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Hack my labs: LDL and Total Cholesterol have gone psycho on Paleo/Leptin/CT

Discussion in 'The Epi-Paleo Diet' started by Dan in Utah, Mar 19, 2012.

  1. Dan in Utah

    Dan in Utah New Member


    I spent my lunch hour reading through this blog post. Thank you Shinjin13.



    This fellow,Gregory Barton, seems to have had a similar experience with VLC and resultant high lipids. Here's what he had to say:



    "One of the claims of low carb dieting is that it will normalize the symptoms of metabolic syndrome. Blood pressure, blood sugar and blood lipids, it is claimed, will all come down on a low carb diet, in addition to weight. For most people this happens. But there is a significant minority of people on Paleo and other low carb diets whose blood lipids defy this claim. (See the list of low-carb celebrities with high LDL in this post.)



    Why should this happen? Why should some people’s lipids fall on low carb while other people’s lipids rise? Suboptimal thyroid might be the proximate cause for lipids rising on a low carb or paleo diet. Broda Barnes and Lawrence Galton have this to say about thyroid disorders:



    “Of all the problems that can affect physical or mental health, none is more common than thyroid gland disturbance. None is more readily and inexpensively corrected. And none is more often untreated, and even unsuspected.” — Hypothyroidism: The Unsuspected Illness



    I went very low carb in April in an effort to address metabolic issues, eating as little as 15grams carbohydrate per day. I had great results with blood pressure, sleeping, blood sugar and weight loss. But lipids bucked the trend.



    I had expected triglycerides and cholesterol to drop when I cut the carbs, but they did the opposite: They surged. By July my total cholesterol was 350, LDL 280, and triglycerides bobbed around between 150 and 220.



    I did some research and found several competing theories for this kind of surge:



    Saturated fat: The increase in saturated fat created a superabundance of cholesterol which the liver cannot handle. Also, Loren Cordain has claimed that saturated fat downregulates LDL receptors.

    Temporary hyperlipidemia: The surge in lipids is the temporary consequence of the body purging visceral fat. Jenny Ruhl has argued that within a period of months the situation should settle down and lipids should normalize.

    Hibernation: The metabolism has gone into “hibernation” with the result that the thyroid hormone T4 is being converted into rT3, an isomer of the T3 molecule, which prevents the clearance of LDL.

    Malnutrition: In March, Paul wrote that malnutrition in general and copper deficiency in particular “… is, I believe, the single most likely cause of elevated LDL on low-carb Paleo diets.”

    Genetics: Dr. Davis has argued that some combinations of ApoE alleles may make a person “unable to deal with fats and dietary cholesterol.”



    I could accept that saturated fat would raise my cholesterol to some degree. However, I doubted that an increase in saturated fat, or purging of visceral fat, would be responsible for a 75% increase in TC from 200 to 350.



    There are two basic factors controlling cholesterol levels: creation and clearance. If the surge was not entirely attributable to saturated fat, perhaps the better explanation was that the cholesterol was not being cleared properly. I was drawn to the hibernation theory.



    But what causes the body to go into hibernation? According to Chris Masterjohn, a low carb diet could be the cause. Although he does not mention rT3, he warns,



    “One thing to look out for is that extended low-carbing can decrease thyroid function, which will cause a bad increase in LDL-C, and be bad in itself. So be careful not to go to extremes, or if you do, to monitor thyroid function carefully.”



    If low carb is the cause, then higher carb should be the cure. Indeed, Val Taylor, the owner of the yahoo rT3 group, commented that “it is possible that the rT3 could just be from a low carb diet.” She says, “I keep carbs at no lower than 60g per day for this reason.”

    Cortisol and Getting “Stuck” in Hibernation



    So what about temporary hyperlipidemia? Bears hibernate for winter, creating rT3, but manage to awaken in spring. Why should humans on low carb diets not be able to awaken from their hibernation? There are many people who complain of high cholesterol years after starting low carb.



    A hormonal factor associated with staying in hibernation is high cortisol. It has been claimed that excessively high or low cortisol, sustained over long periods, may cause one to get “stuck” in hibernation mode. One of the moderators from the yahoo rT3 group said:



    High or low cortisol can cause rT3 problems, as can chronic illness. It would be nice if correcting these things was all that was necessary. But it seems that the body gets stuck in high rT3 mode.



