Wow. I hadn't realised that a short period of over-eating could trigger such big changes.

Is there any danger from triglycerides going much below the target of 60?

Dr. Davis --

What might cause a substantial rise in LDL, while triglycerides and HDL are lower than ever?

Here's what happened with my tests over the last year and a half:

** Summer 2007, eating the standard American diet **
Total Cholesterol: 266
Triglycerides: 109
HDL: 79
LDL: 165

** Summer 2008, just a few weeks into my new diet (no processed foods, no grains, no sugars, no vegetable oils) **
Total Cholesterol: 225
Triglycerides: 63
HDL: 72
LDL: 140

And now, January 2009 (same diet as before):
Total Cholesterol: 341
Triglycerides: 55
HDL: 99
LDL: 231

My triglycerides and HDL are better than ever, but my LDL has gone way up.  I didn't overindulge over the holidays, but I was losing weight (slowly) when I got that latest test.

I know -- thanks to your blogging -- that inferred LDL values are highly unreliable.  And I also know that there's a difference between small LDL (bad, caused by eating high carb) and the bigger, fluffier (okay) LDL.  The LDL number doesn't differentiate between those values.  Or might something else be the cause?

My doctor wants to do a cholesterol recheck next month -- and I'm thinking that I ought to ask for a measured LDL value and a particle size test.  Does that seem reasonable to you?  

BTW, my heart scan from six months ago is totally clear.  So I don't care how much my doc pushes, I absolutely refuse to go on any kind of cholesterol-lowering medication.

Also, thanks to you, I got a vitamin D test -- and my values were excellent.  (I do supplement.)  Yeah!

Dr. Davis,

While it is true that overindulging in carbs causes all the changes you cite here, if your patient really wants to stick with the program life-long, she'll do better learning how to carb up a bit at the holidays, and then correct afterwards, rather than getting into a lifestyle of self-denial that will build up an undercurrent of feelings of deprivation that will eventually blow her completely off course.

I've been there, done that. Three family holiday seasons without eating any of our traditional foods left me depressed and miserable. Food is a complex issue with deep emotional roots.

Something like a family death or a cancer diagnosis can trigger binges that derive from that deprivation and really derail the diet.

I have found it much better to build in safety valves into the diet, here and there.  The lipids will recover very fast once she goes back to eating the low carb diet.  

I've been doing a low carb lifestyle for going on 11 years now, and I attribute its success to the safety valves. Yes, I do gain a few pounds over the holidays, but I take them off in January.  

The psychology of successful dieting is often to accept "good enough" rather than perfect. Perfect has a nasty way of ending up in disaster.

If you doubt this, just read the low carb diet boards where for every person who has maintained perfectly for 5+ years there are 25 people back after catastrophic regains caused by being too stringent.

Is it carbs in general or should we be more consciously eliminating the wheat and corn products?  
I eat quinoa,oatmeal,  buckwheat,beans,brown rice, etc. Not to excess but as a part of my usual diet.
Just wondering?

Question: I understand no wheat and what it does to the LDLs, but does that include potatoes? Thank you!

Dr. Davis,

I have a similar issue as Diana Hsieh.  

My Total Cholesterol: 258
Triglycerides : 60
HDL : 61
LDL- 181

I've been on a low carb diet avoiding wheat, rice, starches, sugar, high fructose corn syrups and fruits for the last 6 months.  I've lost 35 pounds and reduced my triglycerides from 296 to 60.  Taking fish oil and slo-niacin. I have been eating alot of saturated animal fats (rib-eye steaks, baby back pork ribs, eggs) Is eating the saturated animal fat causing my total cholesterol to be too high?  Is total cholesterol above 200 dangerous if Triglycerides and HDL are in the 60's?

I am trying for last three years to get my HDL numbers high. So far without success. I have tried exercise and cutting out wheat but without significant improvement. I have now added 4000iu vitamin D. Will do a follow up blood test after about two months to see if HDL level increases.

Any other tips?

