New Lipid Panel

Well I went and ordered up some blood work the other day and results began coming in today. While my past Lipid Panel was blogged right here, this is the new one.

Picture 4

The past one shows a total serum cholesterol of almost the same (219), while I had an HDL of 106 and a calculated LDL of 104. You know what I think of calculated LDL. Well, this isn't a NMR LipoProfile or a VAP. It's the best I can get from Kaiser and it purports to be a direct measurement of LDL (though not a particle count). However, if accurate, I would expect my particle count to be 660-669 nmol/L, which would be considered optimal in terms of particle number (< 1000). Size is something we can only guess on, but my HDLs make it clear that I'm pretty high in fat consumption and that's highly associated with mostly large fluffy LDL and little to no small dense LDL.

It's interesting to note that if you look at Patrik's NMR LipoProfile and assume my LDL Direct to be accurate (for now -- I am still going to do an NMR as well), then calculated LDL overstated our actual LDL by about 50% (45% for him, 56% for me). This is consistent with Dr. Davis' experience. For grain, high-carb, low-fat dieters, calculated LDL usually understates actual LDL particle number (most of the particles small and dense as well) while for Paleo-like, no grain, high-fat, low-carb dieters, calculated LDL usually overstates actual LDL particle number (the vast majority of particles being large and fluffy). Moreover, I predict that as more of these Paleo NMRs come in and get published, we're going to find the understated LDL for the grain eaters is going to be a larger percentage on average than the overstated LDLs for the Paleos.

I didn't have Trigs measured. They were 47 before and I'm quite certain they are still under 50 (and probably closer to 40, now, as I'm lower carb than before and have been on it longer. Let's assume the same 47 for ratio calculation. Here's the ratios from before:

  • Total/HDL = 2.07 (average is 4-6 and ideal is 2-3; I'm on the extreme end of ideal)
  • HDL/LDL = 1.02 (average is .3-.4 and ideal is above .4; again extreme end of ideal)
  • Triglyceride/HDL = 0.44 (optimal is less than 2, so again, extreme end of ideal)

And now:

  • Total/HDL = 1.68 (19% improvement; I'm now off the scale)
  • HDL/LDL = 2.02 (98% improvement; again off the scale)
  • Triglyceride/HDL = 0.35 (20% improvement; off the scale)

Want to know my "secret?" Click right here

I may have some additional test results to report on later, after they come in.

Comments

  1. Minneapolis J says:

    133 HDL Legit Richard? That is ridiculous if true.

  2. Of course, there's always the possibility of lab error, but then again, I was already at 106 and I do eat a LOT of sat fat (lots of coconut milk based Thai curries, as well as it being my chief thickening agent for most all my sauces, now).

    I'll soon get an NMR for an even higher confidence level.

    Richard Nikoley

  3. Paleo Newbie says:

    that is F-ing ridiculous! Can't get any better than that.

  4. Thanks, doc. Pretty pleased myself, though I'm going forward with the NMR for added confidence I'm on the correct path.

    Richard Nikoley

  5. Roberto Garza says:

    I prefer my status as a lurker, but your results merit a post. Fantastic lipid panel!

  6. Erin in Flagstaff says:

    Wow. That is amazing. I hope my next annual physical shows the same kind of improvement. My last one was a disappointment. After cutting sugar and grains for five months, my cholesterol went up 50 points (mainly LDL), my HDL only gained two points, up to 46, and my triglycerides went up to 140!

    Though I had been obese, I was always proud of my cholesterol levels. The prior total cholesterol reading was about 170 — I'd even been as love as 124 once! Knowing what I know now, I can understand why I ended up on anti-depressants at that low level. Still, I expected when I went for my physical late last year that I'd have great numbers, but it didn't happen that way.

    Now I know that the calculated LDL was probably inaccurate. I still want my HDL to increase and am taking fish oil to get that up, plus eating plenty of fat. I also think my triglycerides went up due to all the fat I was losing. Dr. Davis has a post on this: http://heartscanblog.blogspot.com/2008/08/i-lost-30-lbs-and-my-triglycerides-went.html — I had lost 50 pounds in that five month period.

    Anyway, I know that our lipid panel isn't an accurate snapshot of our health. Have you read "The Great Cholesterol Con" by Malcolm Kendrick? As a woman who is 50, it seems that I want a HIGHER cholesterol level. Total mortality numbers seem to improve for older women when their cholesterol levels are higher.

