Philly's Lipid Tests

[PhillyFree]

I got my HDLabs results for Oct 24, 2013 back yesterday. However I question the results on the more well-known tests I've had before and recently such as A1C coming out way too low and not in line with my fasting glucose or past A1C results, total cholesterol coming out quite low at 137, TSH coming out quite high and not in line with fT4 and fT3 nor recent TSH tests, so I may look into a re-run. Also a very low total cholesterol is not in line with a high TSH; if my TSH were as high as they say, I would have a higher total cholesterol, likely 200 or above.

A few preliminary / tentative results, pending a possible re-check:

(Age 63, APOE3/4, BMI 29, weight and diet stable in the last year, weight loss the previous year. Gluten-free, dairy-free, sugar-free, 50-80% raw (veg, fruit, nuts, seeds, some coconut products), 3 jumbo eggs 3x/week, fish 3x/week, occasional beef and chicken. Oats, brown rice. Mixed source protein powders. EVOO. Avocado 3-4x/week. No omega-3 or fishoil supps. No butter. Macronutrients: 10-15% protein, 25-30% fats, remainder is carbs from veg, fruit, oats, brown rice.)

Total Cholesterol 137 (they consider this optimal, result down from 160 and 175 in the last year).
LDL-C 82 OPTIMAL
HDL-C 46 (they consider this High Risk, though it's just 4 points outside of optimal range, not an issue IMO)
Triglycerides 89 OPTIMAL
Non-HDL-C 91 OPTIMAL

Apo B 61 Intermediate risk.
LDL-P 1099 Intermediate risk.

ApoA1 121 HIGH risk.
HDL-P 31.3 Intermediate risk.
Lp(a) mass 8 OPTIMAL

Inflam markers:
Myeloperoxidase 231 OPTIMAL
Lp-PLA 158 OPTIMAL
hs-CRP 2.6 Intermediate risk (up from optimal about a month ago, cause unknown)
Fibrinogen 418 Intermediate risk

Myocardial stress:
NT proBNP 116 OPTIMAL
Galactin-3 15.3 OPTIMAL

Insulin 5 OPTIMAL (test done fasting)
Free fatty acids 0.67 Intermediate risk (possibly from higher-end natural norepinephrine level? test excitement?)

Glucose 94 (they consider this optimal, I'd consider it Intermediate risk)
A1C 4.9 (seems WAY too low for a fasting glucose of 94 and history of ample and prolonged postprandial spike,
seems like A1C should be about 5.8 as in the recent past)
Estimated average glucose 93.9 (note this is their estimate, I'd estimate higher, with Intermediate risk)

Vit D 19 (was 20 a month ago, which is typical for me, and 1,25-D calcitriol is still too high).
Uric acid 5.1 OPTIMAL
TSH 4.73 High risk. (I suspect lab error due to 2 other recent testings, and tests going back 10+ years,
and a high TSH not correlating with normal fT4 and fT3).
Homocysteine 12 Intermediate risk. (up from 10 a month ago, cause unknown, wonder about possible lab error)

Renal:
Cystatin C 0.92 OPTIMAL
EGFR 97 OPTIMAL

Fatty Acids:

Omega 3 total 10.8% [0.1% - 14.1%] (Looks good to me. Comments?)
ALA, DPA, EPA, DHA all look ideal mid-ref range.

Omega 6 total 31.8% [28.6% - 44.5%] (Looks good to me. Comments?)
AA and LA all look ideal mid-ref range.

Other fatty acids - all look ideal mid-ref range:
cis-monosaturated 17.4%
saturated total 39.4%
Trans total 0.6%


They did get my relevant genetics right though, based on a check against 23andme:

APOE3/4 (which they classify as High Risk, though I might classify it somewhere between Intermediate and High).

Factor V Leiden - wildtype - OPTIMAL.

Prothrombin mutation - wildtype - OPTIMAL.

