I’ve lost 10 kg, but what about my cholesterol?

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Folks, here’s a great story about health and weight loss – along with some excellent examples of what to actually eat on the LCHF plan.  I’m often asked about cholesterol and how to interpret the numbers on the blood form. People get (rightly) concerned that their metabolic markers are heading in the right direction.  So that’s answered here too.  Enjoy.

Hi Grant

MY BACKGROUND

  • Have been on LCHF in earnest since since May 2013, cutting out all processed carbs and high carb natural foods
  • Between Nov 12 and May 2013 I cut out sugar only
  • Nov 12 I was 92kgs and now range between 82-85kgs – have had to buy a size smaller clothes during this time.
  • Foods I eat:-
    • Breakfast (choice from one of these)

      • Greek Yoghurt .75 Cup, Raw Almonds .25 cup, Raspberries/Blue Berries .5 Cup, Cream  30ml
      • 2 Eggs and rasher bacon plus Baby Spinach 1 cup, maybe home made mayo 30ml
      • Coconut Cream Smoothie – Coconut Cream .75 Cup, Raspberries 0.5 Cup, Chia Seeds 2 tablespoons
      • Espresso Coffee no sugar, no milk, Cream 0.25 Cup (sometimes this alone can keep me going until lunch time)  
    • Lunch (choice from one of these)
      • Big salad only lowcarb veggies and meat or cheese about 100 grams,Olive Oil and Cider Vinegar Dressing or Home Made Mayo
      • Paleo snack box – nuts, veggies, cheeses, smoked salmon whatever is around that is natural and has low carbs
      • Bought Chicken Satay without rice and extra vegetables
      • No sandwiches (ever)
      • Reheated last nights dinner mainly some fatty meat dish and low carb veggies
      • BBQ with Salad – no carbs
      • Pita Pita – Salad Bowl
    • Dinner (choice from one of the following)

      • BBQ with salad no carbs
      • Roast with veges but excluding potatoes, kumara, corn, carrots, onions
      • Stir fry meat and veges – no rice
      • Salmon and salad
      • Home made curry made with coconut milk served on baby spinach
      • Anything with meat and veges and no carbs
    • Drinks

      • Water
      • Soda Water and Fresh Lime/Lemon juice
      • Espresso Coffee & .25 cup cream – no sugar
      • Maybe a glass of wine or Steiny Pure twice a week. Generally can’t drink alcohol that well these days – very quickly gives headaches
    • Snacks (rare maybe a handful 2 times a week from a mixup of the following)

      • Nuts
      • Cheese
      • Homemade Coconut Oil and Organic Cocoa Powder chocolates with a tiny flick of good quality honey
      • Olives
      • Small peppers spread with cream cheese
  • Pretty much I have excluded processed carbs from my diet and studiously read nutritional info on packaging before it goes in the trolley.
  • I don’t do a lot of exercise but do have a 6 and 8 year old son and do activities with them (mountain biking, cricket, kayaking, walks, nurf gun battles!)
  • How I feel on the diet?:-
    • Never hungry – sometimes think I eat out of habit – “Oh its lunchtime” and generally have a very big gap between Breakfast and Lunch
    • Have next to zero wish for sweet things any more, same goes for Bread, Rice, Potatoes, Chips and baking. Though the smell of fresh baked bread can test me :-)
    • Walk into most cafes and look totally disheartened at the offerings
    • Notice around me everywhere how waistlines are increasing across all walks of life and all nationalities.
    •  I have sustained energy in my job and seem to need less sleep than I used to but have no trouble sleeping.

So hopefully that gives you a picture of me. My concern is, based on my situation, should I view my blood test results as a warning or carry on the LCHF lifestyle which I love?

