How to Interpret Advanced Cholesterol Test Results

After last week’s post on interpreting traditional lipid tests, I promised a follow-up post on interpreting the advanced VAP and NMR Lipoprofile tests that provide measurements of particle size and all the various sub-fractions of HDL and LDL particles. I even hinted that it might be worth bypassing the traditional test entirely and going straight to the advanced stuff if you were going to get your cholesterol measured anyway, because of the greater accuracy and more detailed picture of your lipids the VAP and NMR tests provide.

Well, I’m going to have to reevaluate my stance on the matter and rethink that original suggestion. Recent evidence shows and commentary from researchers concludes that the various advanced lipoprotein particle classification tests can produce wildly disparate results on the same samples to the point of rendering them unreliable (sound familiar?), especially if we’re going to be evaluating our health based on the results. A 2009 systematic review found that the available LDL subfraction literature “does not provide adequate data about comparability in terms of test performance to choose one or another method to serve as a standard nor are data on comparability in terms of predicting CVD outcomes.” In short, it could – and probably does – have diagnostic value, but there are no real standards for measurement or analysis that would allow us to use the information. Yet.

The only study with a full text available examined four different methods for testing LDL subfraction size. Authors took blood samples from 10 females and 30 males, all healthy and ranging from ages 23 through 61 years, which were then sent out to the labs for testing. Four samples from each person (taken one after the other without any lag time in between) were sent out. Each lab used a different type of LDL fractionation and particle size analysis:

  1. LDL Segmented Gradient Gel Electrophoresis – separates LDL particles into 7 subfractions by size and shape
  2. Vertical Auto Profile-11, or VAP – separates LDL particles into 6 subfractions by size, LDL-1 (most buoyant) through LDL-6 (least buoyant)
  3. NMR Lipoprofile – separates LDL particles into A (large, fluffy, buoyant) or B (small, dense)
  4. Quantimetrix Lipoprint LDL System (sounds like a drug from a Philip K. Dick novel), or tube gel electrophoresis – analyzes lipoprotein sizes and assigns either a normal (less than 5.5), intermediate risk (5.5 to 8.5), or atherogenic (over 8.5) “LDLSF score”

The results “varied considerably among the methods.” According to tube gel electrophoresis, 79% of the people sampled fell into large, fluffy pattern A LDL, while VAP found that only 8% of samples were pattern A. Both VAP and NMR stuck 54% of the people into pattern B, but tube gel electrophoresis classified just 5% (two people) as pattern B. As for type A/B (a roughly equal mix of small, dense LDL and fluffy LDL), VAP classified 2.5 times more samples as A/B than did tube gel electrophoresis and gradiant gel electrophoresis (NMR doesn’t do A/B). For a nice visual of the discrepancies, check out the LDL phenotype distribution data in graph form.

When all was said and done, the four methods agreed on the classification of a mere three people whose lipids they measured. NMR matched the other methods the most and VAP the least, for what it’s worth.

And while it’s true that LDL-C measurements were very different across the different methodologies (as this graph shows), the within-patient relative measurement of LDL-C was maintained across all methodologies; the same was not true for LDL particle size measurements.

I think determining LDL particle size will be helpful in assessing a person’s risk for heart disease. I just don’t think we can use the tests that are currently available to do it, not reliably at least. Which do you choose – VAP or NMR or one of the electrophoresis methods? According to the data, NMR’s more likely to put you in pattern A than VAP, but that’s an indictment of the variability in accuracy of the various methods. Relying on that is just trying to game the system. It might be more or less reliable than VAP, but we can’t know that yet.

Beyond the traditional lipid tests, however, there is a measure that’s worth looking into: Apolipoprotein B.

Apolipoprotein B is a protein residing in LDL particles. In fact, every single LDL particle has a single ApoB, making ApoB an effective measurement of LDL particle count. By all accounts I could find, ApoB is reliable and accurate. Every LDL particle has one ApoB, and along with TC:HD ratio, ApoB count is a strong predictor of heart disease risk (again, with the caveat that these studies are on populations leading a decidedly unPrimal and highly inflammatory lifestyle). If you have a lot of ApoB, you have a lot of LDL particles, which could mean the LDL receptor activity is down-regulated. Or, it could mean you’re losing weight, which can affect lipid values in multiple ways. Or, it could mean that today was a particularly “high ApoB day” and that getting it tested next week will give a different result – simply due to natural fluctuations. You just don’t know.