MTHFR C677T wildtype. OPTIMAL.
MTHFR A1298C heterozygous. Intermediate risk. (I say minimal risk, if considered together with C677T wild above.)

CYP2C19*2*3 - wildtype OPTIMAL (not a poor metabolizer on this SNP).
CYP2C19*17 - wildtype OPTIMAL (not an rapid or ultrarapid metabolizer on this SNP).


Anyone else had testing from HDLabs?

[Julie G]

Wow, Philly- You KNOW I'm no expert here, but a few things jump out at me. I see a strange discordance between your very low LDL-C and Relatively high LDL-P. That's usually explained but metabolic syndrome, but your numbers look great there...Then your apoA is a little low, throwing your apoA/B ratio off. I'm sure you're frustrated by the unexplained discordance. I think you are very wise to re-test, paying attention to your thyroid numbers.

Are you exercising now? I know some daily walking, bike riding, etc. could help bring your HDL up and help align the apoA/B ratio.

Out of curiosity, what does your doc recommend?

EDIT: is your HDL-P a typo? 31.3 is great.

[Ski]

Philly, care to share your diet with us in the Nutrition section? Think obviously the two go hand in hand.


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[PhillyFree]

I checked a few APOA1 genetics:

rs670 CC=GG wildtype, result shared by 50% of EUros.
Risk allele = A in regard to lymph node negative breast cancer, I haven't researched enough yet in regard to cardio/AD.

rs5072 GG=CC wildtype, result shared by 83% of EU.

rs5070 GG (technically homozygous variant, however I see the ancestral allele as unclear and suspect that
G is actually ancestral and my result would then be wildtype). My result is shared by 42% of EU.

My tentative speculation is that the wildtype APOA1 may contribute to a too-low result on APOA1 testing. Comments?

From Wikipedia, APOA1 is the major component of HDL-C:
http://en.wikipedia.org/wiki/Apolipoprotein_A1

My HDL-C has always been slightly low or right on the border.

[PhillyFree]

@Julie, my HDL-C has always been slightly low or borderline no matter what I was doing or not doing.

Am going tomorrow to talk w my PCP about the test results and explore any need for a re-do.

[Julie G]

I'm hetero for 2 of those and homo with you on rs5072...

I'll have to study the SNPs to better understand the implications. Did you see 23 and Me has dozens of ApoA1 snp's they check- many more than these 3? Might be interesting to run the all down.

[PhillyFree]

@Julie, I went to talk to my PCP about the HDLabs test results. He's looking into it further, whether lab errors or something else going on. More info when I have it!

[Julie G]

Hey Philly, so glad you're pursuing it further. I've been thinking about your results quite a bit...something's really off there. It's almost like you escaped the pitfalls of metabolic syndrome with your incredible A1c...but your lipids didn't get the message. Does that make sense? Perhaps it's because your carb load is on the high side- even though it's all good stuff???

Maybe nothing a daily shot of EVOO couldn't fix In study after study, raising healthy fats improves the lipid profile...if you think beyond TC...i.e higher HDL, lower TG, etc.

PLEASE let us know what you learn. I feel you. I'm still a little stunned with my results too

[PhillyFree]

Without more investigation, I'm not overthinking this.

I get EVOO nearly every day. I just don't heat it anymore, no more stirfry's
My skin looks so much better since not doing heated oils, am hardboiling eggs instead of scrambling or frying them
in even a small amount of oil, and keeping fats to 25-30% of the diet. One decent sized avocado just about maxes out my fats allotment for the day.

I'm very pleased that my omega 3's, 6's, arachidonic acid, sat fats, monosat fats, DHA, transfats etc all turned out so well on the HDLabs test. Could not be a better balance.

[Julie G]

I'm with you there; I stopped cooking with EVOO too. Glad you still find ways to use it. There's so much research suggesting it's really helpful for us.

Best of luck sorting things out. Let us know what you learn.