    I'm thrilled that you have such great numbers. Even though I don't know if these numbers really mean what modern medicine tells us they mean, it sure shuts up any "expert" who warns you about your diet.

  7. What…223 and they didn't put you on statins??!!!

    Just kidding, great job and thanks for sharing….maybe people will start listening to us crazy sat fat/meat loving people!

  8. Thanks, Mile, and once I get caught up around here I'm doing a FitnessSpotloght link dump on yours and Scott's asses. :)

    Great, great work, youz guys.

    Richard Nikoley

  9. Unbelievable. Have you ever heard of or met anyone with a higher HDL? Would be amazing to know the lipid profiles of modern hunter gatherers. Is this information known?

  10. Something I've been thinking about. Your LDL + HDL is 199. However your total chokesterol is 223, where does the difference (24) come from?

  11. Stephan, at last testing 112, emailed his dethroning acknowledgement.

    Nope. Highest I've ever heard of.

    Richard Nikoley

  12. God question. My last was 104 LDL and 106 HDL which is 110, yet total was 219.

    Don' know but at Lear I have something to investigate.

    Richard Nikoley

  13. Yeah, eating all that saturated fat sure has wrecked your health, huh? When oh when will the "establishment" wake the f*%^ up?

  14. Joe Matasic says:

    Well if the standard formula to calculate total cholesterol = HDL + LDL + (Trigs/5), I would assume that the difference (24) is trigs somehow. Though I really doubt that it would be 5*24 (120) for you.

    I'm guessing since you got the direct measurement of LDL the Freidwald(if that's what its called) equation wouldn't hold true. We know its not accurate anyways. The question becomes what is your trigs? Are they possibly as low as 24? That would be even better. Since the other numbers are direct measurements I would have to assume they're either a lipoprotein not reported or triglycerides, which would be my guess.

    Great results. I need to eat more sat fat than I do. Problem is I need to great my total cholesterol down temporarily for a retest because of life insurance. They screwed me because they consider my numbers elevated, never mind the great ratios or the unproven hypothesis…

    Joe

  15. Adam Cilonis says:

    I could go for some creamy sauces!

    Nice work cous!

  16. Excellent. Congrats!

  17. Sound analysis, Joe. Can't imagine my trigs at 120, for, even prior to going full low-carb / paleo, my trigs were only in the 90s. I've never been a soda drinker or candy, cake, cookie eater except intermittently. Yea, I pigged, now and then, but I'm am convinced that's of minor consequence. It's the day by day by day pounding that does it.

  18. Richard –

    You KN*W already that I am f**CKing jealous of your labs… *WINK* so when are you gonna do some REAL X-fit…? (I'm not kidding :) *haaa ah* come to diablocrossfit.com — your fans Zuckerman and his beautiful wife Brooke would like to meet ya ! )

    Paleo Newbie —
    No offense to your profession…. eg conventional s/p matriculation-M.D./Rad… now you see why Conventional Cardio-Medicine BITES THE BIG FAT DUST… Saturated FATS are necessary for life and… Richard's K*CK OUR F*CKING *SSES lipoprotein conventional Freidewald's panel and (!!) BLOW-ME-away-HDL-cholesterol.

    Can you even imagine the NMR/VAP results…? go ahead Richard…rub it in…

    Strong Work Mr.Puerto Vallarta thank goodness you're back on the mainland to spread your Paleo-knowledge and K*CK OUR *SSES… *biggest widest G-R-I-N*

    You are the talk of the TYP forum!

    -G

  19. Dr. G:

    You crack me THE F@@@***CK UP!!'

    Richard Nikoley

  20. Richard,
    Great blog. Another couple of reference points for folks. Background – pro triathlete…so let's leave out the chronic cardio comments.

    Anyway, ~ 2years ago we were part of the Engine 2 diet pilot studay based off of McDougal-ish/China Study thinking. Very low fat, very high carb, vegan diet. Lots and lots of grains and beans…and wheat. Now we are more modified paleo w/ oats, some rice, quinoa, yams as our main carbs. But we focus on carbs during and immediately after hard (ie longer) workouts. I am 90% wheat free right now. We are probably closer to the 'zone' way of eating or at least 45/30/25 carb/fat/pro with avocado, almonds, coconut, and olive oil being our main fat sources in addition to what is from grass fed beef and wild venison.

