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 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?