Monday, June 15, 2009

Show Me Your Lipids!

If you have great HDLs please let me know your HDLs and lipid panel!

If you have an LDL particle size and count, as Robb Wolf suggests getting at his Crossfit Nutrition certifications (yes, I am certified . . . be scared), that would be bangin as well...

56 comments:

MikeMartial said...

This is taken from a post I made on Sherdog, a MMA forum. The complete post can be found here:http://www.sherdog.net/forums/f15/paleo-eating-blood-lipids-other-shit-one-year-later-886517/#post27425186

Last year:

Chol: 5.06mmol/L (195.8mg/dL, multiple by roughly 38.7)
HDL: 1.70
LDL: 3.1
Triglycerides: 0.6
Chol/HDL ratio: 3.0

My LDH and CK (markers for muscle damage)were through the roof, so I had those re-tested. On looking back through my training log, I had done heavy DL two days before the testing, and MT the night before the testing.

This year:

Chol: 5.67mmol/L (norm less than 5.21)
HDL: 1.80 (norm 0.9-1.6)
LDL: 3.6 (norm 2.0-3.4)
TG: 0.52 (norm less than 2.31)
Chol/HDL ratio: 3.2 (norm less than 5.1)

Dr. B G said...

WOW Mike that is great!

For those in the U.S.:
HDLs = 70 mg/dl
TGs (* 88.57) = 46 mg/dl

Awesome job! Yes -- I often see CPKs elevated after heavy lifting -- generally the lab guidelines are consider halting these activities 24-72 hrs prior to testing.

So... you
--consume 4 eggs daily cooked in coconut oil
--HIIT and no chronic MMA training
--and low carb varied 10-22%
--reduced BF% probably < 10% now (?) and added 5# LBM

That is WONDERFUL. btw great blog!

Thank you,
G

MikeMartial said...

Thanks Dr. BG! I have to say your blog is by far one of the most influential on my habits---as well as Robb Wolf's and Dr. Davis. Robb was the one who lead me to yours, and he basically completely changed the way I eat! Taking his nutrition cert this summer, can't wait.

Keep the killer-super-sexy-dangerously-smart posts a-flowin'!

PS: what's your thoughts on the accuracy of TG/HDL ratio versus actual particle size? Dr Sears mentions this here:

"How can you tell which type of LDL you have? All you have to do is determine your ratio of triglycerides to HDL cholesterol, which would be found as part of the results of your last cholesterol screening. If you ratio is less than 2, you have predominantly large, fluffy LDL particles that are not going to do you much harm. If your ratio is greater than 4, you have a lot of small, dense LDL particles that can accelerate the development of atherosclerotic plaques – regardless of your total cholesterol levels."

My numbers look like this:
* 2007: TG 53.16, LDL 119.97, HDL 65.70
* 2008: TG 46.07, LDL 139.32, HDL 69.66
So, going by that, the ratios lean well towards an abundance of large fluffy LDL.

rosebud said...

I am a 62 year old man who was diagnosed with cad in Sept. and got 2 stents. In nov was tested. results - total c - 187, hdl - 71, ldl - 107, tri - 50, ldl part size - 21.2 pattern a large, hbiac 4.7, c reactive protein - .2. How the hell did I get cad.

chris - fitnessfail.com said...

Two years ago (pre Paleo):


HDL 54
LDL (calculated) 106
Trig 50


Just under one year ago:
HDL 70
LDL (calculated) 91
Trig 40


Don't have a count or more accurate readings. I was very happy at the change in HDL and Triglycerides though. I eat Paleo + Dairy, but do take some liberties with it. (wine, pizza, ice cream)

Anonymous said...

Last year, my HDL was only 41, so I supplemented with Niacin, after reading Dr. Davis's post on that.
Last year:
HDL 41,
Triglycerides 37
CRP 3.3
(I forget the others, they weren't remarkable)
This year:
HDL 79,
tryglycerides 37
CRP, less than 1.0
I think a low carb diet also helped.
Very happy with the increase, esp in HDL, and the reduction in CRP.

Jeanne

Anonymous said...

I'll post anonymously here. Triathlete, so Mark's Daily Apple Chronic Cardio junkie...

2/2009:
Total = 211
HDL = 111
LDL calc = 91
Triglycerides = 47

Diet: Pretty high calorie, breakdown is about 40% carb, 40% fat, 20% protein. Meat, fish, eggs, coconut oil/milk, almonds, avocado, EVOO, lots of veggies, some fruit, potatoes and yams, some oats and rice. No wheat, very limited sugar, chips and salsa vice every couple of weeks.

3/2007:
Total = 180
HDL = 62
LDL calc = 99
Triglycerides = 97

Diet: Very low fat vegan, Ornish/Esselstyn diet as part of the Engine2 pilot study. Lots and lots of grains, wheat, soy, veggies, fruits.

Anonymous said...

Hey Rosebud,

Your lipid numbers look pretty darn good, but lipids aren't the only cause of CAD. Since your Hb1ac is good, I am guessing you don't have high blood glucose levels...

Did you check for lp(a)? Homocysteine? Fibrinogen? Blood pressure?

Life Extension lists 17 independent risk factors for heart disease:

http://www.lef.org/magazine/mag2009/may2009_Heart-Attack-Risk-Factors_01.htm

Let us know what you come up with.

JohnM

Think115 said...

I'm new to this blog. I recently had a blood panel done and I'm trying to figure out the implications of my results. I'd appreciate any feedback.

Cholesterol 213
Triglycerides 42
HDL-Chol. 64
LDL-Chol. Calculated 141
VLDL-Chol. Calculated 8
LDL/HDL 2.2
CHOL/HDL 3.3

The doctor started me on 1000mg niacin. He wants to start statins in 6 months if my LDL doesn't come down. I don't think I want to do that.

