From Chris Masterjohn

Dear Jack,

Since you fasted before the first test but not the second test, making any comparison between the two tests is completely meaningless. Your increase in triglycerides reflects the fact that you ate before the test, and neither value is high enough to suggest insulin resistance (>150 would have worried me a little if you'd been fasting for 12 hours but in this case it doesn't). Your decrease in total cholesterol is too small to conclude there is a real change, but even still it is confounded by fasting status.

Your total-to-HDL-C ratio is very high in both tests and is virtually identical between the two tests. This is somewhat disconcerting. Consistent with this, your LDL particle size is pattern B, which is correlated with a high total-to-HDL-C ratio in the general population. Studies of cardiovascular mortality suggest that among all of these measures, total-to-HDL-C ratio is the strongest predictor and neither adding triglycerides nor LDL particle size adds any additional information. Thus, there is nothing more disconcerting about your second test than was already disconcerting about your first test.

There is an additional reason I'm skeptical of giving preference to particle size. There is, as yet, no standardized way to assess it, and the different methods are in wild conflict with each other. In one study, they sent 40 samples to labs using four different methods of analysis, and all methods agreed on the classification only 8% of the time. Tube gel electrophoresis identified about 80% of people as type A whereas VAP identified 8% of people as type A. You can increase your particle size even more, according to a different study, by having it analyzed by HPLC.

That said, a pattern B LDL could have been predicted based on your first lipid panel due to your high total-to-HDL-C ratio. The fact that these two parameters are in agreement as well as a high total cholesterol suggests to me that you have rather low clearance of LDL from plasma. That's not the end of the world, but it seems like something worth improving to me, if possible.

If all signs of health are in good order, I would not panic about this, but I would look into the possibility of heterozygous familial hypercholesterolemia or poor thyroid function.

On a side note, I would not suggest going on niacin. I wouldn't call it "supplementing" either because that implies that niacin is a vitamin, but niacin when used to increase HDL is not a vitamin at all, but a drug. We don't even know how it works, except that it has nothing to do with its vitamin function. It was thought until very recently that it worked by inhibiting release of fatty acids from adipose tissue, but now the opinion is emerging that it works by decreasing triglyceride assembly and export in the liver. This is likely to cause liver damage. Additionally the most recent clinical study on niacin was quite negative. It would be interesting to see the effect of more virgin coconut oil, but I would try to understand the situation better before coming up with remedies.

I hope that helps.

Sincerely, Chris

This is just my own personal experience: for years I had a banana a day, sometimes two, and always had dried figs around the house. Loved 'em! I've been whole foods since I opened a vegetarian restaurant back in the 70s, was always into the "natural foods" thing, so I haven't done SAD in going on four decades. But the vegetarian thingy only lasted a couple of years as it was an absolute health disaster and I sold the restaurant after a year. But in all the time since, it was no refined grains or sugars, occasional honey or maple syrup, but nevertheless, unsweetened whole grain cereal with nonfat milk, whole grain bread on a sandwich and a banana a day, an apple a day, figs and some grapes and was pretty much low fat and not enough protein. I slowly put on weight up into the 90s but had high triglycerides going all the way back to the 70s.

Then in the mid-90s I read The Zone and turned on a dime. Dropped the carbs, got rid of the bananas and figs, because they were so high-glycemic, and reduced other fruit intake except for the apple a day and some grapefruit. And maybe 10 grapes. But all with protein and some fat. I was a good little Zoner. I dropped 32 pounds of fat weight and gained 4 pounds of muscle weight in a few months.

But more importantly, in that time my triglycerides went from 437 down to 67, and since that time I have considered bananas radioactive. I haven't had one in over 15 years and to this day I will not turn my back should I spy one loitering in someone's kitchen or the store. They are evil. Ding me all you want, fruitarians, but I am confortable in my own skinny skin and my low TG numbers and cannot be thwarted on this because I have my own history to fall back on. Wail, if you see fit. But when I find a food has been wicked with me, I don't whine about poor little ol' me can't have my fun food anymore. I grow fangs and hiss at it. Bananas should be hunted down and skinned. Or fed to monkeys. `Just sayin'. Besides, people slip on the insidious little bastards.

