Paleo Diet and Paleolithic Diet Questions & Answers

Question

3

I'm confused and slightly concerned.

So, I did a blood test a few weeks ago (about 6 weeks after starting paleo, coming off of eating a lot of whole grains). I've never had any cholesterol issues before. My blood work came back with the relevant numbers being:

Cholesterol: 265 (high; reference is <200)

Trigs: 87 (normal; reference is <150)

HDL 65 (reference is >39)

Calculated LDL 183 (High; reference is <100)

Risk Ratio CHLO/HDL: 4.08 (normal; reference is <4.44)

The doc wanted me to do a "CT Heart Saver Scan" which my insurance will not cover. I said maybe; I wanted to see what my CRP was and what my LDL particle size was (tests I'd asked for initially, and he said no).

So he said ok, and I went in last Monday for the test.

Just got a call from the nurse. I have NOT yet seen the paperwork. She said the doctor says that I have "Type 2B hyperlipedemia, that statins are not indicated, but he still wants the CT heartsaver scan"

OK, my first concern is that statins aren't ever indicated for women, as far as my understanding goes, so I'm already not happy that they're even mentioned! Clearly this doc isn't as educated as I would like (new town, new doc).

Then I asked her what that meant (the type 2B thing) and she doesn't know. I'm still clueless...does my doc think this indicates increased risk of CVD? I don't know b/c my doc isn't telling. Sigh.

Then I asked what the particle sizes were, since that was what I'd asked for in the first place. She says "we've never done something like this" and has no clue. I'm 99% sure they didn't run the test I wanted; it's definitely not a VAP and I'm not sure if particle size is calculated in any other test.

My CRP is .2, which I understand is pretty good?? I don't have the reference range, but the nurse said it was low and I said "well, that's good," and she said "yeah."

So....can anyone offer any insight? I'm going to change doctors asap obviously, but should I spend the cash out of pocket for that CT scan thing? I suppose it might give me peace of mind, but I'm just so frustrated now not to even understand this thing that the docs office says that I have!!! (I did google the Type 2B thing, but I confess I'm not sure what to think since so much of that stuff stems from conventional wisdom).

Edited to add: I'm female, 46 years old in a few days. I've been eating Paleo w/ no cheats, though I was doing lacto-paleo at the time of the blood tests (have since cut out dairy).

flag	asked Sep 20 2011 at 17:13 Paleo-ish 591●2●8

	Did you get an A1c result? – Don Sep 20 2011 at 18:19
	He refused to run it (grrr) because my BS is well in normal range. – Paleo-ish Sep 20 2011 at 19:01

Travis Culp · Answer 1 · 2011-09-20 17:59:42Z UTC

When was the last lipid panel before this? What did it say?

6 weeks is a pretty short period of time, so while a heavy butter/cream intake could spike it a bit, it was probably what you were doing before. Now that you've cut out dairy, the LDL will drop.

Low TGs and high HDL are a much better indicator of cardiovascular health because of how much more likely it is for TG-bearing lipoproteins to become oxidized in the blood and create plaques. Your numbers already look good and will only improve as you do paleo longer.

High cholesterol isn't correlated with heart disease in females anyway.

The reason why statins aren't indicated is that 1) you're female and 2) you very likely have large LDL particles which can't penetrate the arterial linings very well and thus are much less dangerous.

The CT scan isn't really necessary since its purpose is to detect calcification in your arteries, which you probably do have from a life of the SAD. I would skip the dose of ionizing radiation and instead preemptively take 300 mcg of vitamin K-2 every day. This will pull the calcium out of your soft tissues and mineralize it in your bones and teeth where you want it.

