NMR LipoProfile results. Completely not what I expected! Worried now!
NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 05:29 PM


Advanced Low-Carber


Well guys, I've been dieting pretty well for 5 months. Very low carb <25 grams of carbs a day. in those 5 months, I've had 3 days where I wasn't low carbing.

I got my NMR lipoprofile test after eating low carb and cleanly for 5 weeks. The results came in. I gotta be honest, I'm completely baffled by the results.

Can you help explain these results to me? (PM me if you want the entire PDF of results, just don't want to post it online completely haha)

And my diet consists of mostly fat as Phinney suggests. And veggies of course. I am pretty obsessive over what I eat.

Also, a previous test says my C-Reactive Protein is less then .5 or something. Basically incredibly low so that's a good sign.

But I was expecting phenomenal levels for these.

This is the number that completely caught me off guard. My LDL-P, the most important number, its through the roof bad.

LDL-P 3132 !!!! (>2000 is highest risk)
LCL-C 323 (>189 highest risk but not concerned about this number)
HDL-C 63 (This is really good >40)
Trig 62 (Also very good <150)
Total C 398
HDL-P 28.4 (Not sog good. average is >30.5)
Small LDL 217 (average is <527)

LDL Size 21.7 (Good is >20.5 for large pattern A)

Insulin Resistance
Large VLDL-P 0.9 (Very good. <.9 is lowest percentile)
Small LDL-P 217 (Somewhere around 30% percentile which is decent)
Large HDL-P 8.5 (>7.3 is highest percentile in favor of sensitivity so this is good)
VLDL Size Unknown - "VLDL concentration too low to allow determination of VLDL Size. Low VLDL concentration contributes minimally to the LP-IR score."
LDL Size 21.7 (>21.2 best percentile)
HDL Size 9.2 (50th percentile)
LP-IR Score 15 (best score is less than 27, worst is over 63 - so this is excellent)




The full PDF has reference numbers and percentiles and what not.

Can someone explain why my fairly simple diet, which consists of things like ribeye steaks - plain, salmon - butter and herbs, chicken (usually stir fried), and various low carb veggies like broccoli, cauliflower, spinach, avocado, artichokes, etc, is not working? Why is my LDL-P so high!!! It goes against every study I've read on ketogenic/low carb high fat diets improving these numbers.

I understand that my particle sizes are great. But using the vehicle/passenger analogy of cholesterol, the number of passengers is irrelevant. Its the number of vehicles that cause congestion. So 100 cars with 1 passenger each is worse than 1 bus with 100 passengers. In my case, it's like I have 500 buses with 100 passengers each! What's going on here?! I'm kind of freaking out here. Mostly cause I really was expecting superb numbers. And I was planning to write this long blog post to try to convince my friends and family that my diet is not only working for my weight loss (which has been a success now that I'm at 12.2% body fat) but for cardiovascular risk factors. Now I have no credibility



Edit: I've attached screenshots of the important parts of the results document.






Edit 2: I also supplement with 2000mg a day of EPA/DHA omega 3. I stopped supplementing with 1-a-days for now since I noticed a blood sugar spike when taking them.


Edit 3: In case you wonder why I dwell on LDL-P so much: http://eatingacademy.com/nutrition/the-s...ol-part-vi

http://www.lipidjournal.com/article/S193...8/abstract

etc.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 05:36 PM


Advanced Low-Carber


Every seems to check out great for the most part. Accept HDL-P and DEFINITELY NOT my LDL-P.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 07:03 PM


Expert Low-Carber


Whoa, take a deep breath!

How long have you been low carbing? Are you actively losing weight right now? (You may have said in other threads, but I'm not good at keeping everyone straight).

I've been re-listening to ATLCX podcasts now that they are on Stitcher and Dr. Mary Vernon said that when you are changing up your diet, there's no way to tell in a blood test whether there are high concentrations of "bad cholesterol" in your blood stream because things are unhealthy or whether these are on their way out as you mobilize the lipids through change in diet. The LDL-P don't wear little signs say "I'm leaving".

Dr. William Davis (on the Track your Plaque blog) says much the same thing. Your Lipids aren't really a good picture of what's really going on until your weight loss has stabilized--he says wait at least 6 months! So if you are actively losing weight and changing up your metabolism now, you may want to take the results with a grain of salt (literally and figuratively).

I know Peter Attia has pointed squarely at LDL-P as THE biggest risk marker, but his explanation isn't finished yet, so he may have more to say--and you might ask him directly about the transit theory that Drs Vernon and Davis seem to subscribe to.