    I will probably get a VAP test soon, but 2 lab comparisons.

    Now:
    Total = 211
    HDL = 111
    LDL calc = 91
    Triglycerides = 47

    Engine2:
    Total = 180
    HDL = 62
    LDL calc = 99
    Triglycerides = 97

    Of course the Doc that ordered the recent one said that my Cholesterol was too high.
    -Brandon

  21. Brandon:

    Cool. Great labs, and I can tell by your Trigs that you're not getting bunches and bunches of starch. I think that for many people if you don't have insulin resistance problems that rice is probably OK in modest quantity. I'm doing it myself, and in fact, I do some potato as well.

    I wonder in terms of a comparison between potatoes and rice, which is a better way to go from a modified Paleo standpoint.

    As to the doc: modern ignorance. What are you supposed to do, bring your HDLs back down into the 60s to lower your cholesterol?

    RB

  22. Re. potatoes vs. rice. I don't know. Mark Sisson suggests starchy tubers…potatoes and yams. Of course, you can look to asia to see that rice is probably o.k.

    In the sense that we are exhausting glycogen stores at times, I really think that the during and post workout timing of quickly absorbed carbs are the key to recovery. Outside of that, it's as paleo as possible. Cordain/Friel did a 'Paleo Diet for Athletes' book that has some good stuff in it.

    But, for the general populous, I am leaning more and more towards the primal/paleo way with minimal starch.

  23. Richard,

    Dude, ur too funny… And… I had to restrain myself… *good-girl-smile*

    I have PALEO-envy!!!!!!!!! *haaa*

    BTW — my lil sister is complete freak, like you (and Stephan), about coconut oil/milk/flour/paste/cream/everything. She is reading how potent and beneficial the sat fats from this tropical fruit/nut are for healing Thyroid disorders (and everything else inbetw). You two are eons ahead of the curve! (or should I say paleo-retro ?)

    -G

  24. Well, since July, my TSH has dropped from 16 to 11. All the coconut milk / oil?. Still way high, but, T3 and T4 were doth in range, but just, i.e., right on the low end. At any rate, doc agreed to prescribe Armour instead of Levathroid. Just picked up the scrip (90MG — about right?) and I just took the first. We'll see.

  25. Hi,

    That's curious why the TSH is so high. Wonder if there is some negative feedback going on at the pituitary-hypothalamus level?

    Optimal vitamin D sometimes boosts the free T3 and free T4 levels, but not always it seems. Low end of normal free T3 and free T4 (were these the tests?) can confer non-optimal muscles, cholesterol, blood pressure and other parameter like Lp(a) and homocysteine. Armour is preferred for some because it contains both T3 (active) and T4 (inactive — also known as Levothroid). Apparently for some Armour is very short-acting and may be taken twice daily to provide more 'even' coverage. For some, starting thyroid replacement can be VERY very activating and stimulating to the heart, circulation and elsewhere. If you notice fast or irregular heart beats, insomnia, akithesia, feel hyped, then the dose may be too probably too much at this time. Many on the TYP forum have noted with thyroid replacement, they require increasing the doses of Thyroid from low, low doses and gradually titrating upward very slowly to prevent the heart stimulation. After replacement 6-12mos, many notice that body temps, heat regulation, mood, and metabolism improve considerably. Lp(a) often drops from DR. Davis' observations.

    Consider of course for optimal organ/thyroid health (in addition to that WONDERFUL coconut oil):
    –Iodine supplementation (shore-based diets provide — but generally most people don't get enough currently)
    –Magnesium supplementation (blood optimal 2.2 to 2.3 mg/dl) — food generally does not contain enough. Urination, sweating, breathing, bodily secretions, caffeine/diuretics/ alcohol all reduce our Mag content …Umm… I don't do any of these things :) *haaa* NONE…
    –Other minerals Zinc (good for prostate/repro health and immunity), Boron, Selenium, etc
    –Casein-free diet?? (not nec for everyone)
    –B-vitamins (esp critically if any elevation of Homocysteine > 8.0 — esp B2 riboflavin, B6, B12 sublingual, folic acid/Trimethyl glycine, etc)
    –Tribulus — helps conversion from useless T4 to active T3 (athletes use for…ummm… max hormone optimizations… etc) — I think IMHO it lowers Lp(a) as well
    –DHEA-s (did your doc ck this out?) — achieve 'youthful' rock-n-roll levels — only need a LOW low dose 5-10mg typically; lowers Lp(a) as well and improves thyroid
    –Flaxseed oil ALA (good omega-6)
    –Borage oil GLA (good omega-3) (not much in meat — though found in *haa* HEMP oil (I'm NOT joking!), sesame seed oil, primrose oil)

