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Ted Byerly
02-25-2009, 04:38 PM
All this reading and still confused. Searched the archives and obviously believe what I read here than from the local "Dr's".

Anyway lurking for a long time, Did CF for 1 year then switched to Gregs WOD..Started with Zone and now mostly Paleo..have only an occasional 1-2 cheat days.

I expected my numbers to be lower or I just really dont know how to read them, so Im looking for some expert opinions....Robb, Dr. G or anyone else that has been involved and are more educated than I am. The local quacks had their usual advice.

Cholesterol 220
TRI 37
HDL 62
Direct LDL 137

I have alll the other numbers if you need them. I take between 15-20 ml Carsons Fish Oil daily..

Thanks
Help?

Garrett Smith
02-25-2009, 09:17 PM
Get your vitamin D levels checked. Supplement as necessary (you can PM me for more on this if your local docs won't do it for you).

If I had similar numbers and I wanted to avoid conventional treatments for cholesterol, I'd look into the following:
--2400mg total EPA+DHA daily
--D3, supplemented based on weight, sun exposure, latitude, and current levels
--Ditch any inkling of Zone
--Get good saturated fats daily, along with monounsaturateds and fish oil.
--No metcons longer than 10 minutes
--Pomegranate juice or supplement (if you don't want the sugar)
--Nice dose of CoQ10
--More sleep
--Better stress management

That should change things nicely.

Ted Byerly
02-26-2009, 08:04 AM
Thanks Dr G...
Im in the ballpark with the fish oil...3900 per day with Carlsons

Have been working on the fats with almonds and macadamia nuts, avocados and olive oil. Any Limit? Or just Paleo

Ill add the supplements..

You Hit the nail on the head with the sleep and stress though...I never seem to get enough sleep and stress has been high lately.

My Choleterol has always been somewhat elevated..I am just now paying more attention to it.

Anyone care to comment on the levels or ratios? Obviously I dont get good advice from the local medical establishment.

Garrett Smith
02-26-2009, 02:00 PM
In all honesty, I think your lipid numbers are just fine.

Get some good saturated fats in there (organic butter, coconut oil), and I'd say you're fine.

I've recently started doing a red blood cell membrane fatty acid analysis...if one really wants to know which fats they need to take to correct any potential/current issues, that's what I'd pursue. More info on this test in these articles:
https://www.bodybio.com/BodyBio/docs/BodyBioBulletin-Cholesterol.pdf
https://www.bodybio.com/BodyBio/docs/BodyBioBulletin-4to1Oil.pdf
https://www.bodybio.com/BodyBio/docs/BodyBioBulletin-Kirunal.pdf

Ted Byerly
02-26-2009, 07:09 PM
Thanks Dr G.... Just read through the forum and now reading up on Vit D..

Picking up the other things tonight.

Thanks for all your time and effort

Will be reading the links

Scott Clark
02-27-2009, 09:19 AM
Dr. G, in your experience have you found that sleep and stress management are the top culprits of out of whack lipids and disease in general? Interesting to see pomegranate get a mention, I've been having a shot of it daily for a few months now.

Garrett Smith
02-27-2009, 02:02 PM
Scott,
In a word, yes. I believe so much in lifestyle choices being the major factors in health (or lack of it), that I'm currently in the process of converting my practice to simply nutrition, focused detoxification based on testing, exercise, and some form of stress relief/management. In my opinion, if those are all addressed adequately, there won't be much room for much dis-ease at all.

Fun studies I just pulled up on the topic:

Relationship Between Forgiveness and Psychological and Physiological Indices in Cardiac Patients. (http://www.ncbi.nlm.nih.gov/pubmed/19229635?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
BACKGROUND: Research suggests that forgiveness is associated with better psychological and physical health and in particular cardiovascular functioning. Despite these findings, most forgiveness studies involve healthy participants. PURPOSE: The current study assessed the psychological and physiological correlates of forgiveness in individuals with coronary artery disease (CAD). METHOD: Self-reported forgiveness, perceived stress, anxiety, and depression, and physiological data, including triglycerides, total cholesterol, high- (HDL) and low-density lipoprotein (LDL) cholesterol, were obtained from 85 hospitalized CAD patients. RESULTS: Higher levels of forgiveness were associated with lower levels of anxiety (p < 0.05), depression (p < 0.01), and perceived stress (p < 0.005) as well as lower total cholesterol to HDL and LDL to HDL ratios (both at p < 0.05) after controlling for age and gender. The psychological indices did not mediate the relationship between forgiveness and cholesterol ratios. CONCLUSIONS: Results suggest that the psychological correlates of forgiveness are similar in cardiac patients and healthy individuals. Further, among cardiac patients, forgiveness may be associated with reduced risk for future cardiovascular events.

