First off, don't panic as this isn't even remotely severe. If you just got off a cycle of anabolic steroids and your TGs were 800, then you might want to worry. Even the average person is probably walking around with your panel or worse into middle-age. This isn't going to kill you anytime soon.

That being said, have you ever had your testosterone checked? Low T could explain a lot of this: http://care.diabetesjournals.org/content/27/5/1036.

Additionally, what are you doing to actively clear triglycerides from your blood? I know you do resistance training, but how much walking do you actually do per day? I walk the dog 5-6 miles a day whether I'm attempting to lean out or not. Walking is simply not optional. Hominin diets have varied significantly over the last few million years, but one commonality that they all had was a high daily volume of low intensity activity. Much of it was performed in the fasted state, since they had to work harder for their food. At low insulin levels and constant activity, muscle mitochondria readily soak up FFAs and triglycerides (from VLDL and chylomicrons). I believe that the TG measurement in lipid panels only measures the content of VLDL, however, if you're creating huge amounts of TGs in chylomicrons with a high fat diet while remaining sedentary, you could definitely slow down the clearance of VLDL-TGs.

I am thoroughly convinced that an individual with elevated TGs can clear them from circulation in a matter of days if they do the following:

Stop glycolytic activity and eat around 150g of starch a day (mostly at night right before bed). Walk/cycle/whatever as much as possible in the fasted state. Do not exceed your anaerobic threshold. Burn more fat through increases in volume, not intensity. The walking doesn't have to be all at once, but it must be in the fasted state. Eat lean meat for a while, but make sure to get your EFAs from somewhere. I recommend 4-5 pastured egg yolks a day. Lower fat will cause a decrease in the production of chylomicrons, which compete with VLDL for binding sites. You only have to decrease dietary fat temporarily.

Walking increases HDL and decreases TGs. It's absolutely vital for health. You can not eat your way around this one.

If you already currently do this, then you're probably looking at low testosterone or something else.

Edit: It's time for me to put my money where my mouth is. If you follow my above advice to the letter for the next two weeks and retest your TGs (with a standard lipid panel or VAP) and they haven't dropped considerably, I'll paypal you the cost of the test. This should work even if you do have low testosterone.

Honestly, I would drop the high fat model and adopt a higher carb paleo with about 60% coming from carbs, and 20-20 fat - protein split. Focus on low fructose starches and lean meats and fish.

Your thyroid is low and you probably dont have good T3, thus your testosterone is also probably low. I imagine your weight loss combined with the 6 months you spent on VLC has lowered your thyroid hormones and Testosterone. Just adding in starch doesn't cut it... you should try some sort of "refeed" diet with higher carbs and low fat to increase T3 and things should look better after a month.

Danny Roddy has touched on this and it seems to be working for him.

EDIT: Also definitely consider an Iodine and Selenium supplment. I recommend Iosol over Iodoral or Kelp.

I feel like I shouldn't even be posting in here because I am so uneducated on this topic compared to the other posters. But I'm going to toss in my two cents because you're one of my favourite paleohackers. I find it so strange that a guy as ripped as you is said to have "probable metabolic syndrome".

Like others have said, I feel this could be thyroid related. Perhaps you are deficient in a micronutrient (iodine, selenium, magnesium, zinc?) and need to go on a higher dose for a bit to make up for the deficiency. On that note, what's your liver/offal intake like? Maybe frequent intake of liver could address a micronutrient deficiency (as well as provide vitamin A as Quilt has suggested). Also, how's your sleep and stress?

after 2 months of VLC and high fat zero starch, with plenty of butter, some raw milk, coconut oil, plenty of whey protein, 3x wk heavy lifting, I tested for 85 fasting trigs back in Oct 2010. So it may be the combination of starch and fat that's getting me

Perhaps you just don't have the genes to do the fat+starch gig. I think the key point is that your trigs were ~30% of what they are now after doing 2 months of VLC. You could try going back to low-carb for a while, while still doing the HDL boosting things you've been doing lately (tons of coconut, eggs, avocado, maybe macadamia nuts and dark chocolate, etc.). ~50-70g of tubers in the evening and ensuring proper micronutrient intake (liver, shellfish, iodine, selenium) should keep your thyroid in business. But again, if you do have a thyroid problem, you should forget about everything I just said in this paragraph and do whatever it takes to get that thyroid pumping. Perhaps a full thyroid panel is in order.

Please take my two cents with a grain of salt. Again, my knowledge here is limited. Keep us posted.

ETA: I assume the reason I got downvoted here is because I may have come across as carbphobic. To add to that last paragraph re: starch+fat being an issue: The other option is to try the high starch/low fat route.

