- John's Lp(a) progress
- Takeaways from my pizza bender blood draw
- Takeaways from righting the ship
- Closing thoughts
For the HbA1c post, I even brought in Aaron to discuss why I could be genetically predisposed to slightly better blood sugar numbers than some (not that my HbA1c was amazing, but it’s pretty good without a lot of effort or carb restriction).
But to be candid, I usually keep an eye on the date of my blood draws and eat with an eye towards the calendar. In other words, I eat a little healthier than I normally would prior to having labs done.
This past April I did just the opposite.
It was the end of March Madness, I had friends visiting for the weekend and was playing NYC tour guide. We ate whatever we wanted and drank more mezcal than I would like to admit. I had a lot of dessert, huge portions of gluten free pizza for dinner 3 nights in a row leading up to the draw (and we did some nice meals too), and even included a pizza meal that ended at about 9 pm on the night before my fasted appointment with the phlebotomist for good measure.
In other words, I wanted to know what my blood would look like when I ate like complete shit for about a week.
I then planned a “normalized” period after that experiment where I would eat my Gene Food assigned diet with some deliberate cheats. Hey, this isn’t exactly the precision of a Dave Feldman food experiment, but I think the exercise has some value. My Gene Food diet type is Mediterranean. I ate oats, almonds and cognac stewed dried fruit for breakfast most days, a Vegan lunch at Jivamukti cafe (usually black beans, quinoa, sweet potatoes, greens, sautéed red cabbage) and roamed for dinner with wild fish, or beans and rice.
After the Jivamukti lunch, I went and got a Paleo muffin (decent dose of crappy carbs and sugar) and a banana, cocoa, almond butter, almond milk smoothie. Once a week, I had a 4-6 oz. piece of grass fed beef. The cheats were added for two reasons – first, no one eats perfect all the time, and second, the plant forward diet causes me to drop more weight than I want to (Vegan bodybuilder propaganda notwithstanding).
John's Lp(a) progress
Takeaways from my pizza bender blood draw
Triglyceride rich LDL-P
When I first saw these results I was shocked. Triglycerides at 277 and LDL-P in the 1,700 range was beyond what I had ever seen on any blood draw I’ve done.
My first thought was I hadn’t given myself enough time to clear my pizza meal before going to the lab. I finished eating at about 9:30 that night and was one of the first in line when the lab opened at 7:30, so these results could have been the result of poor timing. Whether that’s the case or not, the lesson here is simple – getting a once a year blood draw and then basing health decisions on those results is probably not a good idea. It’s important to know what your blood can look like when you eat poorly, but also good to know that it’s relatively easy to get things back in range with improved habits.
Was I insulin resistant?
TG were off the charts, and VLDL-P and VLDL size were also out of range.
This can be a sign of insulin resistance.1
Because I knew this would be a different type of blood draw for me, I had an insulin resistance panel run alongside my lipids. As you can see from the numbers below, I was not insulin resistant. My fasting insulin was actually quite low.
|Insulin Resistance Score (SJC)|
|Insulin, Intact, LC/MS/MS (5)(SJC)|
|C-peptide, LC/MS/MS (6) (SJC)|
Simple carbohydrates can be a problem for lipids
At the outset of this section, I am including a great reader question that I should have been more clear about:
John, when you refer to a carb heavy diet negatively affecting your numbers, do you differentiate at all between processed carbs and carbs related to foods like yams, oatmeal, bananas and other whole foods?
Yes, I absolutely do! This is why I say below a “plant based diet perfectly executed” won’t present these issues because that diet is heavy on complex carbs and not the terrible simple carbs I was eating. This happened to my lipids because I was eating large amounts of processed flours paired with alcohol. Most people can eat complex carbs, especially if they’ve been heated and then allowed to cool, with no issues, in fact, these foods are often quite beneficial.
Back to the original post…
I wasn’t eating a ton of meat and steak, and although all the pizza I had was obviously loaded with cheese, this was a major crappy carb binge.
Since I ate like this over a period of days, I’m thinking what you’re seeing here with the TG level is a process called de novo lipogenesis in action.2 My body was loaded up with so much glucose that it couldn’t use or store that it started converting all that crappy pizza into fat, which then made it’s way into my blood at an elevated level.
