Cholesterol, Thyroid, and Health Results

(Josh Stanisch) #1

Hey guys, I haven’t been here in a long time but I need some reassurance/insight.

Couple of things. I have not been truly keto or carnivore almost all year. In fact this may be the worst year in recent memory where I haven’t even tried tracking my food intake. I primarily eat the usual “keto” stuff: meat (All kinds), eggs, butter, duck fat, tallow, nuts, some dairy, and fruit every once in a while. I rarely eat carbs unless we go out. Then I won’t stop myself if I want to have a dinner roll, burger bun, or a couple beers with friends. I would say 6 out of 7 days of the week I eat very cleanly.

I do OMAD, just cause I have worked up to it and for convenience sake. There if I was to guess I normally consume around 2400-2800cal/day then. Otherwise it is just water (gallon/day), and 2 cups of coffee with some butter or heavy whipping cream in it.

I workout 6/week. Lift 3 days, Muay Thai, BJJ, or Boxing 3x/week. Golf 1-2x/week as well. I can literally go for a run, or haul stone all day in my yard in the middle of the PHX summer afternoons and be perfectly conditioned- literally no one I know can do this. My Resting HR is 50, my HRV is very good as I can go near threshold (178bpm) and drop 30-40bpm down to the 140-130s within a minute. BP is typically 120/80 or a little lower. I am 31yrs old, 6ft, 225-230lbs and sit around 12-14%bf year round.

I recently had my blood work done (roughly 10hrs fasted), and I am just a little interested on what this means? I haven’t changed the way I have been eating much year to year but my Cholesterol and LDL continues to grow.

Can anyone help me? Either with reassurance, or insights that I don’t have? I Maybe any tweeks? Thank you

My Blodword Results:

*TSH to t4
Jun 7, 2024 --13.879uIU/mL HIGH
Jan 26, 2023 --8.756uIU/mL HIGH
Jan 19, 2022 --6.305uIU/mL HIGH

*Free T4
Jun 7, 2024 --0.72ng/dL NORMAL
Jan 27, 2023 --0.91ng/dL NORMAL

*** Lipid Panel**
TOTAL CHOLESTEROL
Jun 7, 2024 --308mg/dL<200 mg/dL
Jan 26, 2023 --246mg/dL
Jan 19, 2022 --238mg/dL
HDL CHOLESTEROL
Jun 7, 2024 --63mg/dL
Jan 26, 2023 --54mg/dL
Jan 19, 2022 --57mg/dL
TRIGLYCERIDES
Jun 7, 2024 --83mg/dl
Jan 26, 2023 --74mg/dl
Jan 19, 2022 --53mg/dl
LDL CHOLESTEROL
Jun 7, 2024 --228.4mg/dLHigh
Jan 26, 2023 --77.2mg/dLHigh
Jan 19, 2022 --170.4mg/dLHigh
VLDL
Jun 7, 2024 --17mg/dL
Jan 26, 2023 --15mg/dL
Jan 19, 2022 --11mg/dL

I wanted to also get my Testosterone done but I have not gotten those results yet.

What do you guys think? Is this something I should be concerned about?

Thank you

(Edith) #2

Considering you have a relatively low body fat and exercise quite a bit, it sounds like you fit the Lean Mass Hyper Responder category.

You may want to look into that.

(Bob M) #3

For the cholesterol, you’re most likely a LMHR (lean mass hyper-responder):

You don’t quite meet the HDL and trigs on that page, but you’re close enough. Note too that how muscular you are will affect this: if you’re quite muscular, those types don’t always hit the LMHR rules on that page. There were theories about why,.

If you get thinner, your LDL should go up, as should your HDL, and your trigs should go down.

If you’re interested in theory, they’ve published some papers on it:

My PERSONAL opinion: you have nothing to be concerned about. I recommend doing your own research, though.

By they way, if you are an LMHR, then the best way to drop your LDL is … to eat carbs. An LMHR eats Oreo cookies:

image

As for the thyroid stuff, I don’t know enough about that, particularly because we low carb/keto folks are “different”. For instance, not eating carbs means reverse T3 can be, and usually is, lower.

(Joey) #4

@JStanisch I’m inclined to agree with much of @ctviggen’s general perspective above … although just how much of an “LMHR” you really are seems to be an open question.

Since you hint that this has not been a “truly keto” year - “the worst in recent memory” - you invite me to wonder about what your current lipid profile might actually be reflecting.

I’m not suggesting that an occasional dinner roll, bun, or beer is dangerous to your long term health for such a generally fit guy in his 30s who generally avoids the carbs, but is that truly all of it? Could there be some wishful thinking for someone who doesn’t really track anymore.