I do very little fruit today. Do with it what you will.

Ed

It seems that everyone can agree that a high fat diet is going to yield positive results. There also seems to be some disagreement surrounding carbs, fruit, etc. I think it speaks loudly that Jack's numbers were looking better when he was VLC. Why not go back to that for a test run and check the numbers again.

Simply speaking- high fat=good. High Fat+Carbs=not good.

I think we need to admit that certain diets can yield healthy results (from a surface level, blood test and appearance stand point anyway) when incorporating carbs, including fruits. There are a lot of crossfit folks that look like gods and goddesses while eating ZONE.

Paleo is not one of those diets that carbs should be added to. By nature it is LC. Maybe the daily banana could be reduced to the weekly double banana/cream treat.

Consider the pizza and beer twice a month cheat too. If we're to believe that it takes 12-14 days for gluten to be removed from the system as Robb Wolf says, Jack could be in a constant state of inflammation and healing depending on the spacing of the cheats, and his sensitivity to gluten.

Maybe pushing the reset button and going strict Paleo for a month or two will give a more focused lens to see what is going on.

The 150-200g carbs seem like a prime suspect to me. I would cut that in half and stop eating bananas, which spike blood sugar easily.

I think you should do a thorough assessment of how many grams of fructose you were eating during that period. If you were eating honey, figs, and bananas for 8 months and then switched to only bananas for the last month, you'd probably have some residual effect persisting. As far as bananas go, simply eating them caused severe reactive hypoglycemia for me in the past, though I was eating more than you do. It seemed to be worse than the advertised number of grams of fructose would allow for, though ripeness plays a large role in how much they have and a large banana may be quite a bit larger now than when the USDA database was compiled.

The TGs and small, dense LDL particles are the same problem and almost certainly the result of your fructose intake. Your high-ish LDL is a separate issue and is likely the result of your heavy cream, and to a lesser extent, your coconut oil intake. When I shot my LDL through the roof via butter intake, my TGs stayed quite low. I think they were 37 last I checked. I've always avoided fructose like the plague. I agree that the former problem is quite a bit more troublesome, but should be easily correctable.

Were I you, I'd replace the bananas with strawberries and don't ingest any other sources of fructose and re-test in a few months. I think a deficiency in vitamin C will potentiate the tendency toward hypertriglyceridemia in the presence of fructose. So, if you're deficient, 50g a day of fructose may be a totally different animal compared to if you are ingesting sufficient amounts. (This is merely a hunch) Strawberries are low in fructose and high in vitamin C. The ascorbate increases urate excretion, hyperuricemia being at least correlated with hypertriglyceridemia and the other symptoms of metabolic derangement.

If you also want your LDL to drop for whatever reason, simply remove the cream and any butter that may be in your diet. I'd wager that coconut oil as cooking oil is playing a much smaller role.

Edit: I don't think that starch played a role here as my TGs dropped from 54 to 37 when I doubled my starch intake to about where you are now. My TGs have steadily dropped as time has elapsed with a very low fructose intake. TGs seem to decline at a much slower rate when fructose is removed than LDL declines when myristic/palmitic/lauric acids are removed.

Good luck; don't panic.

Safe starch diets would improve those numbers somewhat but not markedly. Your trigs should come down close to 100. Possibly your HDL would go up, but only slightly.

The other point to take away from this story is this: I know many people who eat safe starch diets. Not necessarily Paleo but those who eat white rice, tubers, potatoes, very little package foods and sugar.

Their trigs are usually between 100-150. That is, above the optimal level of 60, which indicates your LDL size is the buoyant, harmless one (by 99% probability). Very low trigs are usually a marker of VLC or ketogenic diets. Yet these people are very healthy.

The point is: is the lipid theory valid? You are using Trigs to impute your LDL particle size. But is LDL and its size that important? More importantly, elevated LDL levels?

