10/7/2014
Total cholesterol 239 (<200)
LDL 143 (<130)
Triglycerides 125 (<150)
HDL 71 (>40)
Chol/HDL 3.4 (0.0 - 4.4)
Non HDL ? (<130)

4/13/2015

Total cholesterol 282
LDL 208
Triglycerides 84
HDL 57
Chol/HDL 3.4
Non HDL 225




I have read enough to realize that total cholesterol has little meaning really in terms of coronary risk and that LDL is a calculated number versus an actual number. I also read that the Triglyceride HDL ratio is more predictive of insulin resistence and possible coronary risk than anything else. My ratio in this area did improve.

In review, I have been between 5-15 grams of Carbs (approx 80% fat) since 1/1/2015. I am not taking any medication (but am supposed to be taking Lipitor based on the FIRST results from October). My doc is going to flip out when he sees this.

Thoughts? I am wondering if I should have more sophisticated testing done (NMR?) or be referred to a Lipidologist (who might just well tell me to take statins). I can't for the life of me figure out the HDL decrease. My HDL has always been in the 70's and 80's in the past and I think I had a few 90's actually, and that is when I was eating ice cream and lots of pasts. In case my stats don't show up, I am 5'5.5" starting at weight of 175 1/12015 and now 161.0 # with hypertension (no meds) and no other health history. Fasting blood glucose on this same day was 87. No hx of DMII. I really need some advise.

Dee

Some people do have higher LDL when eating lots of Sat. fat. Does it warrant taking a statin? Well... that's up to you to decide. Just be sure to consider that statins are implicated in all kinds of diseases like heart disease (which they're supposed to prevent) and things like diabetes, memory loss, permanent muscle damage (heart is a muscle).

An NMR isn't going to be much different, IMHO.

You might try raining in some of the sat. fat and see how you respond. Meanwhile, read some of the articles in my signature.

Well your triglycerides went down, so that's good.

I don't know why your HDL went down. Have you been careful about avoiding trans-fats?

I have been lucky in that I can eat the "same thing" most of the time - so easier not to veer off track. I only eat "whole foods" now, and cannot think of any time since Jan 1st that I have had trans-fats at all (not even a cheat).

I suppose I could be getting the trans fats in the meat/eggs that I consume. Maybe I need to go back to doing a food diary and eating more "non-saturated" fats versus whatever catagory coconut oil and olive oil is in? Maybe that is it? I do eat a fair amount of eggs and skin-on chicken. I have not touched processed food of any kind since around December 1st.

I have scoured the internet to find out if the HDL might be a "calculated number" and thus it may be that this number is lower because my LDL is higher, but have not been able to find that info.

These numbers make me want to investigate what size particles I have? (Berkley labs, NMR, etc.) I can just see my physician rolling his eyes right now......as he writes a script for Lipitor.

I don't think HDL is calculated, but LDL is.

Do you smoke or drink lots of alcohol? I think there's some other things that can depress HDL, but can't think of them right now.

You might want to read Jimmy Moore's book. He has high LDL too.

Dee,
You are actively losing weight recently, which might have some impact on the numbers, but it is not as though you are dumping lots of fat. Something to consider. http://www.wheatbellyblog.com/2012/...sterol-went-up/

The lower HDL baffles, it is the component that is directly measured, and an unusual outcome for a LCer.

As Nancy mentioned some people do have to rein in the saturated fats, here is a good article about one RD's decision on it.
http://www.lowcarbdietitian.com/blo...-own-experience

Her article caused a bit of controversy among the die-hard Keto followers, and lucky for us, she posted an Update just yesterday:
http://www.lowcarbdietitian.com/blo...-and-what-i-eat

Long article giving a balanced view and many resouces and theories to consider.
Don't Miss Dr Dwight Lundell's comment about her article!:

Nice post and congrats for sharing your numbers. They are for the most part insignificant in terms of heart and artery health. The key is inflammation of the endothelium, the most common cause is hyperglycemia. So the most important number for heart health is Hb A1c reflecting your average blood sugar. The particle size and number is just an attempt to extend the whole cholesterol theory, which is surely being discredited. The only way cholesterol ever gets deposited in the artery wall is when it is consumed by a white cell, activated by injury to the endothelial cell layer. Ignore the lipid numbers an keep your sugar and insulin low with your current diet.

I am a moving toward this conclusion myself. Husband and I have had multiple NMR's and the numbers bounce around, somewhat in relation to our short-term diet about a week before the test, and other times, makes no sense knowing our diet in the time frame since the last test. I haven't bothered with it for a few years now, more focused with lowering BG and Hba1c.

That's my approach too. I just don't have my cholesterol checked. I tell my doctor that since I have no intention of changing my diet or taking a statin that there is no reason to get my cholesterol checked. She's even come around to agree with me, or at least not fight me on it.

Jean

Janet,

I suspect that my HDL is lower (at least in part) due to a fairly drastic reduction in my physical activity since the fall cholesterol check, and my puposefully cutting back drastically on my hormone replacement medication. Of course I plan to change all that in terms of exercise now. I found your links very interesting, and although I am tempted to have my lipid breakdown run, I may just be opening a can of worms there.

On another note, perhaps you can explain to me what occurs in the minds of healthcare professionals when they monitor "healthy" patients for the presence of insulin resistance. For example, where I work, I see many fasting glucose numbers between 101 and 110, (with repeat blood work showing the same numbers over a few years time) but the Hbg AIC almost never indicates full blown diabetes (>6.6). It seems from what I read that the triglyceride/HDl ratio may be a good surrogate for insulin resistence, but the general medical community does not appear to "get that" in real life where I am from, nor do they seem to worry much about a little bump in fasting glucose numbers over the years.

So many of these folks that have elevated fasting glucose numberes also have abnormal liver labs and are diagnosed with "fatty liver". I guess I am just preaching to the choir here, but there is no real "test" for insulin resistence, correct?

Not Janet, but you can have fasting insulin levels taken. When I suggested to my doctor that I might be insulin resistant, she said Well, let's check your fasting insulin. It came in low, putting both of us more at ease. When she checked my A1c a year later I asked her to repeat the fasting insulin levels. She said it's not standard, but she checked the box without any fuss. On the repeat test, both A1c and fasting insulin dropped, indicating I'm headed in the right direction. I think fasting insulin should be a standard test for anyone with blood sugar concerns.

If you've eliminated hormone replacement, that probably has everything to do with the drop in your HDL.

thank you Liz, very helpful to know what your experience has been.

I supppose indirectly, I would know my insulin response via post-prandial blood glucose checks. I should do that more, but suspect my glucometer is a bit off (72 was my reading simultaneous with blood draw, which was 87 as the result) - in a 4 hour fasting state. thank you again.

Fasting insulin results are difficult to interpretate without other tests, knowing diet, hours of fast before the draw, etc. But if the number is way high, then I believe doctors start thinking about IR.
http://www.diabetesselfmanagement.c...-insulin-level/ And you are right, few in the medical community seem to care about Trig/HDL ratios, and they give the usual advice if there are signs of NAFLD, then cut down on fat.