... And why I need to follow Jean's lead in no longer getting these tests done.
Results from February 1st:
Total Cholesterol: 219
LDL-C: 146 (previously 86)
Trig: 64 (slightly higher than my last test, but I'm pleased)
LDL Size: 21.5
LP-IR Score: <25 (too low to be on the lowest part of the scale that only goes down to <27)
Blood Glucose: 98
My blood pressure during the visit was 136/73.
Here's the note I received from my doctor:
Your blood work shows normal blood sugar, blood count, and liver and kidney function. Your lipid panel show your LDL has bounced up a lot, from 86 to 146. The particle size results are mixed. To recap, LDL is the bad cholesterol, so the higher it is the higher the risk of heart trouble. Becasue LDL molecules can be of different sizes, the number of LDL particles can vary with the same level of LDL. In general, the more LDL particles, the higher the risk, so the smaller the LDL particles, the worse off you are, since it takes more of the smaller particles to equal the same amount of LDL. What we see on the results is that the number of small LDL particles is on the low side, and that's good, but becasue the total LDL has gone up so much, the total number of LDL particles has gone up from 952 to 1600. The cardiac risk calculator, which takes into account blood pressure, age, total and HDL counts but not the LDL information give you an estimated 10 year risk of a cardiac event of 16.9% The biggest risk factor here is your age. This calculator likely overstates your risk, particularly given your overall level of fitness, but it still exceeds the 7.5 to 10% range at which I suggest people consider taking cholesterol lowering medication . Given our past conversations, I think this is not likely to be your choice, but if things change let me know. Otherwise, we'll check this again in six months.
So, we have a disconnect here. My doctor is interpreting the NMR Lipid panel very differently than my interpretation. I was pleased with all the numbers. Triglycerides and HDL ratio continues to be near 1.0. My LDL particle size is predominantly large/fluffy with little risk. My HbA1C at 4.9 is entrenched in my comfort zone and indicates well-managed glucose over the past 3 months. My BG reading on the day of the blood draw is very likely at 98 due to the 12 hour fast, the early hour, and some BG present from gluconeogenesis at work. Since my HbA1C is stellar, this indicates a normal situation for one who is following a ketogenic WOE.
These are my thoughts with what is possibly at work here:
Given that I'm in a keto state, it goes to reason that even after only 12 hours of fasting, my blood fat content is going to show a larger amount of fat present as part of my primary energy consumption at that time. I'm a fat burner, so my blood work shows that. What we need is more research to provide a different health window reflecting those who are primarily fat burners, as these test ranges do not presently account for this condition. My last NMR LIpid Panel was the result of a 12-hour fast with no dairy for 30 days prior to the blood draw. I had lower TC and LDL-C at that time likely due to eliminating dairy.
Rethinking the value of going through this again, as the indication is the desire to test again in 6 months. I know I can hack this and provide excellent numbers by eliminating dairy and continuing to follow the Feldman protocol, but why? When the "Cardiac Risk Calculator" is used, the credibility of this exercise goes down the tubes. To me, the numbers from this test are very positive.