And, I'm eagerly awaiting Dr. Attia's recommendation for what to do with a high LDL-P--it may be what you are already doing, but you have to give it more time--remember, you don't know what the baseline was in the first place--it might have been MUCH higher.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 07:25 PM


Advanced Low-Carber


Almost exactly 5 months strict with only 3 days where I was a higher than <25 grams. Those days were what you'd describe as a typical American diet.

My standard lipid profile a month or so ago showed lower total (by 9) and LDL-C (only slightly lower though). And triglycerides are up by 9 now. And HDL-C is lower by 8. But I assume that kinda of fluctuation isn't that significant and can change daily.

I'm reading about T3 right now. I'm wondering if that may be a huge factor for me? Which makes me wonder, what is causing my lower T3. Maybe its just the sheer fact that my carbs are too low. I never thought that was possible, with the researchers well know LC researchers and all saying lower is better and all.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 10:11 PM


Expert Low-Carber


How's your daily calorie intake? I'm not convinced that it's lack of carbs causing the problem with T3, I think it may simply be inadequate calorie intake (in my case).

Paleo people keep saying that it's carbs, but I haven't seen the studies to back up this claim, and I'm not convinced that people on that paleo-side of the equation have the metabolic issues those of us with "deranged metabolisms". So they may have a better tolerance for carbs than I can ever have.

I know when I did low carbing 12 years ago, I ate a LOT more carbs than now, and lost much more easily.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 10:19 PM


Expert Low-Carber


Speak of the devil:
http://www.wheatbellyblog.com/2012/06/i-...l-went-up/

"–LDL measures go haywire–The conventional calculated LDL cholesterol, or even generally superior measures like apoprotein B or NMR LDL particle number, can go in any direction rather unpredictably: They can go up, down, or sideways. Likewise, the (miserably useless) total cholesterol value can go up, down, or sideways."
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 10:20 PM


Advanced Low-Carber


I think you are right. My caloric intake is definitely on the lower end! Sometimes it's hard to remember to eat while LCing.

I'm wondering if it might be a lack of things like iodine and manganese and such as well. Regardless, I called up my doc and requested a few tests. Free T3 and Free T4. Also requested to see a panel for vitamin/mineral deficiency if thats possible. Not sure if those specific to thyroid hormones will be included.

Anyways, do rest of my other NMR LipoProfile seem to suggest that I'm doing everything ELSE right, right? I'm wondering why my HDL-P is so low if I eat so much fat (including saturated). My HDL-C is decent as expected though... Do I need to eat MORE saturated fats?
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-05-2012 10:24 PM


Advanced Low-Carber


http://www.wheatbellyblog.com/2012/06/i-...l-went-up/

"–LDL measures go haywire–The conventional calculated LDL cholesterol, or even generally superior measures like apoprotein B or NMR LDL particle number, can go in any direction rather unpredictably: They can go up, down, or sideways. Likewise, the (miserably useless) total cholesterol value can go up, down, or sideways."
Hah wow. Right on topic. So I'll wait it out, I'm pretty flow in body fat now. Probably looking to lose an additional 5 pounds. And I'll retest I guess. But in the meantime, I will see if thyroid has done anything crazy lately.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-06-2012 01:41 AM


Senior Low-Carber


bboylayz: Even before I saw JanKnitz post from WheatBelly I just wanted to say give yourself a break. You are probably doing more harm stressing over this than the number from the test is doing. Look at it all again in a few months after you are more settled into this routine. From what you've posted previously you are young and basically healthy....even the worst HDL-P in the world won't do irreversible harm in the time it may take for your system to adapt to this new lifestyle.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-07-2012 01:23 PM


Newbie Low-Carber


bboylayz:
I've got a similar situation to you, I've been eating low carb for several years now and have been stable at my goal weight for over two years. After reading Peter Attia's blog about LDL-P I decided I should have an NMR test done also. Needless to say I was also shocked when I got the results. I knew my LDL-C would be high but because of having large fluffy LDL's I thougth the particles would be OK. I posted my scores below:

LDL-P 2039
LCL-C 216
HDL-C 65
Trig 55
Total C 292
HDL-P 32.9
Small LDL 160
LDL Size 21.6

Insulin Resistance
LDL Size 21.6
LP-IR Score 4

I've self diagnosed the problem as low LDL receptor activity allowing the LDL-P to float around in the blood stream longer than ideal. I still think probably the most important thing is atherosclerosis which is apparently initiated by the LDL-P becoming oxidized or glycated while inside the walls of the arteries. I've decided to get a Coronary Calcium Scan to check to see how much evidence of atherosclerosis I might have.

