Help Interpret my lipid panel w/suggestions
JedsMom63
Posts: 32 Member
Got my lipid lanel back and I know some numbers are good but some others are concerning to me. Would like help and suggestions.
I started keto mid February. Have lost 30 lbs. need to lose 40 more.
H1c - 5.4
Total cholesterol- 294
HDL-c 50
Triglycerides- 81
HDL-p (total) 26.3
Small LDL-p. 1290
LDL size - 21.3
LDL-p 2921
LDL-c 228
I have cut out all sugars Limit carbs to 20 or less. Eat limited processed packaged things (like lunch meat) I stick to meat. Very few veggies. Some hard cheeses. And bacon eggs an kerrygold
Doctors suggestion was to lose weight (duh) and walk or some form of exercise (which I'm doing) he also wanted to up my pravastantion (which I have stopped taking altogether beginning of march)
I started keto mid February. Have lost 30 lbs. need to lose 40 more.
H1c - 5.4
Total cholesterol- 294
HDL-c 50
Triglycerides- 81
HDL-p (total) 26.3
Small LDL-p. 1290
LDL size - 21.3
LDL-p 2921
LDL-c 228
I have cut out all sugars Limit carbs to 20 or less. Eat limited processed packaged things (like lunch meat) I stick to meat. Very few veggies. Some hard cheeses. And bacon eggs an kerrygold
Doctors suggestion was to lose weight (duh) and walk or some form of exercise (which I'm doing) he also wanted to up my pravastantion (which I have stopped taking altogether beginning of march)
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First, as you are likely aware, I am not a doctor, just an empowered patient doing his best to diligently research for the truth in a world of dogma. That said, here is my take based on my research so far, some of which I have posted links to in other threads.
First, the most important info here in terms of heart disease risk is Trig/HDL ratio. Yours is 1.6 which is pretty good. By all accounts over 4 is deadly dangerous and under 2 is preferred. However, there is good evidence that optimal is 1.0 or less. Here is a link to one study showing this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/
The second most important for HD is HDL. This is where you have to be careful. Most labs use a "reference range" which is really just a bell curve showing where most of the people they test fall. This does not mean if you fall in the reference range that you are healthy because those who are sick are more likely to be tested. The reference range here often goes as low as 40 and I have even seen one that shows 35 as the bottom. In reality, 50+ is good and 60+ seems to be optimal. Boston Heart Diagnostics uses the >50 for optimal and 40-50 as borderline. Although this study is on people over 80 yo, it does show the importance of HDL over LDL numbers in regard to health.
https://www.ncbi.nlm.nih.gov/pubmed/24906678
Although LDLp and sdLDL are both now shown to be more important than LDLc (standard measurement in most cholesterol panels), I have had no luck finding what these numbers should be. I believe it was Dr. Nally who said some were throwing around 1600 for the LDLp number, but he followed that with there is no research to really back that up.
Research does show all cause mortality is lowest with total cholesterol between 190 and 310. Cognition problems, aggression and suicide are all much more common with total below 150. These are all correlation studies and not causation, so take them for what they are worth which is to formulate hypotheses to test.
The total you want is higher as you get older as demonstrated in this studies:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674557/
One number you do not have which is hugely important is hsCRP. This is an inflammation marker which is shown to be critical in determining risk. The Reynolds Risk Score (http://www.reynoldsriskscore.org/default.aspx) has been shown to be more accurate by 30-50% over the traditional Framingham score in determining risk.
