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  #1   ^
Old Fri, Feb-09-18, 09:54
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,456
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default Latest NMR Lipid Panel Results

... 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)
HDL-C: 60
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
HbA1C: 4.9

My blood pressure during the visit was 136/73.

Here's the note I received from my doctor:
Quote:
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.
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  #2   ^
Old Fri, Feb-09-18, 11:07
khrussva's Avatar
khrussva khrussva is offline
Posts: 6,939
 
Plan: My own - < 30 net carbs
Stats: 440/205/210 Male 5' 11"
BF:Energy Unleashed
Progress: 102%
Location: Central Virginia - USA
Default

I too have a problem with the risk factor model being drawn from the total population of the average "Joe". Even things like age as a risk factor seem kind of silly to me. What can be done about your age? I do believe that there are populations where high LDL may be an indication of a problem and in other cases the number is meaningless. I recently took a risk factor quiz for diabetes risk. The result: I was at high risk and should call a doctor to be tested for diabetes. My age was a risk factor. My "overweight" status was too. They asked if I had ever had high blood pressure (but they didn't ask if I currently had high BP). The model was kind of a joke. I don't want to be treated for risk factors. I want to be treated for the disease (if necessary).

I don't consider the Feldman protocol a hack, per se. I didn't actually do the Feldman protocol last year when I got my stellar numbers. I sort of borrowed from it and your 'dairy free' experiment. I was dairy free and I just made sure that I ate enough extra fat to be in a well fed state in the days before the blood draw (not burning my own fat - not losing weight). My LDL was 57 on that test. Then 6 months later I was eating dairy again and in weight loss mode before another test. My LDL was 138. Is it a hack just because I know how to manipulate the number? I just feel like I know more about this as it applies to ME than my doctor does. I see it this way... some ketogenic individuals have really low LDL-C in a well fed state. The same individual can have a relatively high LDL-C when they are using their own body fat for energy. Dairy may or may not have anything to do with it. I'll be having my next cholesterol test in a month. I plan on doing the same thing I did last year -- a well fed LCHF state in the days before the test -- except that I will be eating my usual amount of dairy. I want to know if being dairy free contributed to my low numbers last year. The N=1 goes on.

Your numbers look good to me. You are a healthy man, Rob.

Last edited by khrussva : Fri, Feb-09-18 at 14:01.
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  #3   ^
Old Fri, Feb-09-18, 11:32
cotonpal's Avatar
cotonpal cotonpal is offline
Senior Member
Posts: 4,194
 
Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
Default

Quote:
Originally Posted by GRB5111
... And why I need to follow Jean's lead in no longer getting these tests done.


Every now and again I think "maybe I should do some testing" but then I realize that I have no intention of changing the way I eat so why bother? I certainly have no intention of taking a statin under any circumstances. The numbers I am aware of are all good, my fasting bg, my HbA1C, my blood pressure, even my resting heart rate has been going down from the perfectly acceptable low 60's to now in the high 50's. My motto "don't worry be happy".

Jean
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  #4   ^
Old Fri, Feb-09-18, 13:38
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,456
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default

Here's a timely topic with a video interview of Dr. Bret Scher by LowCarbUSA's Doug Reynolds. The topic is titled "Will LCHF Increase Cholesterol Levels and Cause Cardiovascular Disease?"

https://www.lowcarbusa.org/lchf-cardiovascular-disease/

Edited to add: Direct quote: "When lifestyle changes can reduce your risk of heart attack by 50%, there is no change in LDL across the board."

Last edited by GRB5111 : Fri, Feb-09-18 at 13:44.
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  #5   ^
Old Sat, Feb-10-18, 05:02
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,602
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

The numbers on your test are very positive
Even before Dave Feldman made it clear that Cholesterol is an energy system, not a static indicator of anything all that useful, Dr Westman has always said same as you ... Fat-burners/Low carbers should have different "normal” lab ranges.
And wow, that Hba1c of 4.9 is stellar.
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  #6   ^
Old Tue, Feb-13-18, 10:29
Merpig's Avatar
Merpig Merpig is offline
Senior Member
Posts: 6,163
 
Plan: IF/Fung IDM/Potato Hack?
Stats: 375/272.6/175 Female 66 inches
BF:
Progress: 51%
Location: NE Florida
Default

Not to mention that the calculated LDL number is skewed high if your tris are low, as in: http://healthcorrelator.blogspot.co...ations.html?m=1

The “old” method does give a calculated result of 146 for your LDL, but the Iranian equation gives a value of 125.
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  #7   ^
Old Tue, Feb-13-18, 16:57
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 2,456
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
Default

Interesting link, Debbie. Note that with an NMR Lipid Panel, the LDL is measured, and that's why I request the panel along with the other valuable data it provides. I do like the Iranian equation, but it's ironic that we're even talking about calculation methods of lipids that are still not well understood or correctly identified as valid health markers.
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