3

votes

Cholesterol Conundrums

Answered on September 12, 2014
Created February 24, 2010 at 8:27 PM

Fascinating how two people can get such radically different results! Today's lipid panels for your perusal.

First, let's recap what the numbers "should be":

HDL: 60 or higher
LDL: 60 or lower
Triglycerides: 60 or lower

And the ratios between them:

Total/HDL: 2-3
LDL/HDL: < 4.3
Trig/HDL: < 2

So what do mine look like? Absolute crap:

Total: 498
HDL: 54
LDL: 399
Trig: 223

Total/HDL: 9.2
LDL/HDL: 7.4
Trig/HDL: 4.1

My friend, on the other hand, gets five gold stars:

Total: 215
HDL: >100
LDL: N/A
Trig: 61

Total/HDL: < 2.15
LDL/HDL: ?
Trig/HDL: 0.61

As you can see, his numbers are PHENOMENAL, comparing favorably to those of many prominent paleo folks:

http://drbganimalpharm.blogspot.com/2009/06/benefits-of-high-saturated-fat-diets_12.html

The fascinating part? I eat FAR closer to how those people do! He's cut way back on processed foods, sugars, grains and veg oils, but still eats things like Taco Bell, McDonalds breakfast biscuits and Little Debbie brownies a few times a month...and snacks on frosted shredded wheat. Otherwise, he eats very similar to me -- mostly meat, some eggs and butter -- plus fruit here and there like unsweetened applesauce, and with occasional high-fat, low-sugar desserts like homemade cheesecake.

Certainly individual variation counts for a lot, but I have a theory: He's eaten tinned fish for years on a regular basis, which I only started doing recently. Also, he's been taking fish oil capsules for as long as I've been zero-carb (about 9 months). So although we both eat grainfed beef instead of grassfed, his Omega-3 to -6 ratio is likely much better than mine. I can't see it being the only difference -- he has a number of chronic medical conditions -- but it's the first one that leaps out at me.

Other than taking fish oil, what else might be missing from my equation? Far as I can tell, I adhere to the most important methods of improving lipids and avoiding metabolic syndrome:

  • Taking vitamin D3 (5,000 IU/day)
  • Eating no grains, sugars or bad fats (vegetable oils/transfat/etc)
  • Eating once or twice per day (frequent meals raise LDL/blood glucose)
  • Exercise: Intense, brief and occasional, plus slow, regular movement.

Addressing thyroid issues is a last resort, and I don't show any signs of those that I can see.

Finally, blood pressure and blood glucose still look great, and I continue to have negligible visceral/abdominal fat.

Funniest part: The lady said I need vegetables for the "plant sterols". Okay, let's see:

"According to most nutritional studies the average American gets about 250 milligrams of sterols in his diet every day. Vegetarians get a bit more, averaging around 700 milligrams, and people who exist on fast food getting significantly less. The amount recommended by most researchers is two grams."

And then:

"Fruits and vegetables have trace amounts of plant sterols. The amounts are so small that you would need to eat just under 50 pounds of produce to get the recommended .8 grams of plant sterols per day."

Well, that would seem not to make much sense. And apparently, the best sources of these sterols are "grains and legumes"? Then I rest my case. Those have no place in the human diet unless the only alternative is starvation.

And the big laugh? When she asked my friend what he eats, and he said that except a little onion and garlic, he hasn't eaten vegetables in about six months. You should have seen her face! And he gets even less exercise than I do, most of it coming from video games :)

6426d61a13689f8f651164b10f121d64

(11478)

on March 01, 2010
at 11:50 PM

Thanks, dj, and best of luck and health to you.

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 05:43 PM

Dr. Davis also said: "Forget the nonsense about the sterols. Two new studies now suggest that, once they reach the bloodstream, they may cause heart disease." Here's a previous post of his on the subject: http://heartscanblog.blogspot.com/2009/09/heart-healthy-sterols-cause-heart.html

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:29 PM

Marked this as "the answer" since it jibes closest with Dr. Davis' recommendations :)

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:28 PM

Dr. Davis also recommended fish oil, and noted: "Forget the nonsense about the sterols. Two studies now suggest that, once they reach the bloodstream, they may cause heart disease. Know your postprandial glucoses, especially in view of your triglycerides." Since blood glucose seems fine for now, I still plan to add fish oil and try to save up for an NMR. If that test indicates problems that need addressing, I may consider statins as a last resort.

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:26 PM

Dr. Davis was kind enough to reply. In addition to noting only an NMR can truly measure LDL and indicate size patterns, atherogenicity, and whether Lp(a) is a factor, he says: "You almost certainly have a genetic problem, at least heterozygous familial hypercholesterolemia. While I am NOT an advocate of 'statins for the masses' and avoid their use whenever possible, this is an instance in which they should be considered."

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:35 AM

I'll also continue researching lipoprotein(a), consider the possibility of statins/niacin as a worst case scenario, and have an NMR lipoprofile done if I manage to afford it.

