Cholesterol numbers/doctors interpretation

[chono]

O.K. guys and gals I need your help. I have been low carbing for about 3.5 years. Recently I went for a routine physical which of course included a lipid profile. I'm 45 years old and my GP wants me to go for a routine stress test and talk to a cardiologist about my cholesterol levels.

The backround is this. I have HIGH cholesterol and always have. Runs in the family. Prior to low carbing my doctor put me on Zocor. It dropped my cholesterol from 295 to 180 but my liver enzymes went crazy. The doctor took me off Zocor and told me that the reaction he saw was a "class reaction" meaning my body would reject statin type drugs as a whole.

So I started low carbing and my best lipid profile was as follows

Total 262 HDL 52 Trigs 62 - which still puts my LDL way above the accepted ever lowering norm

During my recent physical 1/06 my lipid profile was as follows
Total 330 HDL 50 Trigs 105 - Which puts my LDL into the stratosphere!

I've read the Eades book and am familiar with the chapter on cholesterol. The school of thought that the Trig/HDL ratio is most important is very comforting afterall they say a ratio under 5 is O.K. and the closer to 1 is ideal!

That puts me between 1.19 and 2.10. Great eh? Supposedly that would make my LDL primarily the good type.

THE PROBLEM is this: It seems that nobody in mainstream medicine has even heard of the Trig/HDL, large fluffy LDL theory. I'm now in a position where I will have to discuss/debate this with a cardiologist at the Texas Heart Institute, St Lukes Hospital, Houston Texas.

Can anybody point me to a credible body of evidence and/or current peer reviewed study that will support these theories ? My GP looks at me like I'm crazy! Under current guidelines I should be dead by now :) I hear talk about getting LDL levels down to 80! I'm currently over 3 times that!

Thanks in advance

[Gabriel Guzman]

The backround is this. I have HIGH cholesterol and always have. Runs in the family.


I've seen comments like this in many occasions and I always ask the same question... How does the person know that the problem is really a 'family' type of problem? Familial Hypercholesterolemia (FH) is a problem that 'runs in the family', and yes elevated LDL levels tend to correlate with the genetic defect but the only way to know is through a specific diagnostic test, which is not very difficult but it's not a routine one.

FH is basically a genetic problem with the gene that encodes for the LDL-receptor. LDL-receptor gene defects can be identified with genetic testing, generally undertaken when:


A family member has been shown to have a mutation;
High cholesterol is found in a young patient with atherosclerotic disease;
Tendon xanthomas (these are visible lessions in the tendons that look a bit 'waxy') are found in a patient with high cholesterol.


Anyway, the point is that sometimes, hypercholesterolemia may not be really FH and to be sure, the genetic test should be done as well as a test to determine the LDL profile of an FH suspect to see which particle size is more abundant. Usually, and sometimes unfortunately, the cholesterol values are the only indication that's considered in the decision making process of prescribing cholesterol-lowering drugs.


Prior to low carbing my doctor put me on Zocor. It dropped my cholesterol from 295 to 180 but my liver enzymes went crazy. The doctor took me off Zocor and told me that the reaction he saw was a "class reaction" meaning my body would reject statin type drugs as a whole.


This was very fortunate for you!


I've read the Eades book and am familiar with the chapter on cholesterol. The school of thought that the Trig/HDL ratio is most important is very comforting afterall they say a ratio under 5 is O.K. and the closer to 1 is ideal!

That puts me between 1.19 and 2.10. Great eh? Supposedly that would make my LDL primarily the good type.


Actually that ratio is a lot lower. In PPLP, the Eades indicate the values they think should be the ones to aim: HDL of 50 or more and TGs of 100 or less. So, assuming those 'goal' values, the ratio TGs/HDL is 2, so anything lower than 2 is optimum. The ratio TC/HDL, however, should be lower than 4 and the ratio LDL/HDL should be lower than 3.


Can anybody point me to a credible body of evidence and/or current peer reviewed study that will support these theories ? My GP looks at me like I'm crazy! Under current guidelines I should be dead by now :) I hear talk about getting LDL levels down to 80! I'm currently over 3 times that!

