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How to bring down my LDL?

by (75)
Updated November 20, 2014 at 3:49 AM
Created November 07, 2012 at 3:16 PM

I've been following a Primal diet for 14 months with good results except in the cholesterol department. I've read many cholesterol/diet books that are popular in the Paleo community and feel like I have a good, level headed approach to cholesterol but my numbers have now gotten to the point where even I'm about to freak the heck out. Can anyone recommend something that I may be missing. The problem seems to be specifically my LDL. I know about the Iranian method to recalc the LDL but even doing that it's still not good.

If it matters, I'm female, mid thirties, 2 kids, just finished nursing the 2nd one.

These were my number a few weeks into eating Primal (oct'11): TC 219 HDL 51 LDL 128 Trig 54

I was very happy to see the above numbers but shocked at the results 2 months later (jan 12):

TC 302 HDL 59 LDL 233 Trig 48

Then I made some diet changes - cut back on dairy which I rarely consumed anyways, upped my olive oil intake, took fish oil, supplemented with magnesium, vit k2.

May '12 retest: TC 321 HDL 69 LDL 242 Trig 52

Retested yesterday: TC 370 HDL 75 LDL 282 Trig 66

Doctor of course is to the point where she won't deal with me unless I start taking statins. As far as I know high cholesterol doesn't run in the family but my family is fairly doctor phobic so no one has been tested for cholesterol. My father's side of the family is for the most part long lived. My mom's side, not so much but I'm unsure what everyone died of.

When I started eating Primal I had about 50 lbs to lose, I've slowly lost 25 lbs and have been stalled for the past 8 months. I know I'm insulin resistant so I've recently upped my fats and cut down on protein and it seems to be helping my blood sugars. Could this be why I've had my numbers skyrocket? I've been supplementing vit D and my number from yesterday was 68 and I've kept it high for the past year.

Also why would my Trigs be creeping up especially since I've been low carb the past few months?

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75 · April 25, 2013 at 2:28 PM

Apr 2013 update - Just had a basic cholesterol profile done and my TC has dropped about 140 pts in just a few months! From my earlier testing I had extremely high AM Cortisol which I'm treating with a topical AdrenaCalm, taking Now Cortisol support, 1 tab of Slo-Niacin (which I'm stopping due to side effects) and 500mg berberine (to control BG caused by Niacin). TC went from 370 to 236, LDL from 282 to 164. HDL and TRIGs both dropped a smidgen. Recalc'd my numbers using Iranian formula and my numbers/ratios are excellent now. Will stop Niacin and update after more tests in a few months.

595664fed314cfd5a8e34af0f026ca95
75 · April 25, 2013 at 2:27 PM

Apr 2013 update - Just had a basic cholesterol profile done and my TC has dropped about 140 pts in just a few months! From my earlier testing I had extremely high AM Cortisol which I'm treating with a topical AdrenaCalm, taking Now Cortisol support, 1 tab of Slo-Niacin (which I'm stopped due to side effects) and 500mg berberine (to control BG caused by Niacin). TC went from 370 to 236, LDL from 282 to 164. HDL and TRIGs both dropped a smidgen. Recalc'd my numbers using Iranian formula and my numbers/ratios are excellent now. Will stop Niacin and update after more tests in a few months.

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75 · January 17, 2013 at 3:33 AM

Jan 2013 update - saw Functional doc today and she's ordering more tests. She agrees with Dr. Davis that it's likely a genetic thing but being exacerbated by something else. So she's running tests for inflammation and auto-immune problems and doing a saliva cortisol test. Once done we'll go from there. She also says I likely have low stomach acid even though I don't have indigestion issues. She says it can impact mineral and vitamin absorption which could cause cholesterol issues. Will update again when I know anything new.

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75 · January 17, 2013 at 3:16 AM

He recommends Niacin and if that's not enough to bring stuff inline with his other recommendations then a statin too. Basically a statin is a drug of last resort but beneficial for some people.

