Interventions had OPPOSITE impact on lab results!

[Orangeblossom]

Interested to see that in the blog mentioned, he is 3/4 and says sat fats seem to reduce his levels of LDL-p.

[SusanJ]

Orange, that's why we always say N=1 here, because of the great variation in the genes we have. Everyone reacts differently to dietary choices like saturated fat. There are so many genes at play beyond ApoE4 not to mention our levels of stress or underlying illness. We're just so darned complex as humans.

[jcosmo]

Tomorrow morning, I'm getting blood drawn for fasting insulin and another NMR Lipoprofile. The appointment with the cardiologist/lipidologist is next Tuesday, and yesterday I learned that I might've been shooting myself in the foot the whole time: http://www.sciencealert.com/doing-the-5 ... h-suggests

I've been taking 100 mg resveratrol daily, 20 mg PQQ daily, and 500 mg vitamin C twice daily.

On most days, I've been aiming for 20% calorie restriction, consuming all of the day's calories within a period of 8 hours or less (on most days, it's a 3-6 hour period). If this next round of bloodwork doesn't show improvement - or if the values are even WORSE - I'm going to ditch the antioxidants and try alternate-day fasting. But the more I read about statins, the more convinced I become that they are NOT the answer.

[jcosmo]

I thought the results would be back before my appointment, but they weren't. This might've been a blessing in disguise. (The notice that results were in actually came to my email DURING the appointment.) Now I'm feeling more than a little stumped and hopeless, since the lab values just keep getting worse...

But first, the good news:

Based on having few personal risk factors and a high-ish HDL, the lipidologist ordered a calcium scan and said that if it doesn't show anything, he'll consider me low risk (no need for statins) and will want me to repeat the scan in 10 years, since it might just be too early to detect something.

Brief summary of the main interventions of the past month:

- Daily calorie restriction to ~1250 kcal during the week
- Most of the deficit was achieved by eating less fat
- All calories consumed in a 2-8 hr window (within 5 hrs most of the time)
- Higher carbs on Saturdays (40g net vs. 20g net, usually from bell peppers, blackberries, brussels sprouts, etc)
- Higher calories on Sundays (up to around 1500)
- 100 mg resveratrol daily, 20 mg PQQ daily, 500 mg vitamin C BID
- HIIT at least 4x/wk... which I stuck with for 2.5 weeks before frequency decreased

So here's the latest round of results:

Test ............................ 10/26/17 ............. 11/24/17 ............... 1/03/18
LDL-P .......................... 1968 High ...........1853 High ............. 2168 High
LDL-C .......................... 159 High ............. 154 High .............. 163 High
HDL-C ......................... 70 ......................... 55 (!!!) ................... 68
Triglycerides .............. 98 ......................... 194 High (!!!) ........ 151 High (!!!)
Cholesterol, Total ...... 249 High .............. 248 High .............. 261 High
HDL-P (Total) .............. 38.4 ...................... 30.6 ...................... 39.2
Small LDL-P ................. 725 High ............. 654 High .............. 1014 High (!!!!!)
LDL Size ....................... 21.4 ..................... 21.2 ...................... 21.2
LP-IR Score .................. 30 ........................ 53 High (!!!!!) ........ 40
HgbA1c ........................ 4.9 ....................... not tested ............ not tested
Lipoprotein (a) ............ N/T ...................... N/T ........................ 15
Insulin .......................... N/T ...................... N/T ........................ 6.9

For references, these were the results of my first NMR Lipoprofile from 12/02/16 (~5 months after starting a ketogenic diet):

LDL-P: 1354 High
LDL-C: 141 High
HDL-C: 80
Triglycerides: 112
Cholesterol, Total: 243 High
HDL-P (Total): 34.9
Small LDL-P: <90
LDL Size: 21.3
LP-IR Score: <25
HgbA1c: 5.2

Soooooo what now? Ditch the antioxidants and start alternate-day fasting? Do a 2-4 day extended fast every other week? A daily 1000 kcal meal of olive oil, sardines, vitamins, and kale/spinach? (If those aren't beneficial or at least benign when it comes to the lipid profile, then I don't know what is.) Since each new idea seems to make things worse, I'm afraid to try any of these things, but I can't keep doing what I'm doing and expect things to improve on their own

