Our 3rd annual meet-up will piggyback on the LowCarb USA conference in San Diego, CA, August 3-6.

Fidel's tests

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
Fidel
Contributor
Contributor
Posts: 32
Joined: Sun May 31, 2015 12:08 pm

Fidel's tests

Postby Fidel » Sun May 31, 2015 11:28 pm

At the 6 year mark into vegan dieting (following 3 decades of lacto-vegetarianism), got an advanced lipid panel for the first time, not via NMR but ion mobility fractionation. Does anyone here consider that method as accurate as NMR?

Tc=173, HDLc=42, TG=120, LDLc=107, Tc/HDL=4.1, non-HDLc=131

LDL particle number=1139 (considered optimal by the Quest diagnostic lab whose reference range is 1016-2185), LDL small=260 (high risk), LDL medium=215 (moderate risk), HDL large=4311 (high risk), LDL pattern=B (high risk), LDL peak size=210.3 angstrom (high risk), Apolipoprotein B=91 (moderate risk), Lipoprotein (a)=72 (optimal)

Was testing a diet including daily consumption of some refined grains and added sugars, and that must have contributed to the highest TG number i’ve seen for me, not to mention the first high fasting glucose (102) i’ve seen, though A1c came in at 5.5, not pre-diabetic. Sticking with mostly complex carbs looks like a healthier path for me.

Oils i was eating included red palm oil, canola vegenaise, and Earth Balance buttery spread (palm, canola, safflower, flax, evo). Doesn’t look like there was enough tocotrienols in the red palm oil to counteract the LDL-raising effect of the saturated fat in it. Saturated fat bumps up HDL but it also is known to impair insulin resistance, so i might have gotten better results not using the red palm oil.

Was getting about 60% of calories from carbs, 30% from fat (7% saturated), 10% from protein. After this test i discovered i’m an apoE-3/4, so my present direction is to move toward the suggestion for that genetic group given at http://gg.gg/apoE-macro-guide -- 55% carb, 25% protein, 20% fat, or maybe 60-20-20.

TG/HDLc=120/42 (2.86). My ratio was closer to where it should be -- 83/40 (2.07) on last year’s test when i was testing fatty whole plant food and no refined flours or added sugars. The TG/HDL ratio was better still 2 tests ago in 2012, 64/44 (1.45) when my body weight was lowest. Since that ratio is said to predict LDL particle size, i started to think that i likely had the optimal LDL pattern A in 2012, but after reviewing the case study http://gg.gg/apoE-cs-3 i’m less inclined to think that since the lady had a superb TG/HDL ratio but still had lots of small particles. Has anyone here successfully converted an LDL pattern B into pattern A? Is that as doable as is lowering LDL-c? Paleo promoters make the blanket statement that more fat and less carbs will increase LDL particle size but there are studies showing low fat diets reducing levels of small, dense LDL for apoE 4 people: http://gg.gg/apo-E

Peter Attia makes the case at http://gg.gg/LDL-number that it’s particle number and not size that drives atherosclerosis. If he’s right, i might be alright at present if the ion mobility fractionation test method is sound, since my particle number is now optimal according to that test method. Attia says “Virtually all guidelines (e.g., ADA, ACC, AACC and NLA) only advise LDL-P via NMR at this time.”
3/4

User avatar
Stavia
Mod
Mod
Posts: 3939
Joined: Tue Apr 29, 2014 6:47 pm
Location: Middle Earth

Re: Fidel's tests

Postby Stavia » Mon Jun 01, 2015 3:08 am

Hi Fidel. Your post is jampacked with information and raises many important questions. I anticipate great discussion.I am terribly jetlagged so will respond to only a couple of points.
I agree that its particle number that matters primarily for CVD. After that parameter the evidence appears to me to be murky. Also I am aware of the different risks of male and female carriers. ie higher cvd for men and higher AD for women. All very complex.
Re your current chosen diet - the link doesn't show on my phone properly. What is the evidence they base this on?
Can't think anymore so will just say welcome!!
I look forward to your contribution

User avatar
KatieS
Mod
Mod
Posts: 986
Joined: Wed Mar 05, 2014 1:45 pm

Re: Fidel's tests

Postby KatieS » Mon Jun 01, 2015 9:47 am

Fidel, Excellent question as how Quest's ion mobility compares with NMR. According to my doctor, the "NMR has been replaced by this newer" Quest test. I was unable to find updated comparisons, but this is from Quest:
(http://education.questdiagnostics.com/faq/FAQ134):

"The NMR-derived LDL particle number (LDL-P, nmol/L) includes the 3 LDL subclasses and IDL. The concentration is measured indirectly from NMR signals emanating from terminal methyl groups in the lipoprotein particle shell and core.6

In contrast, the ion mobility-derived total LDL particle concentrations (nmol/L), i.e., LDL small and medium subclasses, are a direct detection and quantitation of the total number of LDL particles.1"

My panel decreased almost 50% within two months of lowering saturated fat to 7% per CRON-O-Meter, pravastatin 10mg, daily intense one hour exercise and increase supplements. It was so dramatic, that I too question the reliability.

