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?
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.
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/
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.)
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.
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.
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!
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.
HI I see this is a oldish post i have similar issues
the full post
now the interesting parts
this is quite enlightening especially for diabetics and people with cholesterol issues on a paleo diet..
>>>>> Central Obesity' part 1
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.
From Harvard Edu
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.
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