Don’t get me wrong … tracking becomes unnecessary once you get into the groove of avoiding carbs for real. But once you start incorporating them into your eating even in some occasional “binge-ish” way, it gets easier to lose track of how much you’re really consuming.

Look, to be candid, LDL simply doesn’t bother me at any level in the context of genuine carb restriction. But at your HDL/Trig levels don’t scream “LMHR” to me - unless they were vastly different before going carb.

I’d suggest you take a careful look at what you’re actually eating and sharpen the pencil on what you have convinced yourself of … just to be extra certain you’re taking the kind of care of yourself you’re aiming for. :vulcan_salute:

(Bob M) #5

A slightly longer fasting time might have helped too. 12+ hours is usually recommended.

My problem for that is that I eat too late, commonly eating after 8pm and near 9pm. Then, the main time I can get to a blood draw is in the morning. So, 12 hours fasting for me for blood is actually hard to do.

#6

I would get your ApoB tested. ApoB encompasses all of the potentially atherogenic particles. I would also get your Lp(a) tested as well.

(Joey) #7

This might be of interest on the topic of Lp(a) and ApoB…

#8

Thanks for sharing. Hopefully, more information will lead to better outcomes, especially when one considers CVD to be the number one cause of death in the world.

#9

These numbers are out of range (note it is always helpful to include the reference range as different labs have different values) What did your doctor say? I would repeat this and also do the entire thryoid panel especially including all the T3s and the two antibody panels but I am a lay person and not an expert at all. Ask your doctor if you should be seeing an endocrinologist

(B Creighton) #10

Actually, most endocrinologists seem to be old school. Functional medicine doctors and other doctors specializing in thyroid seem to do better… These days you will probably rarely find an endo who will order a full thyroid panel. I would ask this question before making an appt with one.

#11

Seriously? How can you not order a full panel if TSH is elevated. Do you have recommendations on functional medicine or other doctors for thyroid

(Alec) #12

My observations on your lipids:

  1. Something wrong with the Jan 26, 2023 LDL number…. Nobody would say that 77.2mg/dL is “high”. Has a number been lost in there? If that was your real number that (IMHO) is dangerously low.
  2. Your trigs are loverly and low. This indicates a low carb diet. This is by far the most important number here
  3. Your HDL is good. 2nd most important number here.
  4. Your current LDL levels are (IMHO) just fine, but whatever they were, with your current trigs and HDL, they are irrelevant and are just what they are supposed to be. Don’t let any doctor persuade you into statins: dangerous drugs that shorten your life. Politely decline.
(Josh Stanisch) #13

I will look into the LMHR thing for sure- I’ve never even heard of that. The carbs is ususally consume are primarily from fruits/nuts/dairy. Again, maybe like a cup of fruit or a handful of nuts (typically). I know I can be more strict, its mainly a social thing that causes me to not be as tight with my own diet, which in turn is my own fault. Thank you for your input!

(Josh Stanisch) #14

I KNOW I have not been as strict as I could/should be. This could 100% reflect that as well. Typically (5-6 days/week) the carbs I get are from a cup of fruit or maybe a handful or walnuts/almonds raw. I can dig deeper and do some additional research with the LMHR as that’s something I have never even heard of before. Thank you for your input as well!

(Josh Stanisch) #15

The “normal” range is listed at 0.35 - 4.94 uIU/mL

The problem is this bloodwork was from an old doctor and my work offers PCP on-site but they aren’t taking new clinets now until Sept. I want a whole bloodwork work up done of everything. Thyroid, Routine, Test, antibodies, etc.

Do you have recommendations of everything one should get in a bloodwork panel?

(Josh Stanisch) #16

1- Sorry that was a typo. Jan 26, 2023 was 177.2mg/dL
2- I agree my HDL to Trig ratio is good. I would like to get it even more even but I was just curious. My ratio used to be closer to 1 and that was back when I was even routinely eating a few more carbs which leads me to believe I gotta look into the Lean-Mass Hyper Responders that @ctviggen mentioned

never going on statins. F*** that S***

(Alec) #17

I personally would not worry about the LMHR stuff… bottom line, all that is just an explanation for why “high” LDL is not an issue for people with certain characteristics. I would contend that what some consider “high” cholesterol is not an issue for anyone. LDL is NOT causal in CVD, so high LDL is not an issue. What is an issue is high trigs, not because of the trigs themselves, but because they indicate a high carb diet and that is glycating and that is causative in CVD. So, high trigs is indicative of an issue that needs addressing. High LDL not at all.

(Bob M) #18

Well, the LMHR stuff is useful mainly because if you’re one of those, you have can find reasoning as to what’s going on and also meet/see a group of like people.

