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Doc wants to talk about getting my cholesterol down :-(

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  • Doc wants to talk about getting my cholesterol down :-(

    Well, I'm feeling a bit flat today. I went primal in June, and dropped 35 pounds and loving it. Still a bit to go. I'm a "young" 51 :-) and 6-2, 205 lbs. Would like to see myself in the 190s.

    Unfortunately, I don't have a baseline lipid panel from pre-primal, however got a physical recently, here are the key numbers:

    Total Cholesterol: 287
    Triglycerides: 103
    HDL: 59
    Non-HDL: 228
    VLDL (calculated): 21
    LDL (Calculated): 207
    Total Cholesterol/HDL Ratio: 4.9

    I got a call yesterday from the doc's office saying he needed to "come in" to discuss getting my cholesterol numbers down, and my low vit D levels. That it wasn't a huge concern yet but I need to "get it under control." Instead of making an appointment like they wanted (so I could go in and pay 125 self-insured dollars for him to tell me to eat more oatmeal and less eggs and meat, and take a vit D supplement), I asked them to print of a copy of the labs so I could study them first. When I picked up my copy, I was again strongly encouraged to make an appointment.

    I have to admit, I was pretty disappointed. I have been quite faithful to primal nutrition, and with rare exception, eat NO grains, NO legumes, NO processed foods, NO sugars. Huge salads with olive oil, grass-fed beef (I bought half a grass fed cow), wild salmon, and chicken, and various veggies. Of course, bacon and DHA enhanced organic eggs a few times a week, too. That's it. Maybe on Thanksgiving I had one roll (yech) and some dressing, and a bit of creamed corn. Otherwise, I am primal all the way, and loving it. The lack of hunger, the ability to eat just two meals a day (so convenient). No pizza, no pasta, the occassional potato or yam. ONLY olive oil, no processed oils. NO fried food. Overall, I would put my primal nutrition compliance at 95% overall.

    I also take 3 grams of fish oil per day.

    Friends have all asked if I've had my cholesterol checked, I am known among them as "the caveman" who devours the chicken skin and carcass that they set aside. Well, now I've had it checked, I'm a bit freaked. I want to completely believe that these numbers don't matter as much as my doc will want me to think they do, but how does one get over the doubt? Obviously, a lot of reading here and other places is in order to understand all this in context. I ALWAYS look at the medical and pharma opinions with skepticism, but in this case...the nagging thought is: "What if I'm wrong?" Do I want my friends in 5 years to be saying, after my heart attack, "well, its no surprise the way he was eating all that fat with that caveman thing he was doing...."

    As I get about 50% of my calories from fat, and am at around 2,000 cal per day average, that's about 110 grams of fat per day. If I were to lower that to 20 or 30 grams like the doc would surely tell me to do...that's 700 or 800 calories I'd need to replace with protein and carbs. Replacing those calories withh 200 grams of protein isn't realistic, unless I pound whey protein every three hours; and replacing with carbs defeats the whole purpose of eating primally...and would put me back in the "hungry every three hours" mode, which I don't miss AT ALL. But I have to admit I am now questioning myself on my fat intake, and wondering if I'm gambling with my health and longevity with all this.

    Any thoughts and advice for best things to study would be appreciated. I know there's a lot of resources and I want to evaluate as many as I can. This has me quite worried, and I almost ran to the store today to buy a big can of oatmeal to start having in the mornings, and was tempted to have 5 egg whites and one whole egg, rather than my usual 4 whole eggs. And I ALMOST skipped the bacon.

  • #2
    It's really hard to say since you don't know what they were before. Maybe it's an improvement, maybe you're still shuttling stuff out of your body and therefore it's a sign your body is healing... hard to say.

    I'm hoping someone else has some insight since I'm definitely no expert.
    Last edited by RitaRose; 12-18-2011, 11:13 AM.


    • #3
      So~ you don't know what it was before~ and yet, you assume it's higher because you're eating meat instead of oatmeal? How do you know it hasn't dropped 100 points? I think you need 6 more weeks and then another test to see which direction things are going~ FWIW~ you're more likely to have elevated cholesterol from oatmeal than whole eggs~ for one thing, egg yokes contain lecithin~ the great emulsifier and they don't trigger an insulin spike that signals the liver to make more cholesterol!
      Last edited by Nady; 12-18-2011, 11:15 AM.


      • #4
        I'd consider this test a baseline reading and get tested again in a month. You've got enough safety margin for that amount of time. Remember to eat plenty of mackerel and salmon to raise your HDL, and plenty of eggs and saturated fat, too!
        Crohn's, doing SCD


        • #5
          Unfortunately one data point is just not sufficient to make a decision. As stressful as it is, I would focus on getting my vitamin D levels normalized (to the upper end of normal using a good quality D3 NOT the D2 they may prescribe you) and continuing to eat primal for a few more months. Then have your labs re-tested. I have read on this forum that lipids can be artificially elevated while you are losing weight.

