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Paleo dieters and high LDL-p numbers?

by (897)
Updated about 20 hours ago
Created April 06, 2013 at 10:41 AM

If you read Peter Attia's Straight dope on cholesterol he seems to think the LDL particle number is the number one risk factor for athrosclerosis. Whether you choose to believe that is another story. I know people tend to pick and choose what markers are more important depending on their bias.

But my question is, do many people on this diet have a low ldl particle number? Basically everyone who has had this type of testing on paleo forums has a ldl-p of over 1000, sometimes over 2000, depsite having low trigs and high HDL.

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897 · April 17, 2013 at 10:23 PM

"Actually you can have high LDL but low LDL-P". Yes, but it seems a lot rarer than having low LDL and low LDL-p. The inflammation argument doesn't sound to reassuring. I would prefer to not clog my arteries in the first place, rather than taking the risk.

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1336 · April 09, 2013 at 9:32 PM

I had TSH and free T4 checked - not free T3. My free T4 was 1.01, smack in the middle of the range. And yes, my cholesterol (TC & LDL) was much lower pre-paleo.

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1211 · April 09, 2013 at 12:39 PM

Just to clarify, CW advocates TC<200, LDL<131, HDL>40, TC:HDL<4.5, TG<150. So, yeah, LDL 70 is much lower. Also keeping in mind that low LDL and TG=150 may result in higher LDL-P. I believe Peter Attia also has low TG. It would be interesting to better know the LDL-C and TG cross-over points for LDL-P=1000.

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897 · April 09, 2013 at 6:15 AM

Thanks for the comment markES. Although what is considered a "good CW looking lipid panel" is considered high to many. I'm guessing people with an LDL of 70 would have much less of a chance of having high LDL-P compared to people with LDL's over 120. The only paleo/low carb dieter that I have seen with a low LDL-p is Peter attia, but he has a low LDL.

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1211 · April 08, 2013 at 11:34 PM

This study showed those above 1414 LDL-P didn't fare as well. It would be interesting to see more data. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

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578 · April 08, 2013 at 6:48 PM

Agreed, you don't want atherosclerosis if you can help it. But what if it's part of aging like skin folds or hair graying? We have evidence that the hunter-gatherers had it, and so did early agrarians in Egypt. What you want to avoid is excessively high LDL-P that promotes dangerous atherosclerosis, one resulting in stenosis (artery narrowing). My point is that you're not likely to have that at LDL-P of 1000-2000. You need way above it. Plus, the best measure for that is the coronary calcium scan, not LDL-P.

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1211 · April 08, 2013 at 12:19 PM

Some good things to keep mind. Also ferritin. The best might be to have low LDL-P, low inflammation, low stress. Not sure I want an atherosclerosis promoting diet.

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578 · April 08, 2013 at 7:46 AM

Did you actually check FT3 and was it near the midpoint? I'd say about 1/4 have this. If your LDL and TC weren't elevated prior to a Paleo diet, then the cause is more likely to be Ft3 or ApoE4, not FH.

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578 · April 08, 2013 at 7:42 AM

After ruling out low Ft3, hypo, copper deficiency, etc. if your LDL-P starts rising over 2000, then I'd look into whether it's due to ApoE4. At that point, a higher carb, starchy Paleo diet might lower LDL-P and ApoB.

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578 · April 08, 2013 at 7:37 AM

LDL-P is the latest metric in vogue but it tells pretty much the same thing as TC/HDL. It's a measure of how LDL results in atherosclerosis. It's useful but its importance is overrated. From atherosclerosis to a heart attack or stroke, you need inflammation, which most often exists as high trigs and low HDL, i.e., high TC/HDL and Trigs/HDL ratios. Even with high LDL-P, if you have low TC/HDL, it's still protective, except perhaps for FH. For most people, some degree of atherosclerosis is inevitable. The Inuits had it but rarely died from heart disease.

