Blood work is back! (UPDATED with fractionation results)


(John) #4

Yes I got the book back out and he says under 2 is good.

Can’t wait to see what my doc thinks of this. Ha.


(Khara) #5

Congrats @PoolBum79 on your weight loss and feeling so great with this!
These numbers are pretty dynamic too. I’ve had a couple times where I got different tests on the same day or within a week of each other and was surprised at the differences. For example a year ago March I had a Tri/HDL ratio of 1.33 and then 6 days later it was .95. Six months after that I got both a 1.65 and a 1.51 on the same day. The reason I have different numbers at the same time is due to a doctors office blood draw and also an NMR. I had in my notes that the ideal Tri/HDL ratio was 1 or below (old notes, not sure where from). Based on these 4 numbers, if only one of them was obtained, depending which one, I would’ve had quite different reactions. I’d have been elated with .95 for example but probably a bit disappointed in the 1.65 (using my 1 or below ideal reference).
For years I thought that the results I got once a year were these hard exact numbers. I thought I had to work for the better part of a year to see any changes. That’s how the doctors always seemed to portray it. Then I got these differing results from tests on the same day or week and realized it wasn’t actually so tight of a marker. My triglycerides actually varied by 30 points. This is enough variation to cause a doctor to either say everything looks great or to prescribe statins - from tests the same day or week! I asked my doctor at the time about this incongruity and he had no explanation. I think he didn’t often (or ever) have a patient get tests the same week and compare or question them.
Sorry for the digression. I just saw that your numbers went up a little which made me want to share. We’ve been so trained to see this as a bad thing and to get all worried. I’ve seen doctors who prescribe statins if a persons total is over 200. I’ve had a doctor tell me my cholesterol was REALLY HIGH when it was 218… that’s just 18 points outside of the ideal range. When I can sit and look at my own drastic variation in results taken less than a week apart, these teachings we get from our doctors just seem Incredibly lacking in credibility.


(John) #6

The Quest lipoprotein fractionation results are back. I’m a little confused.

LDL particle number 1602 nmol/L. (standard range 1016-2185)
optimal risk <1260; moderate risk:1260-1538; high risk >1528

So even though I’m in the “standard range” I’m at high risk?

LDL small 185 nmol/L (standard range 123-441)
optimal risk <162; moderate risk:162-217; high risk >217

LDL medium 427 nmol/L (standard range 167-465 nmol/L)
optimal risk <201; moderate risk:201-271; high risk >271

LDL large 5402 nmol/L (standard range 4334-10815)
optimal risk >9386; moderate risk:9386-6996; high risk <6996

LDL pattern. I am “A pattern”

LDL peak size. 219.9 angstrom
optimal risk >222.5 moderate risk:222.5-218.2; high risk <218.2

So I was expecting to see a small amount of small dense LDL and a high “large and fluffy”. According to the quest diagnostics risk profiles, for small LDL I am moderate and for large I am high risk, despite being within their “standard ranges”

This will present as a problem because my doctor admitted to not knowing how to read this fractionation result so she will be looking at the same ranges I am.

Any thoughts on these values? This is my first bummed out keto moment.

Thanks.


(John) #7

Wondering if I should bump this or start a new post.

Any comparisons to your own tests or any evidence this these test results are normal?


(Khara) #8

It always takes me a while to interpret my results. The document is hard to read with columns and data fields poorly aligned. That said, your test has more information than mine. I do not get the small, medium, and large LDL results that you’ve gotten. I get only:

  1. A small LDL-P count which for my most recent test was <90 and the reference/ideal range is <527.
  2. LDL size which was 22 most recently and the reference/ideal range was >20.5 with Large Pattern A range being between 20.6 and 23.

The way I interpret my results is that the majority of my LDL-P are the Large Pattern A size and a relatively small portion are Small Pattern B.
Although my total particle count is always out of reference range high to very high, my particle types/sizes are good. I know there is disagreement in the lipid expert community as to which of these are more important in determining risk.

Keep in mind too that “reference range” just means the average results of the population getting tested. It’s likely there are more LC people getting these NMR tests than HC but labs in general are going to be showing reference ranges from a largely carb-centric population. Personally, I’m not so sure whether being in the average range is necessarily a good thing.

This is the LDL-P particle number range breakdown from my tests:
Low <1000
Moderate 1000-1299
Borderline High 1300-1599
High 1600-2000
Very High >2000


(Khara) #9

This was a good presentation. I don’t have time to find where in the video this occurs but at some point Dr Gerber likens dropping LDL particle count below 1000 to dropping total cholesterol below I believe he said 100. If someone watches, please confirm or correct me here. I just remember it was very illuminating the way he said it.


(Bacon is a many-splendoured thing) #10

According to a couple of lectures I’ve watched by Dr. Phinney, and one by Dr. Gerber, the numbers to be concerned about are small, dense LDL, triglycerides, and HDL. The first two generally track together, apparently, and the real number to watch is the triglyceride/HDL ratio. So even if LDL and trigs are elevated, if the HDL is also elevated enough to bring the ratio under 2.0, then you’re in good shape.


(Crow T. Robot) #11

Before you get bummed out (stop laughing, UK ketonians!) remember than these numbers are extremely variable depending on your meals and amount eaten. @DaveKeto explains it all on his site. This video interview he did is extremely interesting: https://www.youtube.com/watch?v=oydeTasQD0c

Also, “atherogenic particles” are only dangerous if you have systemic inflammation, which based on your CRP and trig/HDL ratio is not a problem for you. KCKO :slight_smile:


(Bacon is a many-splendoured thing) #12

“Fanny pack” is another one that sets off my Brit friends, lol!