I think these labs are curious but it is like doing a smog check when it is the alternator busted...

Without a salivary cortisol x4, you can self assess your body/brain indicators with Dr.Rind's metabolic symptom matrix. Thyroid and adrenal function are intimately tied and practically co-function together. Both are usually 'off' but different degrees. Also it is dynamic -- as our health responds to relaxation, supplements, food, environment, sleep, the symptoms rapidly shift.

Things I would consider for priority if you have adrenal insufficiency and suboptimal thyroid:

(a). Adrenal (the alternator/spark) -- many people have insufficiency and I believe IMHO in epigenetics as Kruse is often alluding to. You were born in the 80s and if your mom was somewhat on the SAD, pesticide-laden grains, eating margarine over butter, and corn oil, the health and gut dysbiosis she might have suffered was passed down to you in form of a poor gut microbiome as well as epigenetically affected cortisol and other hormone effects. McBride-Campbell (GAPS) talks about it. This is also shown stress in mother rats will raise cortisol and BP in babies rats but many things improve this to optimum and correct (like omega-3). Briffa talks about adrenal fatigue in teens HERE. Personally I developed some adrenal issues with doing endurance stuff whilst ketotic. Some people are really healthy adrenal-wise (I think Kruse! the Eades! Gary Taubes! Sisson and Doug McGuff!) but many just aren't esp younger ones like you (and I haa). Have you read Kruse's post on adrenals? Personally I rotate between Standard Process and Metagenix adrenal support. They contain glandulars which help the adrenal to rebuild; ancestrally we all ate glands (chorizo, whole small fish, leaf lard, sweet meats, etc).

(b). Testosterone -- ditto the above comments. I observe T tripling with vit D supp alone. Vit D is very powerful and even Guyenet supplements this (only in the winter he told me; but he is very untan and lives in Seattle w/sunny French blood!). When the adrenals perk up -- so will thyroid and T... There are tricks to get it up... j/k.

(c). Thyroid -- low thyroid is epidemic for a variety of reasons. You sort of need to figure out why. Low adrenal? Over exercising? Mental stress? Metal toxicity? Lack of micronutrients (vitamin D, omega-3, zinc, mag, calcium, selenium, iodine, etc)? For me, vit D normalized my TSH to 1.0 for the first time in my life (then I fried my adrenals and TSH increased again). Many things affect HDL/TG including low thyroid. Low thyroid causes insulin resistance and difficulty to oxidizing fat for energy. See Rind's chart.

(d). Liver -- the ALT AST appear mildy high (experts believe < 15 ALT is nl for men, 12 women). It's not the beer imho... Has the ferritin ever been high (rule out hemochromatosis)? Was liver high before? For formally SAD/fructose damaged, this is not uncommon. Omega-3 has value if it is mild NASH. The common causes of NASH/fatty liver are (via PPAR pathway disruption): high carbs/fructose/fruit, omega-3 deficiency, excess n-6 pufa and fat gain. In the medical literature the converse all improve NASH/fatty liver: fructose restriction, lower carb, fat loss, and omega-3 supplementation. Omega-3 also improves CRP and silent inflammation and autoimmune disorders via PPAR activation. Only takes 2-4wks to normalize if fatty liver.

(e). Gut -- it's central.

Edit: Jack, have you ever had your testosterone checked? Low T could explain a lot of this: http://care.diabetesjournals.org/content/27/5/1036.short

The only thing that stands out to me is the somewhat high TSH; do you supplement with iodine and selenium? Hgb looks to be right where you want it even with the low iron. I can't imagine that iron wouldn't take care of itself on most paleo diets unless you're giving blood all the time or something.

Vitamin D is at a safe level, though some would want it higher. Anywhere around 60 is probably the best place to be.

I just listened to this the other day: http://chriskresser.com/episode-16-chris-masterjohn-on-cholesterol-heart-disease-part-2

The focal topic is whether lipid panels are diagnostically useful (and it's not strictly theoretical--CM offers some specific approaches to interpreting panels that might be helpful). So along the lines of Jay's comment--I wonder whether these numbers actually indicate a problem...?

A lot of people are telling you different things. A potential problem I see is that you can't just try a week of one diet, you are going to have to tightly regulate your nutrition for months and then re-test. It's going to be grueling, as both diets being suggested (low-fat, keto) are at the extreme end of things. I would suggest getting a subscription to cron o meter online so you can make sure your mineral intake is optimal while you do either diet.

I would also be curious if you have some kind of chronic infection. Have you had a full stool panel? The body often chelates iron to fight infection.