Jack Kronk · Answer 2 · 2011-09-20 20:03:59Z UTC

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Just want to point out that we have the same TC at 265, but my trigs came back at 224 and my HDL at 35. In other words, If I am able to drop my trigs to what you have (87) and raise my HDL to 65, this would seem like a miracle and huge success to me and I would be bouncing off the walls like Tigger. I don't think you have much to be concerned about with your LDL since your HDL and trigs look fine like Travis says. Even your HDL to TC is decent at 4.07. If you can raise your HDL a bit more, you can drop below the [more] desirable range of "3.5 or better".

answered Sep 20 2011 at 20:03

Jack Kronk
19.9k●4●33●102

	Thanks JK! I'm going to go back to the comments on your earlier panel posts. I recall folks suggested ways to do that (raising HDL and also getting LDL nice and fluffy). I've gone off dairy, but I seem to recall adding butter back in might be a good thing. (still on my phone so haven't done a search yet) – Paleo-ish Sep 20 2011 at 21:05
	Butter will raise LDL-C in a dose-dependent fashion, which isn't necessarily a problem if you're recycling it rapidly dude to vitamin D/sex hormone synthesis but more of a problem if those lipoproteins are sticking around longer and being oxidized. – Travis Culp♦ Sep 20 2011 at 21:18
	So does that mean if my vit D levels are high via a lot of outside work (as opposed to supplementation) then butter is cool, but otherwise it's better to avoid butter? – Paleo-ish Sep 21 2011 at 12:45

Don · Answer 3 · 2011-09-20 18:10:30Z UTC

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Dr. Davis posted this today. I think it was meant for you.

http://www.trackyourplaque.com/blog/2011/09/what-is-this-wacky-thing-called-weight-loss.html

answered Sep 20 2011 at 18:10

Don
789●3●10

Good find. I think it was in GCBC where Taubes talks about hypercholesterolemia being pretty much inevitable while losing weight because you are mobilizing your fat stores. Personally, I no longer let docs test my cholesterol unless my weight has been stable for a while, too many money wasting and nerve racking visits and follow ups otherwise. – Happy Now Sep 20 2011 at 21:05

Paleo-ish · Answer 4 · 2011-09-20 18:15:38Z UTC

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Thank u all for ur answers! On my phone now schlepping kids around, but y'all have made me feel better! The original panel was abt 3 weeks ago, and the newest one last Monday. Off to read the Davis blog. I absolutely love Paleohacks.

answered Sep 20 2011 at 18:15

Paleo-ish
11●1

Thanks for the link! I've lost abt 27 pounds recently, so yes, this does sound like it was written for me. Have an appt with a new doc on 10/28 (recommended by the local Paleo/primal community). Looking forward to, hopefully, a much better experience with the doc – Paleo-ish Sep 20 2011 at 18:25

Matt B · Answer 5 · 2011-09-20 18:05:34Z UTC

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Your numbers look good. When triglycerides are low, calculated LDL is a little higher than when it's measured directly. Your TG/HDL ratio is fantastic. http://www.ams.ac.ir/aim/08113/0014.pdf

answered Sep 20 2011 at 18:05

Matt B
563●2●9

Bryan de la Puente · Answer 6 · 2011-09-20 18:27:04Z UTC

First before I expound I'm not a dr. or medical expert. I share based on the research and data crunching that I spend an inordinate amount of time doing and practice myself with extraordinary results. You may want to have what's called a c-reactive protein and homocysteine screen to determine your level of internal inflammation as well. As you're hearing here the numbers can be a bit skewed according to conventional wisdom. And yes do look for a Dr. that is educated or an athlete himself, they're out there. High numbers don't mean much anything if you're not on fire inside put simply :-)

Noah Rosser · Answer 7 · 2011-09-20 19:46:48Z UTC

Pretty sure the "type 2B" just refers to the pattern of high cholesterol you have (whether or not you also have high trigs, etc), and nothing to do with a causal diagnosis. If you wanted to measure "heart disease", the best tests available I'm aware of are 1) CT scan, 2) CIMT (harder to find). Neither are perfect, but much better than a blood lipid test if that is your concern. Problem with the CT scan is the radiation, not a big dose, but not something you'd want to get done a bunch of times if could avoid it. We don't know what the increase in your numbers mean, or when exactly they occurred. It's possible you had a high particle count both before and after paleo, and the higher fat intake changed particle size and gave you a higher total. This is not necessarily bad, possibly good. A good next step would probably be to diet to ideal weight, wait a few weeks, and test lipids again, before fretting too much over it. Losing weight everyone seems to agree will help lipids and everything else. And actually your total/hdl ratio doesn't seem too bad even as is.

doc says I have Type 2B hyperlipidemia

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