(Dave) #13

As I always like to point out, TG is the “noisiest” of markers I track – which makes sense given they are energy on demand. Your HDL being above 60 and TG generally below 100 is a very good thing. CRP at 0.1 is phenomenal – your liver must be on vacation.

??? In Cholesterol Code? Do I have that somewhere on the site?


(Dave) #14

This too looks like a great lab for a standard low carber. I wouldn’t even consider you a hyper-responder.

Remember, these ranges were generated from those on a carb-centric diet and the associations were more likely when higher LDL was indeed indicative of trouble (such as chronic inflammation – which can oftentimes show a CRP above 10.0 consistently, for example). LDL is used for transporting fat-based fuel AND dealing with trouble; it wears many hats. The point is – you are now powered by fat and thus, you are literally trafficking more LDLp to bring TG to your cells for fuel. Check out my Simple Guide series for more info… cholesterolcode.com/a-simple-guide-to-cholesterol-on-low-carb/


(John) #15

Thank you Dave. Great reply. I appreciate it.

I meant Cholesterol MYTH! (Sinatra’s book) haha. Code must have been on my mind.


(John) #16

I realize now that my results are Ion Mobility, not NMR.

I asked the doc for NMR but got this test from Quest.


(John) #17

QUICK FOLLOW UP: I got the official letter from my doctor and she said

“Your total cholesterol level and LDL are slightly high. Based on the old guidelines that aims at specific LDL targets, your LDL is slightly above target. However, based on the new guidelines that look at an individual’s risk profile you do not need to be on a cholesterol lowering medication”

HEY GREAT NEWS - DOC IS ON BOARD! All other markers are in range! WHEW.


(Jim) #18

I just got my results back from Quest, and their method and results (Cardio IQ ) seem to be different than the NMR (NMR LipoProfile w/ Lipids) results I see commonly posted. Can someone explain how the results from both tests compare?

For the record:
Medium Carb diet for 6 months then keto the last 3 months

Reference Numbers for “OPTIMAL”, “MODERATE”, “HIGH” in brackets.

    TC                  =  242 mg/dL (HIGH)     [ <200, 200-239, >=240 ]
    HDL-c               =   56 mg/dL (OPTIMAL)  [>= 40, NA, <40]
    Triglycerides       =   84 mg/dL (OPTIMAL)  [<150, 150-199, >=200 ]
    LDL-c               =  169 mg/dL (HIGH)     [<100, 100-129, >129]
    Non-HDL-c           =  186 mg/dL (HIGH)     [<130, 130-159, >159]
    Trig/HDL            =    1.5 (My calculation, not on report!)
    TC / HDL            =    4.3 (MODERATE)     [<=3.5, 3.6-5.0, >5.0]
    LDL Particle Number = 1860 nmol/L (HIGH)    [<1260, 1260-1539, >1538]
    LDL Small           =  223 nmol/L  (HIGH)   [<162, 162-217, >217]
    LDL Medium          =  451 nmol/L (HIGH)    [<201, 201-271, >271]
    LDL Large           = 6873 nmol/L (HIGH)    [>9386, 9386-6996, <6996]
    Apolipoprotein B    =  115 mg/dL (MODERATE) [<80, 80-119, >=120]
    Liproprotein (a)    <   10 nmol/L (OPTIMAL) [<75, 75-125, >125]

Hs-CRP 1.9 mg/L
Serum Insulin 7.0 uIU/dL
Glucose 102 mg/dL
Hemoglobin A1c 5.0%


(Khara) #19

Surprised no input yet. I am not an expert but If it were me, I’d be happy with these numbers - with the limited knowledge I currently have. Even your high’s really aren’t that high. And from what I’ve read the Trig/HDL ratio is the most important and under 2 is good. I like that your lab is able to give a breakdown of small, medium, and large particles. NMR just gives a count for small and then particle size on a numerical scale which as best I can tell indicates either the majority or the average are the size shown. One thing that’s interesting and confusing and that I can’t rectify is that my small particle reference range for optimal shows <527 nmol/L. This does not seem to convert to your <162 mmol/L optimal range. (Note the nmol vs mmol.) So, I’m having a hard time comparing your small particle count results to mine since the units differ.


(John) #20

I’m not sure if you wanted me to weigh in or someone with more experience.

I think this looks in line with what a ketogenic diet would produce. From what I read your triglycerides and HDL are both in the good range, which is the most important.

My LDL fractionation was from Quest, too, and said high for everything as well but I don’t think those reference ranges are meaningful. It appears you are a pattern A since if you graphed the small / medium / large you would show a much larger peak up in the large range which is the large and fluffy kind. So I think this is good!


(Jim) #21

Yes, numbers should have been nmol, not mmol. I corrected the original post to reflect this fix.


(Khara) #22

Huh, so your reference range for small particles is <271 nmol/L (to not be “high”). My reference range is <527. I only have this high reference, no breakdown for low, medium, and high like you have. So, depending on who the test was done through, people would/could be thinking they are in the high range with Cardio IQ but not with NMR.

Either they are testing with different methods or their reference population is considerably different. It is my understanding that lab results such as this are based on the population of people who have been tested. In other words, having a “high” result means your number is higher than most of the people who’ve been tested. Results being “ideal” or not is another thing. And, the majority of Americans are carb eaters so references for labs are based on people eating a very different diet. (Granted, it’s possible, maybe even likely, that there is a higher population of low carbers getting these particle count lipid panels).


(Jim) #23

NMR And Cardio IQ are different methods to measure LDL particle size, hence the results and targets are different. My original post is asking how to relate Cardio IQ results to NMR results. Actually, I would like to understand if these Cardio IQ results are what is expected when on a Keto diet.
The only references I can find are based on NMR. Sort of like measuring temperature in Fahrenheit and Celsius. There should be a way to correlate the two.