Got my labs back

[Rasputin]

Last week, I went in for a physical and had them draw blood so that I could get a window into what's going on inside me. For the past almost four years, I have been eating a diet which is comprised of mostly meat with low-starch vegetables and the occasional low-sugar fruit and 85% cocoa dark chocolate. ~65% of my daily calories come from fat, especially saturated fat such as those found in Beef and Pork, Butter & Cream, eggs, and coconut milk. Zero grains. The rare sweet potato fried in coconut oil or baked with butter and cheddar cheese on top.

Meals are taken in an 8-hour window each day, leaving a 16-hour Intermittent Fast with only water the rest of the time. Hunger is notably absent right up until when I eat my first meal at 10am which usually consists of 4 eggs, butter, spinach and/or peppers, and American Cheese.

3x a week I lift heavy weights and help teach our jujutsu class, although after the warmups it is not as physically taxing as it was before I began to assume a teaching role.

I do not perform dedicated cardio exercise in the way of running, biking, treadmill, swimming, or elliptical. My heart rate does rise while lifting weights, but it is usually back to normal by the time I am finished.

On to the stats:

I am 41 years old.

My resting heart rate is 52.

My blood pressure, taken first thing in the morning, was 112/70. Before I started eating this way, my BP was hypertensive at 140/90.

I had just gotten over a bad stomach bug two days before which may skew the CBC results somewhat. Turns out that I was also getting ready to endure a bad head cold, both that and the stomach bug being the first time I had been sick in ~2 years.

UA
SpGr 1.023 Normal (1.001-1.035)
pH Ur 5.5 Normal (5.0 - 8.0)
ProtUr Negative
GlucUr Negative
Ketone 10
Hgb Ur Neg
Bili Urine Neg
Urobil Neg
Leukocyte Esterase Neg
Nitrite Neg
Sed Req Yes
WBC Ur None
RBC Urine 0-1
Epith Ur None
Bact None


CBC
WBC 3.9 Low (4.0 - 11.0)
RBC 4.71 Norm
Hgb 14.2 Norm
Hct 40.6 Low (42.0 - 52.0)
MCV 86 Norm
MCHC 34.9 Norm
RDW 12.0 Low (12.1-14.9)
Plts 229 Norm
MPV 7.3 Norm
Neut % 45 Norm
Lym % 42 Norm
Mono % 9 Norm
Eosin % 3 Norm
Baso % 1 Norm
Neut A 1.7 Norm
Lym A 1.6 Norm
Mon A 0.4 Norm
Eos A 0.1 Norm
Basos A 0.0 Norm


Chem 12:
Calcium 9.3 Norm
Gluc 89 Norm
BUN Level 24 Norm
Creatinine Level 0.79 Norm
Na 141 Norm
K 4.1 Norm
Cl 105 Norm
CO2 24 Norm
TotPrt 6.8 Norm
AST (SGOT) 21 Norm
AlkP 53 Norm
Bili T 0.8 Norm
ALT (SGPT) 19 Norm
Alb 4.1 Norm

Lipid Surv:
Chol 174 Norm
Trig 55 Norm
HDL 37 Norm
Ch/HDL Ratio 5 Norm
LDL 126 Near Optimal/above optimal
LDL/HDL 3 Near Optimal/above optimal

TSH:
TSH Ultrasensitive 1.481 Norm

Insulin Level 3.2 Norm

25 Hydroxy D Total (D2 + D3) -- 117.96 High


Now, the first letter that the doctor sent back to me in the mail about this had NO data. It was a cover sheet only and it stated:

"Labs were all normal except for elevated LDL cholesterol. I recommend you get your first stress test & can discuss getting further lipid studies with cardiologist."

So much to take away from this experience.

First of all, a stress test isn't going to show anything. It will only give an anomalous result if I have already received damage to my heart muscle, and there's no reason that I would have that at 41 years old with no other symptoms and labs that look that good. I understand that he is just a family physician, but come on.

Second, I asked him specifically to order a particle size test on the lipid panel because the number listed under LDL above is not an accurate measurement of the amount of cholesterol being ferried about by my LDL particles. That is a calculated amount, and it is skewed horribly in cases where triglycerides are as low as they are in my case (which is a good thing, by the way).

The Friedewald Equation (http://en.wikipedia.org/wiki/LDL#Estimation_of_LDL_particles_via_cholesterol_co ntent) is the method used by labs to estimate the amount of LDL in your blood. It states:

L = C − H − 0.16T

Plugging in my numbers, you get:

L = 174 - 37 - 0.16 * 55

L = 128.2, or ~ the 126 listed above.

The problem is that we are subtracting triglycerides from the total, and if trigs drop precipitously, the remainder (which is assumed to be the LDL containing cholesterol) must rise.