What I’d really like to see is a little high-def moving graphical representation of your arterial health. Like, instead of getting a single snapshot of the state of your blood lipids, you’d go into the doctor’s office and strap on a non-invasive device (which, if required for its operation, applies the perfect dose of ionizing radiation to provoke a hormetic response, rather than a pathogenic one) that monitors your blood lipid activity. You’d wear it for maybe a week, during which time it would monitor your blood, download the data, and give you a play-by-play summary of what exactly happened in your body. It would even convert it into visual form, so you could watch a nice Pixar-quality video at the end showing cartoon LDL particles with frowny faces oxidizing (or not), interacting with receptors (or not), happy-faced ones delivering cholesterol to be turned into sex hormones, increasing because thyroid health is compromised and LDL receptors down-regulate, decreasing because they’re making more deliveries to cells (good), decreasing because you had a stressful four days of no sleep and low-nutrient junk food and the resulting systemic inflammation was oxidizing them and they ended up as atherosclerotic plaque and no longer in your bloodstream to be measured. Such a device would be great and truly useful.

We don’t have that (yet), but what we do have, while imperfect, isn’t totally useless. Using a traditional lipid test and ApoB, we can still get clues. Next time we talk about this stuff, I’ll go over some strategies for responding to these numbers – if any response is warranted.

Thanks for reading, and be sure to leave a comment in the comment board telling us of your experience with advanced lipid tests, especially if you’ve had several done using different methods (did they agree with each other?).

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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60 thoughts on “How to Interpret Advanced Cholesterol Test Results”

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  1. This is why we need the Primal philosophy. It helps us cut through the details and BS and puts sensible decisions within the grasp of mortal man. No wonder we’re all so easily baffled by BS.

  2. Many of us are interested in the amount of large , fluffy, buoyant LDL particles vs the less buoyant/dense particles. since the latter are associated with artherosclerosis. I think what ever test was used (no matter how inconsistent the results between various tests) we should stick to one test and track the progress. so far I had 2 tests in the past 12 months, time for a third. is this a plausible strategy???

  3. Its all so irritating, so often these tests they use to prescribe dangerous medications are useless because they cannot get the same results twice in a row! So CW says go ahead and take that messed up medication but we need to advocate for ourselves more and believe them less and this shows that. I think I will just listen to my body more and the doctor less.

    1. Statins do not work on particle size anyways. So if someone has 260 total cholesterol but with 30 triglycerides, most or probably ALL of the particles are billowy, fluffy.

      So one would start taking drugs to literally RUIN someones perfect health!

  4. This is why you should focus on the basics: quality food, quality sleep, lots of activity (including plenty of play!), and quality, real-life social interactions with people you care about.

    The rest is fluff. Health is quality of life, not a number on a lab test.

    1. That’s right. Mark has gone too deep, so that we don’t have to (Thankyou, Mark).

  5. Thanks Mark – good info for me.
    I had a VAP test done after 6 weeks strict primal.
    LDL 183, Pattern A, HDL 47, VLDL 16, TG 60, LP(a) 4, ApoB 126, Apo AI 129, Apo Ratio is .98.
    As mentioned above, every single LDL particle has a single ApoB particle, but this doesn’t state which marker is the one to look at – if my ApoB is the right measurement my LDL is lower that expected which means my TC is lower and therefore TC:HD is better. If the LDL is the right measurement, then, well, I’m in trouble…
    Seems the desirable for ApoB is 109, so I’m a little elevated, but the ratios are ok.
    Seems from this Danish study ratio over 1.2 of Apo seems to be a higher risk factor
    It seems that (not surprisingly) vitamin E and exercise helps reduce ApoB.

    1. Andy, I was so glad to hear vitamin E helps lower ApoB!!! I looked at the article you linked but did not see that good information. Do you know if its been shown that plain alpha tocopherol (vit. E) or one with mixed tocopherols, and/or mixed tocotrienols is most useful for lowering ApoB?