Dr. Davis,

Is there often a direct correlation between low triglycerides and a greater proportion of large LDL particles?  Thanks

- John

Here were my lipids on a Heart Healthy (sarcasm) Diet

Trigs 380
HDL 25
LDL 165

Add simvastatin

Trigs 185
HDL 33
LDL 75

Here they are on a low carb diet with my BG more or less normalised
(70 - 90 and postprandials mostly below 110 and seldom over 120)

Trigs 39
HDL 47
LDL 105

Adding more saturated fat

Trigs 62
HDL 55
LDL 94

Spot the reversal of HDL to LDL

IME low carbing decimates the trigs and tends to increase HDL and LDL both, tinkering with the fat content and type adjusts the balance between these BUT there's a lot of individual variation as to exactly how this works. Some people just seem to have high LDL whatever they do, maybe a long term change from years of insulin resistance and hyperinsulinemia, maybe genes which would respond to a different balance of fat types in the diet.

My #1 weapon has been BG testing

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

which is deprecated in the UK. Lipid breakdowns are often unavailable and Full Lipid Panel is deprecated in favour of TChol which is pointless but cheaper. The money saving is probably to pay for the blanket prescription of statins, and it also serves to conceal the toxic nature of the diet

http://www.nhs.uk/Change4Life/Pages/default.aspx

here's the diabetic version

http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Food_and_diabetes/Balancing_your_diet/

I feel like part of a eugenics experiment

It's just part of big pharma's racket.  The public has been propgandized to fear cholesterol, statin prescriptions are based on an antiquated calculation, and the people who set cholesterol targets have financial ties to the drug companies.  This has created a big cash cow for big pharma.

The only people to benefit from statins are middle aged men who have had a heart attack and even then, the benefit is small.  If statins were restricted to those who would truely benefit, it would mean a lot less $$$$ for big pharma.

Today's news said millions more Americans over 60 could benefit from statins to combat the c-reative protein problem. How many more so called great things will statins do for us? Is this another terrific marketing ploy?

Dear Doc,
all this NMR is black magic to me so far, besides I will wait for some advanced lipid measurements until I am at least 40.
But I suspect that the LDL size can be guesstimated from e.g. triglicerides / HDL ratio - could you please supplement your post with the figures for both persons. I suspect there will be a difference there. TIA

And if a million or so "Lauries" are given Lipitor for their 85 mg/dl  real LDL, I don't expect their all-cause mortality will IMPROVE .

Doc:

My speculation is that this is merely an effect of the huge to-market costs pharmaceutical companies must endure, owing to FDA regulations.

If people didn't have false-security -- as you have shown -- of FDA hurdles and implicit [expensively purchased] assurances, they might just take a bit more proactive, intelligent and informed approach to their own health, and maybe drug companies might go back to serving an informed consumer who no longer simply bows to an authority (the FDA) because they have the power to be who they are.

My neighbor is being lipitor by his internist because both his parents have alzheimers. At least that is what my neighbor told me.  I told him I'd never heard of that and he said he'd trust the doctor to know.

Statins don't lessen the risk of heart disease by lowering cholesterol. They work by lowering inflammation which is not what  they were designed to do and was not expected. Happens a lot - drugs being created for one thing and being found to work for something else so are then subscribed for other conditions.

Statins are powerful and dangerous drugs that block the production of cholesterol. Our bodies NEED cholesterol. By blocking its production, it also blocks Co Q10 and dolichols, and more. Side effects range from minor muscle pains to the complete destruction of muscles, kidney failure then death. Also transient global amnesia (TGA) which doesn't show up immediately and is dismissed when it does. They cause depression and violent behaviour. That's why people on statins have a higher morbidity from all other causes and not heart attacks.

As renegadediabetic  above says, they show slight benefit for middle-aged men who have already had a heart attack. Oh yeah, tell us again why we need them?

"morbidity"? Um, mortality.

Darn. Message went to wrong place. Mortality is what I meant.

[...] standard practice is to usually look at your LDL cholesterol, the value that is calculated, not measured, then–almost without fail–prescribe a statin drug. While there are indeed [...]