Associations of usual sleep duration with serum lipid and lipoprotein levels. (http://www.ncbi.nlm.nih.gov/pubmed/18517035?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed)
STUDY OBJECTIVES: We examined the individual association between sleep duration and a high serum triglyceride, low HDL cholesterol, or high LDL cholesterol level. DESIGN AND SETTING: The present study analyzed data from the National Health and Nutrition Survey that was conducted in November 2003 by the Japanese Ministry of Health, Labour and Welfare. This survey was conducted on residents in the districts selected randomly from all over Japan. PARTICIPANTS: The subjects included in the statistical analysis were 1,666 men and 2,329 women aged 20 years or older. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Among women, both short and long sleep durations are associated with a high serum triglyceride level or a low HDL cholesterol level. Compared with women sleeping 6 to 7 h, the relative risk of a high triglyceride level among women sleeping <5 h was 1.51 (95% CI, 0.96-2.35), and among women sleeping > or =8 h was 1.45 (95% CI, 1.00-2.11); the relative risk of a low HDL cholesterol level among women sleeping <5 h was 5.85 (95% CI, 2.29-14.94), and among women sleeping > or =8 h was 4.27 (95% CI, 1.88-9.72). On the other hand, it was observed that the risk of a high LDL cholesterol level was lower among men sleeping > or =8 h. These analyses were adjusted for the following items: age, blood pressure, body mass index, plasma glucose level, smoking habit, alcohol consumption, dietary habits, psychological stress, and taking cholesterol-lowering medications. CONCLUSIONS: Usual sleep duration is closely associated with serum lipid and lipoprotein levels.
Sleep and stress are huge, likely two of the biggest things that people take for granted in their health.

Mike ODonnell
02-27-2009, 04:09 PM
stress = up in cholesterol production.....lack of sleep is a stress to your adrenal glands and cortisol production....just ask anyone who's cortisol is done/blown and sleep 4 hours a night and work stressful jobs.....good luck to those people shedding excess weight if they don't do something about their lifestyle.

Body wasn't meant for the stressors we put on it today.

Scott Clark
02-27-2009, 05:15 PM
Dr G that's all good stuff. Good luck with the new direction of your practice. I watched the stressors of finances and 80-90 hour work weeks land my father on a table with his chest cracked open for a double bypass at the age of 51. My grandfather (his father) was buried at 48 after suffering massive heart attacks brought on largely by a horrible lifestyle and stress. While we all like to debate about diet down to the nth degree, I firmly believe that stress is the #1 bad guy we all have to learn to keep at bay.

MOD, I hear ya. For the past 2 weeks I've been getting between 3-4 hours of sleep every night. I even put in for time off (today) just to refocus, recharge, and basically force myself to make sleep my top priority.

Garrett Smith
02-27-2009, 10:25 PM
An older ND I know just told me about his huge practice that he had in Canada--he got to the point where he realized he would either sell it soon or it would kill him.

I'm too smart to let it get that far, I also am still watching my father go through the last years of his dental practice...I hope to leave practice on a different note.

Craig Loizides
03-06-2009, 08:57 AM
Dr G, the second study you listed is interesting because it shows a U-shaped curve between sleep and HDL/triglycerides for women. 6-7 hours sleep was best with more than 8 hours just as bad as less than 5 hours. The full text states that other studies (but not all studies) have shown U-shaped curves between sleep and mortality, diabetes, CVD, etc.

Gaspard Winckler
03-10-2009, 07:16 AM
Hi all, I just got some results after moving towards a Paleo approach:

Triglycerides: 56 down from 63
HDL: 72 up from 60
LDL: 150 up from 90

After doing some searches it appears to be a common profile among people on the Crossfit boards: http://board.crossfit.com/showthread.php?t=42143 wfs

One explanation is problems with the calculation at low TG levels, another is that the 'fluffy LDL' weighs more and comes out with a high total cholesterol but is benign.

Interested if any other paleo eaters have similar experience.

Gaspard Winckler
03-10-2009, 01:01 PM
So I found the study that indicates TG/HDL as being the key ratio and highly (r = 0.803) inversely correlated with lipoprotein particle size:

http://dx.doi.org/10.1016/S0009-9120(01)00263-6

That's from 2001. In 2004 we have http://dx.doi.org/10.1373/clinchem.2004.031757

"AIP [atherogenic index of plasma, which is log TG/HDL] was inversely and significantly correlated with measures of insulin sensitivity, such as the homeostasis model assessment and quantitative insulin sensitivity check index."

So knowing your TG and HDL can give you a marker for your insulin sensitivity, i.e., the lower the ratio the better.

The last piece of the puzzle is why people eating relatively clean paleo diets should see (apparently benign?) LDL increase.

Garrett Smith
03-10-2009, 01:58 PM
I've seen two people (myself being one of them, an avid CFer the other) with LDL numbers over 200, while eating a pretty darn clean Paleo regimen and obviously exercising.

There is something to the LDL numbers among this crowd. As Gaspard pointed out in his post, both myself and the other CFer both had great HDL (high) and TG (low) numbers, which are what I'm more concerned about.