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578 · April 08, 2013 at 7:27 AM

Actually you can have high LDL but low LDL-P. Plus, LDL-P is a long-term risk factor for atherosclerosis which in itself is not directly harmful. To have a heart attack or stroke, you need a catalyst in the form of an unhinged plaque, which is normally caused by inflammation. So even if you have LDL-P>1000, you may not necessarily die from cardiovascular disease as long as you keep inflammation low (i.e., low trigs, high HDL, low liver enzymes, low CRP, ESL). LDL-P, unless extremely high, is not immediately threatening. The Inuits had atherosclerosis but very few died from CVD.

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578 · April 08, 2013 at 7:22 AM

So the question: Are you E*/E4? If you are, high fat low carb diets may not be suitable and a ketogenic diet certainly isn't. What answer? High starch Paleo: 150 g of carbs. Definitely more than 75g of carbs to consistently keep ketosis at bay.

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578 · April 08, 2013 at 7:19 AM

The most plausible answer is your genes: ApoE4. That could explain your high TC driven by rising LDL. Also, LDL-P and ApoB increase in your case. Even though your LDL particle size is mostly large and bouncy, they nonetheless increase the overall number of LDL, so LDL-P increases. Past studies where mixed results are shown can be explained by this: For about 75% TC and LDL decrease. Fro about 25%, TC and LDL rise by a huge margin. If you average these results you could get have an overall increase in LDL and TC even though more people had their TC and LDL lowered.

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694 · April 07, 2013 at 6:56 PM

I've noticed this too. I've been doing a very low carb nutritional ketosis paleo experiment and checked my cholesterol and found that they were super high, and when I checked with the NMR, the LDL-P was high also. I did some looking around and saw that I wasnt' the only case and there are some theories out there... with no definitive answers.

Here are the main ones I came across:

  1. Increased consumption of saturated fats -> Increased liver production of fats -> High serums cholesterol

  2. Deficiency in certain micronutrients such as choline and copper -> Through some unknown mechanism -> High serum cholesterol

  3. Natural response of the body being in ketosis is to mobilize more fat for energy -> Higher serum cholesterol

  4. Chronic low carb -> Hypothyroidism (low T3) -> Decreased expression of LDL receptors in the liver -> Higher serum cholesterol

I'm currently in the process of trying to figure this all out and have pretty much ruled out #1 as a cause in my case.

If you want to read more you can check out the cholesterol posts that I've written in which I try to work all this out:

Part 1 Part 2 Part 3

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578 · April 08, 2013 at 7:22 AM

So the question: Are you E*/E4? If you are, high fat low carb diets may not be suitable and a ketogenic diet certainly isn't. What answer? High starch Paleo: 150 g of carbs. Definitely more than 75g of carbs to consistently keep ketosis at bay.

D33a8d5f095a8532ddf7a0d6c27bfe63
578 · April 08, 2013 at 7:19 AM

The most plausible answer is your genes: ApoE4. That could explain your high TC driven by rising LDL. Also, LDL-P and ApoB increase in your case. Even though your LDL particle size is mostly large and bouncy, they nonetheless increase the overall number of LDL, so LDL-P increases. Past studies where mixed results are shown can be explained by this: For about 75% TC and LDL decrease. Fro about 25%, TC and LDL rise by a huge margin. If you average these results you could get have an overall increase in LDL and TC even though more people had their TC and LDL lowered.

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3521 · April 08, 2013 at 2:13 AM

My total cholesterol was super low, like 145, and my HDL was 75, despite eating lots of fat. I also eat quite a bit of fructose and trigs were only 32. I might have an infection of sorts because this doesn't seem right at all. Or some of us just react differently to fat intake.

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1211 · April 07, 2013 at 1:36 PM

Sounds like interesting data to me. Chris Kresser advocates LDL-P<1000 and paleo-type diets, which tends to support it's happening in reasonable quantities in his patients.

Of course high LDL contributes to LDL-P, even with low trigs, high HDL. And often those getting LDL-P tested and posting them on forums will have high LDL.

One concern are those that might have high LDL-P and CW good looking lipid panel, but don't get LDL-P tested.

