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Blood test numbers - unexplained elevated triglycerides and sub-optimal cholesterol

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Updated about 8 hours ago
Created October 24, 2013 at 3:13 PM

Been Paleo for about 2 years now, but this is my first post on here. I've dug and dug and can't find any solutions to what I'm experiencing so I'm hoping this awesome community can help.

I consider myself a good paleo follower, practicing 80/90% most weeks in terms of food, and lifting primal while incorporating plenty of play (sports, like Basketball and Ultimate). I feel great, but have been troubled by the numbers that I've consistently gotten when I do my annual blood panels. I accidentally left the sheet in my car but I recall the numbers and they look like this:

Trigs: 151 / HDL: 47 / LDL (calculated): 131 / TSH/T4: I don't recall the numbers but they fell within the "normal" reference range

Any thoughts on what could cause this? My wife and I food prep together and her numbers were the typical rockstar profile you would expect of a paleo (trigs in the mid-40s, etc). I know my body tends to run cool (one morning I woke up at 95.7!?!?, but my TSH and T4 came back normal so not sure if there's anything there). I'm 5'8, 184 and generally lean though I carry some adipose fat around my stomach, which I literally cannot lose even when I go whole30 for extended periods of time.

Thanks in advance for your input!

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2357 · October 28, 2013 at 7:54 PM

Sodium excretion measurements are more accurate indicators of sodium *intake* than other measures? Please provide supporting evidence and, perhaps, an explanation of you work backwards from excretion to intake. In addition, if all the salt studies have been conducted in elderly sick populations, why should those study results be considered applicable to any other populations?

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15 · October 28, 2013 at 7:48 PM

Sodium excretion is more accurate than dietary logs/report of sodium intake. These have been known to be notoriously under/overreported. In many studies they haven't been adjusted for total caloric intake (the more you eat the more salt you ingest, if people with higher salt intake get this or that disease you can't pinpoint it on the salt as all kinds of things are eaten more often).

Most salt studies have been conducted in elderly sick populations.

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2357 · October 28, 2013 at 7:26 PM

I looked up the PMID you provided. The study population, patients with established CV disease or diabetes mellitus, doesn't seem to correspond exactly with the PH population. More importantly, diet wasn't studied at all. We don't know what the sodium intake was. Just because mean 24-hour sodium excretion in this population was about 5g/day doesn't tell us anything about the optimal average intake for someone on a paleo type of diet.

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15 · October 28, 2013 at 6:17 PM

PMID:22110105

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2357 · October 28, 2013 at 4:13 PM

Who said anything about restricting sodium? I think it's appropriate on a paleo diet to drink at least 2 C of salty broth daily as well as get plenty of dietary potassium. BTW, you still haven't provided your source for a recommendation of 15g/day of sodium.

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15 · October 28, 2013 at 1:58 PM

Excessive exercise worsens thyroid function.

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0 · October 28, 2013 at 1:36 PM

I guess I should have clarified...I don't mean that I plan to increase my total amount of exercise, rather, re-calibrate to focus more on LHT and sprints. I particularly think the sprint while in a fasted state could go a long way to improving my blood panel.

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15 · October 25, 2013 at 7:42 PM

On isocaloric basis other diets far outperform the paleo diet in terms of blood lipids.

The site you linked has blog entries such as "fruit is candy". That's telling me that you're obviously too entangled in all that low-carb propaganda to have an objective view on the issue.

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15 · October 25, 2013 at 7:38 PM

The science on salt restriction is standing on very thin ground and is mostly justified by its negligible effect on blood pressure. Looking at real outcomes such as CHD incidence and mortality, doses up to 15g/day should not pose a lot of problems. In contrast, too low salt is associated with increased cardiovascular death just as too high salt is.

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15 · October 25, 2013 at 7:38 PM

A high potassium low salt diet will elevate aldosterone (which increases sodium reabsorption and wastes potassium), a hormone that's associated with inflammation and fibrosis. Having enough salt in the diet will keep aldosterone low and actually help retain potassium.

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2357 · October 25, 2013 at 6:35 PM

My citation for salt intake on a ketogenic diet comes from The Art and Science of Low-Carbohydrate Diets, by Phinney and Volek. What's your source?

My source for potassium requirements comes from every single nutrition text, both conventional and paleo/low-carb I've ever come across. No adverse affects have ever been reported for ingesting food-based sources of potasssium. What's your evidence to the contrary?

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2357 · October 25, 2013 at 6:33 PM

Dozens of anecdotal reports do not outweight the tens of thousands of anecdotal reports nor the growing body of clinical trials that show a paleo or low-carb diet improves lipid profiles.