The JUPITER trial which was touted by statin makers as showing how statins save lives was only testing those with an hsCRP score over 2.0 which is considered high risk. The average participant had a score of over 4.5. The reduction in inflammation correlated to reduced disease more closely than did the lowering of the cholesterol. For that reason, I would be far more prone to find ways of reducing inflammation without all the side effects associated with a statin. As for hsCRP score, <1.0 is optimal, 1-2 is borderline, over 2 is high risk.7 -
I mean no disrespect to the inventors of Framingham and Reynolds scoring, but IMHO they seem like back-of-the-envelope estimators; better than nothing, but prone to misassessment of actual risk. CRP, triglycerides and HDL are better, but trigs and CRP can hop around a fair amount (which your risk level shouldn't), and the standard lipid panels only give you part of the story. The NMR sub-particle analysis fills in some blanks. @JedsMom63, Tara Dall and Thomas Dayspring have a few videos on the myHDLinc YouTube channel that review advanced lipoprotein test results. The ranges they use might not match those of your lab... Thomas Dayspring's crash course on lipids & lipoproteins and a few other vids (one by Chris Kresser included) for us unwashed end-users:
www.youtube.com/playlist?list=PLrlCcUWvravoCtZxuVqmMo9ENvRlgbsXv
However, actually looking at the same arteries the various cardiac risk estimators are guessing about seems like it might be a better way to go. (CAC CT scan - $99 off the street in my neighborhood.)
Ivor Cummins - Short version:
https://youtu.be/kxUGlZTcDis
Full vid:
https://youtu.be/xiUNNJrTDRQ 1 -
Thank you for your responses. I will look into the info offered.
I was just wondering if anyone seen anything alarming in the results. And if so, suggestions.1 -
Thank you for your responses. I will look into the info offered.
I was just wondering if anyone seen anything alarming in the results. And if so, suggestions.
I'm not a doctor. These are my off-the-cuff personal reactions based on the ranges used by the lab that did my last tests. They may not match yours.
HbA1c - 5.4 HIGH - MILD DIABETES
see http://www.rajeun.net/HbA1c_glucose.html
Total cholesterol- 294
HDL-c 50
Triglycerides- 81
HDL-p (total) 26.3 ... LOW (HIGHER RISK)
Small LDL-p. 1290 ... HIGH (HIGHER RISK)
LDL size - 21.3 ... HIGH (LOWER RISK)
LDL-p 2921 ... HIGH (HIGHER RISK)
LDL-c 228 ... HIGH (HIGHER RISK)
IF it were me...
I would definitely get a CAC CT Scan (see above).
A doctor's order is not usually required in the US, but it's not usually covered by insurance. Prices for the exact same test vary widely, so it's best to check around.
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Ok. Thank you. Will check into the testing you have suggested Have read some of that article and will go back and read again. I suspect my A1c was way higher before the diet change. Doctor didn't want to do that test but this last time I insisted. With the LDL's though, didn't I read somewhere that they may be high until I get down to my settled weight? I can't find that info now for some reason
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Ok. Thank you. Will check into the testing you have suggested Have read some of that article and will go back and read again. I suspect my A1c was way higher before the diet change. Doctor didn't want to do that test but this last time I insisted. With the LDL's though, didn't I read somewhere that they may be high until I get down to my settled weight? I can't find that info now for some reason
Yes, good catch! Lipids do tend to behave unusually in ketosis until your weight has stabilized and you've been in maintenance mode for a while. Stephen Phinney regularly emphasizes this point.
(Realistically, it may be that many standard test ranges and risk breakdowns can't be sensibly applied to people in ketosis. Dr. Westman, for example, reckoned an OGTT visited on someone who's been in ketosis is likely to show a pronounced glucose spike that may not be at all indicative of what the pattern would be like otherwise....)
Having had one CAC already, I think it will be more useful to compare my next CAC to the first one to see how things are progressing rather than theorize in %-ages on the basis of blood tests.
I had hoped for a score of 0, so I could just chuck the *kitten* statin, but it was not to be. I blew a 31 (mild calcification) in one artery, which puts me squarely into the gray zone of "extreme cardiac risk" with a new LDL target of < 55 (according to the AACE, but not the AHA). Of course, lowering cholesterol, as @cstehansen noted, is not necessarily a great thing for your cogmition and mental health.
A quandary....0 -
Here are a couple interesting articles on advanced lipoprotein analysis:
Comparison of four methods of analysis of lipoprotein particle subfractions for their association with angiographic progression of coronary artery disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990359/Conclusion
Four methodologies confirm the association of small, dense LDL with greater coronary atherosclerosis progression, and GGE, NMR, and ion mobility confirm that the associations were independent of standard lipid measurements.