  6. Your timing of both these posts was amazing. That day we had just got our results back. since going primal our results went from perfect CW results to not so perfect CW results. I am in the health field and used to interpret results for people in a wellness program and any LDL over 140 I suggested they get it down closer to 100 or else the doc might put them on meds. Now my LDL is 143. I decided from reading these posts and investigating on the web that I am not going to worry, if I am eatting primally and living a healthy lifestyle and my TC/HDL ratio is 2.5 with HDL 91, no need. These labs are not real tests they are just a screening tool. If the results are considered “abnormal” then you investigate further to see if there is reason to be concerned, are there areas in my lifestyle that would support the LDL’s in a bad way leading to heart diease. My investigation was to look at my lifestyle and to see if there is any area I can improve on that might give cause to be at risk. I came up with maybe being more concerned with how much omega 6’s I might be taking in from nuts etc. I used to be a chronic cardio type, still am somewhat so pay attention to that area. Thought about doing the VAP test but after this post why spend the money. Live healthy, watch your P’s and Q’s and don’t worry (stress, a risk) Thanks Mark

    1. Hi Colleen,

      You are wise! Btw, I just watched a Danish special based on a new study that argued none of these numbers mean much for women who still have their periods. This study suggested that the better association was your Omega balance. Women with better Omega balances were thinner and had lower rates of heart issues, but the study only looked at 180 women.

      1. I am old and wise, no longer have those messy ol periods, yay!!!! but traded those in for those damn night sweats and sleepless nites hmmmmmm
        Yes, will watch my omega balances, thanks

        1. Those periods become quite tolerant when on a primal diet.
          I used to be in pain to the point of passing out and had my period for 5 days +.

          Now I don’t even feel when it starts and they’re gone by the 3rd day evening.

          I used to have irregular menstruation, but since primal it’s right on time every 28th day between 8 am-10 am it starts and leaves by the 3rd day around 6-8 pm.
          I love it.

  7. I’m so happy you retracted your initial support of these tests. As a physician who sees a ton of these results, especially since I take care of a highly insulin resistant population, I can tell you that discordant results have left both my patients and myself confused. Most importantly they have not added value to using the more standard lipid profile test which as you know can be more refined through the use of non-HDL scores, TC/HDL ratios and TG/HDL ratios as well to evaluate the effects of a primal or low carb diet. When I have patients go primal or low carb, sometimes I only monitor the triglycerides initially since the other values vary so much over the first few months. Especially a common drop in the HDL with initial body composition changes can be discouraging. I agree that this technology will get better and then we can more reliably monitor our diet and exercise changes. Currently I find the VAP or NMR tests to mostly be useful in my intermediate risk patients. In these patients who have failed lifestyle changes and their numbers are on the edge of requiring medications (which I do my best not to overprescribe!), a positive test will push me further in favor of prescribing medications or hopefully providing additional motivation to get these patients to be more aggressive with lifestyle changes. I use coronary calcium testing in these situations also, but that’s a whole other topic.

    1. Ty, Dr. Ron. I also wish Mark would admit women exist. It’s important. Women are different – our numbers are different – these tests apply differently to us – they need to be interpreted differently – but alas in the Paleo world no one will admit that women exist.

      We are different! Vive la difference! When will a paleo person speak honestly about women’s health?

  8. This is so frustrating for me, I have been VLC for about 18 months, lost 40# and was on a statin prior to this. I have been off of the statin for 6 months before this test was performed. BTW my HDL increased when I went off of the statin. These are my latest numbers – My doctor can’t interpret these, I have to get an appt with a lipidologist just to find out what this result means.

    Cholesterol – 299 mg/dl
    Cholesterol/HDL – 3.4
    Crea .62 mg/dl
    Glucose 105 mg/dl
    HDL – 88 mg/dl
    HDL Particles – 42.5 (15332984) umol/L
    HDL Size – 9.8 nM
    INS Resistance Score – 4
    LDL – 199 mg/dl
    LDL Particle Numbers – 2202 nmol/L
    LDL Particle Size – 21.9 nM
    Large HDL Particles – 15.9 (15332984) umol/L
    Large VLDL Particles – < 0.7
    Non HDL Cholesterol 211
    Protein TOTA – 7.0 gm/dl
    Small LDL Particles – 179 nmol/L
    Trigs – 61
    VLDL Size – not applicable

    1. Because your HDL is excellent over 60 is very good and your Trig are only 61(150 is considered normal) don’t be concerned, that’s the least of your problems.
      Your glucose is a little high if it’s at fasting. Non-Diabetic fasting blood glucose ranges from 70 to 90. Of course no one agrees with these numbers.
      For the real information (not ADA) on everything related to diabetes an more check Dr.Richard K Bernstein’s “Diabetes Solution” is worth reading.
      Good Health to You~

      1. I am one of those people whose fasting glucose is the highest if the day. My glucose actually goes down after I eat. My A1C number is 4.9