Kronk,

(haa ahha) Did Stabby offer to help you ameliorate the iron problem with his exclusive solution (stab stab)??!

Give more blood... Consider the high value of the APOE4 test (and other tests!). E4 is the ancestral hunter-gatherer allele (Meat-Adaptive Genes and Evolution of Slower Aging, Stanford and Finch, 2004). Those with this allele are more highly susceptibly to glycation damage (oxLDL, small dense LDL, rampant heart disease, diabetes Type 3/Alzheimer's, osteoporosis) and LEAD, ALUMINUM, MERCURY accumulation.

http://www.lewrockwell.com/miller/miller14.html

http://www.uwplatt.edu/research/purf/henning03.pdf

http://www.howweheal.com/Godfrey-I.pdf

Here is Genova's genetic testing info on metals and known chronic diseases related to apoE4: http://www.gdx.net/core/sample-reports/Cardio-Genomic-Plus-Sample-Report.pdf

A high GI carb diet (tapioca flours, white potatoes, bananas, et cetera) is the slow death of ApoE4'ers. I'm not trying to cr*p on your current experiment because the benefit may outweigh the risks since moderatish carbs will heal adrenals and high cortisol (VLC make adrenals worse if the adrenals are incompetent). A lot of herbals/hormone replacement help MORE with lowering cortisol (Relora, omega-3 fish oil, vitamin D, bulking fiber (I don't like guar gum but glucomannan, psyllium, chorella, parsley/herbs/cilantro, etc are great as well as help our gut/organs to eliminate metals harbored in deep soft tissues).

As you can tell from research by Dreon and Krauss et al, a high carb diet produced pattern B and increased small dense LDL (by proxy oxLDL and glycation) on VAP; high fat, the least amount of sdLDL: http://atvb.ahajournals.org/content/15/1/105.full

What is your ANCESTRY?

Other labs you can consider with your conventional wisdom doc:

-- fasting insulin (if >5 mUI/L then you are still IR/LR, resistant to insulin and leptin)

-- MMA (methyl malonic acid) for B12 deficiency

-- homocysteine

-- ferritin

-- SHBG, Free T, Total testosterone (good end-game markers!! AHHH! cr*p on the rest!!)

-- Thyroid panel (real this time!) incl rT3, Free T4, Free T3, antibodies

I ask about your ancestry because I suspect like others who have LDL > 200s, that you are of northern Europe descent where E4 is the most prevalent. If so, you ancestors were skull-crushing, marrow-munching, liver-loving CARNIVORES! No joke they likely ate TONGUE-TO-TESTICLES!!

As hominids 30-100 millenia ago dominated northern Europe, they migrated away from mineral rich marine shores and sea flora and fauna. The natural selection of mineral hoarding genes for iodine, magnesium, zinc, calcium and upregulation of cholesterol production and intestinal absorption compensated. In the north way from UV-radiation rich sunlight and rich fruits/vegetables that were rich in Vitamin C, less iron from dietary sources were absorbed (vitamin C and acid upregulate iron uptake in the intestines). Iron hoarding genes like hemachromatosis were selected since pregnancy dictates a 2-3 fold increase in iron requirements for baby and mom.

After grains/lectins entered the food chain, the hemochromotosis genes became set in the population. Grains/lectins trigger the iron overload phenotype by two semi-lethal mechanisms that lead to low iron: (a) lectins/casein/gluten cause enterocytes to die by gut dysbiosis and at the tip of enterocytes are our mineral transporters, (b) grains/lectins/phytates bind dietary minerals making them biologically unavailable. Unsoaked legumes, soy, lentils, nuts and seeds are can be major problems.

With less vegetable intake and increased meat/organ meats, in northern evolving hominids (like Neanderthals 30k-200k years ago) hypomethylation of B vitamins was needed otherwise overload of activated B vitamins would have been detrimental epigenetically (role in DNA methylation) and for enzyme processes. Downregulation of beta carotene conversion as well to retinol as organ meats, fatty grassfed meat and brain tissues provided excessive vitamin A/retinol, Vitamin B12 and methylated folate/MTHF/TMG/betaine/SAMe/etc. Organ meats, particularly liver, and marrow/meat and fat also contained vital nutrients for the brain/pregnancy/birth like trace minerals, DHA, other omega-3 (EPA), saturated fat, vaccenic acid, CLA and iodine.

If you do the complete suite of genetic testing (like 23andme.com or elsewhere) I think a lot will be revealed to you, as Kruse has discussed at length with you. It is wonderful to see you questioning and evolving your critical brain!