    James LaValle & Stacy Lundin in Cracking the Metabolic Code: 9 Keys to Optimal Health wrote:



    When a person experiences prolonged stress, the adrenals manufacture a large amount of the stress hormone cortisol. Cortisol inhibits the conversion of T4 to T3 and favours the conversion of T4 to rT3. If stress is prolonged a condition called reverse T3 dominance occurs and lasts even after the stress passes and cortisol levels fall. (my emphasis)



    What I Did



    First, I got my thyroid hormone levels tested. A blood test revealed that I had T4 at the top of the range and T3 below range. Ideally I would have tested rT3, but in Thailand the test is not available. I consulted Val Taylor, the owner of the yahoo rT3 group, who said that low T3 can cause lipids to go as high as mine have and, “as you have plenty of T4 there is no other reason for low T3 other than rT3.”



    I decided to make these changes:



    Increase net carbs to ~50 grams per day. Having achieved my goals with all other metabolic markers I increased carbs, taking care that one hour postprandial blood sugar did not exceed 130 mg/dl.

    Supplement with T3 thyroid hormone.

    In case the malnutrition explanation was a factor, I began supplementing copper and eating my wife’s delicious liver pate three times per week.



    I decided to supplement T3 for the following reasons:



    The surge in TC was acute and very high. It was above the optimal range in O Primitivo’s mortality data.

    I increased carbs by 20-30g/day for about a month. TC stabilized, but did not drop.

    The rT3 theory is elegant and I was eager to test my claim that the bulk of the cholesterol was due to a problem with clearance rather than ‘superabundance’.



    What happened?



    I started taking cynomel, a T3 supplement, four weeks ago. After one week triglycerides dropped from 150 to 90. After two weeks TC dropped from 350 to 300 and after another week, to 220. Last week numbers were stable.



    Based on Paul’s recent series on blood lipids, especially the post Blood Lipids and Infectious Disease, Part I (Jun 21, 2011), I think TC of 220 mg/dl is optimal. As far as serum cholesterol levels are concerned, the problem has been fixed.



    I believe that thyroid hormone levels were the dominant factor in my high LDL. Saturated fat intake has remained constant throughout.



    My current goal is to address the root causes of the rT3 dominance and wean myself off the T3 supplement. I hope to achieve this in the next few months. My working hypothesis is that the cause of my high rT3 / low T3 was some combination of very low carb dieting, elevated cortisol (perhaps aggravated by stress over my blood lipids!), or malnutrition.



    Another possibility is toxins: Dr Davis claims that such chemicals as perchlorate residues from vegetable fertilizers and polyfluorooctanoic acid, the residue of non-stick cookware, may act as inhibitors of the 5′-deiodinase enzyme that converts T4 to T3. Finally, Val Taylor claims that blood sugar over 140 mg/dl causes rT3 dominance. I couldn’t find any studies confirming this claim, and don’t believe it is relevant to my case. Val recommends low carb for diabetics to prevent cholesterol and rT3 issues but warns not to go under 60g carb per day.

    Issues with T3 Supplementation



    There are some factors to consider before embarking upon T3 supplementation:



    Preparation: In order to tolerate T3 supplement you have to be sure that your iron level and your adrenals are strong enough. This requires quite a bit of testing. I’ve read of people who cut corners with unpleasant results.

    Practicalities: T3 supplementation requires daily temperature monitoring in order to assess your progress. People who are on the move throughout the day would find this difficult.

    Danger: Once you get on the T3 boat you can’t get off abruptly. Your T4 level will drop below range and you will be dependent on T3 until you wean yourself off. If you stopped abruptly you could develop a nasty reaction and even become comatose.



    My advice for anyone doing very low carb



    As Chris Masterjohn said, in the quote above, if you are going to do very low carb, check your thyroid levels. I would add: Increase the carbs if you find your free T3 falling to the bottom of the range. It might be a good idea to test also for cortisol. A 24-hour saliva test will give you an idea whether your cortisol levels are likely to contribute to an rT3 issue. It might also be a good idea to avoid very low carb if you are suffering from stress – such as lipid anxiety!"


