2

votes

Very high LDL cholesterol but good ratios overall?

Answered on August 19, 2014
Created January 28, 2013 at 10:02 PM

I read through lots of lipid and VAP test questions here, but this seems to be a new one. Here are my VAP results:

LDL 235

HDL 75 (>60 is optimal)

TTL 331 (TTL:HDL = 4.4 where <5:1 is good & 3.5:1 is optimal)

TRG 92 (<150 is good) (TRG:HDL=1.2:1 where <2:1 is good)

NON-HDL 256

LDL Size A (Large, fluffy particles, not A/B mixed or dense B)

HDL2 19 (>10 most protective)

HDL3 57

VLDL3 11 (<10 is optimal)

The doctor said, "We don't really know what to do with results like this. This is the highest LDL I've seen in a couple of years, but it's almost always coupled with poor HDL or triglyceride levels."

Even though I know from my pre-paleo days that low-dose statins are very effective, I can't tolerate them at all (lots of muscle pain). Finally, there's no family history of heart disease.

It seems to me I'm in the clear despite a scary number. Can I just ignore the results entirely and carry on my paleo (high-fat/low-carb/med-protein/no-grain) diet?

Or to be more prudent, should I try to bring down the LDL by, for example, giving up my beloved bulletproof coffee in the morning?

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 30, 2013
at 11:47 AM

The relationship between inflammation and heart disease is very complex and the cause and effect is not yet clear. See: http://www.heart.org/HEARTORG/Conditions/Inflammation-and-Heart-Disease_UCM_432150_Article.jsp

D13278772f6612432bf53413fad4e7af

(801)

on January 30, 2013
at 01:34 AM

Ted, thanks for your input. My D levels are a high 55 ng/ml, I get outside every day on dog walks, and I supplement with D3, K2, Omega-3's, magnesium, and a couple of others. You may be right that inflammation is the real cause of heart disease, and I need to learn more about that.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 09:57 PM

On Pantethine, you neglected to mention that the 28 clinical trials comprised a pooled population of 646 and the average study sample size was 22.3 subjects and none were on clinical endpoints. Clearly this needs more research.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 09:52 PM

The relationship between vitamin D and cholesterol levels is complex (http://www.theheart.org/article/1418905.do) and there is not yet any evidence that supplementation will lower LDL. In fact, the latest short-term study was completely negative for all parameters (http://newsroom.heart.org/news/vitamin-d-supplement-fails-to-238018). Longer term studies are in progress.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 12:18 PM

Dan- I am editing my answer to take into account the information you have provided; see above.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 12:17 PM

Caveboy- What seems clear is that a high-fat diet causes high cholesterol in some people. If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to modify their diets are clear and have to do with both lowering and altering the fat content. – John 1 hour ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 11:42 AM

Dan- I am editing my answer to take into account the information you have provided; see above – John 1 min ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:36 AM

Dan- I am editing my answer to take into account the information you have provided. – John 1 min ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:36 AM

Caveboy- If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to alter their idea are clear and have to do with both lowering and altering the fat content.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:35 AM

Caveboy- If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to alter their idea are clear and have to do with both lower and altering the fat content.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:34 AM

Dan- I am editing my answer to take into account the information you have provided.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:33 AM

If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are offered. My ideas on how to alter their diet are clear. – John 0 secs ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:33 AM

If I am posting similar things on these threads its because the issues are very much the same along with the suggestions that are offered. My suggestions on how to alter their diet are clear.

64433a05384cd9717c1aa6bf7e98b661

(15236)

on January 29, 2013
at 05:18 AM

Yeah that's pretty amazing that a doctor admits they don't know something. seriously

D13278772f6612432bf53413fad4e7af

(801)

on January 29, 2013
at 02:57 AM

John, thanks for the cautious approach. 1) I'm 63 2) No health issues 3) No family heart/cholesterol issues 4) No other risk factors 5) No other labs (although doc suggested a calcium heart scan) 6) Eating 40/30/30 fat/carb/protein for about three years. Virtually no sugar or grains, limited starches. Pre-paleo, my total cholesterol was high (290) and various statins were tried, all reducing numbers to "safe" rang but also causing severe pain after a few weeks. This was pre-VAP, I think, so I can't compare specifics. Britt, this aligns with what CD suggested above. I agree.