Dr. B G said...

Mike,

You're gonna luv the cert! The best part for me was talking about my fav subject... F O O D... *haa* and being in a roomful of HAAWWTT Paleo bods didn't hurt either.

Heard he's gone pretty low carb since my cert in October. I msg'd him yesterday to get his and Nicki's labs -- nothing recent -- so I have to wait to see how the Paleo stud is doing. He talked a LOT about coconut oil for Xfit fat blocks... and being totally lame-o I just sat on it until recently. Coconut oil has made BEASTLY differences for me.

Granted no weird CETP-deficiency your TG/HDL ratio = 0.65 appears bloody RIPPING! Large and phat! I was gonna post on the ratio soon. Thanks for bringing it up. Here's a preview. Yours is definitely TYP-worthy...


TYP Goal v2.0(Dr.BG):
TG/HDL Ratio = 0.60 or 60 %
for predominantly Pattern A+++ large buoyant LDL particles
(UK: 1.3; U.S. standard 0.6)

I think I am a little more aggressive than Sears for optimal longevity and vitality (and regression).

GRAPH

Dr. Sears:
TG/HDL Ratio < 2.0 ideal Pattern A
TG/HDL Ratio < 4.0 non-ideal Pattern B 'bad'

The Omega Rx Zone by Dr. Sears really affected me and he is truly wonderful. The Japanese have enviable ratios of 1.5. Having a ratio of 5.0-10.0 confers like an extremely high risk of heart attack of within 5 - 10 yrs. These ratios however no longer seem to 'work' when someone is on synthetic medications (like statins or fibrates), I've observed. Iatrogenically, the predominance of small dense particles still may still be there. Sears talks about the deceptive value of statins being like the 'powerful Oz' and his own severe premature heart disease family hx HERE.

Thanks, G

Dr. B G said...

Hi Rosebud,

I'd concur with JohnM -- one can totally appear 'healthy' on the outside but when there is an internal mileau of inflammation, plaque unfortunately has a chance to initiate and grow.

Here is a great list of risk factors.
Emerging CV Risk Factors (Pahor, Arch Int Med 1999)

And this post is devoted to how we treat most of these at Track Your Plaque.
Plaque Eradication: Part Deux


A couple of things you might want to consider with your (hopefully enlightened physicians) are:
--potential food allergens (wheat, gluten, casein, diff foods even nightshades like tomatoes peppers etc, egg whites, etc)
--vitamin D deficiency is easily corrected
--coagulopathies -- have you ever had a DVT or PE on a plane or anytime?
--heavy metal poisoning (play with mercury as kid? excessive dental fillings?)
--low thyroid (is your TSH > 1.0 and/or your free T4 < 1.5 or is your basal temperatures < 98.2 in the AM?)
--HIGH CARB LOW FAT DIET which predisposes toward small LDL-P though on paper your #'s appear fine (though that particle size is good! but I can't really tell from the rest unless I know diet, BF%, supplements and NMR results)

Well, please let us know what you find out and inform us of your progress! For EBT one to two coronary vessels are still scannable (w/good technical skills). You can still track the coronary calcifications to see if your heart program is working for you toward your goals (zero CAC score).

Good luck!
-G

Dr. B G said...

Chris,

WOWO those are great labs and a definite improvement evident in the MASSIVELY higher HDLs! (and I betcha if you re-rechecked they may be even more phenomenal esp if your vitamin D is optimal 60-80 ng/ml)

Looks like you and SOG had a great climbing time!!

I can't get over how O M G YOUNG and health-aware y'll are... Keep up the excellent work!

-G

Dr. B G said...

Hi Jeanne,

Yes -- isn't that funny? The Trigs were spectacular but something was amiss, right? I take a little niacin too (slo-niacin 1g prn 4-6x per month when I remember) -- it has antiviral, anticancer, antioxidant, antiwrinkle and anti-aging benefits for me.

I love the 200% increase in HDLs! That is incredible!! I agree -- I believe diet contributes 80-90% to changes like this.

hsCRP is so finicky... even seasonal allergies raise it so checking it at different seasons yields diff results but low carb diets and vit D have been shown to lower hsCRP.

Great improvements! I really appreciate your sharing them...

-G

Dr. B G said...

OK Cardio Junkie *haa*

That HDL is definitely cardio-protective! Another 200% increase from baseline here today! Very VERY nice changes. It's amazing how just tweaking the diet induces such profound changes in inflammation and the risks that go with it. I hope you have noticed better athletic gains, performance, speed and mental clarity with the change from the wheat, high HIGH carb, fatty-acid-deficient pilot study?

If you have a family history of any heart conditions, however, you may also want to consider an NMR and EBT to verify the program is as optimized as possible. Tri training is grueling as are the events themselves (though I wouldn't know coz I've only done sprints so far -- but gonna try a real soon w/ a totally short 800m swim coz I'm a WUSS). Excessively high blood presures for sustained periods of time combined with IL-6 and other inflammatory consequences can sometimes be the trigger for plaque in younger people.

You have a vice?!? That's it?? *ha* Even Mark MDA admits to a beer or something more wicked...

-G

Dr. B G said...

Hi Think115,

How are ya tolerating that niacin?

Flushing?

That is a particularly high dose to start off with, isn't it?

