apod NMR Lipoprofile Results

[apod]

I just went in for my first NMR Lipoprofile (I'm an APOE 3/4.) For the past year or so, my weight has been stable and diet has been fairly consistent. I've been eating ~2-3 square meals (with the occasional small dark chocolate / nut / fruit snack) around a 16-8 schedule or so with exercise 4-5 days a week (resistance + some light cardio.) I've been doing a fairly high amount of fat (lots of olive oil and mac nuts), with 3 boiled eggs eaten several times a week, with some fairly regular dairy (butter + cheese + milk + a little bit of ice cream), around 60-100g of protein (mostly meat-derived), and often just enough carbohydrates to stay out of ketosis, though occasionally dipping into ketosis -- basically, a low-carb paleo/primal diet. I drink green tea fairly regularly (matcha), and supplement b vitamins, occasional minerals (mostly magnesium), k2, occasional fish oil, occasional curcumin. I eat a ton of fiber (though, a lot of that is insoluble) and I do a decent amount of green bananas and cold rice / potato, where there is a decent amount of resistant starch there as well.

I've managed to gain some weight (almost all lean mass) over the past year, so I'm not at too much of a caloric deficit, although I could probably eat a bit more calories, my body fat is around the <10% mark or so.

LDL-P: 1322 (borderline-high)
LDL-C: 116 (near optimal)
HDL-C: 71 (desirable)
Total Cholesterol: 199 (desirable)
Triglycerides: 59 (desirable)

HDL-P: 29.3 (low)
Small LDL-P: 126
LDL Size: 21.6 (large pattern-A)
LP-IR Score: <25 (low -- insulin sensitive) (I'm not sure why there isn't an absolute value there -- it just says "<25" on the results.)

Notes: VLDL levels not sufficient for VLDL size determination.

I'd like to get LDL-P under 1300 (ideally under 1,000) without messing up Trigs or HDL-C, I'd also like to bump up HDL-P. I'm thinking more carbohydrates, less dairy, and some plant-protein in place of animal protein might help somewhat. I might also look into thyroid / inflammation panels and vitamin d / homocysteine. Any thoughts on these results / diet / exercise / supplementation are welcome!

[KatieS]

Overall your results look like you only need to focus on the LDL-P with the dietary changes you mentioned. I would immediately cut the butter and saturated fats down. You might consider tracking this dietary change with CRON-O-Meter (free:https://cronometer.com/#). Next time I would add the CRP, HCY and lipoprotein(a). Both the small LDL and the IR score are optimal, I would think your A1c is low.

[SusanJ]

I'd second the idea to lower your saturated fat and see if that can bring the LDL-P down. Definitely lose the butter and if you eat land animals, only the leanest cuts, and grass fed if you can afford it.

[KatieS]

Since I crave a creamy dairy, like you, I am finding nonfat kefir satisfying.

[Robin2038]

This is a wee bit off topic, but I've been "kicked" out of the MUSES study and had been waiting to get my blood work done but I still don't have the information from MUSES to tell my dr what to order. My physician is giving me a blood test anyway for other reasons next week, and she will add whatever I think MUSES would ask her to order. (I'm going to still participate in the 6 month "free" MUSES support). Since many of you are so knowledgable,what do you think my physician should test for? I've never had any detailed lipid profiles ,just the usual. I can add any additional tests MUSES asks for at a lafter date.

[apod]

Since I crave a creamy dairy, like you, I am finding nonfat kefir satisfying.

Ah, that looks interesting -- I've been meaning to try dairy kefir (I keep an active culture of water grains that I've had going for about a year, which I drink occasionally after a fresh cracked coconut water + ginger 12-24hr low-alcohol ferment.) That could potentially be a decent source of calcium for me on some days. I was also thinking about fat-free mozzarella... although, I have seen some articles that make a good case against low-fat dairy products -- annoying finding the compromise between different health goals and tastes / habits.

[LA18]

apod, I wish my lipids looked like yours! I bet you’ll be able to get into the target range on the ldl-p with your dietary modifications.

I think that my situation is strange (not surprising, given my track record). I’m really, really careful about what I eat and tightly control my blood sugar, but the insulin resistance score on my last lipid profile was high (47). This is despite the fact that I’m in ketosis and my a1c has dropped to 4.9. kitano notes that a1c is likely to correlate with insulin resistance score on the lipid panel. Has anyone else not seen a correspondence between their insulin resistance score and their a1c level? Despite my diet, my triglycerides have also remained too high (68). I’ve got some weird kind of diabetes, and I think that this is probably the root of my lipid problem at this point. Wish I could find a doctor who would address this. To date I have not been able to do so, but I'm still looking.

[Tincup]

I think that my situation is strange (not surprising, given my track record). I’m really, really careful about what I eat and tightly control my blood sugar, but the insulin resistance score on my last lipid profile was high (47). This is despite the fact that I’m in ketosis and my a1c has dropped to 4.9. kitano notes that a1c is likely to correlate with insulin resistance score on the lipid panel. Has anyone else not seen a correspondence between their insulin resistance score and their a1c level? Despite my diet, my triglycerides have also remained too high (68). I’ve got some weird kind of diabetes, and I think that this is probably the root of my lipid problem at this point. Wish I could find a doctor who would address this. To date I have not been able to do so, but I'm still looking.

From what I read in their patent, the NMR IR calculations use data from the various fraction concentrations and sizes. My take is their assumption is that the Tg, LDL, HDL relationships from serum glucose (excess serum glucose driving Tg levels, which has an effect on the others). This may not be valid for those of E4's who control our glucose, but our Tg levels are driven by our slow Tg clearance from sat fat. My perception from my own NMR tests over the last ~10 months is that my actual IR levels haven't changed. However my NMR and corresponding computed IR values vary significantly (range 7-62). Though I didn't pull a fasting insulin every time. When I did last summer it was in the ~3.3 range with a fasting glucose ~86 mg/dL. The HOMA IR value is low. More recently my fasting insulin increased in the ~5 range, but my NMR IR was 7.

You can see the drivers in their calculations by reading their patent:

NMR IR USApp20100100334.pdf

If you are concerned, my suggestion is to actually measure fasting insulin and glucose directly, rather than being concerned with the NMR proxy calculations.

[LA18]

George, thanks for the input. I do think that slow triglyceride clearance is an issue for me. When I regularly supplemented with MCT oil for a period, my triglyceride level increased notably on the NMR panel.

My glucose/insulin situation is just strange. My fasting insulin is really low, often non-detectable, and my fasting glucose, provided I’m in ketosis, is in the high 60s. But I can’t tolerate any rapid acting carbs at all without huge elevations in glucose (similar to the effect that one would see in a type 1 diabetic).

I believe my insulin resistance score is high on the NMR because my VLDL-P is high and my LDL size is small. On closer inspection I see that my LDL size is really at the tail end of the distribution. I think my next step is to consult a lipidologist, and to really watch the saturated fat.

[Tincup]

My glucose/insulin situation is just strange. My fasting insulin is really low, often non-detectable, and my fasting glucose, provided I’m in ketosis, is in the high 60s. But I can’t tolerate any rapid acting carbs at all without huge elevations in glucose (similar to the effect that one would see in a type 1 diabetic).

Could be physiologic insulin resistance (which is a good thing and to be expected). It is quite common with those on a VLC diet. In chronic low glucose situations, the muscles don't use the glycogen - it is saved for the brain. Standard advice for those on a VLC before they take an oral glucose tolerance test is to eat at least 150 g/carbs/day for 3 days before testing. These carbs cause to body to reduce or abandon the physiologic IR.