Alysson's lipids

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Alysson's lipids

Postby alysson » Sat May 23, 2015 11:27 am

Hi folks,

I just had my lipids tested for the first time in almost four years. It was just the basic testing. One question I have is whether you'd suggest I do the advanced lipids testing (the NMR Profile).

Here goes:

Total cholesterol: 203 mg/dL (range: 0-200)
LDL: 107 mg/dL (range 0-99)
HDL: 86 mg/dL (range: >39)
VLDL: 10 mg/dL (range 0-40)
Triglyceride: 51 mg/dL (range: <150)
Total Cholesterol/HDL ratio: 2.4

The last time I was tested, my total cholesterol was 154, with an LDL of 83 and an HDL of 60. I've never had an HDL close to 86 before. Is that a good thing? Might it offset my above-range LDL? Or do I need to get the NMR Profile done to find out?

Honestly, I haven't been paying too much attention to topics about lipids. So really, I'm a newbie and would appreciate your thoughts to help get me started with exploring this arena.

Thanks for your input!
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Re: Alysson's lipids

Postby KatieS » Sat May 23, 2015 11:44 am

Alysson,
I had a spike of the LDL to 110 (not ideal, usual history of 80), but my LDL-P was 1789 (high, discordant with the basic LDL, but consistent with a 92 apolipoprotein B), so I've come around to the opinion all E4s should have advanced lipid testing at least once to confirm what appears to be a low-risk basic lipid panel. Also, my HDL was very high as was the HDL-P, creating a high-risk ratio. All my bad values have responded to my interventions and are in the optimal range now.

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Re: Alysson's lipids

Postby apod » Sat May 23, 2015 12:06 pm

Kitano wrote:Alysson,
I had a spike of the LDL to 110 (not ideal, usual history of 80), but my LDL-P was 1789 (high, discordant with the basic LDL, but consistent with a 92 apolipoprotein B), so I've come around to the opinion all E4s should have advanced lipid testing at least once to confirm what appears to be a low-risk basic lipid panel. Also, my HDL was very high as was the HDL-P, creating a high-risk ratio. All my bad values have responded to my interventions and are in the optimal range now.
I agree, LDL-P is probably the metric to follow rather than LDL-C. This is an interesting plot from Peter Attia's cholesterol series:
http://eatingacademy.com/nutrition/the- ... ol-part-vi
Image
There are some outliers with LDL-C over 130 and LDL-P under 900, while there are also those with LDL-C down under 80 with LDL-P over 1400.

I was under the assumption that HDL-P was protective and that a higher HDL-P with higher HDL-C was better than a higher HDL-C with lower HDL-P.

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Re: Alysson's lipids

Postby rep » Sat May 23, 2015 4:03 pm

Kitano - Are you saying you were able to bring down your LDL-P? Mine still isn't down, even after 5.5 months of drastic diet change and exercise. If you did bring down LDL-P how did you do it?

Are you both a hyper-absorber and hyper-producer of cholesterol as I am?

I've been out of the loop so I can't quite remember if you'll be at the Meet-up but I think you will, right? If so I look forward to meeting you there.

Kitano said
I had a spike of the LDL to 110 (not ideal, usual history of 80), but my LDL-P was 1789 (high, discordant with the basic LDL, but consistent with a 92 apolipoprotein B), so I've come around to the opinion all E4s should have advanced lipid testing at least once to confirm what appears to be a low-risk basic lipid panel. Also, my HDL was very high as was the HDL-P, creating a high-risk ratio. All my bad values have responded to my interventions and are in the optimal range now.

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Re: Alysson's lipids

Postby KatieS » Sat May 23, 2015 4:47 pm

Rep, Here's my post related to lipids:https://www.apoe4.info/forums/viewtopic.php?f=29&t=1332. Possibly another Dr Krause question as to whether this reduction is conceivable, particularly in regards to the lp(a). However, like you, the earlier labs were stressful, so I'm waiting a fw months to confirm. We'll commiserate next week!

Apod, this was the ratio noted in this discussion:https://www.apoe4.info/forums/viewtopic.php?f=5&t=535&p=14487&hilit=HDL+P#p14487Y
You are correct, but my ratio decreased, lowering the HDL-C form 116 to 101 and decreasing the HDL-P from 13394 to 8462. Questions related to this ratio, I submitted to Dr Mahley, as it is confusing.

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Re: Alysson's lipids

Postby LAC1965 » Sat May 23, 2015 7:26 pm

apod, thanks for posting the chart. I wonder if the low LDL-C, high LDL-P people tend to have the high particle count because of insulin resistance, instead of cholesterol over syntheses and/or absorption. Although it’s hard to know without doing the test for the production and absorption markers, I think I’m in this situation. My LDL-C is relatively low and was not affected by an increase in saturated fat with the addition of a significant amount of daily olive oil. But my LDL-P is high unless I severely restrict my carb intake, beyond the point that is likely healthy. And my insulin resistance score remains high even on a very low carb diet.

In any case, I thought my lipids were okay, as my LDL-C was never high, until I did the NMR testing. On my first test, my LDL-P was scarily high, which was a big wakeup call.

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Re: Alysson's lipids

Postby apod » Sat May 23, 2015 9:49 pm

LAC1965 wrote:My LDL-C is relatively low and was not affected by an increase in saturated fat with the addition of a significant amount of daily olive oil. But my LDL-P is high unless I severely restrict my carb intake, beyond the point that is likely healthy. And my insulin resistance score remains high even on a very low carb diet.
It's interesting, I'm currently running an experiment with LDL-P coming from the other direction. I was on a high EVOO diet with a decent amount of saturated fat, which I've replaced with more carbohydrate than I've eaten in years to see what that does to my particle count. In a couple weeks, I should be able to run another NMR Lipoprofile.