D13278772f6612432bf53413fad4e7af

(801)

on January 29, 2013
at 02:49 AM

Good suggestion about an N=1 test. Seems like a good way to rule dairy+butter in or out as a culprit.

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 29, 2013
at 02:42 AM

most of the studies I've seen assume 2 weeks. Most insurances require at least 4 weeks.

2e777bbcd49262eb31a24f821abec6bc

(1974)

on January 29, 2013
at 01:07 AM

I don't think John is suggesting that paleo is causing high cholesterol, but rather that dietary changes may need to be made within his paleo diet. All of the threads that I have seen about high LDL are from people who do high fat/ low carb diets. I keep 40/30/30 and my total cholesterol is 152 (HDL: 80, LDL: 72). I would suggest cutting the bullet proof coffee, as CD suggests, and then have lab work redone.

4523f952f67fa6485efeac2c9ea810cf

(166)

on January 29, 2013
at 12:38 AM

You post this same thing in just about every cholesterol thread. If you think the paleo diet is causing high cholesterol how do you suggest people eat?

7fc82eebafd44badc73c520f44660150

(3275)

on January 29, 2013
at 12:36 AM

How long before a change in diet is reflected in his labs ?

3846a3b61bc9051e4baebdef62e58c52

(18635)

on January 28, 2013
at 10:27 PM

I like your doctors answer. Seems quite honest.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on January 28, 2013
at 10:26 PM

I like your doctor. Thats about the most honest statement he can make about numbers like that.

1edb06ded9ccf098a4517ca4a7a34ebc

(14952)

on January 28, 2013
at 10:26 PM

Travis culp has been pretty vociferous about that (dairy ldl connection) on this site.

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4 Answers

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2
3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 28, 2013
at 10:13 PM

Dan, if you are comfortable where you are at, then stay there.

Personally I would be interested in conducting an LDL experiment. Change nothing about your diet other than removing butter and the bulletproof coffee.

I have seen some hypothesize that butter (and dairy for that matter) increases LDL.

I've also seen several N=1s like this one: http://quantifiedself.com/2012/04/butter-improves-hdl-and-ldl-as-much-as-statins/

Why not do the experiment yourself. 4 weeks no butter/dairy, retest and see what the results are.

1edb06ded9ccf098a4517ca4a7a34ebc

(14952)

on January 28, 2013
at 10:26 PM

Travis culp has been pretty vociferous about that (dairy ldl connection) on this site.

D13278772f6612432bf53413fad4e7af

(801)

on January 29, 2013
at 02:49 AM

Good suggestion about an N=1 test. Seems like a good way to rule dairy+butter in or out as a culprit.

7fc82eebafd44badc73c520f44660150

(3275)

on January 29, 2013
at 12:36 AM

How long before a change in diet is reflected in his labs ?

3ce6a0d24be025e2f2af534545bdd1d7

(26217)

on January 29, 2013
at 02:42 AM

most of the studies I've seen assume 2 weeks. Most insurances require at least 4 weeks.

4
Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 28, 2013
at 11:35 PM

This question is by no stretch of the imagination new. There have been myriad reports on this forum alone of people with high LDL, high HDL, and relatively low triglycerides. In fact, it could become a full-time occupation responding to inquires like this.

Anyway, I don't know what you mean by "It seems to me I'm in the clear despite a scary number." An LDL of 235 is pretty high and outside of the reference ranges. While not as high as some I have seen (I think somebody reported 435 or so), you didn't say how long you have been eating "paleo" and its not uncommon for LDL to continue to go up. You have already mentioned the "large and fluffy" idea which seems to be entrenched here but the newer research indicates that particle number is the real issue and with an LDL of 235, its unlikely you will get a "good" particle number if you test for that. Also, remember that people with familial hypercholesterolemia (FH) have lots of "large, fluffy" particles and they get heart diseases. The reality is that nobody really knows what high LDL means when it happens in the context of paleo/low-carb diets so I would suggest you are gambling with your health by "ignoring the results entirely."