        1. Mary Jo, I had that problem (reactive hypoglicemia) for about 5 years too. It can get to a debilitating condition, be aware. It is perfectly possible to see the blood glucose go all the way down (way below fasting levels) right after eating, especially when eating a higher glicemic load food like carbs, because your insulin response is disproportional.
          I don’t know about you, but in my case the problem was the wrong intestinal flora: I was cured after a full disbiosis (a week of diarrhoea) and recovering with probiotic supplements and foods. (It beats doing fecal transplant!!) 😉

    2. Get off the statins period Mary Jo. Research shows they do nothing – zero, zip, zilch – for women. All these blood numbers have different meaning for women in different life stages – with period, peri-menopause, menopausal.

      But no matter what stage you’re in, statins don’t work for women. They just don’t. So get off them ASAP.

      1. As I stated in my post, I have been off of the drugs for 6 months. Since then my numbers have gone astray, LDL rising alot.
        That is why I had the particle test done to determine what particle size I have.

    3. Your TC and LDL-C could be high if you are one of those people in which long-term VLC diets depress the thyroid. The depressed thyroid down regulates the LDL receptor, keeps cholesterol in the blood for longer and then the liver synthesises more.

  9. Interesting that the subfraction tests aren’t so accurate. I just got one done using the gel electrophoresis method, not surprisingly my LDL size was nearly all in the top 2 categories. Can’t wait for the next installment!

  10. Wow, Mark!
    Just when I thought I knew “everything” you give a cause to stop and question … At my last doctor visit he brought up the subject of cholesterol (idiotic hoax). I asked him; how’s my triglycerides and HDL ? To which his reply was, very good.

    You think I’ll be taking that poison?
    For me, I strive to keep my triglycerides 75 or lower the better. HDL 60 of higher, higher the better and A1C under 5, between 4.6 to 4.9 is my goal. A very low carb diet works for me.

    BTW I really loved your last book…

  11. Thank you for all of this information Mark! I’ve been trying to research VAP and NMR tests for a while and this post was extremely helpful.

    I’m a “hardgainer” and have been eating generally 18-24 eggs a day (the best quality eggs I can find). This scared the daylights out of my doctor who recommended that I get my cholesterol tested, but I’d prefer to analyze the results on my own rather than blindly follow someone else’s advice.

    1. Very few people looking at research take the ‘dietary cholesterol increases serum cholesterol’ idea seriously. Even the new dietary guidelines for Australians made no mention of it

    1. You work out like mad? Then refeed carbs for the muscles?
      You do this often?

    2. @Bill @Mary Jo,
      Paul Jaminet at did a blog series earlier this year about high LDL on Paleo diets. I highly recommend reading the series.
      Best of luck!

  12. Apo B is a much better risk factor than LDL-C. LDL-C really plays no part in oxidation and atherosclerosis. Apo B can give you an idea of how many LDL particles you have and therefore the total surface area of the phopholipid membranes. Higher surface areas are exposed to more oxidants. The small, dense may have less cholesterol in more LDL, high surface area. The large, buoyant have more cholesterol in less LDL, low surface area.

  13. Great post Mark, I have nothing to say about the tests, but before I went off statins a couple of years ago I did a CAT scan of my heart arteries which revealed I had no plaque that would show up due to the calcium found in fat. The radiation was none too flash but if you need to be sure there is no risk of a heart attack this is the one.

    •Multidetector computed tomography (MDCT)
    is used to conduct this examination.

    There are other reasons than heart disease for a cardiac arrest but this does a good job of eliminating the question around blocked arteries.

    1. Can we have more information on the reliability of CAT scans for arterial plaque?

  14. Mark,
    Have you looked into other ways to measure arterial health? For example, using a tool like the Bio-clip Plus to measure aortic pulse wave velocity? Or the EndoPAT test? Or CIMT ultrasound?
    Would love your take on those tests, especially given what you have discovered about the usefulness of the lipid tests.

  15. Ughhh, how frustrating. I had a standard panel done last month, numbers came back “high”, so by myself, I went and got both the NMR and VAP profiles down. Just got the results, the interesting thing to note is that my total was 30 points lower, just two weeks after the first test.

    I need to dig into the results and figure out what they all mean, maybe I’ll post over on the forums to get some feedback.

    But it’s a bummer to hear that these results could now be meaningless, $195 later 🙁

    I love primal living/eating, but do have nagging worries about the cholesterol numbers, and the advice to not be so concerned. I sure would hate to find out we are wrong about this.