Alcohol also raises TG levels and I was on a mezcal bender with friends that weekend.3
But even putting benders aside, this is an issue that vegans and vegetarians should be aware of as well. Plant based diets perfectly executed are unlikely to have major problems with cholesterol or triglyceride, but who follows a perfect diet? No one eats whole plant foods all the time. Instead, those looking to change their diet to a healthier trajectory are often faced with the choice between chicken breast or whole wheat pasta for dinner. Some may find they develop TG rich and elevated LDL-P on a vegan or vegetarian diet because their body’s don’t handle the carbohydrate well.
Strategies for lowering TG
Three promising interventions here that are shown to help lower TG are:
Why was my Lp(a) so low?
The central irony of this whole disastrous blood draw is that my Lp(a) was the best it’s ever been. It’s the only time I have ever seen my Lp(a) in the green. Why? I have no idea. If I had one guess, it would be the high doses of vitamin C I was taking at the time, but it’s a total guess.
Takeaways from righting the ship
Ok, so I stopped eating like a moron and went back to a version of my original diet. TG came way down, and LDL-C at 92 mg/dl came within range as well. Overall, definitely an improvement, however, more work is left to be done.
There is one APOB protein for every LDL-P, which is why measuring APOB is a good way of determining if LDL-P is in range. As a preliminary matter, I find it interesting how often my healthier lipid charts are discordant with my LDL-C levels. In some cases, my LDL-P is in the green and LDL-C is out of range, or with the June test you see LDL-C in range, but particle a bit high.
LDL-P still TG rich
The high sugar cheats and overall higher carb diet pushed into a scenario where my LDL particle was a bit triglyceride rich. How can I tell?
My LDL-C was in range, as was my triglyceride, but the particle count at 1,300 was out of range. This tells me that the triglycerides coming back on the high side (while still in the green) were to blame for bumping up my particle number. When my LDL-P has been optimal on past draws, my LDL-C was about the same, but my TG was way lower at 66 mg/dl. This is why my hunch is that the elevated particle count was a bit more TG heavy. And this drives home my point about balance on a plant based diet. To get the extra calories I needed to maintain body weight, I resorted to crappy carbs and more fruit. My TG went up as a result.
In my best readings, I am plant based or very low fat (egg whites and tofu) for breakfast, low glycemic and fairly lean protein for lunch and again whole food plant based for dinner.
If your particle is cholesterol rich…
This is where I skew when I am not plant based – when I go plant based I invert the trend.
Here’s where a lot of people are getting bad information. Let’s say your LDL-P is 1,600 and you have low TG. Maybe you’re a lean mass hyper responder, which usually means you have cholesterol rich LDL-P.
If your response is, “yeah, so what, I am on the Feldman protocol,” there isn’t much I can say to help you (although you owe it to yourself to listen to this interview at least twice).
But if you want that number lower, which I believe is wise, it is probably time to push on that carbohydrate lever a bit harder. You’re using TG efficiently, but you are either:
- Absorbing a ton of cholesterol
- Making a ton of cholesterol
- Clearing very little cholesterol rich particle
Or all three.
This is what our balanced fat diet types (Agrarian, Nordic, Mediterranean) have to experiment with – how to get LDL-P in range with a combination of managing glycemic load while also keeping an eye on the body’s response to eating higher amounts of cholesterol and saturated fat (some of us make more cholesterol when we eat saturated fat).
As a practical matter, this is more complicated than just these two levers, but it’s not a bad way of conceptualizing the process from 10,000 feet.
It’s not just the abuse of fat that leads to bad places lipid wise, it’s also the abuse of carbohydrate. At the end of the day, each of us needs to decide where we want these metrics to sit. I don’t necessarily want my LDL-C at the basement floor, but ideally, I’d like my LDL-P at or below 1,000 – a standard I am hitting only about half the time as my diet changes due largely to social pressures.
Lp(a) bumped up a bit
I was veery pleased to see my Lp(a) stay right around the green zone, although it ticked up a touch. Again, no clue why this was the case, my LDL-C went down but my Lp(a) went up a bit.
I’ve done more blood work than this over the last few years, quite a bit more – but these are the times when I had full lipid panels to share for context here.
At the end of the day, my best diet is my Gene Food assigned diet of Mediterranean. I have some room for saturated fat, but not as a staple lest my LDL-P get out of range towards the cholesterol side. However, if I neglect glycemic strategy, things tilt in the other direction, with TG rich LDL-P. Of course, both extremes are not desirable – the key is to stay in the sweet spot where I am effectively using carbohydrates without overloading my body’s ability to use them as energy.
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