So, before going any further we need to rule out FH. You say in your comments that you had a "pre-paleo" TC of 290 which is clearly pretty high but I am going to assume that your doctor ruled out FH but that does make your situation different from most of the cases I have seen here. Usually, the person is younger and had normal lipids which then rocketed up after changing their diet. Did your doctor posit any ideas as to why your TC was so high? You haven't mentioned your weight so were you/are you overweight? What was your diet/lifestyle like pre-Paleo? What kind of physical activity were you/are you doing?

In any event, you say you have no other labs but I find this hard to understand. You mean at age 63 you have never had full blood work done and that your doctor put you on statins without it? Also, you seem to have had at least your TC measured pre-Paleo; did you not at least get a breakdown of the fractions (HDL/LDL/TG's)? It would nice to know how much the increase in your TC came from an increase in LDL as opposed to HDL. If at all possible, please give us as much of your past blood work as possible to have more to go on.

As for your diet, I also have trouble understanding the 40/30/30 macro breakdown. Are you sure about this and if so, did you actually track this using something like Fitday? The reason I asking is that something seems off. Lets assume you are eating 2500 calories/day. That would mean a fat intake of 1000 calories but you say you enjoy your "beloved bulletproof coffee." That suggests you are doing it daily and if memory serves, the recipe calls for something like 110 grams of butter and MCT oil which is almost 800 calories from that alone. Also, 30% of calories from carbohydrates is 750 calories or almost 200 grams. That an awful lot for somebody who eats "Virtually no sugar or grains, limited starches." I need to more fully understand your current diet before suggesting any changes.

So, if I seem to be nit-picking but find the tendency here is for people to jump in with their favorite solutions without knowing anything at all about the person asking the question. As I said, your situation is different from most of the others. We need to try to understand why your cholesterol was high earlier and what exactly you are doing now that might be impacting it before we can go further.

4523f952f67fa6485efeac2c9ea810cf

(166)

on January 29, 2013
at 12:38 AM

You post this same thing in just about every cholesterol thread. If you think the paleo diet is causing high cholesterol how do you suggest people eat?

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:35 AM

Caveboy- If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to alter their idea are clear and have to do with both lower and altering the fat content.

2e777bbcd49262eb31a24f821abec6bc

(1974)

on January 29, 2013
at 01:07 AM

I don't think John is suggesting that paleo is causing high cholesterol, but rather that dietary changes may need to be made within his paleo diet. All of the threads that I have seen about high LDL are from people who do high fat/ low carb diets. I keep 40/30/30 and my total cholesterol is 152 (HDL: 80, LDL: 72). I would suggest cutting the bullet proof coffee, as CD suggests, and then have lab work redone.

D13278772f6612432bf53413fad4e7af

(801)

on January 29, 2013
at 02:57 AM

John, thanks for the cautious approach. 1) I'm 63 2) No health issues 3) No family heart/cholesterol issues 4) No other risk factors 5) No other labs (although doc suggested a calcium heart scan) 6) Eating 40/30/30 fat/carb/protein for about three years. Virtually no sugar or grains, limited starches. Pre-paleo, my total cholesterol was high (290) and various statins were tried, all reducing numbers to "safe" rang but also causing severe pain after a few weeks. This was pre-VAP, I think, so I can't compare specifics. Britt, this aligns with what CD suggested above. I agree.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:36 AM

Dan- I am editing my answer to take into account the information you have provided. – John 1 min ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:33 AM

If I am posting similar things on these threads its because the issues are very much the same along with the suggestions that are offered. My suggestions on how to alter their diet are clear.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 12:18 PM