  16. symbiotic relationships are what makes life thrive here on the globe, earth. if any one species were permitted to expand, it would wipe itself out… everything is in check, life dies for life to live. i.e autotrophs and heterotrophs. isn’t it a great place?
    sure glad i’m at the top of the food chain.

  17. One reason to avoid the VAP test is that once you pay for and take the test, you are on your own to interpret the results. At least I found Atherotech Diagnostic Labs unwilling to discuss results to anyone other than a physician.

    1. Not sure about his conclusion. I eat a VERY similar strict primal diet as Dr. Attia. Have been for 2 years.
      At 40 years old 5’9″ 170 sub 10% BF, my LDL-P is 2081. According to him I am high risk. So what changes should i make? Eat grains? Take drugs? My TC is 302, HDL 70, Trigs 44, LDL size 21.8 and Small LDL-P 160.

      Don’t buy into his “theory”. These guys don’t get it. There is no one “marker”. All of our bodies are different and we each have different “healthy numbers” My resting HR is also below 50 but i don’t think that makes me healthy.

      The proof is how you feel and look (naked).

  18. Hmm so is there a bottom line here? Should I even get one of the three tests? NMR, VAP or GGE?

  19. Well, FWIW, after one year of Wheat Belly, and I mean assiduously followed, along with x1 per week HIT with the addition of x1 per week Japanese Sword , every single one of my NMR parameters, save for triglycerides, was “worse” than the previous measurement. Same lab on each measurement occasion.

  20. Had particle size test done, but I find it difficult to comprehend results. I need to know if I need to see a preventative medicine cardiologist. Thanks.

    LDL Particle Number (NMRLIP) 1674 nmol/L
    Low: 2000
    LDL Cholesterol (NMRLIP) 96 mg/dL
    Optimal: 190
    HDL Cholesterol (NMRLIP) 50 mg/dL
    Desirable: >= 40
    Triglycerides (NMRLIP) 96 mg/dL
    Desirable: <150
    Total Cholesterol (NMRLIP) 165 mg/dL
    Desirable: 34.9
    Intermediate: 34.9 – 26.7
    High Risk: <26.7
    Small LDL-P (NMRLIP) 951 nmol/L
    Low Risk: 839
    LDL Particle Size (NMRLIP) 20.7 nm
    Large (Pattern A):
    23.0 – 20.6
    Small (Pattern B):
    20.5 – 19.0

    Small LDL-P and LDL Size are associated with CVD risk, but
    not after LDL-P is taken into account.
    Large VLDL-P (NMRLIP) 2.7 nmol/L
    Insulin Sensitive: 6.9
    Small LDL Particle (NMRLIP) 951
    Unit: nmol/L
    Insulin Sensitive: 839
    Large HDL-P (NMRLIP) 1.8 umol/L
    Insulin Sensitive: >7.3
    Intermediate: 7.3 – 3.1
    Insulin Resistant: <3.1
    VLDL Size (NMRLIP) 53.7 nm
    Insulin Sensitive: 52.5
    LDL Size (NMRLIP) 20.7 nm
    Insulin Sensitive: >21.2
    Intermediate: 21.2 – 20.4
    Insulin Resistant: 9.6
    Intermediate: 9.6 – 8.9
    Insulin Resistant: <8.9
    LP/IR Score (NMRLIP) 74
    Insulin Sensitive: 63

    The LP-IR Score combines the information from the above
    6 markers to give improved assessment of insulin resistance
    and diabetes risk.
    These laboratory assays, validated by LipoScience, have not
    been cleared by the US Food and Drug Administration. The
    clinical utility of the laboratory values has not been
    fully established.
    Test performed by: Mayo Medical Laboratories, Rochester, MN, unless
    otherwise specified above.

  21. What everyone should be most worried about are their homocysteine and/or hs-CRP levels, both of which measure the inflammation in your body – the main culprit of CVD. Without a high inflammatory process, your blood vessel lining is good to go and your cholesterol values don’t mean a thing. Most persons observing a Paleo lifestyle should have very good homocysteine and/or hs-CRP levels. If not, then you can investigate your LDL particle sizes.