If you of northern European descent, it is no wonder that a high carb, grain based diet offends your gut and organs. (IMHO a high GI carb paleo diet is still problematic long term) ApoE4 are the least agarian-adapted of the entire globe.

I totally concur w/many of Kruse's observations for you. I suspect the same:

--poor B methylator

--hemochromatosis allele(s) HFE C282Y or other mutations

--apoE4 allele(s)

--heavy metal accumulation and damage

--gut permeability

--pancreatic enzyme insufficiency (goes hand-in-hand w/dysbiosis; elastase deficiency, fat malabsorption, protein maldigestion, SIBO, fructose intolerance, you name it)

--silent oxidation, inflammation, subclinical infection/sepsis

--mineral deficiencies (depleted from SAD, high carb and gut dysbiosis) incl Mag, Zinc, Iodine

--poor convertor of betacarotene to retinol

--poor convertor of ALA to EPA DHA and omega-3 deficiency

--celiac (HLA DQ2 and/or DQ8 alleles)

Kruse,

I am with you 120%! However I believe you underestimate the burden of toxicity that our generation and my children's generations are overloaded with. Adrenal incompetence is pandemic and it is worsening with each generation due to many industrial toxins, dietary toxins (HFCS, n-6, GMO lectins like Bt crops/canola/corn/potatoes) and personal toxins (mercury amalgams, estrogenic body fat, n-3 deficiencies, zinc-pica, etc).

Did you see this? Briffa reported how common suboptimal cortisol found in teens: http://www.drbriffa.com/2011/02/10/long-term-behavioural-problems-in-adolescents-linked-with-low-stress-hormone-levels-why/

I know from my own experience I took the supplements you advised though the vitamin C was probably not high enough 1-2 yrs ago (now that I read Majkinetor's info! THANK YOU!) After the heavy metal burden, nothing for adrenals worked except gentle oral chelation and glandulars. Once gut dysbiosis sets in, much harder to do leptin reset without higher carbs to moderate cortisol and to raise insulin. I have low insulin and I intend to keep this long term. Ketosis is fine but adrenals take precedence. Once adrenals are perfect, then ketosis, intermittent fasting, perfect hormones and lowish-moderatish carb (~ < 50-150 grams/day) are the best ways to stay shredded (whilst keeping cheat (high carb) days)!!! Actually I think the balance of a high carb day is more important to reset/maintain sensitivities... Anything is better than the 300-350 g carbs per day S.A.D.!

-G

Jack, did you insurance cover this? if not, can you say what all this cost you? if you dont mind?

You didn't do ferittin, but it looks to me that you don't have iron problems. Its better to have lower iron without anemia. However, it could be a clue together with CRP and HDL.

HDL needs to be substantially higher, without CRP as if both are elevated it might signify chronic infection and autoimmunity. As suggested by some, use fish oil, non-sustained release Niacin (not flush free tho, it doesn't work) and LET technology CoQ10 (30-100mg).

Vitamin K2 is most important - calcium will finish on wrong places otherwise. Take some good supplement containing 100mcg K2 MQ7 (or MQ4).

You need higher Ascorbate. 3x0.5 is good for start but I would go for 4x2. There is some concern that it [all antioxidants] will reduce exercise adaptation but I think you have other concerns here and that research is inconclusive and probably wrong. Its best to take it with protein meal, if your iron is not to big. Do 6 months loading and then check it up. Cholesterol will change for sure. Use powder in magnesium mineral water.

Glucose is perfect.

TSH - in my experience it can differ a lot from day to day. I measured 2 days in a row and one day it was 2.4 the next day 1.4. I think its not that bad really. You fall in optimal range.

I don't agree with less nuts, less butter or cream and less honey [no honey, use Stevia or be a man, don't eat sweets, eat black chocolate].

Thx for sharing results, its always nice hacking logs :)

Can we get to hack the baby now ? :P

What's with the B Pertussis? You have Walt Whitman's whooping cough, Jack!

Aside from that, your labs do look better than the last time. I will mention however that your liver enzymes are moderately high for someone working out and leaning out. Perhaps its the vestige of your sugar-high days and it's on the way down also.

When I leaned out from 220 to 160, my livere enzymes fell from the mid 30s to the low teens. Now, I am always in the low teens for both AST and ALT, and my CRP Quant is always 0.3 and my body fat (measured w/calipers) is about 9%.

I am no clinicians but I tend to see the liver enzymes in the high-20s and above for those who like to snack with sugary and gluten stuff. Isn't that right, Quilt? Do you agree with the observation that Jack's should be between 10-15 for a hardcore Paleo guy working out 5 times a week?

