Extensive Test Results from Cleveland Heart Lab: Dec. 2016

[LG1]

Hey fellow data nerds. Here are the results from my resent labs. I have an appointment on Jan. 4 to go over the results so could use your educated input and/or opinion. I am 4/4 and was on a ketogenic diet (plenty of quality sat fat with dairy, butter, some red meat, bacon plus olive oil) in months leading up to the labs (confirmed ketosis with Abbott Precision Extra).

My IT (Inflammation Testing) Scores (LOW or HIGH Risk):

• F2-Isoprostanes/Creatinine - .45 LOW
  F2-Isoprostanes - 1.29 LOW
  Creatinine, Urine, Random - 284.1 LOW
  Oxidized LDL - 55 LOW
  Microalbumin/Creatinine - 1.8 LOW
  hsCRP - .6 LOW
  LP-PLA2 Activity - 92 HIGH
  Myeloperoxidase - 294 LOW
  ADMA (Asymemetric Dimethylarginine) - 71 LOW
  SDMA (Symmetric Dimethylarginine) - 74 LOW

________________________________________
LIPIDS

• Apolipoprotein A1 - 178 LOW
  Apolipoprotein B - 118 MOD
  ApoB/ApoA1 Ratio - .66 LOW
  sdLDL - 45.2 HIGH
  Lp(a) - 20 LOW
  HDL2b - 33 LOW

__________________________________________
NMR PROFILE

• LDL Particle Number - 1890 HIGH
  LDL Cholesterol, Calculated - 195 HIGH
  HDL-C - 100 LOW
  Triglycerides - 64 LOW
  Cholesterol, Total - 308 HIGH
  HDL-Particle Number - 38.3 LOW
  Small LDL-Particle Number - <90 LOW
  LDL Size - 22.1 Good
  Large VLDL - 42.3 LOW
  Large HDL-P - 17 LOW
  VLDL Size - 42.3 LOW
  HDL Size - 10.3 LOW

________________________________________________
LP-IR Score - <25
__________________________________________________
Hemoglobin A1C - 5.4 Good
Omega 3 and thyroid are both optimized

[Hepoberman]

I only have one APOE 4 allele and I managed to have even worse results than that on 3 out of 4 variations of high fat dieting over two years, --so don't fret, it could be worse. You clearly need to make radical changes though. Your elevated TC and LP-PLA2 predispose you for plaque accumulation.

There is no such thing as "quality" Sat fat. Saturated fat is akin to poison to a person with APOE 4/4. I know it may sound as if I am absurdly focusing on a single type of fat but I assure you that if you could find a way to eliminate sat fat, your lipids would begin to normalize. We 4's struggle to metabolize fat and cholesterol as it is, Sat fat chains are rigid little sticks that really "clog up the works" (not arteries but biochemical pathways). Its nearly impossible to eliminate sat fat entirely.

It took me a few months to make a slow transition towards a whole plant food based diet, but now I love it. (and so does my lipidologist, my wife, and my dinner guests!). Within four months my TC dropped 26%, a year later 41%. My lipidologist says now my labs resemble his centenarian patients. We have to choose who to believe based on real evidence.

In Cholesterol Lowering, Moderation Kills - http://www.dresselstyn.com/site/study05/

The link above refers to published, peer reviewed proof of plaque reversal. TC should be under 150 mg/dl for optimal long term health.

Give the Ornish kitchen a good look (another well known and highly trusted doctor with REAL evidence) - https://www.ornish.com/kitchen/

[Nequals1Guy]

I only have one APOE 4 allele and I managed to have even worse results than that on 3 out of 4 variations of high fat dieting over two years, --so don't fret, it could be worse. You clearly need to make radical changes though. Your elevated TC and LP-PLA2 predispose you for plaque accumulation.

There is no such thing as "quality" Sat fat. Saturated fat is akin to poison to a person with APOE 4/4. I know it may sound as if I am absurdly focusing on a single type of fat but I assure you that if you could find a way to eliminate sat fat, your lipids would begin to normalize. We 4's struggle to metabolize fat and cholesterol as it is, Sat fat chains are rigid little sticks that really "clog up the works" (not arteries but biochemical pathways). Its nearly impossible to eliminate sat fat entirely.

It took me a few months to make a slow transition towards a whole plant food based diet, but now I love it. (and so does my lipidologist, my wife, and my dinner guests!). Within four months my TC dropped 26%, a year later 41%. My lipidologist says now my labs resemble his centenarian patients. We have to choose who to believe based on real evidence.

In Cholesterol Lowering, Moderation Kills - http://www.dresselstyn.com/site/study05/

The link above refers to published, peer reviewed proof of plaque reversal. TC should be under 150 mg/dl for optimal long term health.

Give the Ornish kitchen a good look (another well known and highly trusted doctor with REAL evidence) - https://www.ornish.com/kitchen/

I've also had similar yet worse results from high sat fat ketogenic diet. Hepoberman, I assume you've quit doing ketogenic high fat diets and switched to the Ornish diet? What is your intake percentage of fats, Carbs & protein? Curious if you drink olive oil by the liters like a lot of folks here on the forum. What about nuts (almonds, macadamia, walnuts)?


