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Can you please help me decipher my latest lipid panel

Answered on August 19, 2014
Created March 20, 2013 at 11:49 PM

I've been eating Paleo since June of '12 and I recently got my newest round of numbers back on my lipid panel. Here are the newest numbers compared with the older numbers.

One set is from 11/2012 and the other set is from 03/2013. Nothing in my diet changed but realize that my body is still morphing I only started eating Paleo in June of '12. since june of '12 ive went from 5' 7 191 lbs down to 143 lbs.

Cholesterol, total 11/12 - 204 mg/dl 03/13 - 221 mg/dl

cholesterol, triglycerides 11/12 - 55 mg/dl 03/13 - 47 mg/dl

cholesterol, HDL 11/12 - 56 mg/dl 03/13 - 60 mg/dl

cholesterol, LDL 11/12 - 137 03/13 - 152

cholesterol, vldl 11/12 - 11 mg/dl

besides my lipid panel it is interesting to note that my free Testosterone went from 10.6 pg/ml in 11/12 to 14.5 pg/ml in 03/13. it is also important to note that my Hemoglobin A1C was slightly high (5.8 H%) but ive read in many articles that this is not a very good marker of sugar in the blood and that many low-carbers tend to have high A1C numbers.

I didn't track my weight according to my lab word days but it went from roughly 157 to 145 from 11/12 to 03/13 if that makes any difference.

I know that the Paleo-centric crowd deemphasizes cholesterol and instead worries more about inflammation but my question is this, what cholesterol markers DO i need to worry about? Obviously my HDL is high, and my tri's are low but what about my ldl? is my high ldl cause for concern? Should I get a VAP test to measure the particle sizes?

Any analysis and commentary is welcome and appreciated.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 23, 2013
at 08:46 PM

Nope, the easiest way to check is to see if your RBC/Hemoglobin are outside the range.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 05:09 PM

170 - 230. LDL is not terribly informative, unless it's really high. It does not necessarily indicate atherosclerosis. Instead of obsessing over LDL and thinking you need LDL-P measured, get LP(a), homocysteine, and fibrinogen. That will tell you about real risk factors. Liver enzymes are a proxy for fitness, caloric overconsumption, and insulin resistance. Usually you become insulin resistant as you develop fatty liver. At 10-20, you cannot have fatty liver, and you should not be insulin resistant. Combine this with your trigs and HDL, and you have a pretty good picture of health.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 05:03 PM

My source: years of scouring my and my family members' blood records. But think of it this way: you have low trigs if you're not overconsuming. Low carbing will produce low trigs mostly due to satiety. But those who eat high carb can have low trigs as well. Low trigs along when balanced by equivalent HDL tells you some degree of fitness, as HDL tends to rise with better lifestyle habits. It's easy to spot those who're genetically high on HDL, though, as they tend to have unusually high HDL vis a vis their activity level. The ideal level is trigs under 70, HDL above 70, and TC between

06bf7b92d77f1ac1d8e3dc9d539d8254

(1649)

on March 21, 2013
at 01:44 PM

I am also wondering if you have a source or further info on the low trigs/low liver enzymes to be indicative of low inflammation? I mean, I believe you, I just like to read these things for myself. Good answer, btw!

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 03:46 AM

You have higher HDL but that doesn't necessarily mean better, as your total cholesterol increased. It's a portion attributable to HDL that's supposed to be predictive. That portion actually decreased. If you get your HDL up to about 30% of your TC, that would be improving things. About 68 or mroe.

Medium avatar

(39821)

on March 21, 2013
at 03:21 AM

What do you usually eat and what supplements?

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 03:03 AM

You have other issues. How's your weight, overweight? Or slimmed down from being overweight or recovering from fatty liver? Autoimmunity (and most frequently hypothyroid)? You don't have health issues like gout, PCOS, gut issues, IBD/IBS? Everything else being equal, low trigs and low trigs / HDL signal low inflammation.

3491e51730101b18724dc57c86601173

(8395)

on March 21, 2013
at 01:18 AM

"Low trigs => low inflammation. Low Trigs / HDL ==> low bodily inflammation" Do you have a source for that? My trigs are LOW at 55, HDL high at 97, BUT my hsCRP was 3.9, which is high. Not sure why.

0574164618c1a63a2335aea54e21a2a0

(0)

on March 21, 2013
at 01:03 AM

actually my ldl didn't go down but it went up. All other markers "improved" though.

0574164618c1a63a2335aea54e21a2a0

(0)

on March 21, 2013
at 01:02 AM

all my trends from novemeber of 2012 to march of 2013 look pretty good. higher hdl, lower ldl, lower trigs, increased testosterone but my Hemoglobin A1C went from 5.5 to 5.8 What could be causing that? Anyway, thanks so much for all your analysis it is very much appreciated!

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4 Answers

2
D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 12:40 AM

Those cholesterol numbers are good and there is no need to get your particle size tested. It's clear from your trigs, and Trigs / HDL and TC / HDL ratios that your particle size is large. Now, the large particle size doesn't necessarily mean they are completely harmless. They can still be atherogenic but the important thing is inflammation: you don't have much of it. Low trigs => low inflammation. Low Trigs / HDL ==> low bodily inflammation. How are your liver enzymes (ALT, AST)? Are they in the 10s? 20s? No higehr than 25 or so? Then you have low inflammation. You could test with CRP and ESR but usually the liver enzymes and Trigs are sufficient.