Thanks in advance

One of the first papers showing a prospective study on this subject was published in Circulation (one of the journals of the American Heart Association) in 1997. I haven't been able to find the pdf file I made long time ago to keep in my archive but I did find the link to the full text at the journal's homepage. Here is the link:

Small, Dense Low-Density Lipoprotein Particles as a Predictor of the Risk of Ischemic Heart Disease in Men. (http://circ.ahajournals.org/cgi/content/full/95/1/69?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1142556409851_16631&FIRSTINDEX=0&sortspec=relevance&volume=95&firstpage=69&search_url=http%3A%2F%2Fcirc.ahajournals.org%2Fcgi %2Fsearch&journalcode=circulationaha)

Here are a few more that you can download from this post to discuss with your doctor. If you need more help with them just let us know.

Interestingly enough, the treatment for FH is statin drug therapy, drugs that inhibit the body's ability to produce cholesterol by blocking the key enzyme that regulates the synthesis of cholesterol (HMG-CoA-reductase). Insulin controls the activity of this enzyme, which in turn is inhibited by glucacon... and what does carbohdyrate restriction do to insulin? It lowers it's concentration. So, it's plausible that the dramatic reductions in cholesterol levels during carbohydrate restriction include the regulation of cholesterol synthesis because the enzyme itself is being kept in check. A much less costly way (in money and side effects) to lower choleseterol levels.

[chono]

Gabriel - Thank you for your all of this information. You have given me a great deal to read and digest. I want to keep this going but its past my bedtime !

Back at ya tomorrow:)

[SoPines]

chono,
I just found the new website. My doctor also said that if my numbers were not good we would consult a cardiologist for advice as to meds for my cholesterol. I have been PPLP'ing for almost 3 years and have gone off my three meds (cholesterol, acid reflux, and high blood pressure).
My last test was an in depth test by LipoScience, Inc. of Raleigh NC.

I won't give you all the numbers but a few:
LDL-C 279 (very high, but wait a minute...see below)
HDL-C 77
Triglycerides 88
Total cholesterol 374 OUCH you say!

Good stuff LDL particle size 22.3 nm Large (pattern A)
Large HDL-p 17.5 Low risk
Large VLDL-P 0.2 Low risk

More LDL (large) 1661 88 percent
LDL (small) 233 12 percent
goal on chart is 50 percent

The guy who drew my blood said that this was the test that the doctors got for themselves. My doctor must have liked what he saw because he mailed the results to me without comment. No mention of consulting a cardiologist. Personally, I am proud of my numbers. I have a "family history", too; and my doctor continues to want to refer back to that.
I do not eat the way my parents and grandparents ate, so I need the doctor to give me a break.

On PPLP I have lost 30 pounds (208 to 178), off three meds. I exercise regularly and run 5K races a couple of times a year. Also, since going off 80 mg of Zocor I can now recall instantly the names of my co-workers that I see every day.

Maybe your doctor should order a more indepth study of your cholesterol.
The key, as stated in PPLP, is to keep you HDL high and Triglycerides low. That will give you a general idea as to which subclass of LDL you have.

From an earlier test, I do know I have high lipoprotein LPa. When I learned this I increased my intake of saturated fats (per PPLP). Meds won't help this. The doctor never mentioned it and I didn't bring it up. I'll take this one on with the help of PPLP.

Good luck with your fight with the medical profession.

[Gabriel Guzman]

SoPines, that is in a nutshell quite an amazing story!! Thanks for sharing and congratulations on your wonderful achievement. Look at those numbers!!!

[chono]

SoPines - Thank you very much for sharing your story. It is very encouraging.

I have have posted 2 different lengthy responses but somehow they never end up on the board and are consistently lost in cyberspace. I log in and then post a response only to get a message after I post indicating that I'm not logged in. After logging in a second time the post disappears.

So I'm throwing in the towel with the hopes this post (3rd attempt) makes it to the board. Thank you again! Your support and that of Gabriel are of immense value.

