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Hi everyone,

I've just returned from a doctor's appointment with lipid panel results, the most important ones, I believe, included below:

Total Cholesterol 328

Total LDL-C Direct 183

Total HDL-C Direct 130

Total VLDL-C Direct 15

Total APOB100 Calc 113

LP(a) 14

Real LDL-C 160

Real LDL Size Pattern A

Triglycerides 48

Chol/HDLC Ratio 2.6

Other stats:

Glucose 79 Blood Pressure 90/60 Heart Rate 60

Age 48 Height 5' 5" Weight 103

I follow a primarily Paleo diet (I do eat a bit of dairy in the form of butter and yogurt, and I also enjoy dark chocolate and wine; grains and legumes, though, are very infrequent), and am slowly putting on weight after an illness two years ago.

The note from my primary care physician to my endocrinologist says "she NEEDS meds," and when I mentioned the importance of the HDL/Trig ratio (which, if I've understood what I've read, is significant), the endocrinologist said, "Yes, but the APOB is high; your LDL is HIGH."

So, I can't help but wonder: Do I truly have something to be concerned about?

Thanks for any insight you might have. I've learned so much from you all!

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Fire the doctor. Your APOB is high normal, but still in the normal range; your LDL is also at the very bottom of the high range. Your TC is high, that I agree, but that's a less important value. Can you get a direct particle count? Do you still have a period? Finally, what are your genes? Do you have APOE? – TheRealThing Aug 10 at 0:54

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IMHO, an LDL level of 183 is not too high.

Look at this study run by UCLA: UCLA Heart Attack study

It gathered the cholesterol levels of 59% of the heart attack patients in the US between 2000 and 2006 (137,000 people). What they found was that was that the people with high cholesterol levels were not the ones having the heart attacks.

The group you would fall in--people that had high HDL levels (over 59) and high LDL levels (over 159)--accounted for only 0.7% of all heart attacks--less than one percent.

I believe having high HDL levels is much more important than having low LDL levels. This study shows an inverse relationship between HDL level and heart attacks.

  • HDL < 40: 55% of heart attacks
  • HDL40-59: 38% of heart attacks
  • HDL > 59: 8% of heart attacks

The reason there is such a focus on LDL is because drug companies have developed a drug to lower LDL (which also happens to be a cash cow). No drug currently exists to raise HDL. If one ever was developed, you could be certain that we'd see a full-force marketing campaign warning people about the dangers of low HDL.

This study is worth reading; it's also worth printing out and taking to your doctor and asking them to explain the findings.

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 I've just read through the study. It, and your comments, are tremendously helpful. I'm printing now. Thank you! – Lyrical Aug 8 at 21:00
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I have similar labs, so I'm working through some of the same issues.

I think that the majority of people that have high APO-P and LDL-P (which do in fact increase the risk of heart disease) despite being on a strict paleo diet have some combination of the following: hypothyroidism, persistent insulin resistance, adrenal fatigue, menopause, Vitamin D deficiency, or rarely, copper deficiency.

Ideas

Thyroid: plot daily temperature (will be low if hypothyroid), do a thyroid symptom questionnaire, get TSH, free T3, free T4, reverse T3 (will be high if you have persistent insulin/leptin resistance). Adrenals: do a salivary DHEA and cortisol, low BP is a symptom of deficiency. Menopause: see what your sex hormone levels are doing, temperature chart will also help to see if you're ovulating (mid cycle temperature elevation). Consider also HBa1c, insulin levels to assess insulin resistance. Throw in a HS-CRP to check on inflammation. You need Vitamin D to get LDL moving to sex hormone production.

The body should be using that LDL for good stuff: cortisol, pregneneolone, sex hormones, etc. If it's not, it's usually due to a hormone issue. It could be thyroid even if labs are technically "within normal limits." This is the most common scenario. Daily temperature chart and symptom questionnaire really help in this instance.

Hope that helps.

I'm interested to see what others have to say, too.

Little disclaimer: Educational, not medical advice.

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Thank you, PaleoHappy. I'd not even thought of the impact of menopause, but that may indeed be a factor. My FSH level is in the postmenopausal range; I'm now scheduled to have my estradiol checked, so that may provide a clearer picture. Vit. D is 48, so seemingly fine. The other tests I'm familiar with but haven't had done this year. Terrific recommendations. I'd also wondered whether osteoporosis (yet another battle) might somehow be figuring in. So many questions. I hope some of this will, indeed, be helpful for you, too... – Lyrical Aug 8 at 21:15
This is crucial information. A period protects you from some of these numbers. If you are basically now metabolically post-menopausal, then yes, you have an issue. You need to tighten the screws on your lifestyle and live 100% clean for 6 months to see how that goes. Also get your hormones thoroughly tested, and your genes. – TheRealThing Aug 10 at 0:57
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LDL of 183 is high... Have you tried removing Butter and cream?

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No, I haven't, though I suppose it couldn't hurt to pull back a bit. Thanks for your thoughts! – Lyrical Aug 10 at 0:03

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