Bloodwork back - Should I be worried?

[leonardotmnt]

I'm a 25 year old male. 5'6'' 135. I started eating low-carb around November 2009 but ate mostly processed food and junk food before this. I had a VAP test done and got this stapled to the front of my results.

"Your cholesterol levels are WAY TOO HIGH. LDL - the bad chlesterol is almost 300 and HDL - the good choolesterol is very low and NOT protecting your heart. You really need to start on zocor 40 mg daily for this and then repeat fasting VAP and Chemistry Panel again in 1-2 months if taking the medication." - typos are his

It didn't format right but reference values are right next to my actual values.

All figures in mg/dL

My values Reference - what they want

LDL - 306 <130
HDL - 49 >= 40
VLDL - 21 <30
Chol. Total - 376 <200

Trigs - 63 <150
Non HDL Chol. (LDL+VLDL) - 327 <160
apoB100-calc - 196 <109
LDL-R (Real) - 273 <100
Lp(a) - 8.0 <10
IDL - 25 <20
Remnant Lipo. (IDL+VLDL3) - 37 <30

Clinical consideration probable metabolic syndrome - No

HDL-2 (Most protective) - 10 >10
HDL-3 (Less protective) - 39 >30
VLDL-3 (Small Remnant) - 12 <10

LDL1 Pattern A - 48.7
LDL2 Pattern A - 70.7
LDL3 Pattern B - 130.0
LDL4 Pattern B - 23.2
Low Density Pattern - A
[----------------------------------][----------][------------*----------------------]<----pattern A part of the chart
Pattern B PatternA/B Pattern A

It was a fasting test. Unfortunately this is the first cholesterol test of any kind I've had done so I have nothing to compare it to. It'd be helpful if I knew things were getting better. I'm happy to find out it's type A even if it's not all the way up the chart. I know I need to get my HDL up, which I can hopefully do once I start working out more. It does seem rather weird to me that I'd be losing weight, getting stronger, and feeling better while inside I'm doing worse. Is everything mostly okay as long as I'm pattern A or is there an upper limit for the LDL you want even with pattern A? Are there any tests that I might be able to have done otherwise that would indicate I'm healing inside as opposed to getting worse without having a prior result to compare to?

Are these results okay for low-carb eating? My mother does have high cholesterol. I've lost about 40 lbs since going low-carb as well. Thanks for any insight you can provide.

[Frank Hagan]

I'm not an expert, but there are a couple of things I would mention to you before you start taking the statin drug.

One, you are 25 years old, so you have the luxury of time to try and correct things with diet. You are healthy, disciplined and dedicated to working out, so the doctor should recognize that you are the perfect candidate to try and modify these values through lifestyle. Nothing in your lipid profile suggests to me that there's a "cholesterol emergency", unless there's something in your medical history that would make this one (father, brother, mother all dying at 30 of heart disease, for instance). You might consider choosing another doctor. For me, suggesting statins as a first recourse for an otherwise healthy 25 year old is bordering on negligence.

The test may have measured the values using a formula called the Friedewald formula rather than measuring the component parts individually. In this formula, LDL = Total cholesterol – HDL – (TGL/5). Dr. Mike has blogged about this formula (http://www.proteinpower.com/drmike/weight-loss/low-carbohydrate-diets-increase-ldl-debunking-the-myth/) in the past. The formula works for the most part, but when triglycerides are very high (over 400) or very low (under 100), it is not reliable. Your doctor knows about the "over 400" part and would have asked for direct measurement of the LDL; he probably doesn't know that the same holds true for low triglycerides. Here are a couple of medical journal articles that he might find interesting:

Low Triglyceride Levels Affect Calculation of Low-Density Lipoprotein Cholesterol Values (http://www.archivesofpathology.org/doi/full/10.1043/0003-9985%282001%29125%3C0404%3ALTLACO%3E2.0.CO%3B2)

The impact of low serum triglyceride on LDL-cholesterol estimation. (http://www.ncbi.nlm.nih.gov/pubmed/18426324?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)

Ask for a re-test with direct LDL measurement. Someone may correct me here, because you do have a breakdown of the LDL and VLDL particles, so you may have had a direct measurement already. If that's the case, then you can do some research on the LDL vs. VLDL. Dr. Davis has some info on it at his blog (http://heartscanblog.blogspot.com/2010/04/carbohydrates-and-ldl.html), and Dr. Mike mentions it in his blog post (http://www.proteinpower.com/drmike/weight-loss/low-carbohydrate-diets-increase-ldl-debunking-the-myth/) linked above:



The moral of this story is that if you have been following a low-carb diet and your triglycerides are low (or if your triglycerides are just low) and your LDL reading comes out a little high – or even a lot high, don’t let anyone mule you into going on a statin or undergoing any therapy for an elevated LDL. Demand to have a direct measurement of your LDL done. Or if you get an insurance physical and your triglycerides are low and your LDL up a little, fight to get a direct measurement so they don’t stick you with higher premiums because they think you’ve got an increased risk for heart disease.


What we do know based on the work of many is that low-carb diets change LDL particles to the large, fluffy, harmless variety. Thanks to these other papers we also know that the LDL levels so many people end up with on their lab reports after being on low-carb diets for a while are artificially high.

[leonardotmnt]

I believe the numbers are direct and not calculated. I was a little surprised or at least diasppointed I was told I'd need statins through email and written letter without any dr. even calling to talk about the results.

My trig/hdl ratio is good and my ldl seems to be pattern A but I still wasn't sure iif a very high ldl mattered in this case. I know a moderately elevated one is okay but not many sources talk about one so high.

I did eat a very processed and junkfoody diet for a long time before I went lc so I was wondering if it could be that combined with my mothers history of high cholesterol.

Do you know how exactly the ldl1 and 2 pattern A and ldl3 and 4 pattern B numbers work? The results repot pattern A but the actual numbers show more of B. Do the A numbers just affect the end result more?

I appreciate the reply.

[Frank Hagan]

I don't know about the LDL patterns, but perhaps someone else here does. My impression is that while the overall values are high, the VLDL is much smaller than the larger (some say "protective") LDL. HDL will continue to increase as you eat more saturated fat.

In any case, I would seek out a second opinion, preferably from a "low carb doctor" if there's one in your area, before starting on statins. There's a list of some of them on one of Jimmy Moore's sites: http://lowcarbdoctors.blogspot.com/ Getting a note in the mail is not my idea of a good bedside manner.

[leonardotmnt]

I emailed Atherotech which conducts the VAP tests and the person emailed back saying that it is a little more complicated than the individual numbers on LDL1, 2, 3, and 4. He said that I have a weaker pattern A but it may be moving from pattern B to A if I've had a recent lifestyle change such as eating differently and exercising more. He said if I had no changes occur recently that I may be trending to pattern B now. I'm guessing I fit more with the first one since I've been low carbing for about 6 months now and exercising more. Hopefully I'll continue to move up the A pattern spectrum.

[Frank Hagan]

That's good to hear; at least you know you don't have to rush into taking drugs right now. I'm not philosophically opposed to drugs, but I think they are taken as the easy way out too often when other, less risky options are available.