to get to an 1100 LDL-P, and good luck getting there with anything but statins or unproven crap like zetia (or maybe an Ornish diet ??? me, I choose to eat food). As TO says, get your popcorn.

Jimmy Moore has gotten an NMR, and reported LDL-P of 2130. I see a significant number of low-carbers seem to have spikes in their LDL-C and LDL-P that would appear to be driven by diet. They are not necessarily FHers like me (but I have seen wide ranging LDL-P, from 1500 to 2800, and cannot yet tie it out to diet). Commenter MacKillop below refers to a double-digit percentage of folks on low-carb diets who see very high LDL-C. Mr. and Mrs. Jaminet have blogged at some length on the issue. I see the view expressed by some that this phenomenon is due to ApoE4, but I don???t buy it (I am a 3/3).

Peter Attia May 31, 2012 The question we don???t know the answer to is if an LDL-P of 2,000 in someone who eats no carbs is the same as an LDL-P of 2,000 in someone who does. I had breakfast with Eric Westman today and we discussed this topic. Eric makes a pretty compelling case that these 2 states are not, in fact, the same thing. I think we can safely say we don???t know the answer. At least I don???t. I???ll keep looking for clues, though.

Peter Attia May 31, 2012 I completely agree with Eric???s assertion (in fact, I???m having breakfast with Eric in an hour). This brings up a much larger question that I???m sure I will detail more closely in this series: It is possible that all of the risk stratification we have for heart disease is predicated on someone consuming a normal Western diet? Furthermore, is it possible that once the body stops relying on glycogen and turns over to metabolic pathways of ketosis that the ???numbers??? we target as ???normal??? are irrelevant? I think I know the answer for some physiologic parameters, but I???m still trying to develop my ???universal theory??? uniting it all.

MY questions are these

1) "is an LDL-P of 2,000 in someone who eats no carbs the same as an LDL-P of 2,000 in someone who does

2) "is it possible that all of the risk stratification we have for heart disease is predicated on someone consuming a normal Western diet? Furthermore, is it possible that once the body stops relying on glycogen and turns over to metabolic pathways of ketosis that the ???numbers??? we target as ???normal??? are irrelevant?"

OR

3) Is DR Thomas Dayspring right when he says "Well the 50th percentile cutpoint is not normal if one is trying to prevent atherosclerosis. The 20th percentile cutpoint would be considered desirable: that is 80 mg/dL for apoB and < 1000 nmol/L for LDL-P.

Cbe1731034411e1ce373cdc62e7d4eef

(65)

on August 11, 2013
at 02:01 PM

Love this post. Hits on many of the things I struggle with. Will be neat to see how all this plays out. Also interested in what the recent Jimmy Moore book says when it comes out next week.

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