Niacin helps to
--raise HDL 20-50%
--lower TGs 30-60%
--lower LDL 10-30%

The calculated LDL as you are probably aware is somewhat irrelevant in generally, but especially when a pattern like yours is displayed (high HDL, low TG) that indicates a preponderance of large buoyant LDL particles (or Pattern A). Was your physician concerned due to heart family histories? Any other risk factors?
--pre-diabetes
--borderline or high BP
--age greater than 60? (btw statins have no clinically benefit after age 80)

Did I just read that right? That is quite progressive though of your MD to consider starting niacin first!!!!! Gotta give him credit!

-G

Think115 said...

Hello again.

I am a female, 52 years old, 5' 3 1/2", 122 lb. Blood pressure: 80/58.
No family history of heart disease.
Fasting blood sugar was 70.

At the time of the blood panel I was taking 1000 IU of Vitamin D in gel cap form.

My doctor was very concerned about the total cholesterol being 213, and LDL being 141.

The 500 mg niacin I take in the morning makes me flush and tingle a little; the 500 mg at night does not. (My doctor says he takes niacin daily, too.)

I've now increased the Vitamin D to 4000 IU daily. I've also added 2 Tbsp Liquid Omega-3 Deep Sea Fish Oil daily, and some Vitamin K2.

I'm so grateful for your comments as I didn't know whether to feel ok with my lab results, or to freak out. Thanks so much.

Dr. B G said...

Think115,

Your risk based on everything you have listed is very low for events. My vital stats are nearly identical to yours *haa*! I also take about 3-6 grams of EPA DHA omega-3s as well.

The thing I love right now is fermented COD LIVER OIL from greenpastures.org.

Of course in addition to everything else I take.

Fermented CLO has many of fermentation products similiar to kombucha, stinky cheeses, black bean sauce and natto and many other great antioxidants:
--MK4 and other MKs (not sure about MK7 but it is REALLY stinky -- if I get it on my hands FERGIDET the smell nauseates me ALL day)
--quinones like coenyzme Q10
--vitamin A
--vitamin D (not enough)
--vitamin K1 K2 (MKs)
--omega-3s EPA DHA

(Stephan takes it too *wink*)

-G

Laurie Cags said...

Hi -
Please tell your readers to help people with diabetes using carb restriction by signing the Metabolism Society's petition to the NIH. Here's the link:
http://www.thepetitionsite.com/1/get-the-nih-to-acknowledge-the-existing-science-and-fund-more-research-by-the-experts-who-have

Thank so much!
Laurie

Kateryna said...

Female: Age 59, 5'4", Wt 230 pounds

Lipids done November 2008 after low-carbing and not watching egg or butter, lard, meat consumption for 5 years:

Total: 182
HDL: 65
LDL: 95
Trigs: 104
Ratio: 2.6

Those are the only values showing on my lab sheets.

Think115 said...

Hi Dr. G -

Thanks so much for your reply. I'm now much less worried about my total cholesterol and (calculated) LDL.

I will definitely consider the fermented cod liver oil. I guess I'll just have to hold my nose and take it. :-)

One last question, if you please: assuming a low risk for a cardiac "event" (based on my blood panel and vital statistics), is there a downside to continuing the daily 1000 mg of niacin?

Thanks again - from the bottom of my heart!

Dr. B G said...

Katyrena,

AWESOME! If you have been losing wt -- the labs will reflect higher HDLs approx 6mos later. Keep up the good work!

Our TYP goal is less than 60. You notice mine is not there right now? It is reflective of carb metabolism, insulin resistance, hormone issues, and exercise.

-G

Dr. B G said...

Hey Think115,

Recently I had a few teeny tiny blood vessels breaks on my face... didn't know what it could be. So, it's either the fish oil (coz I've grown gills now) or the niacin. I've had one observation of skin effects with niacin, but again that person takes the combo like us.

At doses greater than 250mg daily it might not hurt to get
--uric acid (gout)
--homocysteine (methylation status; inflammation)
--ALT AST liver tests
--fasting glucose

Rarely niacin may raise these. Hope that helps!
G

Think115 said...

Hi Dr. G -

I will definitely ask for those tests the next time I go in. So far I'm feeling fine, and haven't noticed any broken blood vessels, or anything else.

Cheers!

EverKang said...

As of about 9 months ago, I made a serious effort to get off of starches and sugars, primarily to rebalance my gut flora, which showed in my lipid scores, taken 6 months ago:

HDL: 94
Trigs: 79

I don't have my Total or LDL numbers handy, though I think LDL was about 120.

Since then, I've moved even more toward paleo-style eating (I have starch two or three times a week, typically beans, hummus, or the twice-a-month tacos on corn tortillas), so I expect that my next numbers will be at least this good. My trigs were a bit higher than I would have liked (they have run as low as 46). I may have had a particularly starchy meal the night before I tested; I don't remember.

Sue said...

Here are my dad's results. He is diagnosed as as type 2 diabetic but is on no meds. Docs wants to put him on statins and now ezetrol (ezetimibe). I think its also known as Zetia. He is 65, never had a heart attack.

cholesterol 6.3mmol/L (<5.5)
triglycerides 2.2mmol/L (<1.8)
HDL 1.2mmol/L (1.1-3.5)
Coronary risk ratio: 5.4 (<3.5)
LDL 4.1mmol/L (<3.5)

What do you think?

Dr. B G said...

WHOA Great #'s EverKang! Yes one meal of high carbs can trigger the Trigs to stay high. I believe that is a pretty quick response after diet changes.

Gut flora are our little microscopic ZOO. Very important to keep them healthy and happy so that proper recirculation/ recycling of bile acids occurs. I advise nearly everyone to get some digestive enzymes and/or probiotics if they need it. Vitamin A doesn't get absorbed without gut flora activity. I'm glad you have a happy gut now -- Maybe that translated to your whopper HDLs!

-G

Dr. B G said...