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:33 AM

I also do think I'm a statistical outlier, as plenty of people report excellent lipid improvements ZC'ing on conventional meats. For now I plan to supplement with fish oil and eat more fish and less beef, and see how the numbers change in four months, at which point the ZC experiment will be one year and I'll do a full reassessment.

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:31 AM

At roughly 10 minutes intense exercise per week, and no more high-impact stuff, I'm pretty sure overtraining isn't an issue :) Stress is much lower than ever before; mood in general more mellow and stable. Before ZC I was lacto-paleo about two years, and low-carb grain/legume-free for about two years before that. Yams were definitely at the top of my list of "most acceptable plant matter", which I've been compiling out of scientific curiosity (what has the least poisons and rotten stuff?) and practical interest in case I decide at some point to add back anything not from the animal kingdom.

6426d61a13689f8f651164b10f121d64

(11478)

on February 26, 2010
at 12:56 AM

Yes, statins do notoriously deplete CoQ10. US patent law allows "me too" patents--which are not novel drugs, but can be such things as new commbinations of old drugs, old drugs with new delivery vehicles, or "pro-drugs", which are new molecules that are metabolized into old drugs. Just one of the many crazy areas of US law.

5740abb0fa033403978dd988b0609dfd

(2633)

on February 25, 2010
at 06:17 PM

I forget where exactly I read it -- I think it was spacedoc.net -- if you must take statins be sure to supplement with CoQ10. This is standard procedure in Canada, but in US Merk(?) has a patent on combining the two into one pill.

6426d61a13689f8f651164b10f121d64

(11478)

on February 25, 2010
at 01:28 AM

Although statins are way over-prescribed, there is a place for them sometimes when there is a strong family history of cardiovascular disease coupled with very high blood lipids. Niacin and statins can be synergistic. Also, look at your entire lifestyle. You say you're a zero-carber with low bodyfat. ZC is not for everyone. Maybe you need to add back some carbs in the form of starchy tubers (yams or sweet potatoes) to your diet. Are you over-training? Over-stressed?

9cfa1ab909f6f89544be665d4ef6e3ea

on February 25, 2010
at 12:34 AM

Just turned 40. I've been reading Dr. Davis' recent posts on lipoprotein(a) -- don't think there's much diabetes in my family, but there does seem to be quite a bit of cardio problems, and just about everyone apart from me and my mom is "skinny fat".

9cfa1ab909f6f89544be665d4ef6e3ea

on February 24, 2010
at 09:33 PM

Unfortunately, the cost of an NMR or VAP is out of the question at this time.

9cfa1ab909f6f89544be665d4ef6e3ea

on February 24, 2010
at 09:08 PM

As far as organ meats, I previously ate liver once a week but when I went ZC I cut down to once a month or less, trying to avoid too much vitamin A. My daily calories from fat were 50-80% when I was grainfree low-carb and later lacto-paleo, and currently it's running about the same when I check. Thankfully, canned fish compares favorably in price to most of the meat I've been eating (which at least comes from an excellent local butcher.)

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6 Answers

best answer

2
6426d61a13689f8f651164b10f121d64

(11478)

on February 25, 2010
at 12:25 AM

If your triglycerides are still 223 after 9 months of low-carbing, you may have a large genetic component in your lipid profile. You don't give your age, but values this high are unusual in young adults, which would further suggest genetic influence. Since your bodyfat is low, you probably don't need to lose weight. The "over the counter" remedies you can try are the fish oil, as you already mentioned, and niacin, up to 2gm per day. Try to find a "paleo-friendly" doctor who will work with you on your lipids without proposing nonsensical "low-fat" and "healthy-whole-grains" solutions.

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:29 PM

Marked this as "the answer" since it jibes closest with Dr. Davis' recommendations :)

9cfa1ab909f6f89544be665d4ef6e3ea

on February 25, 2010
at 12:34 AM

Just turned 40. I've been reading Dr. Davis' recent posts on lipoprotein(a) -- don't think there's much diabetes in my family, but there does seem to be quite a bit of cardio problems, and just about everyone apart from me and my mom is "skinny fat".

5740abb0fa033403978dd988b0609dfd

(2633)

on February 25, 2010
at 06:17 PM

I forget where exactly I read it -- I think it was spacedoc.net -- if you must take statins be sure to supplement with CoQ10. This is standard procedure in Canada, but in US Merk(?) has a patent on combining the two into one pill.

6426d61a13689f8f651164b10f121d64

(11478)

on February 25, 2010
at 01:28 AM

Although statins are way over-prescribed, there is a place for them sometimes when there is a strong family history of cardiovascular disease coupled with very high blood lipids. Niacin and statins can be synergistic. Also, look at your entire lifestyle. You say you're a zero-carber with low bodyfat. ZC is not for everyone. Maybe you need to add back some carbs in the form of starchy tubers (yams or sweet potatoes) to your diet. Are you over-training? Over-stressed?