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2357 · October 25, 2013 at 6:31 PM

I agree with your comment about elevated TSH, but the OP stated that his TSH test was in the reference range. That's why I suggested the free T4 and T3 tests.

Total cholesterol has never been shown (by studies with good methodology) to be even correlated with any other marker of health or disease. OTOH, The American Academy of Lipidology has stated that when LDL-C and LDL-P are discordant, LDL-P is the better marker for CVD.

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15 · October 25, 2013 at 5:51 PM

5 grams of salt/day? That is pretty low, if you say paleo diets need more salt. Paleo or not you can safely eat up to 15 grams/day. Or forget all that damaging salt phobia alltogether and just salt to taste.

Also there's no evidence behind all that potassium loading.

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15 · October 25, 2013 at 5:47 PM

T3, T4 are not significantly better than TSH. A high TSH is already a good indicator of low thyroid function without needing T3, T4. All of them are not exact indicators of thyroid function, which is why symptoms, basal temp, pulse and metabolic rate have to be interpreted first, then lab tests.

Also I disagree on getting all that expensive lipid testing. Whole cholesterol is already fine and cost efficient and its sudden rise after starting paleo already tells you enough.

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15 · October 25, 2013 at 5:35 PM

Rewritten.

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2357 · October 25, 2013 at 4:50 PM

What do you mean by your first statement? Poor lipid lab number cannot cause someone to eat a Paleo diet. In addition, some people's lipid profiles do benefit from a very-low-carb diet. And intense exercise, such as sprinting, can use a mixture of free fatty acids and glucose for fuel.

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0 · October 25, 2013 at 2:42 PM

I'm wondering if I went really carb restrictive for a few weeks if that could drop the number. I'm also planning to work in more sprints (up to 2x per week) and *try* to do those on an IF. I don't feel like I should have to work this hard to get the normal paleo blood profile, but maybe I'm battling some genetic predisposition.

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198 · October 25, 2013 at 3:32 AM

You are right, however OP already stated this "General macros are around 25% carb / 50% fat / 25% protein" so he is not a carb fiend.

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2357 · October 24, 2013 at 8:26 PM

"...but won't the lean meats tend to turn into glucose in the blood?"

Not unless your body needs to convert protein to glucose via gluconeogenesis.

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198 · October 24, 2013 at 6:35 PM

http://www.whfoods.com/genpage.php?tname=newtip&dbid=14

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0 · October 24, 2013 at 4:06 PM

A friend suggested I add some more details, so let me do that:

* I utilize IFs 1-2x per week in the morning, prior to a LHT workout (or sprint)

* My weight might seem kind of high, but I have broad shoulders and generally have a stocky build. I don't care too much about weight, but if I could hit an ideal weight, it would probably be at lower bf% around 175.

* General macros are around 25% carb / 50% fat / 25% protein

* I have a couple of glasses maybe 1, 2x a week tops.

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15 · October 25, 2013 at 5:50 PM

5 grams of salt/day? That is pretty low, if you say paleo diets need more salt. Paleo or not you can safely eat up to 15 grams/day. Or forget all that damaging salt phobia alltogether and just salt to taste. Also there's no evidence behind all that potassium loading.

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0 · October 25, 2013 at 5:35 PM

Hi,

I'm new here and still learning but based on my studies here's some info that could be useful in guiding you. Borrowing from Gary Taubes book "Good Calories Bad calories" :-

1. On the diet prescribed by him with fat at 70%, proteins at 20% to 25 % and the balance from complex carbs such as green salads etc your Lipid profile will over time change as follows:-

a. Your overall cholesterol will rise, but that is not necessarily bad as you will understand below.

b. Your good cholesterol which is HDL, will rise too which is good.

c. Your so called bad cholesterol will also rise but change in character from small dense particles (which burrows into artery walls ) to fluffier large particles which are relatively harmless.

d Your VLDL which is the really bad cholesterol should reduce significantly

e. Your trigycerides should come down to well within a healthy range but since this has not happened I assume your more sensitive to carbs than others and are therefore not eliminating enough carbs. I would advise you to :-

1.Look at trying replace more carbs with fat as given above.

2. Read Dave Asprey's Bulletproof Executive website and while I wouldn't advocate you go the whole hog with the entirety of what he prescribes ( as I do not have the relevant personal experience with his complete protocol yet) one area which seems to work and may be of use to help u cut past your inability to use your triglycerides as fuel and thereby reduce them is his INTERMITTENT FASTING method. (his other method of Rapid fat loss fasting protocol sounds too dangerous and is not advocated by even him so do not go in that direction ).