D33a8d5f095a8532ddf7a0d6c27bfe63
578 · April 08, 2013 at 7:27 AM

Actually you can have high LDL but low LDL-P. Plus, LDL-P is a long-term risk factor for atherosclerosis which in itself is not directly harmful. To have a heart attack or stroke, you need a catalyst in the form of an unhinged plaque, which is normally caused by inflammation. So even if you have LDL-P>1000, you may not necessarily die from cardiovascular disease as long as you keep inflammation low (i.e., low trigs, high HDL, low liver enzymes, low CRP, ESL). LDL-P, unless extremely high, is not immediately threatening. The Inuits had atherosclerosis but very few died from CVD.

D33a8d5f095a8532ddf7a0d6c27bfe63
578 · April 08, 2013 at 6:48 PM

Agreed, you don't want atherosclerosis if you can help it. But what if it's part of aging like skin folds or hair graying? We have evidence that the hunter-gatherers had it, and so did early agrarians in Egypt. What you want to avoid is excessively high LDL-P that promotes dangerous atherosclerosis, one resulting in stenosis (artery narrowing). My point is that you're not likely to have that at LDL-P of 1000-2000. You need way above it. Plus, the best measure for that is the coronary calcium scan, not LDL-P.

5dd50f78f47b8848d93724d6eb38d4c1
897 · April 09, 2013 at 6:15 AM

Thanks for the comment markES. Although what is considered a "good CW looking lipid panel" is considered high to many. I'm guessing people with an LDL of 70 would have much less of a chance of having high LDL-P compared to people with LDL's over 120. The only paleo/low carb dieter that I have seen with a low LDL-p is Peter attia, but he has a low LDL.

Cbdc8318738324492f2d5918868ce4c9
1211 · April 09, 2013 at 12:39 PM

Just to clarify, CW advocates TC<200, LDL<131, HDL>40, TC:HDL<4.5, TG<150. So, yeah, LDL 70 is much lower. Also keeping in mind that low LDL and TG=150 may result in higher LDL-P. I believe Peter Attia also has low TG. It would be interesting to better know the LDL-C and TG cross-over points for LDL-P=1000.

Cbdc8318738324492f2d5918868ce4c9
1211 · April 08, 2013 at 12:19 PM

Some good things to keep mind. Also ferritin. The best might be to have low LDL-P, low inflammation, low stress. Not sure I want an atherosclerosis promoting diet.

Cbdc8318738324492f2d5918868ce4c9
1211 · April 08, 2013 at 11:34 PM

This study showed those above 1414 LDL-P didn't fare as well. It would be interesting to see more data. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/

5dd50f78f47b8848d93724d6eb38d4c1
897 · April 17, 2013 at 10:23 PM

"Actually you can have high LDL but low LDL-P". Yes, but it seems a lot rarer than having low LDL and low LDL-p. The inflammation argument doesn't sound to reassuring. I would prefer to not clog my arteries in the first place, rather than taking the risk.

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897 · April 07, 2013 at 5:24 AM

I also read that mysteric acid can raise Lld-p. Does anyone have anymore info?

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1336 · April 06, 2013 at 1:03 PM

I've never had an NMR done, but after a lipid panel which showed high total cholesterol (324) and high LDL (209), I got an Apo-B test, which was also high (163). Thyroid checked out fine. My other lipid numbers are awesome: very high HDL, very low triglycerides. So by some measures I'm at high risk, and by others I'm at very low risk. Quite confusing. There seems to be quite a few paleo eaters who have similar numbers.

D33a8d5f095a8532ddf7a0d6c27bfe63
578 · April 08, 2013 at 7:46 AM

Did you actually check FT3 and was it near the midpoint? I'd say about 1/4 have this. If your LDL and TC weren't elevated prior to a Paleo diet, then the cause is more likely to be Ft3 or ApoE4, not FH.

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1336 · April 09, 2013 at 9:32 PM

I had TSH and free T4 checked - not free T3. My free T4 was 1.01, smack in the middle of the range. And yes, my cholesterol (TC & LDL) was much lower pre-paleo.

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