6426d61a13689f8f651164b10f121d64

(11478)

on March 01, 2010
at 11:50 PM

Thanks, dj, and best of luck and health to you.

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:31 AM

At roughly 10 minutes intense exercise per week, and no more high-impact stuff, I'm pretty sure overtraining isn't an issue :) Stress is much lower than ever before; mood in general more mellow and stable. Before ZC I was lacto-paleo about two years, and low-carb grain/legume-free for about two years before that. Yams were definitely at the top of my list of "most acceptable plant matter", which I've been compiling out of scientific curiosity (what has the least poisons and rotten stuff?) and practical interest in case I decide at some point to add back anything not from the animal kingdom.

6426d61a13689f8f651164b10f121d64

(11478)

on February 26, 2010
at 12:56 AM

Yes, statins do notoriously deplete CoQ10. US patent law allows "me too" patents--which are not novel drugs, but can be such things as new commbinations of old drugs, old drugs with new delivery vehicles, or "pro-drugs", which are new molecules that are metabolized into old drugs. Just one of the many crazy areas of US law.

2
Ef31d612a661d9fcb19c8965d3a2bd12

(533)

on February 27, 2010
at 03:13 AM

Check out Dr. Davis' recent post about genetic small LDL. If you're eating a high sat fat diet and seeing your LDL so high, I wonder if you are in that group. Might want to shoot Dr. Davis a comment about your lipids. Good luck.

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:28 PM

Dr. Davis also recommended fish oil, and noted: "Forget the nonsense about the sterols. Two studies now suggest that, once they reach the bloodstream, they may cause heart disease. Know your postprandial glucoses, especially in view of your triglycerides." Since blood glucose seems fine for now, I still plan to add fish oil and try to save up for an NMR. If that test indicates problems that need addressing, I may consider statins as a last resort.

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 05:43 PM

Dr. Davis also said: "Forget the nonsense about the sterols. Two new studies now suggest that, once they reach the bloodstream, they may cause heart disease." Here's a previous post of his on the subject: http://heartscanblog.blogspot.com/2009/09/heart-healthy-sterols-cause-heart.html

9cfa1ab909f6f89544be665d4ef6e3ea

on March 01, 2010
at 02:26 PM

Dr. Davis was kind enough to reply. In addition to noting only an NMR can truly measure LDL and indicate size patterns, atherogenicity, and whether Lp(a) is a factor, he says: "You almost certainly have a genetic problem, at least heterozygous familial hypercholesterolemia. While I am NOT an advocate of 'statins for the masses' and avoid their use whenever possible, this is an instance in which they should be considered."

2
9d43f6873107e17ca4d1a5055aa7a2ad

on February 24, 2010
at 09:02 PM

I've gotten in tiffles with many zero carbers about this, but I still believe it's true. A diet of mostly cornfed muscle meat and eggs is not very paleolithic. Inuit ate close to zero carb, but they ate marine foods, some offal, and mostly fat...and nothing that was fed grains. I think you are right on about the fish. Perhaps you should trade out some of your meat for things like wild salmon, sardines, and roe?

9cfa1ab909f6f89544be665d4ef6e3ea

on February 24, 2010
at 09:08 PM

As far as organ meats, I previously ate liver once a week but when I went ZC I cut down to once a month or less, trying to avoid too much vitamin A. My daily calories from fat were 50-80% when I was grainfree low-carb and later lacto-paleo, and currently it's running about the same when I check. Thankfully, canned fish compares favorably in price to most of the meat I've been eating (which at least comes from an excellent local butcher.)

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:35 AM

I'll also continue researching lipoprotein(a), consider the possibility of statins/niacin as a worst case scenario, and have an NMR lipoprofile done if I manage to afford it.

9cfa1ab909f6f89544be665d4ef6e3ea

on February 26, 2010
at 02:33 AM

I also do think I'm a statistical outlier, as plenty of people report excellent lipid improvements ZC'ing on conventional meats. For now I plan to supplement with fish oil and eat more fish and less beef, and see how the numbers change in four months, at which point the ZC experiment will be one year and I'll do a full reassessment.

1
5740abb0fa033403978dd988b0609dfd

on February 24, 2010
at 09:35 PM

I presume you've read about the differing types of LDL, large & fluffy vs. small & dense. Considering how high you are, you might consider having the test which specifically measures the type of LDL you have.

Richard Nikoley did a very thorough post on LDL testing.

0
B3e5a9a5b38b17f5286f4f1b868ac766

on September 09, 2011
at 01:40 AM

THIS is the type of guy I'd love to hear a follow-up from. If you're out there, please check in and update us, Damaged Justice.

0
F6c1df7d5699661bd1f0d6d0a6c17fc6

on February 24, 2010
at 09:30 PM

Could you get a checkup to see which pattern LDL you have?

9cfa1ab909f6f89544be665d4ef6e3ea

on February 24, 2010
at 09:33 PM

Unfortunately, the cost of an NMR or VAP is out of the question at this time.

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