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25 · December 14, 2012 at 2:53 PM

So if I understand your other post, Davis also recomends Niacin and Statin?

6c75689340db7a8e128af148465f5205
25 · December 14, 2012 at 2:51 PM

I haven't signed up for Dr Davis Track Your Plaque yet, but was reading some articles by him yesterday. He was giving slightly different advise than I have been getting on here; both say cut the fat a bit, but on here they say to eat more sweet potatoe and rice. Davis says to cut carbs to reduce small LDL and reduce fat to reduce particle count. I could only convince my doc to test for TSH which came back normal, but I read that other numbers can still be off. I wish my Doc was willing to explore more. That's why I went to a naturopath.

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75 · December 14, 2012 at 3:35 AM

Also want to add that I had thyroid testing done and while everything is within range, according to Dr. Davis the numbers aren't in the ranges he likes to see. Having numbers like mine can cause LDL to spiral out of control. I'm hoping the doctor I'm seeing in January will treat my Thyroid by symptoms and not numbers. If not, I'll go off the reserve and by my own thyroid supplements to self treat.

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75 · December 14, 2012 at 3:33 AM

Thank you so much for your reply. Gosh, you sound just like me, especially in the closing paragraph. I'm having to go back and reread everything I've ever read about cholesterol to pick up all those exceptions I glossed over. Right now I'm taking all the supplements that Dr. Davis (Track your Plaque) recommends except Niacin and statins. He also recommended a Functional Medicine Doctor. Actually found one who I'm acquainted with already without even knowing! She was my kids chiropractor a few years ago. I have an appointment in mid January with her. Will report back any updates.

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75 · November 17, 2012 at 12:19 AM

My thyroid panel came back normal except when I calculate my T3:RT3 ratio. It comes out at 15 instead of the minimum 20. I've read that it's next to impossible to find a doctor to treat just based on the ratio. So I'm going to start taking a supplement for thyroid support and see if that helps.

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75 · November 17, 2012 at 12:16 AM

Just wanted to pop back and give an update. I've tested my thyroid and had an NMR. I've only just started trying to figure out at the NMR results mean; so far it seems so confusing. LDL-P 2815 (flagged High) LDL-C 249 (flagged High) HDL-C 69 Trig 47 Cholesterol, Total 327 (flagged high) HDL-P (total) 35.2 Small LDL-P 388 LDL Size 21.4 ***I assume this means I have mostly large fluffy LDL?) Large VLDL-P <.7 Large HDL-P 8.4 VLDL Size - couldn't be calculated because I had too few HDL Size 9.0 (flagged as Low) ***does anyone know what that means? IR risk 17

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2688 · November 08, 2012 at 5:14 PM

FYI a really easy way to get some grass fed beef liver, heart, and kidneys is US Wellness' Liverwurst. I know its a processed item but it makes getting kidneys very tolerable.

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17329 · November 08, 2012 at 4:24 PM

I'm guessing that perhaps the test isn't all that accurate. You'll want to listen/read Chris Kresser's stuff on cholesterol. The type of test makes a difference, not because it's more or less accurate, but because what you want to really know is the oxidation level of LDL, that's what's really important. If your LDL isn't oxidized it's being reabsorbed/used so it isn't problematic.

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2391 · November 07, 2012 at 8:22 PM

Sorry to hear that you might have a more complex situation than I assumed. I hope you can find a doctor/ND who'll work with you to get the lab work I suggested. If not, you can order these tests on your own, though you'll have to pay for them out of pocket. Visit Stopthethyroidmadness.com for more information about where to get these tests.

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75 · November 07, 2012 at 6:18 PM

Thank you for the information. I knew insulin played a role in cholesterol but wasn't sure how. From the January test date through the summer I was consuming quite a few carbs in the form of sweet potatoes and rice and fruit tp try bring my cholesterol down. As you can see it didn't do to much to my LDL numbers but it had negative effect on my blood sugars. That's why for the past 2 months I've been low carb, moderate protein, high fat to get my sugar more stable. But I will definitely look into the links you provided.

