Just wondering whether anyone can help provide some guidance on whether I should be concerned with the change in my lipids below? According to Chris Kresser's basic lipid guidelines it appears I shouldn't be concerned (TC<290, HDL>40, TRIG<125, TC/HDL<4.0), but my conventional doctor is starting to get really worried especially as cholesterol hypersensitivity seems to run in my family. I'm even thinking of slightly increasing starchy carb intake, slightly cutting my saturated fat intake at least get my lipid numbers closer to 'normal' range because things are getting worse understanding lipid markers should 'stabilize' over the long term following my heavy increase in saturated fat intake. I'm 28 years old, 6" tall and 160lbs, relatively active with gym 2x a week and basketball 2x a week.
- TC 147, HDL 62, LDL 77, TRIG 35, TC/HDL 2.4, TSH 1.0, Fasting Gluc 4.1, Iron Sat/Ferritin 8%/244, hs-CRP not tested, fasting glucose 4.1
- Pre Paleo (Aug 2010)
- TC 236, HDL 70, LDL 155, TRIG 62, TC/HDL 3.4, TSH 3.1, Fasting Gluc 4.1, Iron Sat/Ferritin 33%/315, hs-CRP 2.1, fasting glucose 4.1
- Post Paleo (Mar 2013)
- TC 259, HDL 81, LDL 170, TRIG 44, TC/HDL 3.2, TSH 2.2, Fasting Gluc 4.7, Iron Sat/Ferritin 49%/357, hs-CRP 1.0, fasting glucose 4.7
- Post Paleo (Jun 2013)
- Note I probably went paleo at the start of 2012. The difference between Post Paleo (Mar 13) and Post Paleo (Jun 13) was that I've increased my egg intake to 3x/day from 6x/week and increased intake of both iodine and selenium to get my TSH in range (doc didn't test FT3 & FT4 after seeing my TSH drop to normal). Also note following my Post Paleo (Jun 13) iron results I'm currently getting tested for genetic hemochromatosis (results in a few days) after which I'm hoping to donate blood (if my low platelets aren't a problem) and maybe reduce vitamin C supplementation to keep numbers within a normal range. All other blood markers are within range including hsCRP which was 1.0 at Post Paleo (Jun 2013). I'm in Australia with no access to any VAP/NMR testing for LDL particle count etc.
- Carbs (21% calories): mostly cooked non-starchy vegies apart from a sweet potato post workout
- Protein (24% calories): mostly grass-fed beef, calf liver, salmon 3x a week, protein shake post workout
- Fat (58% calories): mostly eggs, grass-fed beef, avocado, coconut cream & oil, red palm fruit oil and ghee
- Other: daily bone broth, sauerkraut, fermented CLO, vitamin C & D supplementation
- Note: saturated fat of 88g/day takes up 25% of daily calories (25g/day from organic coconut cream alone)
I've purchased Chris Kresser's High Cholesterol Action Plan, I've read through Chris Masterjohn's entire website and I've listened to countless podcasts discussing the truth about cholesterol and CVD so I am broadly comfortable with the science, history, myths, etc. But even after all this I'm still worried and confused as to whether I should make any changes as my numbers are just getting 'worse'.
Any help would be greatly appreciated!
--- UPDATE --- 1 July 2013 ---
In the absence of more advanced lipid testing (LDL-P, ApoB:ApoA1, Lp(a), Lp-PLA2, FT3/FT4, ApoE genetic testing etc) which I will talk to / convince my doctor about I'm going to make the following interim dietary changes to try bring the basic lipid markers closer to ???normal??? ranges (noting the irrelevance of the standard lipid markers, but it seems I am hyper-responsive to saturated fat and dietary cholesterol consumption so might not be such a bad idea):
- Decreasing SFA consumption (coconut cream) by 37% or 33g/day
- Increasing MUFA consumption (olive oil) by 44% or 33g/day
- Decreasing cholesterol consumption (two eggs) by 37% or 421mg/day
- Increasing PUFA O3 consumption (sardines) by 28% or 1.1g/day
- Increasing PUFA O6 consumption by 26% or 3.4g/day
- SFA as percentage of total energy down 10% to 15% of calories
- MUFA as a percentage of total energy up 10% to 30% of calories
- Virtually no change to total carbohydrate/protein/fat consumption (20%/22%/58% of calories)
- Virtually no change to total PUFA as a percentage of total energy (7% of calories)
- Virtually no change to O6:O3 PUFA ratio (3.3:1)
- No change to total calorie consumption (3,200 calories)
Will keep you all updated on more recent basic/advanced lipid test results.