Effects of a very high saturated fat diet on LDL particles in adults with atherogenic dyslipidemia: A randomized controlled trial
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293238/
Increasing saturated fat intake may not be a good idea for people with a predominance of small LDL particles (LDL phenotype B ).In conclusion, we found that the increase in LDL-C resulting from very high saturated fat intake in individuals with a preponderance of small LDL was associated with an increase in apoB, and total, medium-sized, and small LDL particles. These results, in conjunction with previous studies, suggest that saturated fat may have heterogeneous effects on levels of atherogenic LDL particles that may depend on the amount of saturated fat consumed, the dietary context, particularly concomitant carbohydrate intake, and/or predisposition to atherogenic dyslipidemia.
@cstehansen @GaleHawkins @JedsMom630 -
I am bushed having just came in from bush hogging but here are my raw NMR lipid data that I has posted after I had the test the last part of May 2017 I think. I need to start getting my head around this subject since I have new lab working coming up 22 Aug 2017 and see the doctor the following week.
NMR LipoProf+Graph
LDL-P 2402 High nmol/
Low < 1000 Moderate 1000 - 1299 Borderline-High 1300 - 1599 High 1600 - 2000
Very High > 2000
LDL-C 221 High mg/dL
HDL-C 69 mg/dL >39 BN
Triglycerides 75 mg/dL 0-149 BN
Cholesterol, Total 305 High mg/dL
HDL-P (Total) 30.7 umol/L >=30.5 BN
Small LDL-P 525 nmol/L <=527 BN
LDL Size 21.8 nm >20.5 BN
LP-IR Score <25 <=45 BN
INSULIN RESISTANCE MARKER
<--Insulin Sensitive Insulin Resistant-->
Percentile in Reference Population Insulin Resistance Score
LP-IR Score Low 25th 50th 75th High
<27 27 45 63 >63
LP-IR Score is inaccurate if patient is non-fasting.
As you can see the LDL-P and LDL-C are over the top but the other NMR numbers are within normal limits at least.1 -
GaleHawkins wrote: »I am bushed having just came in from bush hogging but here are my raw NMR lipid data that I has posted after I had the test the last part of May 2017 I think. I need to start getting my head around this subject since I have new lab working coming up 22 Aug 2017 and see the doctor the following week.
NMR LipoProf+Graph
LDL-P 2402 High nmol/
Low < 1000 Moderate 1000 - 1299 Borderline-High 1300 - 1599 High 1600 - 2000
Very High > 2000
LDL-C 221 High mg/dL
HDL-C 69 mg/dL >39 BN
Triglycerides 75 mg/dL 0-149 BN
Cholesterol, Total 305 High mg/dL
HDL-P (Total) 30.7 umol/L >=30.5 BN
Small LDL-P 525 nmol/L <=527 BN
LDL Size 21.8 nm >20.5 BN
LP-IR Score <25 <=45 BN
INSULIN RESISTANCE MARKER
<--Insulin Sensitive Insulin Resistant-->
Percentile in Reference Population Insulin Resistance Score
LP-IR Score Low 25th 50th 75th High
<27 27 45 63 >63
LP-IR Score is inaccurate if patient is non-fasting.
As you can see the LDL-P and LDL-C are over the top but the other NMR numbers are within normal limits at least.
Well, looks pretty good to me.
Your Small LDL-P is low, and your LDL Size is large. I got from my diabetes doc (a good guy) that if those two are in good shape, then the total LDL-P and LDL-C are not independently worrisome. So in your case, he would say that your NMR has clarified that the LDL = 221 you would have gotten from a standard lipid panel is in fact not that big a deal.1 -
Thanks @RalfLott0
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My pleasure. Common to both studies is Ronald Krauss.
http://community.myfitnesspal.com/en/discussion/10547659/scientific-american-saturated-fat-carbs-and-heart-disease
He is good to hear on lipid issues, as he studiously avoids painting with a broad brush. He was very good with Rhonda Patrick and had to walk Mark Hyman back off some crude overgeneralizations.
https://www.youtube.com/watch?v=7gZt9DQqtZI
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https://youtu.be/TB_SF10kosQ