In the mean time I've been reading all I can find about increasing LDL receptor activity. Apparently when cells are producing all the cholesterol they need, they turn down their receptor activity and when they need to produce more cholesterol they increase receptor activity.

My research indicates that eating less saturated fat has been shown to increase receptor activity, so has taking Curcumin plus it also decreases oxidation of LDL-P, Statin use also increases LDL receptor activity even though I'm reluctant to start taking them again. Red Wine and red grape juice Polyphenolics both increase LDL receptors and decrease APO-B production. Estrogen and Insulin both increase LDL recepetor activity but I'm not interested increasing either of these.

So, I've decided to modify my Low Carb diet to include less saturated fats, take Curcumin supplements, small daily dose of simvistatin and a daily glass of red wine and then have another NMR test in a month and see how things change.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-07-2012 07:49 PM


Advanced Low-Carber


Interesting find with the curcumin! Have you gotten another test since starting these changes? I'd love to hear more about your progress.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-07-2012 07:59 PM


Advanced Low-Carber


It would seem, based on this small study at least, that curcumin in low doses is great for decreasing ldl and increasing hdl. Did I read that correctly? Some is good but less is better?

http://www.ncbi.nlm.nih.gov/pubmed/19151449
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-08-2012 07:03 PM


Advanced Low-Carber


This is interesting bboylayz. I have also been low carbing for about 10 months and just had an NMR at the end of May. My results weren't quite as bad as yours, but were similar (LDL-P 1947, LDL-C 182). Like Chad1, all my other numbers are about the same. I am also disappointed and a little nervous.

One thing you don't mention is what type of lipid values you might have had prior to your low carb diet. I had a standard lipid test about 18 months ago and my LDL-C was 96. Because of this I doubt this is a thyroid or genetic problem. My weight has also been mostly stable through this period (BMI about 24). Given that there are three of us likely following a similar diet my guess is the cause has to be something in the diet.

I don't know the answer, but based on some research I have done I do have some ideas about where to start looking and how to test for it. I know this is probably not the most popular idea on this forum, but the research is pretty clear that a diet high in saturated fat will raise LDL.

This is an old but thorough study (just one of many).

Quantitative effects of dietary fat on serum cholesterol in man.
http://www.ncbi.nlm.nih.gov/pubmed/5846902

I believe Chad1 was correct when he noted that saturated fat will reduce the number of LDL receptors in the liver resulting in slow clearing of LDL from the bloodstream.

Here is at least one study that talks about this:

Dietary fatty acids regulate hepatic low density lipoprotein (LDL) transport by altering LDL receptor protein and mRNA levels.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC294909/

The debate doesn't seem to be so much over whether saturated fat raises LDL, it is mainly over whether or not this is a problem. In my opinion it is and I think you are correct in being concerned (although given the short time frame, I probably wouldn't panic). However each person needs to answer this question from their own research.

The good news is that, based on the Hegsted study above, this should be relatively easy to test. Hegsted altered the diet of his test subjects in four week intervals and saw large changes in total cholesterol even over that relatively short period of time. I see no reason why we can't do the same thing.

I have currently eliminated most saturated fat from my diet. I am also slightly increasing my carb intake but this wouldn't be necessary. Simply doing things like substituting olive oil for butter or coconut oil when cooking and temporarily eating more fish and lean chicken instead of beef, pork or cheese should do it.

Just eat this way for four to six weeks and test again. I don't think you even need to have an NMR test. A standard lipid test should tell you most of what you need to know. If LDL drops, we have likely found the problem. If it stays the same or increases, we need to start looking elsewhere.

I probably won't retest until the middle of July. If I remember I will post my results.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-08-2012 07:24 PM


Advanced Low-Carber



One thing you don't mention is what type of lipid values you might have had prior to your low carb diet. I had a standard lipid test about 18 months ago and my LDL-C was 96. Because of this I doubt this is a thyroid or genetic problem. My weight has also been mostly stable through this period (BMI about 24). Given that there are three of us likely following a similar diet my guess is the cause has to be something in the diet.

I don't know the answer, but based on some research I have done I do have some ideas about where to start looking and how to test for it. I know this is probably not the most popular idea on this forum, but the research is pretty clear that a diet high in saturated fat will raise LDL.

This is an old but thorough study (just one of many).

Quantitative effects of dietary fat on serum cholesterol in man.
http://www.ncbi.nlm.nih.gov/pubmed/5846902

I believe Chad1 was correct when he noted that saturated fat will reduce the number of LDL receptors in the liver resulting in slow clearing of LDL from the bloodstream.