[Gabriel Guzman]

SoPines - Thank you very much for sharing your story. It is very encouraging.

I have have posted 2 different lengthy responses but somehow they never end up on the board and are consistently lost in cyberspace. I log in and then post a response only to get a message after I post indicating that I'm not logged in. After logging in a second time the post disappears.

So I'm throwing in the towel with the hopes this post (3rd attempt) makes it to the board. Thank you again! Your support and that of Gabriel are of immense value.


Well, it worked this time! So, don't throw the towel just yet and keep us posted!!:)

[uskrums]

chono,
I just found the new website. My doctor also said that if my numbers were not good we would consult a cardiologist for advice as to meds for my cholesterol....Good luck with your fight with the medical profession.

Funny, I had basically the same reaction from my doctor. He was concerned about my borderline diabetic condition and my elevated cholesterol. To quote him, "You have the bloodwork of a 55 year-old man" (I'm not even 40!)

I didn't think my numbers were that bad. I've been eating more carbs over the past couple years, but had GREAT success with PP back in 1998-2001. (As soon as I dig up the numbers I will get them out). So I started back in, read PPLP (great book!) and went to get my numbers checked again last week (after 6 months on PP). I get the results this week, but I know I feel better and lost 10 lbs (but didn't need the weight loss).

Here are my numbers from 6 months ago:

Glucose - 97
Tot Chol - 207 (he handwrote HIGH!! next to the lab results)
Triglyc - 66
HDL - 68
LDL calc - 126 (Again HIGH!! written in)

55 year old man?

[LisaS]

look at your beautiful TG/HDL ratio !

[mcsblues]

Welcome uskrums, if you have any reason to return to the low carb/PPLP fold it is your FBG (much better in the 80s) - but your cholesterol results are great ... and your doctor is an idiot!:p I suggest you ditch him and find another doc who knows what he is talking about, and in the mean time check out Anthony Colpo's book on the subject - almost as good as PPLP!

http://www.theomnivore.com/index.html

[uskrums]

OK, so the results came back and there is good news and bad news.
The good news:
(all compared to 6 months ago)
Total went from 207 to 200
HDL went from 68 to 75
Triglyc went from 66 to 51

Tot HDL ratio went from 3.04 to 2.67

Trig/HDL ratio went from .97 to .68


All good news and evidence of the PPLP diet.

However, I need some advice on the problem areas. FBS went 3 more points higher to 100 from 97. How could this go higher when I have been eating far less sugar/carbs than 6 months ago? I am not on this plan for the weight loss. I am below average in weight (although a little of the waistline is nice!) I love all my cholesterol numbers, but I mainly got on this plan because Type II diabetes runs in the family. My grandpa and all my aunts had it and my dad's is getting up there (115).

The other problems areas were that my WBC and platelet counts were low. How does this factor in and what do I need to do to get them up? I feel great but am worried that these are starting to flag when in the past they did not.

WBC counts going backwards over past 3 years (3.2, 5.4, 3.9, 4.5, 3.5)

Funny thing is that the 2 higher numbers were rechecks and I didn't have to fast due to the fact that the FBS and cholesterol were already complete.

Platelet count going backwards over the past 3 years (135, 169, 147, 171, 162)

I realize I am just at the low end of normal on the reference range, but why are these continuing to go lower?? I thought all the anti-oxidants would help (I drink the Paleolithic Punch every morning) or does this not have any effect?

Thanks!

[mcsblues]

I'm not qualified to offer advice on WBC and platelet counts - I suggest you discuss your concerns with your doctor/haematologist.

As for your FBG, an isolated fasting value really doesn't tell you too much - particulalrly with such a small variation (normal daily fluctuations could easily be more than 10). Has your doctor done a GTT, A1C and either a fasting insulin or insulin challenge test?

In any event, I suggest if you are concerned that you get a blood glucose meter to conduct your own tests and give us details of you menus, exercise and carb targets so we can provide more advice on getting your BG levels down.