[Julie G]

(((jcosmo)))- Frustrating! I read back over the thread to get a bigger picture. Because of your strong family history of CAD, I'm glad that your doc has ordered a calcium scan; however, given your age (31?) I doubt it will reveal much. In cases such as yours, I know some docs will order a CT-scan (much higher radiation) to see soft tissue calcification which is more likely at your age. Another option is a carotid ultrasound (CIMT), but the correlation between that and the heart is debated. Many of our members have found poor correlation. The BEST option for you may be a newish blood test called Corus that claims to reveal current risk. (This is something that my lipidologist considered for me as I was balking at the radiation exposure of an EBT.)
-Have you followed up on the thyroid angle? A down-regulated thyroid will be less able to clear LDL.
-How about an underlying infection, like h.Pylori? That will also cause LDL to rise?
-Your fasting insulin is higher that I'd like. Are you using a glucometer? Tracking daily fasting glucose and post-prandial levels would give you a wealth of information. Some on the site would suggest that JUST pursing this angle will give you the most protection against heart disease.
-You describe various dietary strategies, but I'm unable to get a handle on your macronutrient ratios. Do you use CRON-O-meter or a similar program? That information would be valuable to have when tracking diet/lipid interactions.
-When your LDL-P was lower, were you practicing caloric restriction then? What are your macronutrient ratios like then?
-Your BMI is quite low for a male. Has that been trending downwards over the years?

[jcosmo]

My FBG normally ranges from 90 - 120 when I test at home with a glucometer, but somehow, I've NEVER had a high fasting glucose on a BMP or CMP. I'm never sure how much of it is a side effect of a ketogenic diet...

These are the averages for my macros leading up to each test. I used MyFitnessPal for almost a year (which doesn't always have the values for SFA, MUFA, PUFA), but I started using Cron-o-meter at the end of November. I don't count sugar alcohols with net carbs, but the only one I use is erythritol, and I don't use a ton of it.

I hope this isn't too difficult to read:

NMR LP Date Range Calories Protein CHO Fiber Net CHO Fat SFA PUFA MUFA
12/2/2016 10/29 - 12/1 1487 61 53 35 17 127 48 10 24
10/27/2017 9/24 - 10/26 1407 53 35 18 17 116 40 8 33
11/24/2017 10/27 - 11/23 1457 48 51 33 18 127 31 11 59
1/3/2018 11/30 - 1/02 1238 50 70 38 23 95 27 10 34

[Julie G]

Out of curiosity, what kind of meter are you using? Your FBG numbers seem on the high side. Strange that they don't correlate with actual blood work, but your insulin was also a little high this time. This seems like an important area for you to work on given your strong family history of T2D and CAD.

Also, have you checked homocysteine or C-reactive protein? Other inflammation biomarkers? It's important to optimize those.

To be honest, it's hard to decipher your numbers as they're all crammed together. Looks like you're reporting actual grams as opposed to percentiles. I did the math and your current macronutrient ratios look a lot like mine, about: 13%-P, 19%-C, 68%-F. I'm as perplexed as you, my friend. My guess is that if you went back to your higher SFA/lower carb, your lipid numbers probably wouldn't revert back to your previous lows. Others have commented (and I've witnessed) a "honeymoon" period in some members when first using a low carb approach. Was the 2016 data shortly after you first made the switch? Have you ever tried a HCLF approach? If so, what were your numbers like then? How do you generally feel now? Energy good?

I don't like the fact that your small LDL is dramatically moving in the wrong direction...I hate to sound like a broken record, look into thyroid optimization, underlying infections. Your fiber intake is good, considering your low caloric intake. You could consider increasing it with this, which feeds good gut bacteria and promotes GI motility... if that's an issue. Since I've been using it, my cholesterol took a huge nosedive. I like the idea of adding the inulin back into your routine. It's a terrific prebiotic. Perhaps focusing on gut health is an another area of intervention that could help?

I'm proud of you for quantifying, testing and tweaking. Given your family history, I think you're right to be concerned. If your lipidologist/cardiologist doesn't have any other ideas, I might consider working with a functional medicine practitioner who will help you pursue all of the angles I've suggested. Keep sharing your journey, jcosmo. I suspect that you'll figure this out and teach us all something in the process.