--- UPDATE --- 10 July 2013 ---
Got results for more advanced lipid markers today:
- apoB 112, apoA1 200, apoB:apoA1 0.56, lp(a) 8, FT4 14.7, FT3 3.5, RT3 645, FT3:RT3 5, no detected TPO and Tg thyroid antibodies
Based on this it seems as though I shouldn't necessarily be concerned about my change in cholesterol concentration given apoB is within 'normal' range, apoA1 is slightly above 'normal' range, and the apoB:apoA1 ratio is pretty good. This is further confirmed with lp(a) in the better part of the 'normal' range. While it would be interesting to see the impact of changing my diet on both basic/advanced lipid markers described per my previous update I don't see a need at this stage to substantially decrease SFA and dietary cholesterol intake.
The only issue is my RT3, specifically my FT3:RT3 ratio. While all other thyroid markers seem OK I am above the 'normal' RT3 range. I will read into this but my basic understanding is that this may be caused by things such as calorie restriction, carbohydrate restriction, stress and inflammation.
- I don't think I'm restricting calories given I clock in over 3,000 a day
- I do intermittently fast almost daily (~16 hours) so perhaps I should stop this for a while
- I do restrict carbs (20% of calories, mostly non-starchy vegetables) by probably too much, it may make sense to increase intake of starchy vegetables
- My job doesn't cause much stress and stress very little outside work
- I don't think I am suffering from any systemic inflammation given my low hs-CRP result of 1.0
- I'm unsure as to whether I have a virus or infection causing unidentified stress/inflammation
I'm yet to donate blood, but have an appointment booked in.
--- UPDATE --- 31 July 2013 ---
Got my ApoE results back and found out I have the e3/3 gene ("the most common Apo E genotype ... (that) does not predispose the patient to hyperlipidaemia"), suggesting my high cholesterol figures are not releated to genetics.
asked byMike_70 (40)
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on June 30, 2013
at 02:19 AM
Might be the reason for issues with LDL. I'm testing this now myself. I would suggest either cutting fats down OR increasing carbs not both. That way you can see for sure. I find making too many changes might muck the waters.
on June 29, 2013
at 04:33 AM
Two possibilities. The overreaction to saturated fat may be due to your genes (ApoE4). You might indeed react inordinately. In that case, I would do high starch Paleo. YOu have no weight problem and have excellent fasting blood sugar. Why not add yams, sweet potatoes, potatoes, or white rice? Cut down on coconut oil, eggs, and you'll have to cut down on liver, as that's going straight to your iron storage. 75% that increasing your starch portion will solve the problem.
There is another chance that this is related to your low FT3. This is a guess but your TSH started going up as you went Paleo. It's possible that your lower-carb Paleo induced caloric restriction and glucose deficiency, causing FT3 to go down. All the more if you have hypothyroid symptoms. If so, again, getting your carbs up could solve your problem. (Also, how much iodine are you taking? That could be problematic if you have Hashimoto's, unless you're simultaneously on Selenium. If it's a small dose, not a problem.)
Now, your pre-Paleo numbers are also low (I mean, your trigs), so this may not be the case. I mean trigs that low happen usually when VLCing but you claim to have done it without Paleoing. Were you VLCing' pre-Paleo?
on June 29, 2013
at 10:28 PM
It's quite incredible how your TC and LDL values have gone up so on the Paleo diet. Mine have gone up too but only by 10-15%, with Trig/HDL both dropping by over 30%. I eat more fish than you, and probably less carbs (my digestive tract is a bit wonky). But otherwise our diets are not substantially different. So it is hard to suggest changes. However a couple of thoughts:
1) TSH alone is not an indicator of thyroid health. You really need to look at FT3 and FT4. Yet having said this, unless you have overt hypothyroid symptoms it is unlikely that a TSH of 3.1 means trouble. No, it's not an optimal value. But it's nothing to overly worried about. Guys seem to be able to function nicely with a high-ish TSH value.
2) Being in Australia I am surprised you are supplementing with vitamin D. Are you indoors that often? I live in south Florida, I only get modest amounts of sunshine, and my vitamin D level is 55 (normal is 30 and above). Since you also have an iron issue to sort through I am wondering if extra vitamin D supplementation might be working against you somehow?
3) I don't think taking iodine in microgram dosages will do much other than prevent goiters. Such a small amount is probably safe even if you suffer from Hashimoto's, which I have no reason to believe is your problem.
on June 29, 2013
at 01:23 PM
Seems like your labs are getting worse on paleo. I'm curious what your diet was like pre paleo.
I've seen examples where Kresser's basic lipid criteria is met, but LDL-P > 1000.
TC 257 HDL 72 LDL 176 TG 46 TC/HDL 3.57 LDL-P 1437
TC 228 HDL 92 LDL 130 TG 34 TC/HDL 2.48 LDL-P 1012
Interesting LDL-C as high as 130 results in LDL-P as low as 1012.
TC 188 HDL 45 LDL 126 TG 87 TC/HDL 4.18 LDL-P 1641