Maybe your small LDL and slightly high TG is related to starting insulin resistance and can decrease with lowering the A1c. Many of us check home glucose levels one hour after various meals to avoid spikes over 120. Definitely get your weight and refined sugars down when your TG were lower a few years ago.

As a vegan (less B12 availability), have you ever had your homocysteine levels checked? Do you supplement with fish oil?

User avatar
Stavia
Mod
Mod
Posts: 3939
Joined: Tue Apr 29, 2014 6:47 pm
Location: Middle Earth

Re: Fidel's tests

Postby Stavia » Mon Jun 01, 2015 10:16 am

Fidel I'm looking at your numbers after sleep and what is now jumping out at me is possible IR. Which is a risk with a vegan diet if not managed in an apoe4 appropriate way.
I am sure you are aware that HbA1c is only one (more than just sometimes inaccurate) marker of IR and we need to look at all the markers to determine if it is present. Our group and Dr Bredesen and Dr Isaacson etc etc consider it the strongest factor in e4 sequelae. (Second is inflammation. Lipids are important but lower down on the list)
What is your waist circumference? Do you have belly fat? What is your BMI? Do you have LFTs suggestive of fatty liver? What is your fasting insulin?
I see your TGs are higher than we would like for an e4. As you are aware this is a marker of IR. In addition you have too many small particles. Again a marker of IR.

Onto my 2 cents worth re your diet: None of us eat any sugar or refined carbs at all because of the critical role of IR both by itself and because of its role in inflammation, the second critical negative influence on apoe4 downstream effects. I understand that a vegan diet is tricky but I wonder if your carb % is a bit high. I would urge you to target IR first which will improve your lipid profile as well. But lipids are not our primary target. If you reduce your carb % you would have to up your fat% which could come from the safest vegan sources which we consider to be avocado, EVOO, nuts. Within reason our group has not found that increasing non saturated fats has adversely affected our lipids but there seems to be a threshold at which it will. This appears to be individual. But you are far away from it at your present fat %. It appears to be above the 50% mark.
I also urge you to consider your omega 3/6 ratio and supplement with a vegan product suxh as Ovega.
Your link isnt working on my phone but I am not aware of basis of recommending such a high carb % for us. It is contrary to the recommendations of the world leaders in the AD field.

20% protein is much better IMO than 10% because sarcopaenia is a risk factor for AD.

I apologise for my scanty first post. My brain had shut down after many hours overseas travel and a massive sleep debt.

Fidel
Contributor
Contributor
Posts: 32
Joined: Sun May 31, 2015 12:08 pm

Re: Fidel's tests

Postby Fidel » Mon Jun 01, 2015 1:13 pm

Naturally Quest will present their own test as the best, but if they are right about it being a more direct measurement than NMR, then maybe we can count on it.

As a vegan (less B12 availability), have you ever had your homocysteine levels checked? Do you supplement with fish oil?


Haven't had homocysteine checked yet but i think i might get that checked soon. Don't anticipate an issue with that since i take a weekly sublingual liquid dose of methylcobalamin. My serum b12 level actually came in too high on the last test, so i've reduced my weekly dose from 10 drops (2000 mcg) to 5 drops (1000 mcg). My serum folate level was good, and i get plenty of B6 from bananas, so i'd be shocked if my homocysteine is too high.

Since i'm a vegan i do not use fish oil. Presently i've been getting omega 3 ALA from chia seeds, canola vegenaise, Earth Balance spread that contains flax, and some DHA & EPA from Gardein fishless filets.
According to http://gg.gg/apo-E , fish oil can suppress HDLc & HDL2 and raise LDLc for apoE-4 people.
3/4

Fidel
Contributor
Contributor
Posts: 32
Joined: Sun May 31, 2015 12:08 pm

Re: Fidel's tests

Postby Fidel » Mon Jun 01, 2015 3:01 pm

Stavia wrote:What is your waist circumference? Do you have belly fat? What is your BMI? Do you have LFTs suggestive of fatty liver? What is your fasting insulin?
I see your TGs are higher than we would like for an e4. As you are aware this is a marker of IR. In addition you have too many small particles. Again a marker of IR.


