Ok folks. This may very well be the most important question I ever ask on PaleoHacks. I've seen many people on here post their cholesterol numbers. From Travis to Todd to Kamal to Melissa and many others. Well, now it's time for Jack Kronk. I need a hack, big time.
I'm sorry to report that I am very unhappy with the results of my VAP test from last week. I was hoping for something more "Paleo-ish". Instead, I am staring straight down the pipe at needing to make some major changes.
I DO NOT want to make this post. I like the notion much better that you all just think everything is going peachy with Jack Kronk and that I am this picture of health. In many ways, that's true. I am more fit than ever, strong as a bull, and happy with many aspects of my health. But these results have me very concerned. One of the toughest things for a person to do is humbly ask for help, especially when it appears that the help is needed as a result of bad decisions. I will say this... if it is bad decisions on my part, it's certainly not intentional. It would be more correct to blame ignorance, hence the importance of my honesty here. I sat here and thought to myself... should I try to make some changes first and improve the numbers and then report back my success to show everyone how brilliant I am? But then I immediately realized that that's what gets people into more trouble. No. I decided instead to bite the bullet... to be completely transparent.
I will post the results and discuss my thoughts below. Ok, enough prepping. On to the numbers:
Oct 2010: Standard Lipid Panel
(after 2 months VLC - less than 50g per day)
July 2011: VAP
(switched to higher carb Dec 2010 - probably around 150-200g per day from starch and fruits)
Since Oct of 2010, I have skyrocketed my Trigs and my HDL is just sitting there like a lazy bum. My LDL went down quite a bit, and my TC went down a little, but what's the deal with my HDL/Trig ratio?
I eat about a dozen eggs per week, and while that isn't breaking any records, it's also not absent from my diet by any means when you consider that I'm getting about 4-5 dozen per month. Also, I cook those eggs in coconut oil, every time. But that's about my only intake of coconut oil. For a couple months, I was eating 2 tablespoons per day, but I stopped doing that back in January.
Also, I have seriously upped my intake of fruit lately. I've been very vocal about this on PaleoHacks too. I love me some bananas and cream. I think I average at least 1 large banana per day now. Sometimes I have 2 because I figured it may help me add muscle from the starch. Is that what's causing my trigs to go up?
And what the heck is up with the pattern B and the small VLDL? This is the thing I am MOST concerned about. The only thing I can think of is my stubborn HDL and rising Trigs. I wish very much that I had gotten the VAP done back in Oct 2010 as well so I can compare since my Trigs were only 85 then.
I know that some folks would go into freak out mode over this. Understandably so. But I not like "OMG Paleo is killing me! I'm going Vegan!". Um, no. I know too much to think like that. I can identify some key areas that I may need to change and I'm not about to toss out everything I've learned just because I don't like my numbers.
So I'm open folks. You all know me. You know I'm serious and I will do whatever I need to.
Some other key elements to my diet that may be important:
Very little gluten. My only indulgences are the occassional pizza and beer. But my intake of both of those has plummeted to way below average over the last 10 months. I probably eat pizza about twice a month and have beer about 1 pint every 2 weeks or so.
Very little PUFA - I avoid all vegetable oils whenever I can. I never cook in veggie oils, of course. I do eat almonds and pecans regularly. This is basically my only intentional source of food that contains some O6 PUFA.
I will often eat a banana sliced up with cream and a coffee with cream for breakfast. I started doing this about 3-4 times per week maybe 4-5 months ago. I really enjoy it, but I will dump this habbit faster than Chuck Norris if I need to.
Raw honey with nut butter is one of my favorite little snacks, although I haven't had raw honey in over a month and a half so I'm not sure if that played a big role here.
So what do you think? Could this be due to a certain genetic predisposition? If so, how do I test for that?
Should I supplement with fish oil to get more omega3?
Drop the bananas completely?
Supplement Niacin like Dr Davis recommends to rasie HDL?
Increase eggs and coconut oil?
Drop the starchy tubers?
Add more starchy tubers?
Eat more salads and veggies?
Personally, I suspect that my increase in fructose consumption has caused my Trigs to go up, which is why I target the bananas. But would eating ONLY whole fruits like berries and bananas and figs do that? The only juice I get is from Kombucha, and it's very little at 5% content.
Doc wants me on meds of course. Here was my response this morning:
Thanks for these documents. I was expecting to see the full range of other measurements on the VAP like VitD levels, CRP, etc. I suppose the trade off is getting a better picture of what kind of cholesterol I have.
To be frank, I am not pleased with these results at all. I am very concerned about the VLDL, low HDL, low protective HDL, high Trigs, and certainly the small pattern B LDL. That sounds like a bad recipe in many respects and I will not accept this.
Without question, I will be making some significant adjustments to my dietary choices now that I know how my body is processing what I am eating. The adjustments begin today. Right now.