    The whole post is here: http://perfecthealthdiet.com/?p=4457



    I'm formulating a plan...
     
  2. Dan in Utah

    Dan in Utah New Member


    I've been taking 50mg DHEA at dinner for about a month. Range on my lab for DHEA was .630-4.70. So I'm a bit high. Could be from the small supplement or could be that my sex hormones are going to explode when I get my thyroid figured out.



    I haven't nailed down anything yet, but I'm feeling more optimistic. I'm glad to see that mine is not an uncommon reaction to VLC.



    As far as stress goes, 2010 was a very stressful year for me. My sleep was horrendous. I was depressed. I was pretty broken down. That's when I put on my 30 extra lbs. I even went on Wellbutrin for awhile.



    Eating paleo fixed the depression and my sleep has improved a lot, but the stress is still a pain in the ass. Working on it that, too. Must. Get. Optimal!



    BTW: I've been supplementing with the DHEA, 5THP, vitamin D, coQ10, B complex, MVI, and fish oil for about 2 months.
     
  3. Shijin13

    Shijin13 Guest


    Pretty mind blowing eh??? this was a total eye opener... then coupled w/Collen's comments - there's a direct relationship. Whats interesting for me... is I've tried low carb, moderate carb ~50g and keto - I feel better in low carb/keto than I do at the higher carb...what's interesting is my PCP advocated
     
  4. Dan in Utah

    Dan in Utah New Member


    I'm sure this is part of the puzzle. In 10 days of cold tubs, my waist measurement is down a full inch. That fat has to go somewhere. I'd just like to get it out of my blood and into my hormones, brain tissue, and BAT.
     
  5. Dan in Utah

    Dan in Utah New Member

    Dr. Kruse was good enough to respond to my comment on the blog:

    My testosterone, t3, t4 levels are pending.



    I appreciate everyone's input so far.



    I'm putting together my thoughts this week and I'll post my ideas of what I'm going to do the next 6 months.
     
  6. Dan in Utah

    Dan in Utah New Member

    Dr. Kruse made some comments regarding high cholesterol and LDL over on Dr. Davis' blog:
    http://www.trackyourplaque.com/blog/2011/07/the-exception-to-low-carb.html#comment-23777 Interesting...
     
  7. Dr Dan - I don't want to hijack your thread but I have my own lab issue that's making me crazy. I can't get my hs-CRP under control and I'm wandering if you or Dr. K knows if this ALWAYS indicates inflammation. I feel great, have eaten 80/20 primal for a couple years, and was 100% on the leptin reset (with some high-fat dairy) for six weeks when the lab was drawn. My CRP is 3.4 and was 3.5 in October. This last lab had a previous reverse T3 to free T3 issue cleared up (switched to T3 only Cytomel) and Vit D at 101. I do have lower end testosterone readings and had been doing HCG three times a week in January to work on this. I'm doing all this to lower "inflamation" (and take care of my thyroid, and shred all belly fat I guess...), so it's sure frustrating to not see the number really move.



    Waiting on telomere results...
     
  8. MamaGrok

    MamaGrok New Member

    Optim, I'm no doctor, but I'd guess that your 80/20 diet kept you at high inflammation - you probably have some food intolerances, and I'd start looking at gluten first, dairy second - and that it will take some time to get lower. I don't know about you, but I was 99/1 and while it didn't keep my hsCRP up, it kept my ANA & severe fat malabsorption up ... no good. Bad gut inflammation, from just one serving of wheat maybe in each month. I used to be a breadaholic and just can't tolerate it at all any more, it seems.
     
  9. For what it's worth the 80/20 was before October of last year. Some dairy is the only thing I have maintained and it is just so hard for me to believe that could make this result stay so bad. I hadn't had any grain for months at the time of the last blood draw.
     