At the time of the test my BMI was at the low end of normal, about 19. Might have had a little belly fat, but i did a grain-free month after the test and have dropped my BMI to 17.5 at present. Don't know my fasting insulin level and do want get that checked soon. It must have improved since i took the test.
Don't think my liver function tests suggest fatty liver. An interesting thing i can share there is that i learned i was exposed to the hepatitis C virus but my immune system defeated it on its own, something i was told happens only in 20% of cases. My apoE-4 status might have helped protect me there, according to http://gg.gg/E4-HCV.
My bilirubin level was high, but that can actually be good, according to the wikipedia article on bilirubin: Research has indicated that in the absence of liver disease, individuals with high levels of total bilirubin may experience various health benefits exceeding those with lower levels of bilirubin. Studies have found higher levels of bilirubin in elderly individuals are associated with higher functional independence. Studies have also revealed that levels of serum bilirubin are inversely related to risk of certain heart diseases.

None of us eat any sugar or refined carbs at all because of the critical role of IR both by itself and because of its role in inflammation, the second critical negative influence on apoe4 downstream effects.


Did get an infammatory marker test with a CRP reading of .2, indicating a low CVD risk.

But lipids are not our primary target. If you reduce your carb % you would have to up your fat% which could come from the safest vegan sources which we consider to be avocado, EVOO, nuts.


I think i'm more inclined to up the protein % rather than the fat % to replace some of the carb %, but the types of fat you mention do look like wise choices, considering that a higher monounsaturated fat % will protect the omega 6 to 3 ratio by keeping too many polyunsaturated omega 6 fats from worsening the ratio.

Within reason our group has not found that increasing non saturated fats has adversely affected our lipids but there seems to be a threshold at which it will. This appears to be individual. But you are far away from it at your present fat %. It appears to be above the 50% mark.
Your link isnt working on my phone but I am not aware of basis of recommending such a high carb % for us. It is contrary to the recommendations of the world leaders in the AD field.


The research at that link appears to focus on suggestions for apoE variants in terms of heart disease prevention. A low fat diet can be very protective for E4 people from that standpoint. Generally, maybe women can handle more fat than men, and men need to be more concerned about heart disease than women, while women might need to be more concerned about AD. My father died from heart disease and i haven't heard of any AD in my genetic line.

I apologise for my scanty first post. My brain had shut down after many hours overseas travel and a massive sleep debt.


No apology needed. Appreciate you taking the time to weigh in on my results.
3/4

User avatar
Stavia
Mod
Mod
Posts: 3939
Joined: Tue Apr 29, 2014 6:47 pm
Location: Middle Earth

Re: Fidel's tests

Postby Stavia » Mon Jun 01, 2015 3:16 pm

wow Fidel, you are lean!! Impressive.
I await your fasting insulin with great interest.
Yes, e4 men do have to dance between AD risk and CVD risk. I am of the opinion that there is huge overlap, but not completely. As a man with a family history of CVD, I agree that you need to carefully balance on the knife edge between lipids and IR. Its terribly tricky and we are all on this forum continually testing and tweaking.
I agree with your instinct to fist up the protein and focus a bit more on the MUFAs.
Good luck!
Please keep discussing, you have an excellent grasp of the subtleties :)

Fidel
Contributor
Contributor
Posts: 32
Joined: Sun May 31, 2015 12:08 pm

Re: Fidel's tests

Postby Fidel » Mon Jun 01, 2015 10:50 pm

Am thinking that toxins like to hang out in body fat, so dropping weight down can help dispose of toxins. A person who eats 100% organic food and breathes nothing but fresh, clean air all the time might be able to have a bit more body fat without trouble. Being underweight has some association with bad outcomes, just as being overweight does, so i'd say it's especially important to be getting all nutrients when one is very light.
3/4

Harrison
Contributor
Contributor
Posts: 197
Joined: Wed May 06, 2015 10:24 am

Re: Fidel's tests

Postby Harrison » Fri Jun 05, 2015 9:37 am

Just wanted to mention that the dietary recommendations at http://www.gbhealthwatch.com/GND-High-C ... l-APOE.php
particularly the 55% carbohydrate recommendation for e4+ appear to be from The perfect gene diet by Pamela McDonald. My personal impression of the book seems to match-up to Stavia's review I found on this site.

Fidel
Contributor
Contributor
Posts: 32
Joined: Sun May 31, 2015 12:08 pm

Re: Fidel's tests

Postby Fidel » Fri Jun 05, 2015 1:19 pm

I wonder if that gbhealthwatch page is using Pam McDonald as their source, or if they are both relying on another source. Pam does seem to have achieved good results with her patients, so i'm not going to brush her off that quickly.

One thing i personally find peculiar is that when i look at the frequency distribution of the apoE types at that same page http://gg.gg/apoE-macro-guide, the 3/4 phenotype is the 2nd most common among all the ethnic groups listed there, except for the Italy caucasians where it is one of the most uncommon at 1.5%. That jumps out at me because my parents were born in Italy. Can't help but wonder if it's a typographical error but maybe not?
3/4


Return to “Our Stories”

Who is online

Users browsing this forum: No registered users and 2 guests