cross post from Rob Wolff's forums*
Been eating PALEO since Sept '09. I was about 250lbs, I am down to 195 @ 6'1 as of this month. Weight loss has stabilized, and I am still losing body fat and increasing muscle mass. Started Crossfit back in August of '10. My box leans towards heavier oly lifts, and I goto the box 3 times a week. Cardio is long walks, slow rowing, hiking.
I didn't want to go this route but I went ahead and geeked out a bit and had some blood work done. I am a 27 year old male, 6'1, 195, no previous medical issues other than right knee ACL/meniscus reconstruction 10 years ago. Lots of family history of cancer, and one grand parent who had heart disease.
I've been eating, what most would categorize, as a cyclical ketogenic paleo diet. I eat probably 70% store bought meat/30% grass-fed meat. I take a tablespoon fish oil when I eat the standard meat (works out to be 3-4grams of EPA/DHA). Other fat sources come from pastured butter, coconut, avocado, some olive oil (only as dressing).
With all that said, here is the blood work that came back (24 hour fast before results taken):
Fasted Blood Glucose - 93mg/dL
Cholesterol, Total - 377
Triglycerides - 86 mg/dL
HDL Cholesterol - 72 mg/dL
vLDL Calc - 17 mg/dL
LDL Calc - 288 mg/dL
25-Hydroxy - 62.8 ng/mL
A1C - 5.5
CRP - 0.75 mg/L
TSH - 2.150 uIU/mL
T4,Free(direct) - 1.2 ng/Dl
T3 - 69 ng/DL
Everything seemed within paleo norms, except the obvious: LDL @ 288.
I was hoping my fasted blood sugar would have been in the mid 80s, and that my A1C would have been closer to 5. T3 was just outside the spectrum by one 1ng/DL.
I was happy with the HDL count, and the Trigs overall.
Thoughts on the LDL?
I have similar blood counts after eating basically low carb since 2009. While my HDL and Triglycerides went up, so did my total cholesterol. HDL up from 62 to 87, Triglycerides from 158 down to 67, but total C up from 258 to 371. One explanation I have found is that some people have an Apo E4 allele that means they don't process fat well. Here is a comment from Joe D. Goldstrich, MD, January 23, 2011 at on the proteinpower blog (http://www.proteinpower.com/drmike/lipid-hypothesis/the-big-lie/#comments):
"I believe the low carb, higher fat diet is the best diet for around 75% of the population. However, about 25% of the population carry the Apo E4 allele. These individuals will increase their LDL-C, LDL-P and sdLDL as they increase their fat intake. I am Apo E3/4 and have been eating low carb for the past 5 years and at the same time struggling with LDL issues. I recently began limiting fat (especially saturated fat) as well as carbs and lost approximately 15 pounds over a 10 week period while concomitantly cutting my LDL-P and sdLDL in half with little change in my LDL-C. My LDL particles got bigger and hopefully less atherogenic. My weight has now stabilized. One diet apparently doesn’t fit all."
Also, there is a different calculation for LDL when your triglycerides go below 100. Here is a link to the study: http://www.ams.ac.ir/AIM/08113/0014.pdf and here is a link to the calculator: http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm
I think the LDL is too high. I probably shouldn't speak for my boyfriend Chris Masterjohn and I am prodding him to post on this, but high LDL is possibly a sign of poor thyroid function, which unfortunately has many causes.
I would definitely eat more real seafood or use kelp as a seasoning. Fish oil doesn't contain the rich variety of minerals that seafood does. I might also look towards replacing some coconut with tallow and lard. It's possible you are genetically sensitive.
There are plenty of high-fat dieters with target LDL levels, myself and Chris included.
A high LDL like that is typical for Paleo. Mine is 211. But your trigs are low and HDL is a healthy 72. Also, your vLDL is fairly low at 17. I think the best way to really know if your LDL might be troublesome for you in the future is to get a lipoprotein analysis/VAP test to determine your LDL particle type. If you've been on Paleo for a year and a half, then you've got to know by now that if your LDL is dominated by large, bouyant particles, that's regarded as a good sign. If that be the case, I don't think you have anything to worry about.
Remember, the only reason why we even stress over the LDL count is because of the faulty theory that got us into so much trouble int he first place. Imagine if they took CVD and heart attack statistics from a large group of Paleo only eaters. I'd wager a fair sum that the 'high' LDL count and 'high' total cholesterol would confound the so called experts. Just because high LDL and high TC has been associated with heart disease in group studies doesn't mean it's true for all, as I doubt very much the people studied had the same 'kind' of LDl and TC. It is highly likely that their diets were nowhere near appropriate, making these 'target numbers' to shoot for completely unreliable in my opinion.
What I am really saying is that I believe that if someone were testing cholesterol numbers from the cave man days, we'd likely see numbers similar to yours and many other Paleo peoples. A slightly elevated LDL (only known as "elevated" based on today's conventional standards") would probably have been the norm.
I would say add in maybe a bit of iodine from kelp supplements or eating kelp and then add in some starch. I had some thyroid symptoms until I added more carbs in the mix.
Also note - iodine can cause a rise in TSH initially, not sure why, but it goes back down again. Make sure you are eating enough and you should take breaks from any caloric restriction. DO not fast so much either.
I don't know that the a1c is unreasonable, but I would have expected, from your description of diet and lifestyle, that the FBG would be lower, espc. Since you have done this for 18 months.
A full thyroid panel, including the rt3, would give you more info. But I am pretty sure Doc Harris would say that you're just looking for trouble. I'd wait, check the a1c again in a year a log with a vap or NMR which counts cholesterol rather than calculates.
More seafood this year wouldn't hurt, and less fish oil!