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75 · November 07, 2012 at 6:10 PM

Thanks, I will look into one of these tests.

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75 · November 07, 2012 at 6:09 PM

I eat no more than 20 carbs a day.

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9 Answers

00cd3b6f51530a6832fcda1712edbec3
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2391 · November 07, 2012 at 5:11 PM

It's possible that the root problem lies in your thyroid and the amount of carbs and protein you're eating. The connection is through insulin levels. Your body produces insulin in response to carbs (a lot, to regulate blood sugar) and protein (a moderate amount, to help synthesize proteins). In addition to these two functions, insulin also signals the thyroid to make T4. So, if you make less insulin due to lowered carb and protein intake, your body makes less T4. That's a natural, adaptive response.

In some people, though, this adaptation creates a problem. The body converts T4 to T3, the active form of the thyroid hormone. One of T3's roles is regulating cholesterol. As you produce less T4, your body is supposed to convert more of the T4 to T3. If your body isn't very efficient at this conversion, you can get rising cholesterol plasma concentrations. This isn't a problem until your TC gets above 240.

The simplest way to test whether you're one of these people is to add back some starch, e.g., sweet potatoes and white rice for 3 months, then re-test your cholesterol. How much starch to add back is going to vary by individual, but Paul Jaminet recommends 30% of your calories from starch. You might start with with 20% for 3 months. If your cholesterol levels don't normalize with this experiment, then I suggest you do some in-depth thyroid testing.

00cd3b6f51530a6832fcda1712edbec3
2391 · November 07, 2012 at 8:22 PM

Sorry to hear that you might have a more complex situation than I assumed. I hope you can find a doctor/ND who'll work with you to get the lab work I suggested. If not, you can order these tests on your own, though you'll have to pay for them out of pocket. Visit Stopthethyroidmadness.com for more information about where to get these tests.

595664fed314cfd5a8e34af0f026ca95
75 · November 07, 2012 at 6:18 PM

Thank you for the information. I knew insulin played a role in cholesterol but wasn't sure how. From the January test date through the summer I was consuming quite a few carbs in the form of sweet potatoes and rice and fruit tp try bring my cholesterol down. As you can see it didn't do to much to my LDL numbers but it had negative effect on my blood sugars. That's why for the past 2 months I've been low carb, moderate protein, high fat to get my sugar more stable. But I will definitely look into the links you provided.

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2688 · November 08, 2012 at 5:51 AM

Also from Paul Jaminet. Certain micronutrient deficiencies like copper and choline can cause elevated LDL. Check this out http://perfecthealthdiet.com/2011/03/answer-day-what-causes-high-ldl-on-low-carb-paleo/

Good luck

Bdcb4ecc75f7b6867b785a7eadf25ece
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38 · December 30, 2013 at 5:25 PM

@Infinitum

HI I see this is a oldish post i have similar issues

the full post

http://paleohacks.com/questions/507332/cholesterol-ldl-went-crazy-now-trying-plan-b-what.html

now the interesting parts

this is quite enlightening especially for diabetics and people with cholesterol issues on a paleo diet..

>>>>> Central Obesity' part 1

http://www.maxwettsteinfitness.com/Library/Belly%20fat.htm

I am quite surprised that a few of Pro;s writing books and holding seminars etc did not highlight visceral fat ,

as a a cause for LDL soaring, when on a low carb high fat diet.

and >>

From Harvard Edu

http://www.health.harvard.edu/fhg/updates/Abdominal-fat-and-what-to-do-about-it.shtml

Research suggests that fat cells — particularly abdominal fat cells — are biologically active. It’s appropriate to think of fat as an endocrine organ or gland, producing hormones and other substances that can profoundly affect our health. Although scientists are still deciphering the roles of individual hormones, it’s becoming clear that excess body fat, especially abdominal fat, disrupts the normal balance and functioning of these hormones.