Hi Sue,

The lipoproteins that your Dad displays is significant for a pattern of small dense LDL and insulin resistance. TYP and Paleo would be ideal to address the issues and shift to a more heart healthy pattern
--we desire a preponderance of large anti-atherogenic LDL
--reduce the small LDL to nothing
--raise the good HDL cholesterol (you can see it is at the bottom of the UK normal range)

Consider: exercise (gentle and slow to start of course), low carb diet, gluten elimination, veggies, wild seafood/fish, pastured poultry and meat, some almonds, some berries and grassfed butter/cream (if not casein allergic), coconut oil liberally, dark chocolate, etc.

Thyroid is typically an issue for EVERYONE. Consider getting this optimized as well for heart function, BP, glucose and cholesterol.

Vitamin D? omega-3? You know the drill!!

Would love to hear about his transformation later :)

-G

Hans said...

Cholesterol: 8.3mmol/L (320.46mg/dL)
HDL: 2.7mmol/L (104.25mg/dL)
LDL: 4.28mmol/L (165.25mg/dL)
Triglycerides: 0.6mmol/L (53.1mg/dL)

LDL calculated using Iranian Formula.

I love your blog and your writing.

Dr. B G said...

Hans,

Spectacular!

-G

Matthew said...

CALORIE RESTRICTION SINCE I WAS 18 (am now almost 25).

Total : 3.7 (144mg/dl)
HDL: 1.5 (59mg/dl)
LDL: 1.9 (74mg/dl
Triglycerides: 0.6 (53mg/dl)
Total chol / HDL ratio; 2.5
HDL : Total chol ratio; 41%

hsCRP - 0.2 mg / L

TG's usually go between 0.4 (35mg) to 0.6.

Not only has calorie restriction given me zero risk for diabetes, heart disease, stroke, cancer... It also seems like I still haven't aged and still look around 16-17 :D

George must lose weight said...

Hopefully you're still responding to posts on here as it's been a while (apart from Matthew's)

In June I was diagnosed as pre-diabetic. My blood test results were:

Total cholesterol: 6.2 MMOL/L
HDL: 1.2
LDL: 3.9
Triglyceride: 2.47
Plasma glucose: 5.6
Fasting glucose: 7.1
Plasma sodium,: 142
Plasma calcium: 2.44
Plasma potassium: 3.2
Plasma corrected calcium: 2.34

I am 54 and at the time of the test I weighed 16st 4lbs.

I am male.

Since then (six weeks later) I have lost weight through exercising 5 times a week and eating fewer carbs. Nonetheless I eat 7 pieces of fruit a day etc

My weight is now 15st 8lbs.

About a week ago i started reading about Paleo, Sat Fat's are good etc etc type diets and jhave been investigating ever since.

So, I have a question. Rather than just switch completely to the Paleo-type diet - especially given the limitations here:

http://articles.mercola.com/sites/articles/archive/2000/09/03/rea-interview1.aspx

really I should have blood tests etc done again.

In addition to the above are there any other ones I should have?

Thank you very much for your time

George

Dr. B G said...

George,

The mercola link is not working for me -- sorry can't comment more.

Is there premature heart disease in the family?

Baseline labs typically advised are:
LDL particle counts and sizing (pattern "A" is desirable)
lipid panel
thyroid panel
electrolytes
liver and kidney panel
diabetes panel -- Hgba1c (ideal less than 4-4.5)
homocysteine
Lp(a)
uric acid
hormones -- insulin, T E P preg DHEA-s, cortisol (via salivary are the most accurate)


Fruit is pretty high carb -- may increase the Trigs and lower the heart protective HDL fractions. We limit fruit at TYP for these reasons. Berries infrequently are usually fine but otherwise fruit literally causes diabetes, heart disease, fatty liver and probably triggers many autoimmune diseases.

Your past labs indicate elevated insulin.

I'm certain they are much better with any semi-Paleo approach! Keep up the strong work!

-G

George must lose weight said...

Thank you for your comment.

The Mercola link has to be cut and pasted as it covers two lines.

I tried it just now and it works...

What is 'T E P preg DHEA-s,' please?

In UK homocysteine is rarely done.

On another topic I did a search on your blog for female pattern baldness but there was nothing. Aside from minoxidil have you any other recommendations? My wife (she is the person with the female pattern baldness) has had thyroid tests.

Thanks once again

Dr. B G said...

Warning -- you may become the carnivore/omnivore you were meant to be!

http://www.carnivorehealth.com/main/2009/5/17/diseases-of-civilization-hair-loss.html

George must lose weight said...

No history of heart atack.

I will be asked this so it's better for me to ask here - why blood tests for this:

Baseline labs typically advised are:
LDL particle counts and sizing (pattern "A" is desirable)
(what's pattern a)

electrolytes
diabetes panel -- Hgba1c (ideal less than 4-4.5)
Lp(a)
uric acid
hormones -- insulin, T E P preg DHEA-s, cortisol (via salivary are the most accurate)


Many thanks again.

Thanks for the hairloss link...I'll investigate

Matthew said...

DR B.G. I'm still trying to read some of your previous posts on your blog. Interesting... even though I don't agree with all of it :-)

High GI frutis can lower HDL and increase TG's true, however *fruits* are still an important part of the diet I think. I eat quite a bit of fruit but mostly in the morning. Like apples, banana, different berries, mango etc as part of a green smoothie i make (with spinach or kale).

My last glucose test came back at 77mg/dl and my Insulin 1.4 mIU/ml.

Super insulin sensitive. So it's possible to have very good health biomarkers on high carb ;)

Dr. B G said...

George,

These are the factors most commonly associated with CAD (coronary artery disease). They are just surrogates for inflammation which is the real cause of CAD (and cancer and mental illness).