    -G

  26. G:

    Here's the numbers:

    TSH – 11.36 (0.10-5.50 uIU/mL)
    Free T4 – 0.9 (0.8-1.7 ng/dL)
    TRIIODOTHYRONINE – TRUE,SER/PLAS,QN – 112 (70-200 ng/dL) – is this Free T3?
    PARATHYROID HORMONE INTACT – 39 (10-65 pg/mL) – or is this T3?
    Homocysteine – 16.1 (<12.0- umol/L)
    Lp(a) – 4 (<30- mg/dL)
    ULTRASENSITIVE C-REACTIVE PROTEIN – 0.8 (<3.0- mg/L)

    Other stuff – Calcium (9.6), Albumin (4.7), D3 (85), Magnesium (2.2) all within standard range.

    The doc didn't mention anything about the homocysteine, just thyroid. I took the second of my 90mg armour, no ill effects yesterday or today, whatsoever. Yesterday I was fasting and by about hour 20 my hands and feet were cold. The Thyroid didn't do anything for that, nor did I expect it on first dose. However, I feel great this morning. Really great, in fact.

    Looks like I need some B vitamins for the homocysteine.

  27. Hey Richard,

    Interesting results from my latest cholesterol check. It was a free one here at the health clinic at work. I don't buy the cholesterol hypothesis, but I keep a watch on these.

    TOTAL: 272(new high)
    HDL: 76(really good, new record)
    LDL(calculated): 184(new high)
    Triglycerides: 62(new low)
    Fasting Glucose: 93. Perfect.

    My trigs dropped, so LDL calculated may be up due to that. My HDL/trig ratio flipped in a good way. I think that is due to the Cod Liver Oil and saturated fat.

    Lots of the numbers improved greatly, but the calc LDL and Total appear high. Any advice?

  28. Jeff, while I wouldn't worry about it, you might go ahead and get an MNR or VAP. Otherwise, the main thing is that your HDLs are getting into a good area (80 and above is probably optimal) and your Trigs are going down.

  29. Hi Richard,

    TRIIODOTHYRONINE – TRUE,SER/PLAS,QN – 112 (70-200 ng/dL) – is this Free T3?
    PARATHYROID HORMONE INTACT – 39 (10-65 pg/mL) – or is this T3?

    I think that is the Free T3 — and should improve to closer to upper range after Thyroid replacement therapy.

    PTH is a measure of bone breaking down — optimally I see it < 20 pg/ml and this slowly improves as Thyroid, Pituitary and Vitamin D levels are optimized. Sex glands, Parathyroid, Thyroid and the Pituitary are all inter-related and feedback loop toward each other.

    Coconut oil is extremely thermogenic as well as 'healing' for organ repair, including the THYROID gland.

    Yes, you are correct on the Homocysteine. With your awesome Paleo diet and rich intake of diversely colored vegetables and some berries, I'm surprised it is what it is. Likely a genetic polymorphism where B-vitamins are not adequately activated for use is likely present. It is in fact fairly common in the general population. Unfortunately it can lead to more systemic inflammation and oxidated stress which is not good. Activated B-vitamins protect against DNA damage and breaks and lower Homocysteine as well.

    Consider:
    –folic acid 2-3 mg daily
    –B12 1000 mcg daily (get the adenosylcobalamin sources that are sublingual which absorb the best)
    –B6 50mg daily
    –Trimethly Glycine — an activated folic acid form (I like the NOW brand)

    Goal Homocysteine < 8 — I generally see this improve in 2-3 mos.

    Everything else looks pretty d*mn GOOD — keep up the strong work!

    -G

  30. This is incredible. I've never seen HDL that high. Have anything else done? Calcium-scoring? Echo?

    • Calcium was mid range at 9.6, magnesium fine, LP(a) super low, c-
      reactive protein super low. vitamin D in the 80s.

      I had a heart scan done around the first of the year and there was
      mild calcification in one artery. Once all the weight has come off
      from my years of junk, carb and processed food abuse and the benefits
      of a super-high saturated animal fat diet has worked its wonders, I'll
      get another EBT scan.