I will be testing again soon.

Gaspard Winckler
03-12-2009, 11:17 AM
A few bits of research:

People's cholesterol levels react differently to diet depending on their genes, so some crossfitters can eat vast amounts of bacon and their LDL doesn't budge, but not all can.

Elevated LDL with good TG and HDL is common with all low carbers, both in the scientific papers and on low carb forums.

So there are at least 3 factors:

-something about low insulin and reliance on fat metabolism may increase LDL (by weight) in some people, due to increase in particle size; however this would go against the fact that LDL is well established as an independent risk factor (i.e. a high LDL still represents a risk even if the other 2 numbers are good, and treating LDL by itself reduces cardiac events)

-some insulin sensitive people may also be more sensitive to dietary cholesterol (eggs) http://atvb.ahajournals.org/cgi/content/abstract/23/8/1437

-some paleo dieters may be avoiding some of the more useful sources of soluble fibre like apples (and potatoes of course) that they used to eat and eating somewhat more saturated fat in getting their protein requirements

The main problem is that most research is not done on people who exercise and have no other risk factors, and who eat a low carb diet even though they are not overweight or 'dieting'.

However, the fact that this LDL (and TC) increase appears to occur across a proportion of low carbers in general, regardless of the activity level, would seem to imply that it is a phenomenon independent of exercise, and of insulin sensitivity (i.e. there will be some fit people who get heart attacks, although they are relatively rare). The fact that insulin resistance correlates only similarly to LDL in heart attack prediction (The Copenhagen Study) (http://atvb.ahajournals.org/cgi/content/abstract/atvbaha;17/6/1114) implies LDL should be monitored independently.

I've concluded from reading all this that I may not be in the genetic group of those who can eat saturated fat and cholesterol and keep a low LDL. I'm going to see what happens if I reduce the sat fat somewhat and make a point of getting plenty of soluble fibre when I do eat it.

Arien Malec
03-12-2009, 04:13 PM
Here's a take on similar paleo lab results:

http://www.freetheanimal.com/root/2009/03/nmr-lipoprofile.html

My take is that this is all new science -- epidemiologic studies on correlations of LDL to CV risk may not mean that high LDL causes CV risk, particularly if high LDL is typically found in a pattern with high TG and low HDL, large waist size, insulin resistance, etc. (metabolic syndrome).

What does high LDL mean in the presence of high HDL, low TG, good insulin sensitivity, and a trim waist, particularly when the LDL is of the large particle type, and apo B is low? Risk models based on the western diet don't really cover that situation, but I'd note that those profiles look a lot like Inuit blood lipid profiles (which is probably a good thing).

How you view this probably depends on how you view the lipid heart hypothesis. If you think that low HDL correlates with systemic inflammation, and that's the real heart risk, you'd see the lipid profile above as benign. If you think that high LDL and low HDL are the causes of heart risk, you'd scratch your head a bit about how to treat the lipid profile above...

Gaspard Winckler
03-12-2009, 11:01 PM
Thanks, of course we are talking about risk *within* the already low risk population of fit people who exercise. This article http://www.theheart.org/article/527905.do shows the debate within the medical community where there is an example of basic LDL having the same predictive value as particle number.

The main use of the particle number is identifying risk in people who have an apparently low LDL number. So in your link above there is a link to a testing company website that shows someone with LDL of 98 (apparent low risk) who is in fact high risk because of her number of particles.

It doesn't follow from this (and I detect a bit of denial going on, especially on the atkins/ low carb discussion boards) that this means a high LDL ceases to be a risk factor in what is a very complex process. LDL and risk vary independently of HDL, TG and insulin sensitivity. If insulin insensitivity and inflammation were the whole story, HDL and TG would be totally predictive and LDL a dependent variable or irrelevant.

So if you can keep your high HDL and low TG but also lower your LDL by small diet adaptations (which are probably also beneficial in other ways), why not do it?

Arien Malec
03-13-2009, 09:07 AM
Thanks, of course we are talking about risk *within* the already low risk population of fit people who exercise. This article http://www.theheart.org/article/527905.do shows the debate within the medical community where there is an example of basic LDL having the same predictive value as particle number.

Great reference -- note that the parameter in question is non-HDL, not LDL (LDL is a subset of non-HDL). So high TG counts for non-HDL.

The best predictors of CV risk in that study are TC/HDL ratio and CRP. So someone who adopts a dietary approach that lowers TG and raises HDL dramatically, and raises LDL moderately, will show an overall risk reduction on those terms (particularly if CRP is also reduced).

I do agree with the notion that there's some wishful thinking in the LC community -- my only point is that the science points to overall risk reduction, but this is a fairly unstudied area, because most of the risk epidemiological studies correlate against is associated with metabolic syndrome. So what does low TG, high HDL, borderline high LDL mean for overall risk? Who the hell knows?