Hope that helps!




Matthew,

Of course you are super insulin sensitive! That is a lot of fructose though... you are young and the pancreas hasn't started to poop out yet. Morning fruit and carbs for the rest of us however is the best way to raise insulin (inflammatory) and glucoses (glycosylating damage). Thank you for your visits :)

-G

George must lose weight said...

Hi

What I really meant was if I just give my Doctor this list:

Baseline labs typically advised are:
LDL particle counts and sizing (pattern "A" is desirable)
(what's pattern a)

electrolytes
diabetes panel -- Hgba1c (ideal less than 4-4.5)
Lp(a)
uric acid
hormones -- insulin, T E P preg DHEA-s, cortisol (via salivary are the most accurate)

will he understand them? Sometimes 'acceptable shorthand' (eg T E P preg) for one party in anothe rcountry is not understood by another party in another country.

For example I asked for vitamin A and D testing for my wife (hairloss) and the Dr said 'why?' I muttered about 'vitamin deficisncies' and she just replied 'eat a balanced diet'.

So, really, I need to be able to say 'here are the tests, in full, I'd like to have and if they are not done on the National Health service, then I will pay' AND when the results come, to be able to interpret them (may I post them here?)

thank you!

Dr. B G said...

George,

I have definitions for most of those here:
http://drbganimalpharm.blogspot.com/2008/04/passion-for-eradication-part-deux.html

Your doc ought to know the rest Testosterone Estrogen Progesterone DHEA Pregnenolone etc

Good luck and let us know how it goes.

-G

Nick W said...

Hi Dr. G,

I found your blog via Robb Wolf. This is my first comment, sorry to be rude and ask for help straight off the bat but I just had some blood results yesterday that I hoped you might comment on.

I'm 33yo, male, and a type 1 diabetic. I'm eating pretty strict low-carb paleo diet with a fair amount of sat fat, taking my fish oil, and exercising. I'm pretty lean (visible abs etc.) and my lipids have always been fine in the past.

My latest results were:

Total Cholesterol: 5.9 mmol/L (approx 228)
HDL: 2.4 mmol/L (approx 93)
LDL (calculated): 2.5 mmol/L (approx 96)
Trigs: 2.2 mmol/L (approx 195)
HbA1C: 6.2%

In the past I've had similar numbers except my trigs have ALWAYS been 0.7 or below, so this is a massive jump.

My HbA1c is the best it's ever been, and I attribute that completely to the diet. However, my doc is fixated on the high trigs / total cholesterol and is trying to advise I change my diet again to include more carbs and less fat. Obviously I'm not going to do this, but I'd appreciate your opinion on whether or not the high trigs are anything to worry about, and whether there's anything I could / should do to lower them.

For the past month I've been trying to put on some mass so I've been eating a caloric excess; could that be the reason for the rise in my trigs?

Thanks a lot for any insight you can give, appreciate the help! The A1C result was excellent and had me thinking I'd cracked the whole diet-exercise thing, but the high trigs have me a bit worried...

Dr. B G said...

Hey Nick W,

I love Robb! I had never really heard of any clinical disease reversal stories until I found him and Xfit (and TYP). Now I am a BELIEVER.

You are doing GREAT in my opinion -- honestly, one Trig lab test may not be relevant b/c even 1-2 high carb meals or rapid body fat loss transiently elevate the Trigs. The 0.7 mmol/L and below are good goals to maintain longterm. There is no rush. Best to wait until your body recomposition stabilizes for at least 4-8wks, then to test. (However, for Crossfit newbies and those embarking on lower carb Paleo diets, after 4-6wks, AWESOME results and particle sizes are typical and evident. When MASSIVE body fat loss or body recomposition occurs, then the labs get screwy.)

If thie lab HgbA1c is one of your best, then don't worry at this time. As you know even excess protein (for increasing lean muscle gains) will trigger a temporary Trig response. Have you read Dr. Bernstein 'Diabetes Solutions'? He is Type 1, in his 70's, mod-high saturated fat/low carb, and no (repeat, no) T1DM complications at all.

Do you use an insulin pump?

Thanks for sharing your progress!

-G

Nick W said...

Hey,

Thanks for the swift response, you've put my mind at rest! I've been eating a lot of protein (it's hard not to when you're trying to put on mass and limiting carbs...) so that could be the cause. Like you say, I won't read anything into the one result, I'll see how things stabilise out next time.

I've read Bernstein and learned a lot from the book. I don't agree with everything in there (not a fan of his exercise recommendations or his reliance on artificial sweeteners etc.) but 95% of the book made perfect sense and really resonated - it was that plus Robb's stuff that turned me on to a low-carb paleo diet, and the results are fantastic (that A1C has dropped from 7.6 to 6.2 in about 11 weeks of paleo; I fully expect it to go ever lower). And yes, Bernstein's control is an inspiration!

I'm not on a pump, but might blag my way onto one next year. Pumps are rare in the UK, but the diabetic specialist at my local hospital is starting a pump clinic there; he doesn't necessarily think it'll help my control but is willing to put me on one for a 3- or 6-month trial, which I may well take up. If he can swing a CGMS as well I'll be over the moon...

Thanks again for the feedback, it's really appreciated.

Cheers,
Nick.

Dr. B G said...

Nick,

You are VERY welcome!

Does Bernstein talk about Taurine, a protein supplement? Taurine is kinda devoid in our diets, being a heat-labile essential amino acid found in only meat/seafood/eggs sources and raw pastured goat milk. We need to eat (or drink) it because we don't synthesize it.