I found this discussion on DietDoctor  http://www.dietdoctor.com/great-cholesterol-numbers-4-years-ultra-strict-lchf-diet/comment-page-1#comments Page 2 has a contributor who quotes an enormous amount of so called evidence to suggest that LCHF diets do increase Cholesterol in a bad way and you should consider Statins to put things right. That just feels wrong on many levels to me, we shouldn’t need drugs to maintain sustained health and surely aren’t designed that way.

I’m hoping you could have a quick look at some lipid results and put some fears to rest. Please see attached blood test results covering three tests since Nov 12.

From my point of view….

GOOD

  • Increasing HDL
  • Decreasing TOT CHOL / HDL ratio
  • Low Triglycerides

BAD

  • Rising LDL
  • Rising overall Total Cholesterol level.
Nov-12 Jun-13 Feb-14
Good Cholesterol HDL 1.37 1.63 1.87
Bad Cholesterol LDL 4.10 3.80 4.50
Total Cholesterol (TC) 6.47 6.23 6.70
Triglycerides (TG) 1.00 0.8 0.8
TC/HDL ratio 4.72 3.82 3.60
HbA1c 30.00
TG/HDL 0.72 0.49 0.42

Anyway, any feedback or advice you could provide would be much appreciated.

I have been watching your momentum build and doing my bit to get the word out there. If you ever want to bring a seminar to Queenstown please let me know I’d be happy to help anyway I could.

Many thanks,  Andrew

One of my doctoral students, Catherine Crofts, who is also a pharmacist, specialises in understanding these numbers and more specifically the role of hyperinsulinemia in health – so here’s Catherine’s excellent summary of cholesterol number interpretation.

Well done in taking such an interest in your health, including weight, energy, sleep and blood tests!  I think the first thing to set straight is that we shouldn’t think in terms of “good” or “bad” cholesterol.  (This science is about 20 years out of date.)

Cholesterol just “is” and it is needed in every cell in your body, especially in the nerves and brain.  One important job for cholesterol is to package up triglycerides and transport it around the body.

In simplified terms:

  • LDL, or low-density lipoproteins, take cholesterol from the liver to the body to be used as energy or for storage
  • HDL, or high-density lipoproteins, take cholesterol from the body back to the liver for reprocessing.

LDL can increase for many people after starting on LCHF, as you start mobilising your triglycerides more and shifting them around the body.  This is normal and these LDL levels may not return to baseline for up to a year according to some studies.  But quite frankly, LDL is not a useful measure of metabolic health.

The biggest catch to interpreting LDL cholesterol results is that is LDL is never actually measured….instead it is calculated.

The main formula used is LDL = TC – HDL – (TG/2.2)

Slight variations in formulae and rounding differences will explain why the numbers don’t totally add up when you apply this formula to your numbers.  But what is not always realised is that this formula is inaccurate when your triglyceride levels are above or below certain cut offs.

When your triglycerides are low, your LDL is artificially inflated.  So LDL falls just short of hopeless for assessing health, especially when eating low-carb tends to lower your triglyceride levels, as yours have done.

What we actually need to be looking at is LDL particle size and whether we have “large buoyant” LDL particles or “small dense” particles.  Small particles are unhealthy and are more likely to get stuck in the blood vessels causing blockages, whereas the large ones float around in the blood and just do their job. Small particles can more easily enter a damaged site.   By just measuring LDL, we can’t tell your particle size.  It’s a bit like measuring how many people are travelling down the motorway.  By counting heads, we miss out on measuring whether they are travelling in buses or cars…but which measure is more important to working out road congestion?   Head numbers or Vehicle size?

The easiest way to do this is to look at your TG/HDL ratio, which I added to the results you sent Grant.  Aim to get this number as low as possible…..and quite frankly, yours are fantastic.  Some studies suggest the TG/HDL ratio should be below 3.5.  That is way too high in my opinion, I think below 2 would be better, but we need more research in the area.

Your final marker of HbA1c is also great.  HbA1c is being suggested as the latest and greatest marker of metabolic health with levels below 37 (5.5%) indicating great metabolic health.