At this time, I am not interested in cholesterol meds. I understand the implications, and the importance. I would like to retest for the VAP in about 3 months to monitor this more closely for a time so I can get a clear picture of what's really going on.
I am very serious about correcting this, and I will do whatever is necessary to ensure that I have good cardiovascular health.
Thanks for your help everyone!
EDIT: Some people are asking what I think about cholesterol and the lipid hypothesis.
I'd like to put my viewpoint out there so everyone knows where I stand on this.
I believe the diet-heart hypothesis is faulty, and I believe the cholesterol lipid hypothesis is VERY faulty.
Specifically regarding lipid numbers, I should have noted in my question that I come at this from a very non-conventional perspective and I have a fairly advanced understanding of what this all means. I say 'fairly' because I won't even begin to pretend to understand it from a bio-mechanical perspective like, say... Chris Masterjohn does. But I know what to look for beyond just TC and LDL, which for some reasons, are still the typical things that docs freak out about.
I believe total cholesterol number is almost worthless. TC should not be calculated the way it is by conventional standards. It makes no sense. If you ask me what I think 'healthy' cholesterol numbers are, I would say they should have the following points:
High HDL: 60+ (and closer to 80+ is even better)
Low Trigs: <100, (and <80 is even better)
Low VLDL: fuzzy, but should probably be less than 20
LDL should be large, buoyant pattern A dominance over small, dense pattern B
VitD should be at least 35 ng/mL
Low C-Reactive Protein levels
Even then all we can do with this information is speculate, since these are only markers for good cardiovascular health. I don't care much about the total LDL number because I think the calculation of it is faulty. I also think the measured LDL number is misunderstood still and that even an LDL of 200+ may not be a bad thing if all other areas listed above are present.
So why I am concerned? Because I miserably failed the top 4 important points and didn't get the last 2 so those are still unknown.
Hopefully that helps clarify where I stand with cholesterol.
----EDIT---- It has been noted that I was told fasting wasn't necessary. Most of the research I am seeing backs this up, yet everybody on here agreed that I should have fasted. Look at this page for the Atherotech VAP testing (one of many). It says: "Because we are directly measuring LDL-C, fasting is not required."
Is that true for LDL-C (calculated), but not true for triglycerides?
If fasting is still required to get an accurate measure of fasting trigs, than they are making a big mistake telling people they don't need to fast.
I am Mr Mom all night and won't be able to get more than 10 minutes, let alone the many more minutes that I want to devote to this. You and I have been trading posts since the PaNu forum days and I feel that I "owe" you a thoughtful response. However bandwidth this evening notwithstanding, my initial thought was "how do I provide a substantive, thoughtful, referenced response to address the points I want to make to a guy that probably knows more about Paleo than I do. I still intend to do that to the best of my abilities ASAP.
However I am going to take a different approach that will perhaps be more valuable for you and all...
@ Melissa McEwen -
You don't know me from Adam, but I am making a personal request to you. Can you please ask Chris Masterjohn to address this post from Jack? I only know Jack through this forum and intially from PaNu's defunct forum. But to me, Jack is a pillar in our community here and I think many would agree. He has given this community a lot and deserves a lot when he needs it...like now based the concern he has expressed.
I believe Chris is the go-to guy on this topic and I am not blowing smoke up anyone's ass in making this comment. Moreover, with the recent about-faces in the Paleo community by some regarding fats, carbs, etc, I think there is a fair bit of concern recently about the shifting landscape and what it means to the assumptions that have gotten us here, including that of the Lipid Hypothesis.
I don't think this is just an important question for Jack, but for all of us here-to-date cholesterol skeptics. I have joined the bandwagon many times in chanting "screw the Lipid Hypothesis". Perhaps Jack has too. Additionally I have discounted n=1 issues like many. However n=1 is all that matters when you are faced with data that places you at the crossroads of accepting or rejecting conventional wisdom. It is easy to be a skeptic when life is great and you are "strong as a bull". But when potential adversity hits, not so much...
Anyway, I think the insights Chris would have to offer would be so incredibly significant for all of us, like Jack, that have been all-in with the tenets of Paleo. I hope you will at least consider this request. It is made with the utmost of humility and respect for his opinion and your thoughtfulness to at least consider asking him.
From Chris Masterjohn
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.
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.
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.
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?
I'd be ready to change anything to get the small particles gone. I hope you find a solution.
I'm not sure what ppl around here think about "Mastering Leptin" by Byron Richards but here is a quote from page 130: "When a person eats too often, especially meals high in sugar, the liver goes into a chronic stimulation of VLDL synthesis...Thus from a dietary point of view, the foremost reason for elevated cholesterol is snacking between meals, not the cholesterol content of food."
So maybe some ppl eat bananas within the window of mealtime and have no problem whereas someone who snacks with them gets into trouble.
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.
Got my VAP test results - now what? 9 Answers