I started eating LC a little over a year ago to lose 50 lbs. It was my first time at this WOE. Within 7 months of starting I had nearly reached my goal weight and have maintained over the last 8 months or so. I did this without doing any exercising. I'm in my mid 40's and I've never felt better in my life and nearly all the things that use to ail me are no more.

I eat a VLC diet (~ 20 carbs/day) that basically consists of 3 eggs and 4 pieces of bacon and an ounce or 2 of cheese for breakfast daily. I use HWC in my coffee and also use it to make yogurt, of which I have about 4 ounces at night. I cook with coconut oil and also eat 2-3 T of it by the spoonful daily. I eat fatty steaks and chicken thighs with skins and salmon a few days a week for dinner. I supplement with all the usual things (Carlson's fish oil ~3 tsp/day, 500mg chelated Magnesium, daily multi, 5,000 IU D3, etc etc). I also started using MCT oil in my coffee as well as using it to make salad dressings.

Anyway, having maintained for many months, I thought it would be a good time to get an NMR test done to see what my lipids looked like. Given the amount of fat I ingest, I expected my LDL-C to be somewhat high, but these levels are troubling. Here are the numbers (lab ranges in parentheses):

LDL-P = 3198 (>2000 very high)
LDL-C calc = 252 (>=190 very high)
HDL-C = 63 (>=40 desirable)
Trig = 74 (<150 desirable)
Cholesterol (total) = 330 (<200 desirable)
HDL-P (total) = 29.2
Large HDL-P = 9.0
Large VLDL-P = <0.7
Small LDL-P = 953
LDL size = 21.2
HDL size = 9.1
Insulin Resistance Score = 17 (0 - 100)

Particularly worrisome to me is the very high LDL-P, LDL-C and the Small LDL-P which is at the very high end of the chart.

I had some other lab work done at the same time. These were performed by my local lab. I ordered a direct LDL measurement and it seems to coincide with the calculated LDL the NMR gave.

Cholesterol (total) = 337
LDL (direct) = 242
HDL = 77
Trig = 84
ApoA1 = 189 (94-176)
ApoB = 162 (52-109)
TSH, w/reflex to free T4 = 1.36 (0.27 - 4.20)
Vit D3 = 85 (30 - 100)
CRP-hs = 0.5 (<1.0 low)
Homocysteine (total) = 9.4 (<15.0)
Glucose = 80 (70 - 99)
BUN = 11 (6 - 23)
Creatine = 0.8 (0.6 - 1.4)
Sodium = 134 (133 - 145)
Potassium = 4.3 (3.3 - 5.1)
Chloride = 94 (95 - 108)
CO2 = 26 (21 - 30)
Calcium = 10.1 (8.3 - 10.5)
AST = 32 (0 - 40)
ALT = 40 (0 - 41)
Alkaline Phosphatase = 55 (35 - 129)

Triglycerides, HDL, particle size, D3, CRP, TSH, Homocysteine are all good if not great. So why is my LDL-C and LDL-P off the charts? I've been reading that some people who eat VLC screw up their thyroid, which in turn causes LDL to spike. I was thinking of making another appointment with the doc to get a full thyroid panel. In the meantime, I'm going to change some things and go back in a couple of months to see if my numbers are moving in the right direction.

a) Increase carbs to about ~50/day in case VLC is messing with thyroid. These will mostly be in the form of veggies. Lots of veggies.

b) Cut back on the coconut oil and use it for frying only.

c) Stop using MCT oil for now

d) Stop using HWC for now

e) Cut back on the bacon and fatty meats and replace some of the sat fats with mono fats (olive oil).

f) Go back to getting some cardio, jogging a couple miles a day.

e) I've also started taking 1500 mg Niacin and 100 mg C0Q10 (ubiquinol) daily.

Any other thoughts as to why my LDL is so out of whack when everything else looks good, or suggestions as to what course of action I should take or what I should get checked when I go back to the doc in 8 weeks? Thanks.

Your plan sounds great.
You can use fat free half and half in your coffee and make your changes for 3 months and check your labs again. Make sure you fast at least 8 hrs. before and-no coffee before your test.

Did your doctor put you on medication to lower it?

Black coffee is fine, and I usually fast at least 12 hours before blood draw, taking water only.

I only used this Dr to order the tests I wanted. He had the results mailed to me and said I was welcome to make a return appt to discuss the results. Instead, I'll go back in 2-3 months and get another lipid panel. I just don't know whether it's worth asking for a thyroid panel at that time since my TSH looks fine.

It's going to be a real bummer if I have to substantially reduce my saturated fats just to get my LDL numbers to a reasonable level. I love this WOE too much. But maybe it's just too much of a good thing.

For someone who is at goal you are ingesting a tremendous amount of fat, much of it almost pure saturated fat. Why are you still keeping your carbs so low? Did you not work through all the phases of low carbing and end up on maintenance? Your thyroid results are fine so I would seriously doubt that is the problem. The fact that your HDL is good is significant. Is there any familial hyperlipidemia in your medical history?

I'm not following Atkins, just eating HFLC because I feel great and love this WOE. Alas, I probably got carried away with the saturated fats.


No.