Scientists are also learning that visceral fat pumps out immune system chemicals called cytokines — for example, tumor necrosis factor and interleukin-6 — that can increase the risk of cardiovascular disease. These and other biochemicals are thought to have deleterious effects on cells’ sensitivity to insulin, blood pressure, and blood clotting.

One reason excess visceral fat is so harmful could be its location near the portal vein, which carries blood from the intestinal area to the liver. Substances released by visceral fat, including free fatty acids, enter the portal vein and travel to the liver, where they can influence the production of blood lipids. Visceral fat is directly linked with higher total cholesterol and LDL (bad) cholesterol, lower HDL (good) cholesterol, and insulin resistance.

Good luck

chessguy

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25 · December 13, 2012 at 5:13 AM

Hey, I'm probably late to the game posting an answer, but I know how you feel, I'm having very similar results. Here are my latest readings:

TC - 480, HDL - 71, LDL - 390, Trigs - 52, Apo-B - 2.0

I think my numbers are even higher than yours, and unfortunately for me I didn't deal with this as soon as I should have and also didn't monitor it as well as you did. Kinda regretting that and wondering what kind of damage I might have done. It's tough because there are a lot of opinions on here and I've been known to express the same things about cholesterol but I can say from experience it is a whole different thing when you are the one with these crazy numbers.

I've been doing a bunch of research but I've decided to go back on a small dose of Crestor at least for now. I don't think there is any benefit in having that much LDL floating around in my system. I plan to continue working on this with my Doctor and Naturopath, and will try to go off of the Crestor again in the future. Unfortunately we are not in a position where we can say "well it's a little elevated, but I'm living clean so I should be OK". Instead we're in a spot where we have to chose between 2 bad's, Statin Side Effects or the possibility of a heart attack or stroke.

I've learned a couple new things in the last couple weeks:

1) The main number to be concerned with is LDL Particle count. You can get them directly counted like you did on the NMR or get an APO-B reading which from what I understand is a pretty good approximation. Both your's and mine are not good.

2) Dairy drives up LDL in some people.

3) There are certain people (20 to 25% of the population) that don't respond well to the High Fat/Low Carb Diet. I'm doing some diggin on that too.

4) When Trig's are low the standard Friedwald calculation of LDL-C that your Dr's Lab does is not very accurate. I cald'd your's using the Iranian and your LDL-C is 239. A little lower ;)

Those are some rambling thoughts to start. I feel for you, it's scary. It's funny that as I was reading all this stuff in the beginning, learning about Paleo and Cholesterol, I would alway gloss over the anomalies. Like when FH was mentioned, or the Genotype thing, I would think that doesn't apply to me, because there is very little chance that I am outside of the general population. Well, surprise, surprise, gotta go back and re-read with different eyes.

6c75689340db7a8e128af148465f5205
25 · December 14, 2012 at 2:51 PM

I haven't signed up for Dr Davis Track Your Plaque yet, but was reading some articles by him yesterday. He was giving slightly different advise than I have been getting on here; both say cut the fat a bit, but on here they say to eat more sweet potatoe and rice. Davis says to cut carbs to reduce small LDL and reduce fat to reduce particle count. I could only convince my doc to test for TSH which came back normal, but I read that other numbers can still be off. I wish my Doc was willing to explore more. That's why I went to a naturopath.

595664fed314cfd5a8e34af0f026ca95
75 · December 14, 2012 at 3:35 AM

Also want to add that I had thyroid testing done and while everything is within range, according to Dr. Davis the numbers aren't in the ranges he likes to see. Having numbers like mine can cause LDL to spiral out of control. I'm hoping the doctor I'm seeing in January will treat my Thyroid by symptoms and not numbers. If not, I'll go off the reserve and by my own thyroid supplements to self treat.

