To Kindy, Zach’s parents, and the NBIA/PKAN kids: I’ve been reading papers on the disease and trying to figure out the best diet for the disease. But the biochemistry is a bit complex, more complex than I realized last week, and I want to make sure my advice is sound. So I’m delaying my NBIA/PKAN/ketogenic diet posts until next week.
My sincere apologies for the delay!
I’m a little busy this week – busy with work, busy with learning about NBIA/PKAN, and eager to spend time with my brother who is visiting from Germany – and so I thought I’d do a “You be the doctor” quiz.
Here’s the puzzle. Someone adopts a low-carb Paleo diet. Very healthy diet, right? But their LDL cholesterol level starts to rise. And rise. And rise.
Larry Eshelman emailed me last December with this problem. His LDL history:
- 103 mg/dl (1990-2002, eating a low fat diet)
- 115 mg/dl (2002-2007, eating a low carb diet)
- 195 mg/dl (2007-2009, after reading Gary Taubes and adding saturated fat)
- 254 mg/dl (Dec 2009, very low-carb Paleo for 5 weeks)
- 295 mg/dl (Jun 2010, very low-carb Paleo for 7 months)
(SI system readers, convert to mmol/l by dividing by 38.67.)
A common problem
This is not a terribly uncommon problem in the Paleo community; it afflicts famous and brilliant bloggers as well as ordinary folks. It’s been discussed by Richard Nikoley in several posts:
Some examples of high LDL on a Paleo diet, with links – most of these provided to me by Larry (thanks Larry!):
- Jimmy Moore, 278 mg/dl (Nov 23, 2009)
- Peter Dobromylskyj, 261 mg/dl (Dec 31, 2007)
- Lightcan (commenter at Hyperlipid), 433 mg/dl (Nov 16, 2009), up from 109 in 2003
- Lynn M. (commenter at Hyperlipid), LDL-P (particle number) 1458, 75% sdLDL but a zero calcium score (Aug 12, 2009)
- Mtflight (commenter at Hyperlipid), 201 mg/dl and LDL-P 2576 (Oct 2007)
- IFWC (commenter at Hyperlipid), 261 mg/dl (Sep 30, 2008)
- Frederick (commenter at DailyLipid) 214 mg/dl (Jan 13, 2009) up from 92 mg/dl (May 2007)
- GK (commenter at WholeHealthSource) 301.9 high-sat-fat low-carb Paleo (Oct 12, 2010) up from 101.4 pre-Paleo (Jun 15, 2005), 179.4 Paleo (Oct 15, 2007), 210.6 post-Taubes with higher saturated fat (Nov 11, 2008)
- Lars (commenter at WholeHealthSource) TC went 228 to 390 mg/dl in 1.5 years Paleo (Dec 14, 2009)
- Sc (commenter PaNu forum) 376.3 mg/dl (Apr 29, 2010). Also on that thread: Mike Gruber, TC 585 mg/dl; Ben, LDL 487.5; MikeB 266 on low-carb, 408 on “strict PaNu”.
- John (correspondent of Richard Nikoley) 396 mg/dl paleo from 150 mg/dl pre-Paleo
- TonyK (commenter at FreeTheAnimal) 289 mg/dl (Aug 25 2009) from 135 mg/dl pre-Paleo
- Scott Shapiro (PaleoHacks ) LDL jumped 80 points on Paleo
- Ugk (PaleoHacks) 318 mg/dl post-Paleo from 110 mg/dl pre-Paleo.
- Otterotter (PaleoHacks) 280 post-Paleo from 114 pre-Paleo.
OK, that’s enough: this is a minority phenomenon, but it’s definitely not an exceptional n=1 phenomenon.
Larry’s Progress
Larry wrote me at the beginning of December asking for advice. He implemented everything I suggested. I just heard back from him this week with new data.
His LDL decreased from 295 mg/dl to 213 mg/dl in a recent test. His HDL rose from 74 mg/dl to 92 mg/dl. His triglycerides fell from 102 to 76 mg/dl.
LDL is still high, but improving; the others are excellent and improving.
So, quiz questions:
- Can you guess what my December advice to Larry was?
- What causes these cases of soaring LDL on Paleo? (Of course, there are multiple possible causes of high LDL, but I think among Paleo dieters one explanation is more likely than others, and that’s what I’m looking for.)
My answers tomorrow night.