I think you're returning to the traditional, incorrect, dogma in thinking reducing fat will help small dense LDL.

Firstly with numbers like that on low carb, you need to get tested for genetic disorders that cause high LDL - with low trigs and high HDL, and low carb, those results look really dodgy to me. If you do have genetic issues, then medication is likely the only thing that will help, and is a specialist issue that a doctor will need to help you with.

If you don't have a genetic issue, then this is an excellent article:

http://chriskresser.com/the-most-im...out-cholesterol

Lee

Right, some people just have genetically high numbers. My boyfriend eats low carb and hi fat and he has really gotten his numbers low with statin meds so he can still eat his fatty steaks.

The issue is the small particle LDL, you can ignore the large stuff. As best we know it is harmless.

Dr. Davis's Track-Your-Plaque program is a great place to start to figure out how to get that lower. I think he often finds that Vit. D3 deficiency is often a culprit as well as low thyroid. Yours may be fine.

But the TSH test used for testing thyroid is useless because the issue is often with low Free T3. Burn that into your brain... Free T3. Total T3 is useless because some of it is bound and useless. Only Free T3 can be used. So get that tested. If you're low in FT3 (FREE T3) then that can elevate cholesterol.

Some people have genetic predisposition for creating lots of small LDL. He has advice for that too, but you can only do so much. (APOE4 gene, I think). There is genetic testing you can get done at 23andme.com and other places.

Anyway, Dr. Davis is the expert at this and it might behoove you to pay the small fee to get some counseling on his message forums.

If my LDL skyrocketed because of this new way of eating, I think it prudent to cut back some until I get to the root cause. I'll still eat VLC, but will replace some of the sat fats with olive oil for now.


Thanks for the link. What he says there is one of the big reasons I started eating this way. You can imagine how I felt when I saw that my numbers moved in the opposite direction by a lot. It basically shouldn't happen unless something else is wrong.

Thanks. I joined TYP to see what he says. If the ApoE4 gene is the issue wouldn't I have high trigs to go along with the high LDL? That seems to be the case with others.

Bah, I basically got the NMR to prove to my mom that I wasn't killing myself eating lots of fat. Turns out I am.

I also had the NMR done, and have higher LDL numbers than before going very low carb 21 months ago. The LDL particle number is still in the moderate range, but worrisome compared to the stellar HDL and Trig numbers. My thyroid was not checked at that time, but now I plan to do so this week.
You mention reading about high LDL and thyroid issues when on a VLC diet, and there are some interesting discussions on this topic on the Perfect Health Diet website. http://perfecthealthdiet.com/2011/0...rb-the-thyroid/. Interviews with Paul Jaminet indicate correcting this by raising carbs back up to about 100g, which can all be obtained from nutrient rich vegetables, or a small portion of his "safe starches". The thyroid issue is also mentioned in Jenny Ruhl's new book, Diet 101, and one study indicated that a level of 105 carbs avoids the problem.

Then there is the other issue of how useful the advanced blood tests really are:
http://www.marksdailyapple.com/how-.../#axzz1hrGjWgjS
All very confusing...but you are not alone with the high LDL on low carb as you can read at the first link.

Well, your last sentence might not have any basis in fact, but joining TYP is a good move.

I'd be curious to see what your results are. Dr. Davis is fairly certain that my elevated LDL has it's roots in my genetics, and given my geneology and family history, he may be right. I've ordered the test to see for sure.

He suggested, however, that a thyroid problem wasn't likely to cause my numbers to go this high. Yet I read that some people on this board who had very similar numbers to me found they had low T3 and corrected it by taking supplimentation. Their TC subsequently dropped, sometimes dramatically. Take 'awriter'. She had great numbers except for TC which was near 400 while eating VLC. After 1 month on oral T3 her TC dropped 100.

http://forum.lowcarber.org/showthread.php?t=404752

I was going to wait a couple of months until my next visit to the doc to get the thyroid tests, but I've decided not to wait. I've been reading that weakness or fatigue might be a sign of a problem. Well, I tend to get sleepy after lunch even though I get 7-8 hours of sound sleep every night. I also lack energy some days (mostly in the afternoon) and I haven't been able to pinpoint why.

So what tests am I looking for? FT3, FT4, rT3.....anything else?

That's true for a bunch of folks here. Merpig, a guy whose name I've forgotten, and a few others.

You want to get FT3/FT4, RT3 is great, but if you have plenty of FT4 and low FT3 then you can pretty much tell you've got high RT3 anyway.

A 24 hour saliva cortisol test is nice because if your adrenals are out-of-whack you won't tolerate T3 well. Good B12 status is essential too, as is good iron status. I'd just supplement with methylcobalamin sub-lingual rather than pay for the expensive test.

The iron tests were covered on a page about reverse T3... let me see if I can find it.

Here you go!

Here's a forum for thyroid help too: http://forums.realthyroidhelp.com/

My thyroid tests look OK, but after having read so much about this problem and other issues when one stays VLC for a long time, I am still leaning to raising my carbs with more nutrient rich non-starchy vegetables. Since you are at goal and doing so well with eating this way (you listed a perfect primal diet), just upping carbs slowly with low calorie veg to see what happens seems like a good plan.