[jcosmo]

Is there a way to post a grid? I had copied and pasted the values from a spreadsheet... I pasted them again and entered spaces to space them out, but when I looked at the preview, it looked exactly the same.

I'm using the Nova Max Plus meter because it tests ketones as well.

There doesn't seem to be any kind of logical pattern when I look over historical data...

I moved at the end of 2014 and didn't find a GP until 2016. She ordered labs and recommended a low-carb, low-fat diet. I was a vegetarian at the time, and didn't see a practical way to do both, so I went low-fat and my biomarkers got worse. I did some research, read about the ketogenic diet, tried it, and my markers improved, though my LDL was still high, which is why I had the first NMR Lipoprofile done. I wasn't convinced that my entire risk level could be based on a single value. That was also the highest HDL I've ever had (80).

I switched to a ketogenic diet in the first week of July 2016 and had the first NMR LP done 5 months later. When I look back at what I logged in MyFitnessPal the month before the test, I was eating more eggs, cheese, nuts, fish, and coconut oil. Calories were often between 1400 and 1600. I also weighed around 98 lbs (I'm 5'2").

I only have one set of lab records that actually shows normal lipid values. These are from December 2014, right before I moved. I was working as a contractor, traveling often, eating a very small breakfast (if anything), skipping lunch, working long hours, and eating dinner (from a grocery store or The Fresh Market) high in all 4 macronutrients: protein, fat, carbs, and alcohol. I was also drinking 1-2 glasses of wine 4 or 5 days out of 7.

December 2014:

Total cholesterol = 187 mg/dL
HDL = 50 mg/dL
TG = 81 mg/dL
LDL = 121 mg/dL
FBG = 91 mg/dL
HgbA1c = 5.2%

I checked homocysteine recently after learning that I had 2 copies of the MTHFR C677T variant, though it was 1-2 months after I'd already started taking methylfolate and methylcobalamin.

October 2017:

Homocysteine = 8.3 umol/L
CRP, cardiac = 0.44 mg/L
HgbA1c = 4.9%

I moved again in December 2016 and I'm seeing my original GP again. She doesn't consider my TSH to be high, though my TSH was 3.27 in Dec 2014 (when I had lipid values WNL).

Thanks for the fiber recommendation. I'll look into it! TBH, I only added inulin to my coffee for 2 weeks or so before listening to a podcast that said anything with calories will halt the fasting state and its benefits (autophagy, etc) >_<. Since soluble fiber is supposed to keep the cholesterol component of bile from being reabsorbed, is it only effective when taken before high-fat meals, or does it matter?

I searched for a practitioner of functional medicine, but only found 3 within reasonable driving distance and wasn't sure if any of them accepted my insurance. Fortunately, the cardiologist/lipidologist I saw on Tuesday doesn't believe in treating lab results, so the calcium scan is scheduled for 1/22.

I just looked up my Walgreens Rx history and saw that I was taking niacin 500 mg ER at the time of the first LP. I'd forgotten about that. When the doctor wanted to put me on statins, I'd asked for niacin instead, but had stopped taking it when the cost jumped from $15 to $80. I still want to see if I can improve my biomarkers on my own... but if the next thing I try doesn't do it, niacin might be the best option.

[SusanJ]

Just a heads up, taking niacin might spike your homocysteine, so make sure you put that marker on the pile when you retest.

All very tricky, indeed. Keep us in the loop!

[Julie G]

All great info. Your homocysteine is a little high, but not bad. Are you addressing with the trifecta (b12,folate, B6) of Bs? Your hbA1c is terrific, which really makes me wonder about two things: 1.) could your glucometer be off? 2.) hard to synchronize that with your higher insulin. You may have a very labile pattern that's giving you the mixed messages OR things could have gone south since Oct also accounting for the elevated small LDL-P...

Another member (whom I consider to be wise) and I were "chatting" about your mixed clinical picture and we both came to a similar hypothesis. We're wondering if the CR isn't serving you well. Perhaps your body is misperceiving a chronic energy shortage and your liver is ramping up cholesterol "energy" to compensate. I wonder how your numbers would change if you kept the same healthy diet and lifestyle habits, BUT only practiced CR every other day? Just a thought.