Otherwise, fr your information and in my humble opinion ( again borrowed from a lot of studies but primarily from Gary Taubes ) saturated fat is good for you and fatty meat (not lean meat, in fact the more fat the better) will help your lipid profile. I know this sounds strange and even I have to keep telling myself to look at the science and not go by what I have been conditioned to hear by the media and public health authorities but that is the truth as I understand and believe it.

In your quest fr information dig a little more and validate what I say by using the following resources:-

1. Get a copy of Gary Taubes simpler (not so technical and with more practical tips ) book - "Why we get fat and what to do about it ". Just fr your info, Taubes is an investigative journalist who has done a stellar job of explaining the history and science of low carb dieting, obesity, heart disease and to an extent the cholesterol enigma.

2. Visit Dave Asprey's website "the Bulletproof Executive".

Good Luck !!

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2357 · October 25, 2013 at 4:47 PM

Lowering carbs to less than 50g/day is likely to put you in a state of dietary ketosis, where you're burning dietary and body fat for fuel. This isn't bad, but you need to take some precautions, namely increasing your electrolyte intake, esp. salt. At this level of carbs, Dr. Steve Phinney says you can safely eat up to 5 *grams* of salt/day, since the kidneys rely on insulin signaling to retain water (salt's water-soluble), and you won't be creating much insulin. Also, eat more potassium-containing veggies, such as swiss chard (960 mg/cup (raw) or 960 mg/cup (cooked)), or low-sodium V8 (800 mg/cup) (but 10g of carbs). If you tolerate dairy, eat some cheese, yogurt, or raw milk (not just organic) for calcium. Supplement with chelated Mg., too.

I sympathize about having to work extra hard to get a normal lipid profile; I'm on the tail end of some genetic distribution curve, too.

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2357 · October 28, 2013 at 7:26 PM

I looked up the PMID you provided. The study population, patients with established CV disease or diabetes mellitus, doesn't seem to correspond exactly with the PH population. More importantly, diet wasn't studied at all. We don't know what the sodium intake was. Just because mean 24-hour sodium excretion in this population was about 5g/day doesn't tell us anything about the optimal average intake for someone on a paleo type of diet.

00cd3b6f51530a6832fcda1712edbec3
2357 · October 28, 2013 at 4:13 PM

Who said anything about restricting sodium? I think it's appropriate on a paleo diet to drink at least 2 C of salty broth daily as well as get plenty of dietary potassium. BTW, you still haven't provided your source for a recommendation of 15g/day of sodium.

Thumbnail avatar
15 · October 25, 2013 at 7:38 PM

The science on salt restriction is standing on very thin ground and is mostly justified by its negligible effect on blood pressure. Looking at real outcomes such as CHD incidence and mortality, doses up to 15g/day should not pose a lot of problems. In contrast, too low salt is associated with increased cardiovascular death just as too high salt is.

Thumbnail avatar
15 · October 25, 2013 at 7:38 PM

A high potassium low salt diet will elevate aldosterone (which increases sodium reabsorption and wastes potassium), a hormone that's associated with inflammation and fibrosis. Having enough salt in the diet will keep aldosterone low and actually help retain potassium.

00cd3b6f51530a6832fcda1712edbec3
2357 · October 25, 2013 at 6:35 PM

My citation for salt intake on a ketogenic diet comes from The Art and Science of Low-Carbohydrate Diets, by Phinney and Volek. What's your source?

My source for potassium requirements comes from every single nutrition text, both conventional and paleo/low-carb I've ever come across. No adverse affects have ever been reported for ingesting food-based sources of potasssium. What's your evidence to the contrary?

Thumbnail avatar
15 · October 25, 2013 at 5:51 PM

5 grams of salt/day? That is pretty low, if you say paleo diets need more salt. Paleo or not you can safely eat up to 15 grams/day. Or forget all that damaging salt phobia alltogether and just salt to taste.

Also there's no evidence behind all that potassium loading.

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15 · October 25, 2013 at 2:57 PM

Paleo dieting causes unfavourable blood lipids, there are dozens of reports here and on other paleo boards. What you NOT want to do is restrict carbs even more and exercise even more, that is the opposite direction to go.

Hypothyroidism is a major cause of elevated LDL. An impaired liver due to excessive exercise and lack of glucose will lead to reduced T3 production, elevating your lipids.

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0 · October 28, 2013 at 1:36 PM

I guess I should have clarified...I don't mean that I plan to increase my total amount of exercise, rather, re-calibrate to focus more on LHT and sprints. I particularly think the sprint while in a fasted state could go a long way to improving my blood panel.