Dan- I am editing my answer to take into account the information you have provided; see above.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:36 AM

Caveboy- If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to alter their idea are clear and have to do with both lowering and altering the fat content.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:34 AM

Dan- I am editing my answer to take into account the information you have provided.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 10:33 AM

If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are offered. My ideas on how to alter their diet are clear. – John 0 secs ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 12:17 PM

Caveboy- What seems clear is that a high-fat diet causes high cholesterol in some people. If I am posting similar things on these threads its because the issues are very much the same along with the dubious suggestions that are being offered. My ideas on how to modify their diets are clear and have to do with both lowering and altering the fat content. – John 1 hour ago

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 11:42 AM

Dan- I am editing my answer to take into account the information you have provided; see above – John 1 min ago

0
0b73cdbd0cb68aeeda14dafeebb2f828

on January 29, 2013
at 12:22 PM

In this thread I have listed some basic ideas for reducing inflamation and lowering LDL and VLDL numbers. Doctor wants to put me on statins - 24 y.o. male (Updated with VAP Results)

Unless your 25(OH)D is at or above 125nmol/l 50ng/ml it is certain you are not fully benefiting from Vitamin D3's maximum anti inflammatory potential. You need Paleo Vitamin D levels if you want to benefit fully from a paleo diet. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l = 46ng/ml

Magnesium deficiency reduces activation of Vitamin D3 to Calcitriol, which is also enhanced by the omega 3's EPA and DHA, (Vitamin D receptor ligands)

Raising 25(OH)D to the point of natural vitamin D3 equilibrium enables a higher absorption of magnesium and calcium however magnesium may not be present in sufficient quantities in your diet. Slomag dietary magnesium calculator Don't forget to check the mineral content of your water supply. Potassium depletion inhibits reabsorption of Magnesium.

You may also want to consider Pantethine More than 28 clinical trials have shown consistent and significant improvement in serum lipids. TC is decreased by 15%, LDL by 20%, Apo B by 27.6%, and TG by 36.5% over 4 to 9 months. The recommended effective dose is 300 mg 3 times per day or 450 mg twice per day with or without food. Pantethine increases anti-inflammatory essential fatty acids EPA and DHA, while lowering pro-inflammatory levels of arachidonic acid.

The problem as I see it comes from INFLAMMATION hence all the suggestions above relate to improving anti-inflammatory status. If you want to reduce any potential risk it may be worth checking your Reynolds Risk Score

D13278772f6612432bf53413fad4e7af

(801)

on January 30, 2013
at 01:34 AM

Ted, thanks for your input. My D levels are a high 55 ng/ml, I get outside every day on dog walks, and I supplement with D3, K2, Omega-3's, magnesium, and a couple of others. You may be right that inflammation is the real cause of heart disease, and I need to learn more about that.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 09:52 PM

The relationship between vitamin D and cholesterol levels is complex (http://www.theheart.org/article/1418905.do) and there is not yet any evidence that supplementation will lower LDL. In fact, the latest short-term study was completely negative for all parameters (http://newsroom.heart.org/news/vitamin-d-supplement-fails-to-238018). Longer term studies are in progress.

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 30, 2013
at 11:47 AM

The relationship between inflammation and heart disease is very complex and the cause and effect is not yet clear. See: http://www.heart.org/HEARTORG/Conditions/Inflammation-and-Heart-Disease_UCM_432150_Article.jsp

Ea1bb0c24b59345463ef96880b6b27fc

(300)

on January 29, 2013
at 09:57 PM

On Pantethine, you neglected to mention that the 28 clinical trials comprised a pooled population of 646 and the average study sample size was 22.3 subjects and none were on clinical endpoints. Clearly this needs more research.

0
64433a05384cd9717c1aa6bf7e98b661

(15236)

on January 29, 2013
at 05:20 AM

I agree to try removing all dairy. Also, have you had a full thyroid panel? There are definite connections between thyroid and LDL receptor activity. Oh and I'd use turmeric on everything (also relating to the LDL receptors).

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