Conclusion: No, I don't think so. Cardiovascular health needs to be examined in the context of the following other variables: homocysteine, micronutrient levels, inflammation (CRP, ferritin, Sed Rate), infection markers (WBC, HDL), autoimmunity markers, and most importantly, your HbA1c.

Your A1C (along with self-tested fasting BG and PP BG) is probably the most important number reflecting overall health, i.e., future health. It's your ability to metabolize carbohydrates (and sugar) that is the precursor of heart-related ailments and chronic diseases. Your fasting BG above 83 will be very revealing if you used to test 83 and now test 95 or worse 105. Most docs would say it's okay since they're used to seeing FBGs of 115 in Americans, 2/3s of whom are seriously overweight and are in the stae of becoming progressively insulin resistant. Remember, insulin resistance is a continuum, not a state of being either/or, like diabetes is.

That FBG elevation could be due to steadily increased sugar and gluten consumption. C.f.: refer to past discussions regarding how safe starches do not impair your carb metabolization but sugar and gluten grains certainly do. There is a plethora of evidence regarding the Pima, Kitavans, Okinawans, Tarahumaras, etc. Humans ate a starch-heavy diet. Just about all humans except for the Inuits, Masais and some Swiss.

So we're back to a full circle here. It comes back to fructose (sugar) and gluten again. The safe starches I think are exempt from impairing cardiovascular health, despite the somewhat elevated trigs and LDL particle size numbers.

Sorry if this is so amateurish - but with my own wacky tests recently I've been doing some reading up. I have to say that I can't believe that your one banana a day is going to make you results flake out - but that's just a personal belief.

However, have you considered adrenaline/cortisol issues. I hate to say it because I myself am sick and tired of hearing these words bandied about the Paleosphere - but they could be a real player in this. Chronic elevation = lots of freed up sugar which, if not used = high trigs and high LDL.

I may be shot out of PH for good for saying this, but I think this may in fact be a reflection of VLC. I personally need to keep my carbs up, which I get mostly from fruit, a bit higher so that I don't get cortisol-ed out (bitchy). I still consider myself lower carb than an average SAD dieter, though.

Also, what is your vitamin D status. D can really pump up the HDL, which was something I was actually concerned about because mine is so high. DO you supplement and/or get your sun?

Hi Jack,

The only thing I can add to all the response here would be to remove variables from the equation to make it easier to solve. Eat a very simple menu for the next three months. Grass fed beef, green leafy stuff, eggs, (cooked in butter) and lots of water.

A simple diet of stuff you know to be healthy for you. Skip the banana (for now) and the nuts. No cheating.. Set the baseline. In three months you will have important data to move forward.

Hey Jack. Off the top of my head, I remember you often referring to allowing more cheats than the normal person, or being more liberal to the occasional gluten containing food and or beer. Perhaps this, with the addition of a decent amount of fruit, in the presence of a mostly Paleo diet might have that effect on the numbers, i.e. high trigs, lower HDL?

I've always kind of thought (but recognize I may be wrong) that Paleo with cheats may be more dangerous than one might think.

I think we eat fairly similar outside the gluten & fruit. My numbers recently came back as follows:

•Cholesterol, total 280

•Triglycerides 24

•HDL 115

•LDL 160

•Triglycerides / HDL Ratio 0.21

From Chris:

For Jack Kronk, there are two important questions:

First, how many hours had you been fasting before each test? Was dinner the night before relatively similar, or dramatically different? Second, had you been weight-stable in the several months before each test, and if not, how much weight had you gained or lost prior to each test?

Lacking something? link text

Since December, Larry has been taking all the recommended supplements and eating 5 ounces per week of beef liver. As I noted yesterday, Larry’s LDL decreased from 295 mg/dl to 213 mg/dl, HDL rose from 74 mg/dl to 92 mg/dl, and triglycerides fell from 102 to 76 mg/dl since he started Step Three. This is all consistent with a healthier vasculature and reduced production of endothelial lipase.

