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  #1   ^
Old Mon, Jun-22-09, 15:05
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default Why did your LDL go up on Low Carb?

Mods, could you sticky this one? It's asked so frequently I think it'd be worth having it readily available.

A few doctors, extremely few unfortunately, understand the problem.

http://www.proteinpower.com/drmike/...nking-the-myth/
Dr. Eades
Quote:
For reasons we donít need to go into here, LDL is fairly difficult (as compared to total cholesterol and HDL) to measure. It can be done, but itís expensive. So instead of measuring it directly, most labs calculate it based on an equation derived by William Friedewald and others in 1972.

Friedewald realized that it was pretty simple to measure total cholesterol, HDL-cholesterol and triglycerides. He knew that total cholesterol was the sum of all the various subfractions of cholesterol, which can be presented by the following equation:

Total cholesterol = HDL-cholesterol + LDL-cholesterol + VLDL-cholesterol

Rearranging this equation to solve for LDL gives us this one.

LDL = Total cholesterol - HLD - VLDL

Friedewald knew that it was easy to measure total cholesterol and HDL but difficult to measure the others. His insight was that the triglyceride level if divided by five could give a close approximation of VLDL. In running his experiments he also realized that this relationship held only if triglyceride levels were 400 mg/dl or under. If they were over this, all bets were off.

So, Friedewald substituted triglycerides (TGL) divided by 5 for VLDL in the above equations, giving us the so-called Friedewald equation for calculating LDL.

LDL = Total cholesterol - HDL - TGL/5

And this is how it is still done in labs all over the world 27 years after Friedewaldís paper. If youíve had a lab report showing an LDL figure, I can guarantee it was calculated by the Freidewald equation and not measured directly.

Whatís wrong with this if it works? Nothing. If it works. Problem is, it doesnít always work. Friedewald himself found that in subjects with triglyceride levels greater than 400 mg/dl the equation didnít hold. Anyone reading this who has had a lipid test showing triglycerides greater than 400 will have note on their lab report saying that LDL couldnít be calculated because triglycerides were too high.

Iíve always thought the same held true for triglycerides under 100 mg/dl, which would apply to almost everyone who sticks to a low-carb diet for any length of time. Triglyceride levels of 40-90 mg/dl are not uncommon, and are, in fact, typical. When Friedewald did his work, the triglyceride levels were mainly up in the 150 Ė 250 mg/dl range, and in this range his equations match pretty well to directly measured LDL levels, but all bets are off with triglycerides above 400 mg/dl and, I suspect, triglyceride levels below 100 mg/dl. MD and I did find this ourselves in a few patients that we did direct LDL measurements on in our practice.


Dr. Davis, a cardiologist, has written extensively about how unreliable the calculation is for people with low triglycerides.
Multiple articles

To sum up. If you have triglycerides under 100 the Friedewald calculation used in every "standard" cholesterol test is going to be messed up. You need to have your cholesterol directly counted, which can be done with an NMR or VAP cholesterol test. You might be able to get your doctor to order one, or you can order it yourself but they are rather pricey.

So stop panicking and flush those statins down the toilet, or better yet turn them over to the hazardous waste management service in your area, and keep doing what you're doing.

Last edited by Kristine : Fri, Jul-15-16 at 06:36. Reason: Fixing links to Dr Davis' blog
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  #2   ^
Old Wed, Jun-24-09, 09:12
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Benefits of a high-saturated fat diet on the heart
http://drbganimalpharm.blogspot.com...t-diets-in.html
Quote:
It was observed that in post-menopausal women with documented heart disease from the Estrogen Replacement and Atherosclerosis (ERA) trial, a multicenter clinical trial evaluating the effects of hormone replacement therapy on atherosclerotic progression, in the group consuming the highest-saturated dietary fat diet (12.0% Sat Fat), an enlargement in coronary diameter of 0.01 mm and a 0.1% regression in coronary artery stenosis.

Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women.
Quote:
Dividing the saturated fat intake into quartiles, the individuals at the highest quartile (dietary saturated fat intake: 12.0%) demonstrated the least progression on angiogram of coronary diameter. In fact, this was the only group that exhibited REGRESSION.

This group was also characterized as having the:
--least medications, including lipid-lowering medications
--the least medications and the higher the saturated fat, the more coronary artery widening in coronary artery diameter
--highest LDL (low density lipoprotein) measurements
--highest HDL (high density lipoprotein 'good cholesterol)
--lowest Trigs
--MOST PAST AND CURRENT SMOKERS
--highest dietary fat intake
--highest monounsaturated fat intake
--lowest dietary carbohydrate intake (47.1% v. (!!)69%)
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  #3   ^
Old Sat, Jun-27-09, 20:15
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Here's another article on the failure of the calculated LDL test on low carbers:

When Friedewald Attacks And the cool part is it offers an alternative calculation when your triglycerides are below 100.