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Re: Alysson's lipids

Postby KatieS » Sun May 24, 2015 7:01 am

Apod, I made the same dietary change of decreasing saturated fats from 20-30g to 10-15g/day while doubling my fruit intake to 6/day.How did you increase your carbs? Please post your next NMR results.

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Re: Alysson's lipids

Postby Tincup » Sun May 24, 2015 8:37 am

After quite a few NMR tests under a variety of conditions and looking at much of the data, I was unconvinced that optimizing this was a sure answer for me. For example, I've got a local doc who treats people with a LCHF diet. He's been on same for 15 years. His LDL-P is 1700. His EBT calcium score is zero. He says he's got many patients who eat this way, have high LDL-P results and no calcification progression on limited Doppler CIMT tests. His PA says she only sees progression associated with insulin resistance. However my first imited Doppler CIMT showed some soft plaque, I'd been on a LCHF diet. The soft plaque indicates recent deposition.

I recently posted about serial EBT calcium scanning: https://www.apoe4.info/forums/viewtopic.php?f=5&t=1355&p=14812&hilit=EBT#p14806. Figure 3 from the Raggi paper indicates that if you can limit your year over year increase to 15%, you've reduced your risk by 95% (posted later in the same thread) Image

To me, these serial EBT scans answer the question, "is what I'm doing effective and enough," regardless of what your lipid results are.

My first EBT scan calcium score was 17. This puts me in the 47%ile for my gender, race & age (59) http://www.mesa-nhlbi.org/Calcium/input.aspx. My interpretation is that I do have calcification, however it is mild and I have time to see if my program is working to minimize increases in calcium. A recent poster to my doc's FB page said he has a score of 1060, but his progression was 2%. When asked about his program, he linked http://pi-bill-articles.blogspot.ae/2011/03/5-steps-you-can-take-to-reduce-your.html He also said, "I do take K2 and D3 for a miriad of reasons. Not really sure of the effect of K2 on plaque growth but I believe D3 is a key player. Dr Davis found that in his practice. He also found aggressive keeping BG low a significant factor. The best home monitor for those with CVD is a blood glucose meter. Keep BG low with LCHF. Just measured mine at 77." He also follows Dr. Blanchett's suggestions I summarized here: https://www.apoe4.info/forums/viewtopic.php?f=5&t=1043&p=14553&hilit=EBT#p14553

For me, I have a consult with Dr. Gundry in 6 weeks or so. I've received results from his Singulex and HDL labs tests. I already eat his "Matrix" diet as modified for E4's (low lectin, no nightshades, limit animal saturated fat, omega 3 or pastured eggs OK as are shell & white fish, emphasize unfiltered EVOO) linked here: https://www.apoe4.info/forums/viewtopic.php?f=16&t=1078&p=11591&hilit=gundry+matrix#p11591 My interpretation of my fatty acid profile is I should add more EPA & DHA. However, an NMR test where I maximized fish oil intake spiked both LDL-P and small LDL-P. A question for Dr. G. On a Labcorp NMR taken 2 days after the Singulex test, my LDL-P was 1292 and small LDL-P was <90 (off scale low). This is on the Matrix diet + 1 gram/day of niacin as Slo Niacin brand. Per Gundry's suggestion for niacin, I take 60 mg/day pycnogenol and 200 mg/day grape seed extract. I do take a modest amount of EPA - 360mg/day and DHA 240 mg/day.
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Re: Alysson's lipids

Postby apod » Sun May 24, 2015 9:12 am

Kitano wrote:Apod, I made the same dietary change of decreasing saturated fats from 20-30g to 10-15g/day while doubling my fruit intake to 6/day.How did you increase your carbs? Please post your next NMR results.
For a while carb intake has been around 20% (tons of vegetables with a bit of starch and not much sugar with maybe a small serving of fruit / berries) with SFA up over 30g/d from the EVOO I would put over the veg (probably up over 40g+ SFA some higher energy days with dark chocolate+nuts+grass-fed cheese, though I wasn't tracking back then.) I've doubled down on carbs bringing it up around 45-55% of calories (out of ~2100kcal/d) with lots (bordering on tons) of fruit and a bit more starch. It seems like I'm actually eating a little bit less veg lately than when I was on a lower carb diet. Looking at a particularly carby day, SFA was at 14.4g / 62g total fat with carbs up around 448g with ~200g of starch and 200g of sugar. On another day, I'm seeing sugar up around 230 grams with starch around 54 grams. When I need more calories, carbs seem to go through the roof while restricting SFA (I would be curious to see what this looks like on my blood sugar / a1c.)

Overall, my SFA intake has been cut down by more half and is averaging out to ~13g now supplying 5.6% of my daily calories with around 350mg dietary cholesterol (primarily driven up by seafood and eggs -- limited to 2 eggs in a day just a few times a week.) Total fat is averaging out around 71g for a ~4:1 ratio of unsaturated:saturated fats and a ~2.8 n-6:n-3 ratio with PUFA intake ~13g. Total carbs are averaging out to 250g. I've switched out full fat grass-fed yogurt with grass-fed non-fat filmjolk / skyr. I'm also considering throwing a fiber supplement over the top and dipping into whole grains. If the data doesn't show too much improvement, I'll move back in the direction of a lower-carb / mediterranean / paleo diet for another data point.

Next NMR should be early next month-ish.


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