Taurine is depleted also in autoimmune conditions, stress, heart failure, heart conditions, hypothyroidism, etc. In the medical literature it reverses ALL diabetic complications including neuropathy. It also improves glucoses, BPs, heart function, and shifts lipoproteins to more buoyant particles. The dose used in clinical trials is 3000mg twice daily (bulk powder: 3/4 tsp twice daily)

Do you get enough vitamin D? As you are probably aware the research has shown that both gluten exposure and vitamin D deficiency prior to age 12mos is highly associated with Type 1 (like other autoimmune conditions, like my Hashimoto's).

I agree, Paleo is the only way to go!

-G

Nick W said...

Hey,

There was no mention of taurine supplementation in Bernstein's book, and I'd not heard of that before. Sounds like a no-brainer - I assume it's safe for long-term consumption at those levels?

I probably don't get enough Vit D - I don't supplement it, and I live in northern England so the winters have pretty short days and little sunlight. I'll get onto that straight away as well. Are we talking just a standard 400iu tablet per day, or more?

Are there any other supps I ought to be taking? I'm on a high dose of fish oil already (about 10g EPA/DHA per day); should I be looking at any others? Magnesium? Potassium? If so, what kind of doses are we talking?

Sorry for the barrage of questions, and apologies if this is already covered in the blog; I haven't had time to read through everything on here yet (I'll get there though!!!)

Cheers,
Nick.

Nick W said...

Hi,

Just wanted to say sorry for the dumb Vit D question on the last comment - should have had more patience and spent all of 5 minutes reading your site for the correct dosages etc.! Feel free to wipe it if you prefer.

I'd still be interested in any other supps you think worthwhile for a T1D though - so far I plan to continue the high-dose fish oil, and add taurine (3g twice per day) and Vit D (will get a blood test for current levels of course, but would be amazed if I'm not deficient). Anything else you think I ought to be gunning for would be great.

Thanks again for the wealth of information on the blog - I'm reading through the entire thing slowly, it's an absolute goldmine!

Cheers,
Nick.

taliesen said...

Fantastic blog, just found you! Over the moon!

My recent panel:

Total: 8.3
HDL: 1.81
LDL: 6.0!!!!!!
Trigs: 1.0

Er, please tell me my astronomical LDLs are the harmless, fluffy and cuddly sort?!

I am male, 33, 70kg, 188cm, don't exercise (don't judge me!)

Diet: animal fat, animal protein. Lots off eggs. Heavy cream in my coffee. No fruit... An onion here, a pepper there. 85% chocolate. Some days zero carb I guess. Not supplementing yet with omega 3. I don't drink or smoke but have recently come off 20mg/d Citalopram which I was on when I had the tests.

Dr. B G said...

Hey Nick!

You have wonderful questions! I think u r amazing and have achieved muscle mass increases that Dr. Bernstein has failed to achieve. It is VERY very impressive. You and Robb should write a book later! Seriously...

No doubt you are in the UK and totally vitamin D deficient. We generally start dosing at 4000 IU in the morning (can cause insomnia if taken at night). Dosing is about 1000 IU per 25 lbs of body wt (or about 10 kilos). Fatty foods, grassfed meat might have some D but usually it is pretty negligible. I'm only about 120 lbs but I need about 4000 to 8000 IU to keep my asthma away and the blood level at 60-80 ng/ml.

The blood level for Mag will tell you what you need as well. Goal is 2.2 to 2.3 mg/dl. Cramps? Constipation? You are probably depleted, if so. We generally start with 1-2 caps daily. My athletes at my Crossfit like ZMA.

Do you eat pastured organ meats? Do you make a lot of broths, stews with pastured beef or pork bones? It is great stuff (may stimulate progenitor stem cells). If not you may want to consider getting some K2 and vitamin A. I wonder what Bernstein says about these?



Here is some Taurine info. Sorry had to put on to a jpeg file so hopefully you can blow up and read it.

Taurine monograph info:
Page 1
Page 2
Page 3
Page 4


Nutr Hosp. 2002 Nov-Dec;17(6):262-70. Taurine: a conditionally essential amino acid in humans? An overview in health and disease.
Lourenço R, Camilo ME.

Taurine, a sulphur containing amino acid, is the most abundant intracellular amino acid in humans, and is implicated in numerous biological and physiological functions. This comprehensive overview explores areas, from its characterisation to its potential clinical benefit as a conditionally essential amino acid and a pharmaconutrient. In healthy individuals the diet is the usual source of taurine; although in the presence of vitamin B6 it is also synthesised from methionine and cysteine. Taurine has a unique chemical structure that implies important physiological functions: bile acid conjugation and cholestasis prevention (GALLBLADDER), antiarrhythmic/inotropic/chronotropic effects, central nervous system neuromodulation, retinal development and function, endocrine/metabolic effects and antioxidant/antiinflammatory properties. Taurine is an essential amino acid for preterm neonates and is assured by breast milk. Specific groups of individuals are at risk for taurine deficiency and may benefit from supplementation, e.g. patients requiring long-term parenteral nutrition (including premature and newborn infants); those with chronic **hepatic, **heart or **renal failure. Further studies are required to determine the benefits of replenishing taurine pools as well as the need to include taurine routinely in parenteral nutrition regimens. PMID: 12514918

Can u email me? I have some articles for u.

-G

Dr. B G said...

taliesen,

Not bad dude!! Hope your mind is healed! The trigs could be lower -- we shoot for < 0.5 for optimal health and longevity. It is related to carb intake, inflammation, and exercise.

E X E R C I S E . . . *haaa*

Otherwise, you appear to be on the optimal diet. The HDLs and LDL rock. I'm sure they are pretty fluffy but with the Trigs over 0.4-0.5, some may not. Hard for me tell.