However, the "Iranian" equation, found here:

http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

...provides a much more accurate estimate when triglycerides are lower than the Standard American population.

Plugging my numbers into that calculator, you find that the number for LDL that results is 103.52, which is a lot closer to the 100 that has arbitrarily been assigned as being healthy.

But we're not yet done. When triglycerides are <90, what is usually found is that the LDl particles which are present are in the form of large, fluffy bundles of lipids (including cholesterol but also other fats) which are benign and not atherogenic.

The only way to tell for sure is to have an LDL subfraction/particle size test, which is what I asked for in the first place. It's a shame when you have to educate your own doctor in how to do his job.

Now, honestly, I expected to see a higher result for my HDL. After all, dietary saturated fat raises HDL better than anything short of a statin drug, and we simply aren't going there. I have added more saturated fat to my diet since receiving these results and will repeat the lipid panel in the next year to see if I can bring this up. Others eating a similar Paleo/LC diet report HDL of 60 or higher. It could be that they are getting more sleep than I am (avg. of 5 hours a night thanks to my kids), or that they are getting more exercise than me (known to raise HDL). It could also be down due to my being sick the week before, since cholesterol is involved in repairing the body's tissues.

Regardless, I am pleased with these numbers.

References:

http://www.amazon.com/Genocide-Your-Doctors-Dietary-Ignorance/dp/1419685821/ref=sr_1_6?ie=UTF8&qid=1300602556&sr=8-6

http://www.amazon.com/Great-Cholesterol-Really-Causes-Disease/dp/1844546101/ref=sr_1_1?s=books&ie=UTF8&qid=1300602574&sr=1-1

http://www.amazon.com/Fat-Cholesterol-are-Good-You/dp/919755538X/ref=sr_1_1?s=books&ie=UTF8&qid=1300602595&sr=1-1

http://www.amazon.com/Ignore-Awkward-Cholesterol-Myths-Alive/dp/1453759409/ref=sr_1_3?s=books&ie=UTF8&qid=1300602595&sr=1-3

http://www.amazon.com/Know-Your-Fats-Understanding-Cholesterol/dp/0967812607/ref=sr_1_1?s=books&ie=UTF8&qid=1300602620&sr=1-1

[Jonathan Randall]

I'm impressed by your hard work; both in maintaining your stringent program and your efforts to become educated on health matters - to the point of knowing more about tests than your doctor. The five hours of sleep is a real problem. Less than seven regularly can have really negative effects on a person. Don't know the answer, though, if family responsibilities are the cause. In any case, keep up the good work.

[Rasputin]

I try to sneak in a nap every day when I put my 3-year-old down for HIS nap. Sometimes it works, sometimes I simply have too much energy to fall asleep. My lack of sleep is mostly an artifact of having to get up at 6:45 to get kids ready for school and staying up on my computer until 1am because that is my "mental health" time; allowing me to de-stress after hours of parental responsibilities. In a couple of years the kids will be more self-sufficient in the morning and hopefully I'll be able to leave their morning routine to the wife, who unlike me (I retired in 1994) has to get up at that time anyway to get ready for work.

There goes any hope I had for sympathy for my plight :-D

Anyway, I forgot to add my supplement list to the above. I wish my Chem 12 had also checked for Mg, since I get a lot of that in an effort to replace the magnesium which would have been present in the hard spring water which humans would have consumed as their main water source for their millenia of development.

Here is what I take every day:

6,000 I.U. of Vitamin D3
500 Mg of chelated Magnesium Citrate
625 mg calcium Polycarbophil (bulk laxative) been taking this my entire adult life. Thanks, Dad.
5 mg Vitamin K2
400 I.U. Vitamin E
1000 mg Vit C
Multivitamin
225 mcg Iodine (from Kelp tablet)
100 Mg CoQ10
100 Mg Celebrex (ever since getting my knee replaced; helps with general wear & tear and pain from working out)
1 tsp fish oil in triglyceride form (~1000 mg EPA + DHA)

If I were able to stomach organ meats (pun intended) I could dump most of these, but I just can't. I have tried recently, too, which I will recount in another thread.

[DragonMind]

My recent numbers check had my doc confused as well. My HDL has risen 25% and he still wants me to lower my LDL. What he can't reconcile is that statins only raise HDL 20% at best and it bugs him that my diet results are better than his drugs. LOL

[Erik]

I think you're very dehydrated in this, Dave.

[Rasputin]

I'm possibly a wee bit dehydrated, although not pathologically so. Remember, the first part of the labs is the urinalysis, and any serious dehydration would have shown up there pretty markedly.

