Category Archives: Quiz

Low Carb Paleo, and LDL is Soaring – Help!

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!):

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?