Honestly, all this stuff is way over my head, sorry I'm not much help :/

Oof, that HDL needs to go up. I would use coconut oil for fat, and completely cut out the nuts. It can't hurt. Pufa can lower HDL, so that's definitely something to think about. Paul Jaminet has also talked about HDL being lowered with infections, so that's a possibly avenue for exploration as well.

Also, while I don't normally think fruit is a problem, you might want to cut it out for a little bit and see if that makes a difference. It may, it may not, but it'll be worth it to find out. I think the kitavans have slightly elevated trigs, but don't show signs of much heart disease. Regardless, I wouldn't drop the starchy tubers. I don't think they're problematic in individuals with relatively good insulin sensitivity, and they provide lots of potassium and reduce/eliminate the need for gluconeogenesis. That's good in my book.

I imagine you'll get some better answers than mine soon enough, as I'm obviously no expert. Best of luck Jack.

All I can say is that as much as I love coconut oil, it did a bad bad number on my LDL--and when I switched from coconut oil to butter to fry my eggs, down went my ldl. so sad, too bad--bit the CO was the culprit for me--

I suspect Jack's doing 50-60g of sugar per day. The average American does 90g.

High carb Paleo would mean "safe starch" Paleo. I.e., high carb mainly from safe starches like tubers and rice which do not have much sugar. Yams and sweet potatoes have almost no sugar, despite the sweetness. Neither do potatoes or yuca.

At 50-60g of sugar, that's about 30g of fructose. I would keep my sugar under 20g per day and still do high carb Paleo.

His Trigs would be closer to 100.

Great question, post and debate going on here. It goes without saying that I am sorry it is at the expense of Jack's bloodwork. However, I think questions based on n=1 results such as Jack's are what this forum is all about. I look forward to seeing where this goes. I personally hope all would be a little more respectful of others' opinions and input. There's room for all respectful and thoughtful comment. No one has "the" answer. We are are still trying to figure this puzzle out.

Since age has been brought up a couple of times in this thread, for a lark, I went back over a number of these posts and comments making a note of ages of the posters and it's apparent that most of the fruitaholics and the starchaholics pushing for revisionism of the paleo diet are in their 20s and 30s. This is most telling. When I was in my 20s and 30s I could do just about anything and get away with it but that didn't hold up. Today I have very little to do with fruit and starch and I explained the reason why a few days ago over here -

http://paleohacks.com/questions/50347/hack-jack-kronks-vap-test-results/50907#50907

Not only that, most younger adults are prone to excepting theories as long as it meshes with emotional attachments. Nothing like physical degeration to unlatch those. I don't mean to come off sounding patronizing, but it might be better not to fix everything is stone just yet.

So begging your forgiveness for operating with the benefit of hindsight and experience, I'm curious how many will be able to hang onto their newly acquired dogma into the decades. I read Denise Minger's paper and if that's what you're clinging to as proof of your general theory of paleotivity, please keep a light rein. I am fairly certain many of you down the path will not look back as it recedes over the horizon. It was a nice paper, interesting, and I did learn a few things about giant African fruit, but not one thing that could be incorporated by a European, North American or most Asians. I noticed she is rather young too. I wonder if someone could prod her expound on my still very valid example of the banana. Or would that not gel with the agenda?

Anyway the effects of sugar and starch in the long run is what will bring most knowledgeable people back to the real paleo.

Ed

How much non-weight bearing exercise do you do?

Hello Jack! I've discovered this post after suffering a similar situation myself. I read your comments in Dr. Davis blog and I have also posted a question in this forum: http://paleohacks.com/questions/83913/high-ldl-tryglicerides-and-uric-acid#axzz1gpFGBP3x

What has been the evolution of your situation? Did you resolve it? How? May I contact you? Thank you

See this post: http://paleohacks.com/questions/50312/interpreting-my-lipid-panel-results#axzz1RY65w7n2

People should stop worrying about their lipid panel numbers.