Also, based on your exercise, your HDL should be above 60, based on your higher whole foods starch and less sugar diet, your trigs should be somewhat below but not by much. Your LDL particle size should be closer to A but there might not have been enuff time. It's probably still stuck in B but more closer to the right toward A.

Not an answer to hack jack's tests per say, but if we have an athletic male with good fitness markers and no symptoms how helpful is it to micromanage these markers.

Is there enough evidence that Jack needs hacked? Can these current levels indicate a near optimal metabolic state in your case? Everyone recognizes the need to tweak their paleo template to their own tastes and goals, but without symptoms or overt reason should he really be stressing here?

In my view fitness markers good, you feel good, diets is clean, reduce stress = body will find homeostasis and be near about as optimal as possible for you.

Kronk,

I concur -- those baseline labs will be very helpful at elucidating what might be at the core... Thank you for the updates!

FYI -- this might be helpful as well... It breaks down the lab testing used by Kruse, me and other integrative practitioners to diagnose 'core' problems that lead to silent inflammation. Please send to your doc if needed. It explains a lot.
http://drhyman.com/downloads/HowToGetWhatYouNeed.pdf

Is the chest discomfort related to any foods that are not being digested? Is it reflux or regurgitation related? That is odd esp if it persists. http://www.rockwellnutrition.com/Gluten-Testing-by-Metametrix.html

For intestinal permeability (leaky gut) is below by Metametrix -- utilizing DNA PCR technology for buggers involved with small intestine overgrowth, SIBO, protein/fat/carb malabsorption, fermentation/putrefication, etc. http://www.integrativepsychiatry.net/gi_effects_stool_analysis_profile.html

If testosterone and/or thyroid come back whacked... consider the below test (Robb Wolf has discussed -- google his blog 'training at 39' and/or 'paleo and testosterone'): http://www.integrativepsychiatry.net/adrenal_stress_index.html

How about ferritin (repeat? was there a first?)? For the mildly elevated liver tests, have you considered a liver ultrasound (rule out NAFLD, fatty liver, iron damage)?

For the coronary CT -- it won't tell you degree of blockage like 20% v. 90%. It only quantifies the absolute amount of scar tissue, e.g. calcification, in affected vessels (one, two, three, etc). You'd have to recheck in 1-2 yrs to verify regression of coronary artery plaque (if there is). One value IMHO fails to provide a lot of meaning in the framework that since you started paleo, all western civ diseases have diminished/reversed/resolved... Let's say when you were overweight, 30 lbs heavier, there was plaque but since paleo, all the plaque is regressing. The trend is downward, but to verify EBCT needs to be repeated in 1-2 yrs. There is no reason why it wouldn't reverse as long as the HDL is trending upward.

For me, to save lettuce$$$$ the value is on tracking the HDLs as you are insightfully doing.

Also the older technology EBCT (electron beam) delivers only 3-4 chest xray equivalents of radiation compared with the fancier n-slice CT that delivers 400 chest xray equivalents of radiation... out of pocket costs range from $250-500 just FYI and the knowledge doesn't tell much until you repeat it in 1-2 yrs.

Sorry, don't mean to complicate things -- just for later to consider in your therapeutic plan and strategies... but I hope the Hyman resource helps to clarify! It is like a 'how to' synopsis...

-G

A couple suggestions probably not relevant to your issue, but thought I'd throw them out there just in case helpful.

I didn't notice anything about alcohol consumption. I'd make sure its minimal for troubleshooting purposes. I'm suspicious of alcohol/fructose-fatty liver-strange blood lipid connections.

Didn't notice homocysteine level either, may want to get it tested if not already. Anyone eating paleo and a lot of meat will probably have issues here, especially if not going out of way for folate (liver). At least my levels were high. And I find myself wondering if vascular damage caused by high homocysteine can lead to high lipids for repair.

Kronk, I replied again HERE. In E2/E2, trigs are quite high, constrasting with E4/E4, the trigs are typically low despite high carb intakes (and high 'death band' LDL-IVb subfractions). It wouldn't surprise me if the E alleles were E2/E4.

My blog today may begin to help you think more clearly about what is really ailing you. I told you I wont give up on you til you get it. Your case will help many. You may not have seen it then or even now.....but it will I promise. Here is how I knew about your Vitamin K2 status described in detail. The best way is to measure your osteocalcin level but given what you initially posted I hacked you with out you knowing how I did it. That is part of clinical medicine and expertise. Many may not want it.....but I think you might find it interesting

http://jackkruse.com/how-to-find-your-inner-masterpiece/