Ever since I began my n=1 experiment of the concept of “nutritional ketosis” in May 2012 that has resulted in a 50+ pound weight loss so far while consuming lots of healthy high-fat foods to raise my level of blood ketones, people have been asking me about what’s been happening with my lipid panel. But as we heard from Dr. Jonny Bowden in Episode 632 of “The Livin’ La Vida Low-Carb Show” podcast this week discussing his brand new book on this subject entitled The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will, is this something we really need to be concerned about? Whether the answer to that question is yes or no, what do the numbers really mean anyway? And are they different for people who eat a high-fat, moderate protein, low-carb diet to produce an appropriate level of beta-hydroxybuterate (blood ketones) that Dr. Stephen Phinney and Dr. Jeff Volek discuss as optimal for health and performance in their bestselling 2012 book The Art and Science of Low Carbohydrate Performance?
I’m currently on a personal quest to find the answers to these questions and more by speaking directly with as many of my expert friends in the medical, nutrition and research fields over the next six months researching and writing my book all about this topic tentatively titled A Patient’s Guide to Understanding Your Cholesterol Test Results (releasing Fall 2013). People are so confused about what to believe about their cholesterol test results that this book is way overdue. Arming people with solid information will help them make a more informed decision about what to do about the current state of their health rather than blindly following some dubious drug therapy promoted by their doctor to treat risk factor numbers. It’s high time we start treating actual DISEASE rather than risk factors anyway.
But every single week, I receive at least a dozen e-mails from people all over the world who are concerned about their cholesterol test results. Even for those people who have gotten away from the traditional lipid testing that only shows LDL-C, HDL and total cholesterol to the more advanced particle size testing from places like the Raleigh, NC-based LipoScience who created the NMR Lipoprofile test, there is pause for concern because their doctor tells them they need to be taking a statin drug lest they fall victim to a heart attack or worse. I’ve never understood the scaremongering that goes on regarding “high cholesterol” and the knee jerk reaction that taking a pharmaceutical drug such as a statin will somehow protect people from ever having a heart attack. A timely example of this is the late television newscaster Tim Russert who had “perfect” cholesterol numbers while ostensibly on a statin drug and yet tragically died of a heart attack in June 2008. Watch Justin Smith’s $TATIN NATION documentary for more information about just how insidious this push for a risky drug therapy to treat a non-existent disease has become.
I’ve been a big fan of having my cholesterol tested using the NMR Lipoprofile test for many years because they are the only truly accurate cholesterol particle testing company in the world. According to lipidologist Dr. Thomas Dayspring who addressed cholesterol testing in Episode 29 of the “Ask The Low-Carb Experts” podcast recently, this cholesterol test from LipoScience is the only one that he’s aware of that will directly measure your LDL-P (the total number of LDL particles in the blood) and Small LDL-P (the dangerous Pattern B LDL cholesterol that penetrates the arterial wall and leads to atheroschlerosis). Knowing where your numbers stand is a critical starting point for anyone wanting to optimize their health. Your doctor can actually run this test if you ask for it (although some will think it’s unnecessary or a “fad”) or you can use one of those online health testing outfits like Private MD Labs that work with your local LabCorp offices to pull the blood without a doctor being involved like I did last week to get my latest lipid panel update.
In mid-November before leaving on my trip to Australia for a three week, 5-city “Low Carb Down Under” speaking tour, I’ll be sharing a 6-month update about my nutritional ketosis n=1 experiment (read all of my updates for Day 1-30, Day 31-60, Day 61-90, Day 91-120 and Day 121-150). I’ve got some really interesting information to share with you regarding an experience that has happened to me during this 30-day cycle that could help those of you who might be wondering why your blood ketones aren’t where you want them to be. I’m amazed by how much I’m STILL learning about all this and look forward to passing along what I’ve discovered with you in the months to come. My target date for publishing my Day 151-180 results is November 11, 2012 or sooner. Stay tuned!
There’s still a lot of controversy about whether the LDL-P number (and the parallel marker of Apo B) is as or more important than the LDL particle size. Dr. Dayspring is adamant that it’s all about the LDL-P number and that the size isn’t relevant when it comes to heart health. He explained his reasoning for this position in Episode 585 of “The Livin’ La Vida Low-Carb Show” podcast. And in his popular “The Straight Dope On Cholesterol” blog post series, Dr. Peter Attia notes that the number of LDL particles and not just their size determine the atherogenic risk. But a Gilbert, AZ-based family physician who specializes in heart attack prevention named Dr. Rocky Patel (listen to him in Episode 62 of the “Low-Carb Conversations” podcast) noted in his September 2012 blog post entitled Does LDL-P Matter? that his personal LDL-P score of “over 3000” was initially “horrifying” until he had a Carotid Intima Media Thickness (CIMT) test showing his vascular health was equivalent to that of a 16-year old! Additionally, his low-carb diet has helped him lose weight, feel energized and brought his inflammation (CRP) levels to “not detectable.” Cool! Dr. Patel concluded his blog post by stating a truth that should be the basis of all healthcare decisions: “We must always remember to treat the patient/disease and not the number.”