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[Julie G]

LG1, excellent LPIR, good ratios, nice HDL- all cardioprotective, BUT, your elevated LDL-P IS concerning. Many here use a similar approach, but limit SFA to 10% or less of total calories. Have you considered replacing much of your SFA with MUFAs and PUFAs? (avocado, olives, nuts, EVOO, fatty fish.) Many here have had dramatic reductions in LDL-P using that approach. Any idea of your macronutrient ratios? I'm wondering in particular about your fiber intake. Even though I limit my carbs to 20% of my total calories, I eat over 10+ cups of non-starchy vegs a day. The fiber is very helpful for us hyper-absorbers. Do you use intermittent fasting? Are you exercising? As I recall, you're around 50 (?) How's your BP, BMI, homocysteine, Vitamin D, stress level, sleep quality? Do you have a history of either AD or CVD in your family? Thanks for sharing. We learn so much about lipid/diet interactions from generous contributions like yours.

We have to choose who to believe based on real evidence.

Hep, sweeping comments like this are generally unhelpful and besmirch the quality of our community. The implication is that "false" evidence has been presented. If you see something untrue on our forum, please correct it (with your evidence) but refrain from belittling opposing opinions/evidence.

[LG1]

Ha ha,such passionate responses. Really appreciate you guys taking the time to give me your opinion based on your experience.

There is a ton of controversy regarding which numbers matter and which don't...some say disregard high cholesterol in the presence of low inflammation markers. I will be digging into this info and posting what I find confusing in the next few days. I know Gundry doesn't like sat fat and I know switching to muffas and puffas could likely make those numbers better. I'm just not convinced the high numbers mean plaque build up. If it does, then why do I show such great numbers in all other inflammation areas? I am not convinced but curious enough to go ahead and give the diet switch a try although I absolutely loathe the idea of eating that way. I like my heavy cream in the morning coffee and bacon in my brussels sprouts. Sad.

Julie, I am 50, my BP is amazing (used to be a runner), my BMI is 22.63, 137 lbs. and 5'6" (want to be 125), homocysteine 9, Vit D within range but want to get it higher, stress level pretty chill, sleep like a baby, walk 3 days wk, weights 2 days (want to do more and add HIIT), no IF (willing to try by starting small).

One thing to note: I am dealing with thyroiditits which can cause high LDL but last year my LDL was also high and no thyroid issue. It is now optimized by the way and I will not have to be on synthroid forever... but may be some months before I can get off of it.

Also, I stopped drinking wine and my HDL went from 135 to 100, at least I think that is what caused the change.

My fiber intake is irratic so sometimes spinach with a meal and sometimes none at all. When you say 10 cups do you mean cooked or raw? 10 cups of raw spinach wilts down to a very small amount.. maybe 1 cup? Can you clarify what you mean by 10 cups? I have been trying to do better.. I made rainbow chard and kale in the crockpot with onion and garlic and it was good... then I added broccoli sprouts and spinach to my smoothie... but now I guess no more smoothies.. If I can't have cream or coconut mile forget it. (Pouting, almond milk is not exciting to me)

This should be an interesting experiment. I'll redo my numbers in a couple of months.

Going to ask my doc about advanced cardio testing to see if there is any clogging going on, yikes.

Have a Happy New Year!

Laura

[ERK]

I only have one APOE 4 allele and I managed to have even worse results than that on 3 out of 4 variations of high fat dieting over two years, --so don't fret, it could be worse. You clearly need to make radical changes though. Your elevated TC and LP-PLA2 predispose you for plaque accumulation.

There is no such thing as "quality" Sat fat. Saturated fat is akin to poison to a person with APOE 4/4. I know it may sound as if I am absurdly focusing on a single type of fat but I assure you that if you could find a way to eliminate sat fat, your lipids would begin to normalize. We 4's struggle to metabolize fat and cholesterol as it is, Sat fat chains are rigid little sticks that really "clog up the works" (not arteries but biochemical pathways). Its nearly impossible to eliminate sat fat entirely.

It took me a few months to make a slow transition towards a whole plant food based diet, but now I love it. (and so does my lipidologist, my wife, and my dinner guests!). Within four months my TC dropped 26%, a year later 41%. My lipidologist says now my labs resemble his centenarian patients. We have to choose who to believe based on real evidence.

In Cholesterol Lowering, Moderation Kills - http://www.dresselstyn.com/site/study05/

The link above refers to published, peer reviewed proof of plaque reversal. TC should be under 150 mg/dl for optimal long term health.

Give the Ornish kitchen a good look (another well known and highly trusted doctor with REAL evidence) - https://www.ornish.com/kitchen/

I've also had similar yet worse results from high sat fat ketogenic diet. Hepoberman, I assume you've quit doing ketogenic high fat diets and switched to the Ornish diet? What is your intake percentage of fats, Carbs & protein? Curious if you drink olive oil by the liters like a lot of folks here on the forum. What about nuts (almonds, macadamia, walnuts)?