  22. As a layman I am trying to grasp the value of the LMR test. I ordered it on my own and I need assistance. I already did the test ratio of TG/HDL 78/55 = 1.3 Sounds good right? Here is LMR report:
    NMR report shows;
    LDL-P = 2108 High
    LDL-C = 171 High
    HDL -C = 55
    TG = 72
    Small LDL-P = 588 High
    TC = 240
    HDL-P Total = 29.2 Low
    LDL size = 21.1
    HDL size = 8.6 Low
    LP – IR Score = 37 Ref Range less than 45

    So I am confused. Sounds like a horrible LMR. I am below 50Carbs daily and only carb back load for events the next day like Ice hockey game. What are your thoughts?

  23. Hello! I am a 62-year old woman with the following blood lipids results:
    Total C = 296
    HDH = 66
    LDL = 216
    Tri – 71
    My Tri/HDH-C ratio is .93 so this is pretty good – right?

    My VAP scores showed a total HDL of 71, with only 19 mg/dl composed of large HDH particles. Close to 52 mg % of total was HDL-3 – smaller and more dense , less protective particles. What about the size of my LDL’s? I follow a very low-carb eating style and feel great- even with my hypothyroidism! I went off statins after reading the Grain Brain book and want to stay off them because the muscle cramps were so very severe.

    I am scared of my numbers! Am I right in staying low carb even with such high total cholesterol? My Dr. is begging me to go back on statin drugs. Please advise!


    1. what your doctor needs to look at is non-LDL cholesterol because it’s a better predictor of cardiovascular risk than the rest of the lipid panel.

      most doctors ignore that number (non-LDL) because they were never taught what it means. it’s all the intermediate particles (size-wise).

      cholesterol is like a passenger that can either get into either an LDL “car” or an HDL “car”. the problem is not so much the number of passengers but the number of cars — i.e. particle number (LDL-P).

      you may have high cholesterol but a low particle number.

      cholesterol is an outdated way of looking at things. it’s an OK screening test.

      what you need to worry is LDL-P and NON-fasting triglycerides.

      there’s more, but it’s late…. there’s plenty of stuff to read out there 🙂

      all the best, Carol

  24. Had two tests done on same blood sample & same day and sent to separate labs. LDL 89 or so on one lab and 197 on the other! LDLP BAD 2400 or something.

    BUT, I have APO-E 2/2 and that is really bad for carbs/sugar. APO-E should be checked.

  25. Kindly suggest on my problem
    Age – 36 , Male & I am Veggi

    TCholesterol – 284
    LDL – 204
    HDL – 49
    TG – 205
    LDL/HDL =4.2
    TC/HDL = 5.8
    VLDL = 42
    GGT = 83
    SGPT = 58
    Dr asked me to take first Udilive -300mg and then go for test. I did the same above is the result( not much changes ) what i should do now. I am worried at a lot.
    Following proper cholesterol free diet since last 2 months.

  26. Hi my name is Christina and I’m a 41 year old mom of 6 kids (2 natural, 4 c-sections) I was finally diagnosed last year with severe Hashimoto’s, Fibromyalgia and Celiac disease by a Naturopath after years of Dr’s telling me my uncontrollable weight gain and numerous other symptoms were all in my head and kept pushing me to take antidepressants.

    We’ve since discovered a strong genetic link as my Grandmother, Mother, Aunt, and sister all have since been diagnosed with Hashimoto’s and various autoimmune diseases by their Dr’s. since my diagnosis.

    I have been gluten free for a year, and dairy free for 8 months. I am mostly Paleo (and feeling much better) but do have a GF grain once a week during our family dinner out. My Dr has me eating 1/4 cup organic coconut oil daily, which I add to my smoothies.

    I just got back my latest lab results today and I’m a bit confused. I’m wondering if you had any thoughts on my results. For back ground info I’m 6 FT tall, 211 LBS (before diagnosis and adapting Paleo I was 245 LBS)

    CHOLESTEROL, Total 169
    LDL SMALL 107
    LDL MEDIUM 247
    HDL LARGE 4842
    LIPOPROTEIN (a) 29

    The lab said that I am in the high risk category for both my HDL CHOLESTEROL and my HDL LARGE. My LDL-CHOLESTEROL, CHOL/HDLC RATIO, LDL MEDIUM AND APOLIPOPROTEIN B are listed as a moderate risk. These same labs this time last year were all within normal range, so I am confused why after losing weight and adapting a mostly Paleo lifestyle they have gotten worse? Any ideas?

  27. Any update on advanced lipid testing? Is it ready for prime time?

  28. Mark, have you looked into the Ion Mobility testing method from Dr. Krauss. If yes – can you comment on how it is comparable to the other 4 methods of testing you explained in this article?