UPDATE: Answers here: Answer Day: What Causes High LDL on Low-Carb Paleo?
via this link:
Vegans and vegetarians vs the meat-eaters. Republicans vs. Democrats. Creationists vs. Evolutionists. Yada-yada-yada. I make it simple and stick with what’s been proven a fact, what’s in the fossil record, and the fact is that although paleo isn’t for everyone, there is no scientific evidence whatsoever to support these unsupported theories that we evolved to be some solely herbivorous primate hybrid like some of our primate cousins (i.e gorillas). We ate a varied omnivorous diet then and still do, although some choose to exclude the most nutrient dense foods on the planet (i.e. organ meats).
Vegans and vegetarians are free to practice their beliefs as it is a free society, but no amount of opinion will convince me that it is other than a personal choice they make – and not one based on sound science. As to LDL, the level means nothing as long as the particle size is large/fluffy. My issues have more to with genetics, inflammation, and hormone imbalances as I am learning. Since my original post above, I have experimented with omitting SFAs low PUFAs and ate mostly MUFAs to see if it made any difference vs. eating a diet higher in SFAs, MUFAs, low PUFAs. The diet eliminating mostly SFAs produced a WORSE lipid profile, one lower in HDL, higher in small-particle LDL and worse insulin resistance than the one with a higher intake of SFAs. Caloric and carb intake was unchanged on both diets. Not a controlled study by any stretch, but my own n-1 which means something.
And the real marker to look at, far more atherogenic than LDL, is Lp(a) which is 100% genetically-determined and one in which diet hasn’t any effect whatsoever.
Further, the so-called evidence that humans were consuming cereal-based foods 19,000 years ago (yes I did peruse the blog you posted) does nothing to convince me to start consuming the grains of today which bear little resemblance to their old-world counterparts. And I won’t even get into the anti-nutrients that plague these grains (i.e. phytic acid, gluten, etc.) which is a completely separate argument. Same goes for today GMO’d Frankenfruits. I eat organic berries of all kinds, and occasionally some other low-fructose fruits because today’s fruits have been engineered to contain way more fructose than our bodies can handle, hence the rise is diabetes. And yes, because of my training regimen, I will consume some organic PRE-SOAKED wild rice, quinoa, and purple potatoes once or twice a week so you anti-low-carbers don’t start picketing in front of my house!
The paleo “diet” is not really a diet, nor is it a fad as many like to accuse it of being, but rather a lifestyle/eating choice, and those of us who follow it, feel it is at the moment the most corrective eating choice one can make in today’s world of processed, GMO’d, irradiated, cross-bred, bio-engineered foods, the bulk of which are fruits and grains that bear little relation to their distant cousins as recent as a 100 years ago.
So, bring on organic grass-fed red meats, range-free poultry & eggs, pastured butter (which incidentally *LOWERS ATHEROGENIC Lp(a)), some blueberries, a big-ass salad with a healthy serving of nuts and seeds and I’m good to go
*so much for Ancel Keys’ obsolete ‘Lipid Hypothesis’
http://rawfoodsos.com/2011/12/22/the-truth-about-ancel-keys-weve-all-got-it-wrong/
The ONLY relevant piece of Key’s work was that he was one of few who insisted that dietary cholesterol was pretty much irrelevant.
And don’t even bring up ‘The China Study’ which has been debunked a million times as nothing more than bad entertainment!
Sorry, mate, but you’re clinging onto now-antiquated and obsolete science. Simple as that.
Not trying to convince bud! Like I said.. I was paleo myself. I followed denise minger. I followed paleo a la sisson. You’re kinda preachin to the [former] choir here lol. The phytates, antinutrients, etc, all that man.. I know what you’re saying…and they are all a problem if you don’t prepare your foods correctly. primitive nutrition blog goes through the studies in the videos. I don’t actually recommend reading the text because it is a transcript. Sadly his voice takes a bit getting used to…. but its all science based. He will address minger (who btw agrees with him on keys), keys, taubes, everyone and all the best studies low carb has to offer.
Do you man! Have fun with paleo. Perhaps you may revisit LDL et al again. When you do – you may be surprised like I was.
Best,
Benjamin Shockley Dover
There’s another possibility I think. As people lose weight and dissolve body fat on a low carb diet, toxins that were hidden away in their body fat are moved into circulation and perhaps very difficult for the liver to handle. I would love to hear what others think of this possibility.