When I am fasting as I do every day from ~6pm to ~10am, my thirst diminishes greatly. I don't even get thirsty at all in the morning until I eat, which shows that I have achieved homeostasis. My urine is pale yellow/straw colored, and in fact if I do drink anything during that time it passes (clear) within about 20 minutes.

[Rasputin]

Dr. Davis has a reasonably relevant post on the subject up today:

http://www.heartscanblog.org/2011/04/what-are-normal-triglycerides.html

Anyone else interested in checking their numbers? if you get it done now, you might actually be in time to do something about it before your first cardiac event instead of after.

[Erik]

I just got mine back the other day.

Triglycerides and LDL were both 209. Not great, but down by a substantial amount.

[Rasputin]

You might want to consider looking into a heart scan, Erik. They are non-invasive, and it will give you a much more accurate indication of your heart attack risk for the next few years. Presumably, if you continue eating as I have recommended, any plaque which you have managed to accumulate up to this point will recede and disappear. But a heart scan is the best way to tell your current risk.

[Rasputin]

Gary Taubes went ahead and posted his labwork results today as well:

http://www.garytaubes.com/2011/04/before-sugar-were-talking-about-cholesterol/

[Erik]

Whoops - I was wrong. LDL was 159. Triglycerides were 209.

On the lab paper were the words "cardiac risk is lower than normal" though I'm not sure how they determined that with high cholesterol.

Working on it....

[DragonMind]

Whoops - I was wrong. LDL was 159. Triglycerides were 209.

On the lab paper were the words "cardiac risk is lower than normal" though I'm not sure how they determined that with high cholesterol.

Working on it....
What is more important than the LDL is the Tri/HDL ratio. What is your HDL?

[De_Franza]

Hey David,
This particle size/subfraction test; is that the LDL-C ? I'm trying to figure out if my insurance covers it. My preliminary research seems to indicate the size test is not more costly when done with a standard lipid panel. I know the LDL-C is covered, but you have to ask for it, as it's not a 'standard' screening, and many docs are like, "you're only 35, don't worry about it."

THanks!

[Rasputin]

If the test is labeled "Direct LDL-C" then, yes, it would directly measure your LDL instead of indirectly calculating it via total C - HDL and Trigs as mentioned above. It will probably not measure particle size, which would be preferable, but honestly if you keep Triglycerides < 100 and your HDL > 50, you will not have plaque accumulating. They don't directly cause the plaque to form, mind you, but they are hallmarks of a system with low inflammation and low amounts of circulating oxidized PUFAs and, most likely, fructose. Therefore, steady or even decreasing arterial plaque.

Personally, I'd strive for fasting triglycerides <60 and HDL as high as you can get.

[De_Franza]

my recent labs in March were a lifetime high of HDL 40... High trigs a lifetime issue. using Tricor keeps both ok, more excercise has finally boosted the HDL over 40. We'll see, I was also eating oatmeal almost every day over the winter but much less now.

[Rasputin]

I remain convinced that your problem isn't a Tricor deficiency.

If you are willing to try my way:

Zero grains
Green leafy and colorful vegetables
Lots of fat from animals (ESPECIALLY grassfed ruminants), less from chickens (higher in Omega-6)
Coconut milk and oil as desired
Meat, hopefully naturally-raised
Eggs, especially from chickens with access to green growing plants and insects
Wild-caught fish
Berries with either coconut milk or heavy cream
Intermittent fasting to allow the body to clean out old, glycated proteins and oxidized fats
If you aren't looking to lose weight, you can keep in starchy vegetables, although they will still skew LDL and trigs due to elevated blood sugar

I think that this, combined with the exercise you already do, would solve the problem.

http://www.drugs.com/tricor.html

The idea behind Tricor bothers me, I must admit.


What is TriCor?

TriCor helps reduce cholesterol and triglycerides (fatty acids) in the blood. High levels of these types of fat in the blood are associated with an increased risk of atherosclerosis (clogged arteries).

TriCor is used to treat high cholesterol and high triglyceride levels.

TriCor lowers elevated blood triglyceride levels by making the liver produce fewer triglycerides and increasing the elimination of triglycerides.

Why is your liver producing excess triglycerides? That is its job. When blood sugar rises, it has to be stored as fat, since muscle and liver glycogen has a far more limited storage ability than your fat cells. Excess fructose will likely be stored locally in the liver, since it is being metabolized directly there. If your trigs are higher than you would like, than it is madness to continue eating foods which turn directly into triglycerides. That's all I'm saying. Dietary starch and sugar is far more responsible for turning into triglycerides than dietary fats. That's elementary biochemistry.