With that in mind, let’s talk about my various health numbers. As you know, I’ve been actively losing weight and body fat (we’ll know for sure I’m losing body fat when I get the comparison results of my DEXA scan coming hopefully before I leave for Australia) on my nutritional ketosis plan and that has not stopped nor do I expect it to in the coming months. But before I even started on this plan in May 2012, I had a Berkeley HeartLab panel of tests run in February 2012 to see how my low-carb diet was working for me. Despite weighing over 300 pounds at the time, some key health markers were pretty remarkable:
I’ve said it many times before, but reducing your carbohydrate intake, moderating your protein consumption and consuming higher levels of healthy fats that include saturated fat are the best ways to not just lose weight but making critical positive changes for the better in your lipid panel happen. Laura Dolson discusses Three Reasons Not To Worry About LDL Cholesterol On A Low-Carb Diet and notes that HDL over 50 and triglycerides under 100 will almost always mean your LDL size is the Pattern A (large, buoyant kind) that you want. Dr. Jeff Volek has found in his research patients a greatly improved triglyceride/HDL ratio eating a low-carb diet and that this is a much better marker for heart health than LDL or total cholesterol. As far as I know, the advanced particle size lipid testing has not been used by Dr. Volek, Dr. Eric Westman at Duke or others looking at low-carb diets in their research. I hope that they do add this extra bit of data for the benefit of those who may see some crazy numbers like Dr. Patel and I (and I’m sure many other low-carbers) are seeing.
So what about my latest test results from my fasting blood draw on October 25, 2012? Some of the numbers shouldn’t be a surprise knowing that I’m eating a very strict high-fat, moderated protein, low-carbohydrate diet with a fat/protein/carbohydrate ratio of 85/12/3:
As amazing as all of these numbers were, the ones people will likely be most interested in are the “high” ones. Let’s take a look:
What I want to know is how I can simultaneously have outstanding insulin sensitivity, an A1c score of 4.5, average blood sugars around 81, a heart scan score of zero, undetectable inflammation, 94% of my LDL particles are the large, fluffy kind (Pattern A), a microscopic triglyceride/HDL ratio of 0.7 and active weight/fat loss AND a greater susceptibility for atherosclerosis because of an extremely high LDL-P and Apo B. The answer is out there and I’m bound and determined to uncover it for my book next year.
But this is more than about some book I’m writing…this is my life. I wholeheartedly believe my healthy high-fat, moderate protein, low-carb diet is vastly improving my health in ways that no other eating plan could even possibly touch. And yet the jury is still out on whether or not there should be concern about the direction my numbers have been going. I did an Excel spreadsheet showing how although my total cholesterol, LDL-C and HDL have all remained relatively constant for the past 4+ years, LDL-P has gone precipitously higher and higher (will it ever stop going up and what’s making that number continue to rise?):
Interestingly, before I started on the Atkins diet in January 2004, my highest total cholesterol was only about 230. Of course, my doctor put me on both Lipitor and Crestor to lower that number and it did get down to 130 at some point (don’t know what the breakdown was of HDL and LDL nor do I know what my triglycerides or LDL-P were at the time either). But people have claimed I have familial hypercholesterolemia because my total cholesterol is now over 300. But I disagree. Something has happened since I began eating high-fat, low-carb and I can’t help but wonder if there is a purpose for that extra cholesterol in the body since we know there are benefits to higher levels of cholesterol in the body. The jury is certainly still out on this.
If there’s one thing you know about me, it’s this: I won’t stop seeking the truth about this and sharing with you what I find. Dr. Dayspring has already invited me to visit him at the Richmond, VA-based Foundation For Health Improvement And Technology to see why despite all my incredible lipid numbers the LDL-P and Apo B seem to be out of whack. It will be interesting to see if these numbers are found to be less important for people on low-carb diets than those eating other kinds of diets. Now that’s some research that could help a whole lot of people. In preparation for my book, I’ll also be interviewing various health professionals from cardiologists to practitioners and everyone in between to get to the heart of what matters most. I’m anxious to get going on this project and can’t wait to see where my journey takes me on this.
Got any comments about my latest lipid numbers? I’d love to hear your thoughts in the comments section below. Feel free to share any knowledge and experience you may have on this subject.