Quote:
When you walk into the doctor's office and ask him to measure your cholesterol, the numbers you get back will generally be total cholesterol, LDL, HDL and triglycerides. All of those except LDL are measured directly. LDL is calculated using the Friedewald equation, which is (in mg/dL):

LDL = TC - HDL - (TG/5)

Low-carb advocates have known for quite some time that this equation fails to accurately predict LDL concentration outside certain triglyceride ranges. Dr. Michael Eades put up a post about this recently, and Richard Nikoley has written about it before as well. The reason low-carb advocates know this is that reducing carbohydrate generally reduces triglycerides, often below 100 mg/dL. This is the range at which the Friedewald equation becomes unreliable, resulting in artificially inflated LDL numbers that make you have a heart attack just by reading them.

I had a lipid panel done a while back, just for kicks. My LDL, calculated by the Friedewald equation, was 131 mg/dL. Over 130 is considered high. Pass the statins! But wait, my triglycerides were 48 mg/dL, which is quite low. I found a paper through Dr. Eades' post that contains an equation for accurately calculating LDL in people whose triglycerides are below 100 mg/dL. Here it is (mg/dL):

LDL = TC/1.19 + TG/1.9 - HDL/1.1 - 38

I ran my numbers through this equation. My new, accurate calculated LDL? 98 mg/dL. Even the U.S. National Cholesterol Education Panel wouldn't put me on statins with an LDL like that. I managed to shave 33 mg/dL off my LDL in 2 minutes. Isn't math fun?
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  #4   ^
Old Mon, Jun-29-09, 19:26
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Want a better reading of your LDL?
Here's a calculator that'll do a better job if your triglycerides are under 100.
http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

Example for me:

Total Cholesterol: 250
HDL: 66
Triglycerides: 59

Friedewald LDL: 172
New Calculation: 143
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  #5   ^
Old Wed, Jul-29-09, 09:42
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Along the lines of low carbing and cholesterol results, you can pay and have an expensive NMR or VAP test done and find out if you're a pattern A or pattern B or you can probably figure it out from your el cheap-o test by looking at HDL and triglycerides.

The Diet-Heart Hypothesis: Subdividing Lipoproteins
From Whole Health Source (great blog by neurological doctorate student).

Pattern B (for BAD!): LDL particles are small and dense. HDL is low. Triglycerides are high. Your risk of heart attack is 3x normal.

Pattern A: LDL particles are large and bouyant. HDL is high. Triglycerides are low. Risk of heart attack is much less, even though your LDL might be higher (see the other articles I posted as to why the LDL is higher... it's a breakdown of the Friedewald calculation used to calculate cholesterol).

So what happens when you eat low fat?
Quote:
Out of the 87 men with pattern A on the high-fat diet, 36 converted to pattern B on the low-fat diet... Taken together, these results indicate that in the majority of men, the reduction in LDL cholesterol seen on a low-fat, high-carbohydrate diet is mainly because of a shift from larger, more cholesterol-enriched LDL to smaller, cholesterol-depleted LDL [sdLDL].
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  #6   ^
Old Fri, Aug-07-09, 00:21
cbcb's Avatar
cbcb cbcb is offline
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Posts: 791
 
Plan: South Beach-esque
Stats: 194/159/140 Female 5'3"
BF:34% / 28% / 20%
Progress: 65%
Default

This is terrific to know. Thank you for posting it.
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  #7   ^
Old Mon, Aug-31-09, 12:02
JudyW's Avatar
JudyW JudyW is offline
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Posts: 759
 
Plan: Atkins/HcG
Stats: 211/168/150 Female 5'5"
BF:
Progress: 70%
Location: Columbus, Ohio
Default Cholesterol/LDL levels

I'm sorry to butt in on your thread but I can't find where or how to post a new thread.

I received my bloodwork back from last week and I thought with this woe that all my levels would be EXCELLENT!!!! Ok, at least better than the last time I had them checked!!

Well, last July (08), I had my tests done and my cholesterol was 186, while my triglycerides were high at 167. This year my cholesterol is 211 and my tris are down to 120. HDL is good -- last year was 34, this year it's 53. But my bad cholesterol went from 119 to 134 which they recommend having the levels below 130.
I'm really hoping my dr doesn't want to put me on any medication. About 3 years ago it was just over 200 and she said we'd see what the numbers looked like the following year and if they weren't down, she was going to put me on medication. Well, I was able to get them below 200 for the last couple of years...until NOW!!!!
I don't believe I eat a lot of red meat and have cut way down on egg consumption.

I'm just wondering if anyone else has the same problem?!?!? What can I do to get the levels back down? I know we're suppose to eat "regular" foods and not fat-free or non-fat so that's what I do.

TIA for any info you can provide
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  #8   ^
Old Mon, Aug-31-09, 13:14
artp3377 artp3377 is offline
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Posts: 84
 
Plan: Bernstein
Stats: 261/251/210 Male 72 in
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Default medication

"I'm really hoping my dr doesn't want to put me on any medication"
Are you not aware that you can say no? Say it with me, no,no, no!! See you can do it. Your doc will feign anger and wring her hands [she answers to the drug companies] but it is your body.BTW your numbers look fine to this layman.
Enjoy some red meat and eat eggs every day if you like them, both will make you a healthier, happier person. Do some research!!
be well
Art
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  #9   ^
Old Mon, Aug-31-09, 23:13
Cajunboy47 Cajunboy47 is offline
Senior Member
Posts: 2,899
 
Plan: Eat Fat, Get Thin
Stats: 212/162/155 Male 68 "
BF:32/23.5/23.5
Progress: 88%
Location: Breaux Bridge, La
Default

Niacin, fish oil and more exercise can bring cholesterol down in addtition of a l/c diet usually doing it...