Fish oil n-3 pufas, vitamin D and some spices/antioxidants and exercise are all natural mood elevators. I used to have seasonal affective disorder. You know, weepy during commercials at wintertime. Irritability. Blah blah blah. Vitamin D and fish oil took care of it. (my hormones are almost better -- that also jacks things up).

Would love to hear your progress later -- keep up the excellent work! Thank you for the kind comments!

(Citalopram is one med that cannot be abruptly discontinued -- only gradually tirated down to prevent withdraw. Consider of course discussing all changes of course with your MD.)

-G

taliesen said...

Thank you ever so much for replying and for your instructive and kind words!

Yes, my mind is much better now, and I tapered down slowly to 5mg/d - now I'm 5 days SSRI free! incidentally, I did a quick google:

http://www.checkdrugsnow.com/EffectsDetail.do?dname=Celexa&sid=11806&eid=7311#relse

I've only been truly LCHF for 4 months, which was actually when I also started the meds. Will test again in 6 months or so.

Just bought a few months worth of fish oil caps (at 5mg/d) today! Exercise it is from now on! Think the meds made me somewhat lethargic...

Thank you again!

p.s. would loooove to read what Animal Pharm thinks of coffee - seemingly every low-carb Paleo person's legit drug of choice! (Mine too haha!)

Nick W said...

Wicked, thanks again! I've sent a mail through, let me know if it doesn't land.

I've started on the Vit D as of yesterday (started at 7,200iu as I'm about 190lbs right now - and yes 7,200 a weird number, but the best gels I could find in the UK are 2,400 each...) I've also got some taurine and started in at 3g twice per day. It'll be a while before I can get tested for magnesium levels; is the best approach to simply wait and see what the results are, or to start on ZMA straight away? I believe there are some potential side-effects if you push the mag levels too high (is that correct?), and I'm not experiencing any cramping, constipation etc.

Organ meats... I eat them occasionally but not regularly, and I don't make many stocks or stews (I really should though, they're delicious!) In fact you've sparked me off, think I'll give the local farm shop a call and see if I can bag any spare bones they have... and maybe some spare pig fat to render some lard...

Err, sorry I digress - you've made me hungry! Getting back to Bernstein, what I can find him saying is:

- He recommends Vit E at 400iu - 1200iu per day as being protective against glycosylation of proteins and lowering insulin resistance.

- NO recommendation at all for Vit D, and in fact he suggests that if you supplement with calcium (which he only suggests for weight loss) you AVOID Vit D supplementation.

- Says that Vit A can help insulin sensitivity but can also be toxic in high doses and cause calcium loss even in modest doses, so he recommends only moderate doses of beta carotene (and this was for T2's, no mention for T1's).

- Magnesium and zinc are only mentioned for T2's, and he suggests getting tested for deficiency and supplementing if appropriate.

- No mention of taurine whatsoever.

- No mention of K2 whatsoever.

Basically, I feel that Bernstein's general recommendations (low carb etc.) are bang on the money, and I have great respect for his work. But his focus is firmly on diabetic control (which he does VERY well), and I think he therefore falls a little short on food quality and some of the fine detail. He relies on a lot of artifical sweeteners and heavy dairy products, and tries to mimic "normal" food with low-carb alternatives; and there's scant information on supplmentation.

I think that for a T1D the control is paramount, but taking a low-carb paleo approach seems far better to me than simply a low-carb "normal Western" diet. And if there are supps that can make a difference it's well worth researching them; the evidence for Vit D for example is so compelling that I feel dumb for not having jumped on it earlier!

Wow, another ramble - sorry for the brain dump!

Cheers,
Nick.

Carl said...

Hi,

Just today, I've had a letter and worried follow up call from my consultant. My results are back:-

Fasting Lipids
- Chol 9.3 mmol/l
- Trig 3.1 mmol/l
- HDL 0.9 mmol/l
- LDL 7.0 mmol/l
- Chol/HDL ratio 10.3%

I've been following Primal diet and exercise for about 2 months now and am worried as I seem to be going in the wrong direction?

I'm under pretty close obsevation medically as I have stage III CKD due to type I MCGM. I've also stopped taking Atorvastatin and Lansoporsol about a month ago, but have kept on taking prednisolone, enalapril, azathioprine, sodium bicarb and aranesp.

I do believe in the primal eating approach and don't want to give it up, however if my results continue as is I believe my specialist will give me no option.

Any advice is greatly appreciated.

cd

Dr. B G said...

taliesen,

COOL BEANS!! (omg sorry the delay)

Coffee is great but I admit it jacks my cortisol (what I barely have remaining) up. Sometimes I find that I grab caffeine just b/c I'm actually lacking sleep, rest, and some good quality family time. So in that regard, coffee is wonderful but not great to fill in for what we really require in life :) THANKS for your sharing the improvements -- that is really wonderful!

-G

Dr. B G said...

Nick,

I've never been on Bernstein's forum but often revolutionary thinkers will update and fast TRACK to modern times as the evidence mounts.

Vitamin D -- he's wrong and hopefully he has noted that by now.
Vitamin A -- again wrong -- most of us who are chronically inflamed or hypothyroid (or other autoimmune illness) cannot convert beta-carotene to vitamin A. It is true we can easily have toxicity but only if vitamin K2 and vitamin D3 are lacking and deficient.