  10. Shijin13

    Shijin13 Guest

    Optium



    concur w/MamaG on the inflammation... of course you can be 100% and still have inflammation... my hsCRP is low .18, but my HbA1C and homocycstine increased w/my last set of labs.. when I had my CIMT done - it show inflammation in my arteries... I've been gluten free for 6yrs, grain free since Nov 2010... working right now to be dairy free, with the exception being ghee. working right now using CT to reverse the inflammation...



    if after my next set of labs I still have inflammation... eggs will get the boot too... I recently discovered I can't do nightshades (tomatoes aren't a problem though for some reason)
     
  11. MamaGrok

    MamaGrok New Member

    Communion at Mass was enough to keep my gut seriously horrible ... and 24-hr fermented yogurt homemade from raw pastured Jersey cream + Kerrygold butter was enough to keep me bloated (looking almost 6 months pregnant many nights) ... it's amazing what a little can do.
     
  12. Dan in Utah

    Dan in Utah New Member


    Like I've said in other threads, I'm kind of a "newbie" when it comes to a Dr. Kruse style hack, but HS-CRP is a non-specific test. It goes up for all kinds of reasons. The big 3 in my mind are infections, auto-immunity, and diet. Sleep can probably play a role, too. These all cause inflammation, but different mechanisms. HS-CRP is just the liver's response to badness being thrown its way, regardless of the cause.



    My HS-CRP is nowhere near optimal, so I have work to do there, too. I'll let you know what I find out as I kick it to the curb.



    Sincerely, Your brother in the HS-CRP kickin' mayhem.
     
  13. healthnut

    healthnut New Member

  14. devil in angel

    devil in angel New Member


    This is very useful to me, ha ha ha ha, thank you healthnut
     
  15. KiwiLauren

    KiwiLauren Gold

    Dan et al, I'm wondering if you can help me with my labs based on all you've learned. One thing I'm struggling with is that my labs were done in NZ so some of the figures/ranges you throw out don't correspond to my numbers (and I've been unsuccessful at finding conversion formulas on line). I've pasted my labs below. My doc is VERY concerned my cholesterol is too high. I cannot get an Rev T3 here in NZ but did get Free T3 and Free t4, as well as DHEAS and hs CRP. (I put any ranges given in parentheses.) Any feedback you have I'd be most grateful. Thank you! Lauren





    hs-CRP 1.20 mg/L (
     
  16. KiwiLauren

    KiwiLauren Gold

    PS I should have probably given a bit of background: 45 year old, female, been paleo for 5 months (prior to that, gluten free vegetarian who ate fish (and very little soy or dairy)). Been doing the Leptin Rx and the Leaky Gut Rx for 3 months (no cheating) and doing CT for about 3-4 weeks. Low blood pressure, history of breast cancer (2 years ago), lots of stress this past 18 months (major earthquakes), 2 children (non-problematic pregnancies/deliveries), about another 25 pounds to lose. Thanks again.
     
  17. KiwiLauren

    KiwiLauren Gold

    KiwiLauren;9137 wrote: Dan et al, I'm wondering if you can help me with my labs based on all you've learned.



    hs-CRP 1.20 mg/L (
     
  18. tigerlily

    tigerlily New Member

    I have been LC since 2003, all programs I followed:

    Atkins

    Dr Richard Bernstein (Diabetic Solutions)

    Dr W Davis (Track your Plague)

    said when you are losing weight yuor chol will be whacky, dont even bother testing them until weight is stable or 2 to 3 months.
     
  19. MamaGrok

    MamaGrok New Member

    Is this, perchance, my favorite tigerlily from MDA?



    Lauren, your #s are pretty similar to mine. And interesting about the weight loss; mine has been pretty constant at averaging 1/2 lb/week for two years now, and LDL really went up as weight loss did a spurt last fall, so that could be another possible explanation, instead of the pregnenolone steal thing.
     
  20. Dan in Utah

    Dan in Utah New Member


    Since your thryoid and ferritin look okay, I'd bet your either Apo E 4/4 genotype or you've just lost quite a bit of weight. I'd just recheck it when your weight is stable.



    I got kinda hung up on my high cholesterol, but it's just one piece of a very big puzzle. I'm not so stressed about it now. I think about it as substrate for my hormone production (which I need because I found out my testosterone is low), and not something that's gonna kill me ASAP.
     

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