So overall, TG, HDL and HbA1c are the best markers for metabolic health.  There is a definite place for statins, they do save lives and people should not stop taking them before having a good chat with their doctor.  But maybe we’ll save that for another post.

28 comments

  1. Catherine Crofts · · Reply

    Grant – I can’t see the table with the blood figures that I recalculated. Also, Andrew’s original table doesn’t want to enlarge. Because I didn’t mention the blood figures in the text, it currently doesn’t make sense. What is the best way to fix?

    C

  2. A good chat with your doctor? providing your doctor is not locked into the science of twenty plus years ago, doesn’t wears blinkers and doesn’t need “hearing aids”……. In a perfect world, a good chat with your doctor would be beneficial, in the modern world you do as you are told… end of story. Change doctors perhaps but where do you find a modern up to date doctor who is not on the pay of the pharmaceutical industry?

  3. Pam@msakl.org.nz

    Sent from Samsung tablet

  4. George Henderson · · Reply

    A good discussion of lipid and other markers.
    I just need to point out that very low HbA1c can be a marker for anaemia, liver disease and a few other things, so is not associated with longevity in non -diabetics. As with cholesterol, the meaning needs to be interpreted in context.

    1. Here’s a reference for HbA1c being optimal at around 4.0-6.4. 6.5> is a marker for diabetes, <3.9 seems to indicate other diseases.
      HbA1c is formed when hemoglobin is glycated and this takes a) hemoglobin, b) sugar, c) time.
      If hemoglobin is deficient there won't be enough to glycate, if red blood cells are being hemolysed hemoglobin won't be around long enough, and low blood glucose (except in deep ketosis) is itself a serious problem (and can be caused by chronic hyperinsulinaemia).

  5. Thank you for a terrific post. Wonderfully and succinctly explained. It’s so heartening to see this coming out of NZ! I have to agree with JustMEinT Musings. Too many doctors listen to big pharma, write out the Rx and enjoy the lunches. I’d be interested to know where statins have a place, how many lives are actually saved and if so at what expense to the many who take them for no benefit and are basically maimed by them. Thanks Grant for all that you do.

    1. Zoe Harcombe…. Dr. John Briffa …. Professor Uffe Ravnskov, Dr. Barbara Roberts and Dr. Macomb Kendrick (to name just a few with fabulous credentials) would be happy to supply you with facts about NNT and possible/probable numbers of patients who have suffered from and are still suffering from the side effects of these toxic drugs STATINS. All can be accessed via Google. Please don’t be misled by the hype that comes out of the Big Pharma machine. LIPIDS can and should be handled with lifestyle changes. But not by increasing carbohydrates and reducing saturated fats and increasing PUFA’s. This has been one big exercise, a trial on the entire human race. A Trial that was not entered into voluntarily and now the human population as a whole is paying the price. Apology for the rant it is something I am quite passionate about.

      1. forgot to mention those with FH are a very different case. I ought not to have generalised. Sorry.

  6. Hello Catherine – Lynda here… those results almost mirror my husband’s results that he got last week! He has been phoned by his doctor’s nurse to make an appointment, no doubt for a statin. His calcium score test done two years ago was zero and his HbA1c is 31. I’ll be showing him this post… and thanks to Grant for bringing all of this out in public.

  7. Reblogged this on Just ME in T's Health Stuff and commented:
    Professor Grant Schofield as always has interesting information… This article is NO exception

  8. My cholesterol is “very high” and I am not the slightest bit worried about it. I am 67, no meds.

  9. Thanks for this post!!
    Hx of sleeve gastrectomy and now LCHF since christmas and low fructose 6 months.
    Cholesterol concerns according to GP. Cholesterol 8.4
    Trig 0.8
    Hdl 1.97
    Ldl 6.1
    Chol/HDL RATIO 4.3
    Dad died at 44.
    Worry about being off lipitor now.
    Please recommend LCHF helpful Dr I can see to organise more complex blood tests. I would be happy to get to Auckland if necessary or by email would be great.
    Thanks

    1. Yes this is probably the ApoE4 gene being expressed and maybe she should be on a more mediterranean diet than LCHF. I think these people might do best on low/no sugar, high O3 fats, plenty of veges. No idea abtou statins – anyone have any ideas there for the ApoE4 group? or similar for these one. Fasting?