Chris Masterjohn (WAPF) and Dr. Stephan Guyenet PhD (Whole Health Source blog) tie these together well. I've discussed vitamin A too :) If you eat liver, absolutely no need to supplement. (I only take it like every other month or if I feel sick).

http://kellythekitchenkop.com/2008/08/cod-liver-oil-update-questions-about.html

http://blog.cholesterol-and-health.com/2009/05/womens-health-initiative-confirms-that.html

http://wholehealthsource.blogspot.com/2008/06/more-fat-soluble-vitamin-musing.html

ZMA is great stuff -- my trainers use it. I'm not sure if it is necessary to use daily but I take some intermittently. I go by blood levels -- shoot for upper end of 'normal' standard range (U.S. 2.2 to 2.3 mg/dl).

That is great that Bernstein discusses vitamin E, Mag and Zinc -- they are in fact critical for Type 2 and Type 1.

For vitamin E -- the whole family of tocopherols and tocotrienols are vital to include in the diet or via supplmentation. I like the NOW brand Tocotrienol E Complex -- has some extra Selenium in there too.

Selenium -- cannot overstate the value of selenium. Like Mag and Zinc, Selenium is necessary not only for enzyme functioning but also mitochondrial energetics, glandular functions, redox and most importantly detoxification. Selenium 200mcg daily is a perfect dose. Again, NOW brand is a wonderful one.

-G

Dr. B G said...

Carl,

I'm sorry -- what were the labs earlier?

Stopping the Lipitor (atorvastatin) probably affected the face-value lipids (higher TG and higher LDL).

Lipitor tends to lower the HDLs -- did this improve you notice?

OK -- I'm sorry I am not familiar with type I MCGM. Could you be more specific? Sounds autoimmune to me? Is it related to Strep?

The best thing you did was to go grain-free (and hopefully dairy-free and legume-free) which limit the autoimmune disease process!

So your stomach is better and no Prevacid (Lansoprazole) is necessary now? GERD bloating and heartburn are usually cured with Paleo/Primal!

OK -- a couple of things for CKD stage 3.
(a) Have you considered the high value of vitamin D and getting monitored per the DOQI guidelines?
(b) Is your BP controlled < 115/70s?
(c) Have you lost significant body fat and weight over the last 2mos? This may explain any screwy labs in the interim -- you could wait another 1-2 mos after stabilization to recheck.
(d) What autoimmune diseases are in your family?
(e) Any premature heart disease or strokes (or dialysis)?
(f) What is your thyroid panel (anti-TPO, TSH FT4 FT3)? There is a high association between ALL autoimmune diseases and low thyroid.
(g) What is the Lp(a)? Undoubtedly this is elevated and associated with progression in nearly all stages of CKD. Hormones, omega-3 fish oil, low LOW carb and saturated fats control this.
(h) lastly, what is your dose of fish oil?

THANK YOU,
G

George must lose weight said...

I'm worried.

During the summer I lost 6 kilos, ate Benecol with plant sterols in - and sitll get bad blood test results. I also injuured myself doing body pump classes (using weights)

My blood test results (which have hatdly changed even though I lost weight) are:

Plasma HDL choolesterol: 1.2 mmol
LDL: 4
Total choletserol: 6.3
Total: HDL ratio: 5.2
Triglyceride 2.47 mmol
Plasma glucose level: 5.8 mmol
Fasting glucose: 7.1

This is all bad.

I've eaten porridge every day for a year too - great tasting but healthwisse doe snot seem to have made much difference.

I have a desk job...

So, if I walk a few miles every day what else should I do?

Low carb and high sat fat?

This seems to say sat fat is dangerous:

http://www.ncbi.nlm.nih.gov/pubmed/19763019

All ideas welcome

Thank you

Dr. B G said...

George,

Dude that is progress!!

You need to post more often -- I haven't hear from you like in a million years!!

What is goal for yourself? Better health? Energy? Reduce heart risk? What is your motivation and drive? How do you feel now? Sometimes the changes are so subtle one doesn't even realize major changes have occurred (body recomp, less edema, less facial puffiness, more energy, waking up with vitality instead of dragging with POOPINESS, etc). Who cares about the numbers right nwo?

Don't despair! You have made an extremely high # of changes!!
--Pump classes (!!! hey COOL)
--6 kilos wt loss
--Diet changes


With wt loss, sometimes the lipoproteins can be mixed up. Please do not fret or worry... :)

The article you posted discussed white adipose tissue (WAT). WAT is just visceral fat and is reduced with coconut oil and MCT oil.

Guess what increases WAT?

Carbs!!!!!

Grains like that porridge!!

Omega-6 oils like in that Benechol!!!


I would consider the high value of adding this to any anti-inflammatory program for a variety of reasons:
--increases thermogenesis
--improves thyroid function (esp if it replaces that STUPID Benechol)
--reduces WAT (visceral adipose)
--provides satiety (so you won't hunger that high-carb grain-based porridge)
--body recomposition
--preserves lean muscle


George -- consider asking your doc who is hopefully progressive and if she/he is not consider switching... about thyroid function. Get the whole panel FT3 FT4 anti-TPO and TSH.

You labs appear to me mildly hyperglycemic and mildly diabetic or pre-diabetic. Dietary carb control is key -- do Paleo, low carb Paleo
--no grains (therefore NIX the porridge, sorry dude, that is killing your fat loss)
--no legumes
--no dairy

Eat only meat meat meat and sat fats and some wild greens. A few berries and nuts are fine too.

Do you want to read a good book? Mark Hyman MD UltraMind is excellent. Broda Barnes Thyroid the Unsuspected Illness you might find to be a good resource as well (start cking your body temps at various times during the day; anything < 98.6 F is HIGHLY SUGGESTIVE of untreated hypothyroidism).

HANG IN THERE!!! I am so sorry to hear about your injury. Heal up well and consider some yoga for cross training, relaxation, reduction in cortisol, and for injury prevention and strengthening.

You are definitely getting there!!!

-G