[Vagabond]

As a medical professional, and Nursing student I am impressed. Thank you so much for going to this extent it has thouroughly convinced me. I also sent you a message why my labs were skewed. Did you have a Hepatic Panal? drawn?

As a result of following my diet (not as fatty as yours, I am making a gradual shift) my labs are back to normal, except for hepatic (it has to heal), and my BP has always been low.

[Rasputin]

I appreciate your writing back, Patrick. I was concerned that I had not heard from you in some time after our last correspondence.

The labwork in the OP is the sum total of what the doctor ordered, unfortunately. I wanted even more tests done, like the LDL particle size test, and a hormonal workup (my father was receiving supplemental Testosterone in his 60s and I am curious as to how I stand there), and things like a CRP for overall inflammation, an Iodine test, Thyroid, HGH, and a few others. However, now that I have taken this baseline labwork, perhaps my next physical I can convince the doctor to order a more complete workup.

As for a liver assay, some of the Chem 12 above detects abnormal liver function if present:

AST (SGOT) 21 Norm
AlkP 53 Norm
Bili T 0.8 Norm
ALT (SGPT) 19 Norm
Alb 4.1 Norm

According to http://www.medicinenet.com/liver_blood_tests/page2.htm#3whatare and http://www.labtestsonline.org/understanding/analytes/cmp/glance.html,


What are normal levels of AST and ALT?

The normal range of values for AST (SGOT) is from 5 to 40 units per liter of serum (the liquid part of the blood).

The normal range of values for ALT (SGPT) is from 7 to 56 units per liter of serum.


All of the levels checked for in the Chem 12 show the liver to be functioning normally.

Keep in mind that MCTs such as those found in coconut milk and oil are easier on the liver and provide energy directly--they may help with the healing process. I enjoy my coconut milk in tea almost every day. Tonight with our cheeseburgers I made crinkle-cut carrots with some butter and beef base, and I finished the carrots with a generous scoop of the cream from the can of coconut milk (the solid which remains if you do not shake up the can. I let the vegetable gum and water drain off, leaving pure coconut). The family actually fought over who was going to get the last of the carrots.

Have you seen the recent studies which show that a ketotic diet can actually HEAL cases of kidney disease? Those wacky ketone bodies--is there anything that they can't do?

[Vagabond]

Yeah, Coconut milk is brilliant. A lot of the Nurses and up and coming DO (Doctors of Osteopathy) are really embracing these new trends in nutrition and hollistic approaches to medicine, so I would not veer away from the medical community just yet.

Your liver enzymes are perfect as far as my knowlege carries me. I would like to post a warning to many people out there, be cautious of taking pain releivers, especially in large amounts. The warnings on the bottle are legitimate :).

Where do you get all of these recipes?

[Rasputin]

Where do you get all of these recipes?

Ooh, there's no easy answer there.

I read A LOT, but actual cookbooks and blogs are only loosely helpful.

The Foodee project (http://www.thefoodee.co/)has a lot of paleo-style recipes, but I have yet to try any of them.

Mark Sisson's blog (http://www.marksdailyapple.com/buttery-catfish-in-a-creamy-shallot-sauce/) as well as Free the Animal (http://freetheanimal.com/) can be counted on for delicious recipes on a weekly basis.

But in real life (tm), my main recipes simply come from knowledge of the tastes and textures of the foods themselves and letting them mix in my brain before they hit the kitchen. I do all the food shopping, and as I wander the aisles (mostly on the outside aisles, of course) the recipes simply come together in a melange of flavors. Certain of my family members are pretty picky, so that is the major limiter of my culinary experimentation.

At my disposal, I have a Sous Vide Supreme (http://www.sousvidesupreme.com/default.aspx?RD=1), a smoker, a charcoal grill, a microwave, an oven and a gas stovetop. Between them all I manage pretty well.

[Rasputin]

Mark Sisson posted a recipe today that I am sorely tempted to try, even though half my family can't handle all the Garlic (I Love It!):

http://www.marksdailyapple.com/garlicky-roasted-shrimp-and-swiss-chard/

[Vagabond]

Do you avoid additional Electrolytes (Sodium, Potassium, etc) is your foods?

[Rasputin]

Nope. The initial few days/weeks are the most difficult as your body fluctuates, trying to find homeostasis. As the body sheds the water that it has been retaining due to the influence of high circulating insulin levels on the kidneys, it tends to dump electrolytes along with it. It is during that time that I recommend that people add NoSalt to their food, as well as using normal salt as desired.

Once blood pressure drops to normal and water weight is no longer being lost, electrolytes tend to fall into balance pretty quickly. If you don't drink a lot of mineral water, I still recommend supplementation with Mg, but other than that, you should be able to get the remainder of what you need from the vegetables in your diet.