          In the mean time, I would ask for a coronary artery calcium scan to see if you there is ongoing inflammation in your vessels and to have my thyroid levels checked.
          Using low lectin/nightshade free primal to control autoimmune arthritis. (And lost 50 lbs along the way )


          • #6
            As others have said you don't know what you were pre-primal. Your triglycerides tell me that you're losing weight and have more weight to lose. The only thing I'll add is to wait until you stop losing fat before you get another blood test (rather than an arbitary period of 4-6 weeks).

            If your doctor said your vitamin D is low, it's probably very low. Make sure you get the number so you can work with that.

            As for dietary fat. Currently I'm going through the draft version of dietary guidelines for Australians. The research cited actually suggests that ALL dietary fat from whole foods is superior to carbs for improving blood lipids.


            • #7
              Agreed. I have no baseline to go by. Something I've been thinking about today though: With primal eating, and subsequent increase in cholesterol ingested, should it not be expected that cholesterol numbers will tend to increase...but we shouldn't be terribly concerned about it, as long as some of the ratios are OK? Do people go primal and see their numbers fall/improve? This is the only part of PB that I don't completely understand.

              Re: Vitamin D, it showed up with a value of 26 ng/mL, with a "reference range" shown as 30-80. I recently had already started to supplement, so that should get straightened out.


              • #8


                • #9
                  It is very common to see cholesterol numbers increase on a primal/paleo diet. This can be due to a number of causes and has nothing to do with eating more cholesterol or fat. For example, going VLC can cause thyroid function to be downregulated, reducing the number of LDL receptors on cells leaving more LDL circulating in the blood. This isn't necessarily bad. So long as the LDL is pattern A you have nothing to worry about.

                  For now, you should just be monitoring trigs and HDL, focussing on lowering the former and raising the latter
                  Four years Primal with influences from Jaminet & Shanahan and a focus on being anti-inflammatory. Using Primal to treat CVD and prevent stents from blocking free of drugs.

                  Eat creatures nose-to-tail (animal, fowl, fish, crustacea, molluscs), a large variety of vegetables (raw, cooked and fermented, including safe starches), dairy (cheese & yoghurt), occasional fruit, cocoa, turmeric & red wine


                  • #10
                    And make them actually count your LDL/VLDL next time, the calculations tend to skew high when there's a higher HDL level. (And I really wish I could remember where I read that so you could check out the source yourself.)

                    Anecdotes<>data, ymmv, and cholesterol numbers don't matter, but my own experience has been that replacing some carbs with more eggs (e.g. eggs instead of oatmeal for breakfast) significantly improved my cholesterol numbers even before I started on the primal path.


                    • #11
                      Are you cooking with olive oil? That'll oxidize a lot of the fat and hurt your numbers.

                      But with everything I've learned about nutrition in the past couple years, I seem to remember that there is no association between cholesterol levels and heart disease. I hate giving advice like that, in case I'm wrong, but I do know it's all about inflammation.

                      By the way, "young" 51 is the only kind.


                      • #12
                        I'm glad you made this topic. I'm a little nervous myself, going in for a six month checkup tomorrow. My baseline from 6 months ago was --

                        HDL : 32
                        LDL : 145 (Calculated)
                        Tri : 103

                        Definitely expecting improvement over that, given 40 pounds dropped and much muscle added.

                        In your shoes, my inclination would be to use your first test as a baseline, "do the right thing" for another 3 months, and retest.


                        • #13
                          Originally posted by sapphire_chan View Post
                          And make them actually count your LDL/VLDL next time, the calculations tend to skew high when there's a higher HDL level. (And I really wish I could remember where I read that so you could check out the source yourself.)
                          When TGL are under 100 the standard formula used to calculate LDL overstates it. The Iranian formula is more accurate. Here is the calculator. LDL Cholesterol Calculator

                          Even better though is a true measure of LDL and it's composition through NMR lipoprotein or VAP tests, usually not covered by insurance but available through for around $100.


                          • #14
                            Thanks all.

                            I remembered I did get a physical 3 1/2 years ago, so I called to have them pull the file with the lipid profile if they still have it. I would think they should have it in a file archive somewhere. This would be way before paleo, but at least give me some sort of starting point.

                            To answer a question, I don't cook with olive oil, or any oil for that matter. I only use a bit of organic butter to sautee grass fed beef or wild salmon, assuming I don't grill instead. I do consume several tb of olive oil daily however, on a big salad, a daily staple of mine. Also I take 3 mg of fish oil capsules, just increased that to 4 mg yesterday to try to get help get the HDL up a bit.

                            Next blood test I will definitely get the profile that includes actual measures for LDL and the types.

                            The more I am reading the more confused I get. This is not something I want to take a gamble on, obviously.

                            Thanks for all the feedback so far.


                            • #15
                              Originally posted by Adrianag View Post
                              When TGL are under 100 the standard formula used to calculate LDL overstates it. The Iranian formula is more accurate. Here is the calculator. LDL Cholesterol Calculator

                              Even better though is a true measure of LDL and it's composition through NMR lipoprotein or VAP tests, usually not covered by insurance but available through for around $100.
                              Thanks. I tried the Iranian formula, which took LDL from 207 to 204...not a big difference.

                              I think I am going to go ahead and order a VAP test online, I really want to know what the LDL actual number is, and what type. Hoping to find it's a high percentage of fluffies, which will put me at ease.