595664fed314cfd5a8e34af0f026ca95
75 · December 14, 2012 at 3:33 AM

Thank you so much for your reply. Gosh, you sound just like me, especially in the closing paragraph. I'm having to go back and reread everything I've ever read about cholesterol to pick up all those exceptions I glossed over. Right now I'm taking all the supplements that Dr. Davis (Track your Plaque) recommends except Niacin and statins. He also recommended a Functional Medicine Doctor. Actually found one who I'm acquainted with already without even knowing! She was my kids chiropractor a few years ago. I have an appointment in mid January with her. Will report back any updates.

6c75689340db7a8e128af148465f5205
25 · December 14, 2012 at 2:53 PM

So if I understand your other post, Davis also recomends Niacin and Statin?

595664fed314cfd5a8e34af0f026ca95
75 · January 17, 2013 at 3:16 AM

He recommends Niacin and if that's not enough to bring stuff inline with his other recommendations then a statin too. Basically a statin is a drug of last resort but beneficial for some people.

D6c5181b0c3b6bf4a026c78f37fb8620
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20 · November 13, 2012 at 3:28 PM

smc1... Approximately, how much starch did you add? Did you consume any fruit or just starch?

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60 · November 08, 2012 at 5:06 AM

I am interested to see how your progress goes... I just recently had bloodwork done and had BOTH very high HDL and LDL. Doc wasn't so worked because HDL was so high, however I personally was puzzle by high LDL numbers. So please repost and let us know your results. Good luck!

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0 · November 07, 2012 at 5:53 PM

I agree with Jake. I had the same issue with rising TC. Once I added more starches (rice, potatoes, sweet potatoes) my TC went back down to 200 (from 320). I actually felt much better after adding the starches back.

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2613 · November 07, 2012 at 4:29 PM

Try getting an Apolipoprotein B test or a LDL-P test. LDL-C tests (which are what you got) are poor predictors of heart disease. The concentration doesn't tell you much, because it's the particle number that matters. Large LDL particles may even be beneficial.

595664fed314cfd5a8e34af0f026ca95
75 · November 07, 2012 at 6:10 PM

Thanks, I will look into one of these tests.

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17329 · November 07, 2012 at 3:53 PM

LDL is controlled by carbs (mostly), so go easy on them. Eat more fats to raise HDL.

Edit: since you say you eat less than 20g of carbs/day, carbs aren't the problem.

There's a lot of info that Chris Kresser addresses in various blog posts, podcasts, etc. These might give you a lot more useful info:

Also here's a good PDF summary: http://chriskresser.com/handouts/cholesterol_brochure.pdf

The key is the type of test. Some are less accurate than others, but what you really are concerned about isn't so much the LDL amount, but whether or not the LDL is oxidized which most tests won't tell you. If you have very little oxidized LDL, it means your liver is recycling it properly, or that it's being used up by tissues that need it, which is what you want.

Also, note that both LDL and HDL are used as part of the autoimmune system, which Paul Jaminet gets into. Here are some links, including one about soaring LDL whilst on a paleo diet, which fits right in with your question:

The answer seems to be missing nutrients, possibly from copper, iodine, and choline. So eat more seafood (esp: oysters, squid, lobster, mussels, crab, and clams), dark chocolate, egg yolks, liver, heart, (and kidneys if you can stand the smell.)

595664fed314cfd5a8e34af0f026ca95
75 · November 07, 2012 at 6:09 PM

I eat no more than 20 carbs a day.

96440612cf0fcf366bf5ad8f776fca84
17329 · November 08, 2012 at 4:24 PM

I'm guessing that perhaps the test isn't all that accurate. You'll want to listen/read Chris Kresser's stuff on cholesterol. The type of test makes a difference, not because it's more or less accurate, but because what you want to really know is the oxidation level of LDL, that's what's really important. If your LDL isn't oxidized it's being reabsorbed/used so it isn't problematic.

7f8bc7ce5c34aae50408d31812c839b0
2688 · November 08, 2012 at 5:14 PM

FYI a really easy way to get some grass fed beef liver, heart, and kidneys is US Wellness' Liverwurst. I know its a processed item but it makes getting kidneys very tolerable.

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