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Same too, terrible numbers on high fat all the way around. Esselstyn does not allow nuts. My 88 year old mother is a 4/4 and has eaten that way her entire life(all plant, no nuts, added oils/fats) . She is the healthiest person I know, physically and mentally (sounds odd for me to say that as I know athletes but this is true). Anyhow Hep, you mention centenarian biomarkers- can you point me in the direction of those studies? Some years ago I remember seeing healthy centenarians have a median TC level. I know that is just marker but I am personally not convinced that high numbers = good.

Even my ND flagged my HDL at 73 high and says that used to be accepted that it's good but not anymore so it depends who you ask.

[Stavia]

LG, I personally believe, after watching different members (and many patients over decades) biomarkers react differently to various inputs, that a cookie cutter approach is too simplistic.
Two issues here seem to be the nub: are your lipid numbers a danger, and if so, what is the correct strategy?

Nobody can guarantee the answer to the first. The evidence is clear that lipids matter sometimes, and sometimes not. Sometimes predictably, sometimes not. It is clearly an extremely complex issue that is still incompletely understood.
My basis for this statement is that unlike an illness for example like Ebola where infection=disease, high lipids (in the absence of a nasty rare genetic disease) do not 100% predictably lead to cardiovascular disease and death. There is inconsistent correlation. Everyone knows personally of examples both ways - those with high lipids who live a long time with no heart disease, and those with "normal" lipids who develop heart disease young. This is exactly why there are two (passionate) opposing camps who each reference the part of the evidence that supports their own interpretation and ignore the rest. We have two (neglected) threads on our forum where we tried to gather the evidence for a low fat diet and the evidence for a high fat diet. This is in my view possibly even too simplistic as diet does not consistently affect LDL either ( I am a 4/4 and my LDL doesn't budge whether I am on 5% fat or 55%. But my HDL has almost doubled on the 55%. Shrug.)

The two camps will never agree with the current level of evidence and some are quite aggressive in their denial of the others' points of view. Some of us do not have allegiance to either but take a measured and individual view of each person and their risk factors.

Secondly, if you want to hedge your bets and consider that it is prudent, yip, sorry, but dropping saturated fat amounts is an obvious way to experiment. It shouldn't take long to see a result. Within 4 weeks you should have most of your response obvious. The only evidence that matters here in this second issue is how your own body responds.

[LG1]

Some years ago I remember seeing healthy centenarians have a median TC level. I know that is just marker but I am personally not convinced that high numbers = good.

Even my ND flagged my HDL at 73 high and says that used to be accepted that it's good but not anymore so it depends who you ask.

This is exactly my point. Very well respected experts with information and studies out there and they all contradict each other. We simply do not have all the answers. I'm not convinced cholesterol is a bad thing at all. Some say it is protective.

I like to self experiment although I'm sure the results will disappoint most data nerds is I'm neither a scientist or an engineer. I'm going to give this change in diet of whirl. Also, just for fun I have ordered a continuous glucose monitor and I'm looking forward to determining what things raise/lower my blood glucose and ketones. I'm also strongly considering getting the cardio scan as well as just for fun the Sniffen Sticks smell test.

[thumperama]

In Cholesterol Lowering, Moderation Kills - http://www.dresselstyn.com/site/study05/

The link above refers to published, peer reviewed proof of plaque reversal. TC should be under 150 mg/dl for optimal long term health.

@Hep, Esseltyn clearly uses cholesterol lowering medications in his practice.

From the linked article: "My own experience with heart disease patients shows that cholesterol levels can be kept below this threshold with a diet low in lipids and cholesterol-lowering medications as needed."

It would be difficult to tease out if its the reduction in dietary SFA or the medications that are halting events in his populations. I think we would all love to know if diet and lifestyle alone could produce similar results.

[LG1]

( I am a 4/4 and my LDL doesn't budge whether I am on 5% fat or 55%. But my HDL has almost doubled on the 55%. Shrug.)

Stavia, thanks so much for the input. That is fascinating... no change! Have you tried any other methods of lowering the LDL at all? What is your LDL number (or if private no worries).

We have two (neglected) threads on our forum where we tried to gather the evidence for a low fat diet and the evidence for a high fat diet.

There are SO many controversies.. even in the high fat vs low fat... ok so what kind of fat, and how much? Yes, each individual is different and on here we are all trying to find out what works best for us while simultaneously trying to find out what our shared Apoe 4 does apart from that.

I will search for the low/high fat threads and see if I can find something to contribute.

Meanwhile, for lunch I had a stir fry of asparagus, onion, mushroom which I loaded with olive oil then sprinkled with broccoli sprouts and chopped avocado. Am I on the right track? Going to stick with high fat for my first experiment... just switching from sf to olive oil. If that doesn't do anything I will up my exercise and/or tweak my macros.