Your LDL did go up from about 140 to 152 but is meaningless because you lost a lot of weight and your may lipids may be stabilizing. Plus that margin of increase is just "noise." In the U.S. LDL is usually calculated indirectly.

As for your A1c, 5.8 is an issue and is considered prediabetic. Most low carbers have high FBG, not high overall A1c. Post-prandial numbers are not affected by ketogenic or low-carbing. A1c is not always reliable but is fairly reliable unless you have anemia or RBC/Hb issues. I'd get that retested and make sure it falls below 5.5 or so. If it doesn't, you may have pre-existing blood sugar issues. If you do, low-carbing or avoiding sugar and processed carbs should fix that over the long-term as you haven't crossed the diabetic threshold.

Your free T is now in the midpoint range. If you're doing VLCing, I'd watch my BUN to make sure it doesn't go over 20-25 or so, as it suggests protein overconsumption. More fat, lower protein, and more natural carbs (yams, sweet potatoes, white rice) would be your solution, then.

3491e51730101b18724dc57c86601173

(8395)

on March 21, 2013
at 01:18 AM

"Low trigs => low inflammation. Low Trigs / HDL ==> low bodily inflammation" Do you have a source for that? My trigs are LOW at 55, HDL high at 97, BUT my hsCRP was 3.9, which is high. Not sure why.

06bf7b92d77f1ac1d8e3dc9d539d8254

(1649)

on March 21, 2013
at 01:44 PM

I am also wondering if you have a source or further info on the low trigs/low liver enzymes to be indicative of low inflammation? I mean, I believe you, I just like to read these things for myself. Good answer, btw!

0574164618c1a63a2335aea54e21a2a0

(0)

on March 21, 2013
at 01:03 AM

actually my ldl didn't go down but it went up. All other markers "improved" though.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 03:03 AM

You have other issues. How's your weight, overweight? Or slimmed down from being overweight or recovering from fatty liver? Autoimmunity (and most frequently hypothyroid)? You don't have health issues like gout, PCOS, gut issues, IBD/IBS? Everything else being equal, low trigs and low trigs / HDL signal low inflammation.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 03:46 AM

You have higher HDL but that doesn't necessarily mean better, as your total cholesterol increased. It's a portion attributable to HDL that's supposed to be predictive. That portion actually decreased. If you get your HDL up to about 30% of your TC, that would be improving things. About 68 or mroe.

0574164618c1a63a2335aea54e21a2a0

(0)

on March 21, 2013
at 01:02 AM

all my trends from novemeber of 2012 to march of 2013 look pretty good. higher hdl, lower ldl, lower trigs, increased testosterone but my Hemoglobin A1C went from 5.5 to 5.8 What could be causing that? Anyway, thanks so much for all your analysis it is very much appreciated!

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 05:03 PM

My source: years of scouring my and my family members' blood records. But think of it this way: you have low trigs if you're not overconsuming. Low carbing will produce low trigs mostly due to satiety. But those who eat high carb can have low trigs as well. Low trigs along when balanced by equivalent HDL tells you some degree of fitness, as HDL tends to rise with better lifestyle habits. It's easy to spot those who're genetically high on HDL, though, as they tend to have unusually high HDL vis a vis their activity level. The ideal level is trigs under 70, HDL above 70, and TC between

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 21, 2013
at 05:09 PM

170 - 230. LDL is not terribly informative, unless it's really high. It does not necessarily indicate atherosclerosis. Instead of obsessing over LDL and thinking you need LDL-P measured, get LP(a), homocysteine, and fibrinogen. That will tell you about real risk factors. Liver enzymes are a proxy for fitness, caloric overconsumption, and insulin resistance. Usually you become insulin resistant as you develop fatty liver. At 10-20, you cannot have fatty liver, and you should not be insulin resistant. Combine this with your trigs and HDL, and you have a pretty good picture of health.

0
A2c38be4c54c91a15071f82f14cac0b3

(12672)

on March 22, 2013
at 07:08 AM

Without knowing your diet, a number of possible factors could have resulted in higher HbA1C.

If you're in ketosis, ketones and ketone metabolites like methylglyoxal can likely be glycating agents.

Nutrient deficiencies could also be at play; thiamine, vitamin C, magnesium (commonly low in many diets), and zinc are all important in preventing our dealing with glycation. Zinc may be the least likely to be low on a paleo diet, but it's still reasonable you could be coming up short on any of those nutrients.

I don't claim to be an expert on the role of HbA1C as an indicator of disease risk, but if your levels could be indicative of a vitamin and/or mineral inadequacy it seems look a good idea to see if that's what's going on.

0
0574164618c1a63a2335aea54e21a2a0

on March 22, 2013
at 05:11 AM

Could the eleveated A1C numbers be because im still losing weight?

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on March 23, 2013
at 08:46 PM

Nope, the easiest way to check is to see if your RBC/Hemoglobin are outside the range.

0
782d92f4127823bdfb2ddfcbcf961d0e

on March 21, 2013
at 12:19 AM

You didn't provide your ldl numbers but I calculated them to be either 152mg/dl per the Friedewald formula, or more accurately 118mg/dl per the Iranian formula (since your triglycerides are below 100mg/dl). Your numbers appear pretty good as many Paleos tend to have slightly higher ldl's but most likely they are the good "fluffy" type (trigs/hdl). This article is very good at explaining lipid panels.

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