    2. Karen, this looks like a pretty good profile to me. Perhaps your LDL has increased? That could be because your LDL size profile has changed from Type A to Type B ie larger LDL particles but less of them. That would be an excellent result. I suspect your Dr doesn’t understand cholesterol biochemistry, in which case he should not be prescribing statins.

  10. Statin’s…? Hell no! Why would I want to take something that increases my chances of poor health with no benefit towards good health?

  11. SherylTakaNZ · · Reply

    Fantastic blog and so interesting to see the experiences of others following this LCHF lifestyle. Thanks so much for posting this great information.

  12. Just wondering why the onions are avoided as well in the food list. Thanks.

    1. Don’t know you’d have to ask him – I will ask

    2. Andrew Busst · · Reply

      Hi Nicolette

      Onions run close to 10 grams of Carbs per 100g so they are just starting to push the low carb ceiling I have set for myself. There are lots of veges with half that amount of carbs you can choose instead.

  13. Andrew Busst · · Reply

    Grant and Catherine, thank you so much for the effort that has gone into your reply and the understanding it has created. I have shown that reply to quite a few of my friends and it has definitely got them thinking now. So I’m feeling pretty good about LCHF at the moment and it feels like its here to stay which is something I have never been to say about any other food regime I have tried in the past! Thanks again

  14. I am a GP, and thought I would relate the experience a patient of mine recently had. In his case, the dietary principles advocated in this blog were dangerous!
    After reading an article in the Sunday Star-times (October 27, 2013) about Wayne Schofield and his dietary theories, my patient altered his previously Mediterranean-type diet accordingly. This patient, of Pacific Island ethnicity, was already taking a statin for high cholesterol. His lipid profile was (fortuitously) checked 3 months later. I was unaware of what the patient was doing with his diet, and was shocked to see the following result: TC 11.0, HDL 1.87, LDL 8.8 and Chol/HDL ratio 5.9. I assumed he must have stopped his statin – he had not – and I asked him to come and see me. He is now, on my firmly worded advice, back on a Mediterranean diet and his lipids are back to normal: TC 4.9, HDL 1.51, LDL 2.9 and ratio 3.2. Even prior to statin therapy, his LDL was “only” 5.8!

    1. I think you probably need to consider baseline lipids – not mentioned, triglyceriides (not mentioned) to have any understanding of the actual risk profile.

      We also have no idea what this person was actually eating. The few dozen randomised controlled trials conducted so far all show improvements in the lipid profiles on a low carb high fat diet. Remember, TG, HDL, VLDL and ApoB are are all driven by dietary carbohydrate in a negative direction.

      Please, we rely on evidence based medicine in these nutrition recommendations – not single case study with much of the data missing on that person. I woudl rude you to wacth a talk I will post soon in lipids and carbohydrate.

    2. I am curious as to if you are stating LDL-C or LDL-P?… and also this patients triglycerides and A1c are not mentioned

      1. helsonwheels · ·

        “Therapy” is an interesting word to apply to taking statins… more like slow poisoning after seeing what they did to my father. Why is this person taking a statin if his cholesterol “was only 5.8″?

      2. helsonwheels · ·

        Apologies JustMEinT, that was meant to be addressed to Jan B. I will repost.

    3. helsonwheels · · Reply

      “Therapy” is an interesting word to apply to taking statins… more like slow poisoning after seeing what they did to my father. Why is this person taking a statin if his cholesterol “was only 5.8″?

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