Here is at least one study that talks about this:

Dietary fatty acids regulate hepatic low density lipoprotein (LDL) transport by altering LDL receptor protein and mRNA levels.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC294909/

The debate doesn't seem to be so much over whether saturated fat raises LDL, it is mainly over whether or not this is a problem. In my opinion it is and I think you are correct in being concerned (although given the short time frame, I probably wouldn't panic). However each person needs to answer this question from their own research.

The good news is that, based on the Hegsted study above, this should be relatively easy to test. Hegsted altered the diet of his test subjects in four week intervals and saw large changes in total cholesterol even over that relatively short period of time. I see no reason why we can't do the same thing.

I have currently eliminated most saturated fat from my diet. I am also slightly increasing my carb intake but this wouldn't be necessary. Simply doing things like substituting olive oil for butter or coconut oil when cooking and temporarily eating more fish and lean chicken instead of beef, pork or cheese should do it.

Just eat this way for four to six weeks and test again. I don't think you even need to have an NMR test. A standard lipid test should tell you most of what you need to know. If LDL drops, we have likely found the problem. If it stays the same or increases, we need to start looking elsewhere.

I probably won't retest until the middle of July. If I remember I will post my results.
I see this is your first post. So, Welcome! And thanks for the great reply.

Please do try and remember to post here after your tests! I'd love to know how cutting out the saturated fat goes. In the meantime, I'll try and fill nutritional deficiencies. If both our numbers turn out better, we will know what needs to be done.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-08-2012 07:38 PM


Advanced Low-Carber


My concern with decreasing saturated fats means you will likely be increasing omega-6 which creates a pro inflammatory environment. Isn't that what we are really trying to avoid? Since without inflammation, less LDL will be at the risk of being damaged by oxidation, which can then start plaque buildup? At least that's my understanding of it. So it's just a matter of what's worse? LDL having time to sit around too long and be at risk of being damaged? Or inflammation providing a dangerous environment for LDL?

Not trying to arguing of course. I'm completely open minded about this topic and if someone wants to correct me, feel free. I am only really starting to learn the intricacies of cholesterol. So I wouldn't be surprised if I'm way off just trying to learn as much as possible!
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-08-2012 09:16 PM


Expert Low-Carber


I'm kind of disappointed that Peter Attia didn't post this week the next part of his cholesterol series. The information that the LDL-P number rather than the particle size seems to be "cutting edge" and I'm wondering if they even really know at this point how diet and medications affect the LDL-P. He seemed to hint that they do have some ideas about this. [/u]
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-08-2012 09:18 PM


Advanced Low-Carber



Likewise! I was refreshing like a madman only to see an unrelated post. Is there going to be one on cholesterol next week? Or is he ending the series there?
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-09-2012 12:23 AM


Newbie Low-Carber



I Share you concerns, I've cut back on the beef, eggs and pork I've been eating and replaced it with a little more chicken, turkey and fish. I'm still avoiding oils high in omega-6 fats. I plan to take an NMR test again in about a week and will post my results here.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-09-2012 12:48 AM


Advanced Low-Carber



Not trying to arguing of course. I'm completely open minded about this topic and if someone wants to correct me, feel free. I am only really starting to learn the intricacies of cholesterol. So I wouldn't be surprised if I'm way off just trying to learn as much as possible!
I definitely understand your concern. I have debated these same questions myself and have yet to completely figure it out.

But while decreasing saturated fats could mean increasing omega-6 fats, I don't think this would have to be the case. For example olive oil is mostly MUFA and contains little omega-6. Fish is of course mostly omega-3. A person would have to be careful in the choices they make, but I think it could be done.

On the other hand I'm not entirely convinced omega-6 fats are quite as bad as some people think. From what I have seen the problems with omaga 6 fats seem to be more a result of too little omega-3's. I agree the processed stuff you buy in a bottle at Wal-Mart should probably be avoided, but I have a hard time believing that nature's nuts and seeds will cause much of a problem.

But in the end it really comes down to what the numbers and my body tell me. All I can do is adjust my diet and see what happens. Since most of the damage from high LDL or high inflammation occurs over relatively long periods of time, at this point I'm not too worried if it takes a few adjustments to get it right.
RE: NMR LipoProfile results. Completely not what I expected! Worried now! , 06-09-2012 12:52 AM


Advanced Low-Carber



Couldn't agree more. I'm only coming up on 24, but I want to figure it out now as to avoid problems down the line. AND so I can recommend the best route for my friends and family who aren't as young as I am who may be more at risk. But the last thing I want to do is suggest a diet that would have their risk factors go through the roof!

But yeah, let's collectively experiment and share results to speed up the "figuring it out" process! Tackle it at different angles and figure out what works and what doesn't.