I think that high LDL by itself seems to be relatively meaningless. I think this is what’s going on:

  1. something is causing damage to the endothelium or another part of an artery
  2. if damage > repair, something bad is going to occur, mainly atherosclerosis at some location
  3. it’s possible something like peri-oxidized LDL or Lp(a) or similar could exacerbate this process, though I’m doubtful (unoxidized) LDL by itself is an accelerant

To me, this is the general process. But there’s also coagulation factors that are involved somehow, and there’s the possibility of non-calcified plaque being problematic too. I can’t quite figure out how these fit in, probably because if you don’t believe LDL is everything, you’re on the outside, and there aren’t many studies of non-LDL stuff.

(Bacon is a many-splendoured thing) #19

There is plenty of evidence to suggest that cholesterol levels are not the concern they’ve been made out to be. The LDL level has been shown to be largely irrelevant to cardiovascular risk; the most informative indicator is the ratio of triglycerides to HDL. Your most recent ratio is 83 / 63 = 1.32, which is pretty good. In American numbers, you want the ratio to be 2.0 or less (0.9 or less, in the units used int he rest of the world), and 1.0 or under indicates a high degree of insulin sensitivity. So your cardiovascular risk is still minimal, but you are becoming more insulin-resistant than you were in January of 2022. This is a sign of future trouble. If you act now, you can easily head it off.

Be sure to be consistent from lab test to lab test. Dave Feldman, the citizen-scientist who identified the lean-mass hyper-responder phenotype, asks people who submit their data to fast between 10 and 12 hours, and to have no coffee before the blood draw. This makes the results as consistent as possible.

As for whether you are a lean-mass hyper-responder or not, as I understand it, the essence of the phenotype is that eating carbohydrates causes LDL to go down, and a low-carb, high-fat diet causes LDL to go up. It is something of an inverse response to most people’s. If you are an LMHR and you’ve been eating carbs, then your response is borderline. I’d have expected a higher LDL and triglycerides and a lower HDL than what you’ve shown. So whatever you are, I’d say that you are still mostly healthy but with signs that things are now going in the wrong direction.

You know how to change that direction, so it’s up to you to decide whether your long-term health is more or less important than your immediate eating pleasure. Sugar, starches, and grains are metabolic poisons, but you may feel that the pleasure of enjoying them now is worth the long-term consequences. Only you can decide that. But bear in mind that your latest lipid numbers show that the long-term consequences have already begun for you.

In any case, stop worrying about cholesterol. At best, our lipid levels are markers for cardiovascular risk, and it is increasingly clear that our LDL level does not cause cardiovascular disease; the real cause lies elsewhere. Manipulating a marker is like a city selling off its fire engines, on the grounds that fire engines are always seen at fires, so reducing the number of fire engines will reduce the number of fires in town.

I don’t really know what to make of the thyroid numbers, except that they generally go down on keto, because the body uses them more efficiently. So the rise you are seeing may be the result of excessive carb intake. As for testosterone, whenever you get that number, my thought is that the level is irrelevant, unless one is seeing actual symptoms of inadequate testosterone. A lot of the so-called “normal” ranges in lab work are based on a general population that is increasingly unhealthy, so it makes no sense to worry about not fitting into such “normal” ranges. A lot of the research into what is normal or not will have to be re-done on actual healthy people, is my guess.

So you know what course of action will help preserve and promote your good health. I wish I had known at your age. But the trick, of course, is to decide what your long-term goals are, and whether the pleasure of unhealthy behaviour today outweighs being healthy in the future.

(Bacon is a many-splendoured thing) #20

Do some research. Some berries and seeds are pretty okay on a keto diet, whereas others are not worth it. As for dairy, avoid low-fat anything and stick to heavy cream and aged cheeses. Their sugar content is low enough to make them acceptable on keto. Ice cream is out, unless it’s sugar-free.

The goal is to avoid elevating insulin to the extent possible, and the foods with more glucose (carbohydrate) in them are the ones that provoke the major insulin response. Hyperglycaemia (too much glucose in the blood) damages the body and can even be fatal; it is therefore accompanied by an elevated insulin response that over time becomes insulin-resistance/hyperglycaemia, as the body finds itself less and less able to deal with the excessive glucose intake.

Hyperinsulinaemia, which is damaging to the body in its own right, starts long before an actual diagnosis of Type II diabetes, but the late Dr. Joseph Kraft, a well-known diabetologist, maintained that an excessive insulin response was a sign of Type II diabetes about two decades before the actual diagnosis, which is based on blood sugar. Unfortunately, he was unsuccessful in changing the diagnostic criterion.

So avoiding sugar, starches, and grains is the best course for anyone who wishes to maintain metabolic health. A properly low insulin level will permit the body to use ketones and fatty acids for energy in place of glucose (except for those cells that cannot live without glucose). This is significant, because fats and ketones can be metabolised without the damaging effects of metabolising too much glucose.