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2357 · October 25, 2013 at 6:33 PM

Dozens of anecdotal reports do not outweight the tens of thousands of anecdotal reports nor the growing body of clinical trials that show a paleo or low-carb diet improves lipid profiles.

00cd3b6f51530a6832fcda1712edbec3
2357 · October 25, 2013 at 4:50 PM

What do you mean by your first statement? Poor lipid lab number cannot cause someone to eat a Paleo diet. In addition, some people's lipid profiles do benefit from a very-low-carb diet. And intense exercise, such as sprinting, can use a mixture of free fatty acids and glucose for fuel.

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8057 · October 25, 2013 at 3:28 AM

Trigs are directly related to dietary carbs. If you want to get that number down, reduce the carbs. To get HDL up, more omega 3's--fish and pastured eggs.

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0 · October 25, 2013 at 2:42 PM

I'm wondering if I went really carb restrictive for a few weeks if that could drop the number. I'm also planning to work in more sprints (up to 2x per week) and *try* to do those on an IF. I don't feel like I should have to work this hard to get the normal paleo blood profile, but maybe I'm battling some genetic predisposition.

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198 · October 25, 2013 at 3:32 AM

You are right, however OP already stated this "General macros are around 25% carb / 50% fat / 25% protein" so he is not a carb fiend.

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2357 · October 24, 2013 at 8:30 PM

Yes, your triglycerides are high, cholesterol concentrations don't typically matter, unless you have familial hypercholesterolimia, TSH is irrelevant, and your need *free* T4 and free T3 tests performed before you claim something's wrong with your thyroid.

Also, get an LDL-P test to see if it confirms the LDL-C test, and get a carotid calcium scan as a confirmation before you start freaking out.

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2357 · October 25, 2013 at 6:31 PM

I agree with your comment about elevated TSH, but the OP stated that his TSH test was in the reference range. That's why I suggested the free T4 and T3 tests.

Total cholesterol has never been shown (by studies with good methodology) to be even correlated with any other marker of health or disease. OTOH, The American Academy of Lipidology has stated that when LDL-C and LDL-P are discordant, LDL-P is the better marker for CVD.

Thumbnail avatar
15 · October 25, 2013 at 5:47 PM

T3, T4 are not significantly better than TSH. A high TSH is already a good indicator of low thyroid function without needing T3, T4. All of them are not exact indicators of thyroid function, which is why symptoms, basal temp, pulse and metabolic rate have to be interpreted first, then lab tests.

Also I disagree on getting all that expensive lipid testing. Whole cholesterol is already fine and cost efficient and its sudden rise after starting paleo already tells you enough.

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10 · October 24, 2013 at 7:59 PM

I am hypothyroid (apparently Hashimoto's) with elevated TSH, which is usually controlled with meds. I've been taking Levothyroxine for about 5 years. However, my triglycerides have always been good; as is my LDL and HDL. Last labs I had an HDL of 68 and that was BEFORE going paleo. So I'm not sure there's a connection, necessarily, between thyroid and cholesterol. If you had thyroid disease, you would likely have unpleasant symptoms, like fatigue, alternating with feeling wired, weight gain, lethargy, irritability and exercise intolerance. I had all those things when I was diagnosed . . .now I have them occasionally.

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0 · October 24, 2013 at 6:25 PM

Won't let me reply to you @samc so having to reply in an answer...

Re: test accuracy, this test confirmed a previous test &I'm finally distraught enough about the #s to seriously dig into it. I used to chaulk it up to "I feel great, so disregard" but I just don't think something adds up. Interesting idea about lean meats and easing up on sat fats, but won't the lean meats tend to turn into glucose in the blood? Guess everyone reacts differently though.

Looking at possible diseases or illnesses is the thing I think is the culprit, but frankly, I'm clueless as to what it could be if not hypothyroid. Also my blood pressure tends to be a touch high~135/70

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2357 · October 24, 2013 at 8:26 PM

"...but won't the lean meats tend to turn into glucose in the blood?"

Not unless your body needs to convert protein to glucose via gluconeogenesis.

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198 · October 24, 2013 at 6:35 PM

http://www.whfoods.com/genpage.php?tname=newtip&dbid=14

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198 · October 24, 2013 at 5:47 PM

If it was me, I'd try going to lean meats and easing up on saturated fats. This would be an experiment for a few months and then retest. But are we then just chasing numbers? I'd also investigate the possible diseases or illness that can cause the elevated numbers. I'd also want to make sure the lab numbers were correct. Often times the results show that they went back and retested do to out of range results. I had that issue with a urine test and the doc had me scared for no reason, reran the test and it was fine.

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