I've also had luck with Chinese herbs and teas....
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  #10   ^
Old Tue, Sep-01-09, 08:09
cbcb's Avatar
cbcb cbcb is offline
Senior Member
Posts: 791
 
Plan: South Beach-esque
Stats: 194/159/140 Female 5'3"
BF:34% / 28% / 20%
Progress: 65%
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For what it's worth, my cholesterol first went high in my teens the year I had an extremely low fat diet, just mainly low-calorie salads (with nonfat dressings) and veggies with a little bit of lean fish and lean meat.

Low thyroid is one thing that can cause cholesterol to go high, and to that end making sure you're not starving yourself is good. As is some reasonable exercise.
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  #11   ^
Old Tue, Sep-01-09, 08:50
JudyW's Avatar
JudyW JudyW is offline
Senior Member
Posts: 759
 
Plan: Atkins/HcG
Stats: 211/168/150 Female 5'5"
BF:
Progress: 70%
Location: Columbus, Ohio
Default

thank you for the replies...

artp -- yes, I have every intention of NOT taking the meds...I would like to try to lower it by my own means.

Cajunboy -- I have been vlc for over a year now so I was hoping my numbers would have been a lot better!!!
I already take fish oil pills (errr..at least I TRY to take them every day -- they are quite a pill to swallow!! Anyway, my ex-husband had a bad reaction when taking niacin pills (red hot flush breakout) so I'm not too keen on the idea of taking THOSE!! I guess I rely on my multi-vitamins having enough niacin in them so taking a supplement wouldn't be necessary. I totally agree with you regarding the exercise -- I could certainly use more of that!! I was planning to swim more this summer and firm everything up but the doggone weather this summer certainly hasn't cooperated! I really need to start firming everything up -- I have so much loose skin especially on my legs. I notice it all kinda "shivers" when I walk

Thanks again for the responses -- I really appreciate someone else's view!
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  #12   ^
Old Tue, Sep-01-09, 09:28
Cajunboy47 Cajunboy47 is offline
Senior Member
Posts: 2,899
 
Plan: Eat Fat, Get Thin
Stats: 212/162/155 Male 68 "
BF:32/23.5/23.5
Progress: 88%
Location: Breaux Bridge, La
Default

Quote:
Originally Posted by JudyW
I was planning to swim more this summer and firm everything up but the doggone weather this summer certainly hasn't cooperated! I really need to start firming everything up -- I have so much loose skin especially on my legs. I notice it all kinda "shivers" when I walk

Thanks again for the responses -- I really appreciate someone else's view!


We have a friend that lives in Columbus, the northeast side and she swims at a nearby indoor YMCA pool everyday, even in winter, from what she tells us, anyway....
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  #13   ^
Old Tue, Sep-01-09, 10:23
JudyW's Avatar
JudyW JudyW is offline
Senior Member
Posts: 759
 
Plan: Atkins/HcG
Stats: 211/168/150 Female 5'5"
BF:
Progress: 70%
Location: Columbus, Ohio
Default

Yes, I use to do that too when I belonged to the "Y". Now we have a huge pool in the backyard that I love to get in after work every day. I really hate to see the colder weather come! Hubby has been talking about getting a membership to the Y, so we'll just have to wait and see....
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  #14   ^
Old Tue, Sep-01-09, 10:53
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,189
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Quote:
Originally Posted by JudyW
I received my bloodwork back from last week and I thought with this woe that all my levels would be EXCELLENT!!!! Ok, at least better than the last time I had them checked!!

If you read the first page or so of this thread it explains why your LDL levels go up and why it isn't anything to worry over. At least read the first page or so. I have a lot of info there that I posted so you can calculate your REAL LDL values and why you shouldn't be concerned anyway.

The only thing I wonder about is why your triglycerides are still > 100. If you're being faithful to your low carb diet and not cheating, or eating a bunch of fruit/fructose, then they shouldn't be that high. Do you drink a lot? I think that might account for the high triglycerides too.
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  #15   ^
Old Tue, Sep-01-09, 12:43
Cajunboy47 Cajunboy47 is offline
Senior Member
Posts: 2,899
 
Plan: Eat Fat, Get Thin
Stats: 212/162/155 Male 68 "
BF:32/23.5/23.5
Progress: 88%
Location: Breaux Bridge, La
Default

I'm not sure, but tests have a percentage error and if your fasting is 10 hours prior to testing compared to 14 hours, it can probably have an impact on the result also, but I'm just guessing this. I had a Nurse Practioner tell me this a long time ago and didn't check it out, but I always fast 14 hours when I do blood work...
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