Confused on NMR results

(Todd Batitis) #1

So simple background. At 6’ tall and 356 pounds, insulin resistant and with metabolic syndrome I got back on the horse I fell from about 2 years prior and started back on the LCHP diet I was doing before that got me down from 387 to 295 before I started back to my old ways (and weighs). Treadmill 3 times a week for 35 minutes at a 9 of 15 incline, MFP tracking and shooting for around 2200 calories, 85g carbs, 160 fat and eating 6 times a day. You know the drill they give you when you are pre-diabetic.

After hearing Joe Rogan mention (but not discuss) “intermittent fasting” for about a year I looked into it and it made total sense and in June I jumped on doing 20:4. Researching (mostly podcasts) I could see how well keto matched up with it and spent a month transitioning to keto and haven’t had any real problems with it and find both very freeing.

Since March I have lost 109 pounds and been happy with the weight loss. Listen to tons of podcasts and have read many of the main books (save for Dr. Fung’s) and found The Great Cholesterol Myth by Bowden and Sinatra to be particularly eye opening. It all makes sense to me, all of it now that I am starting to give a crap about my health at age 50.

What doesn’t make sense to me are the changes in my NMR panel and as I go in for a followup with my primary doctor tomorrow (who is supportive in general) and my cardiologist on Tuesday, I want to have understanding of what I am looking at and what is truly a concern and what isn’t. Some changes seem good, even if only mild improvements, others seems concerning while some numbers seem pretty darn good. I was expecting to see an increase in total cholesterol but expected to see a big increase in particle size and reduction in the small dense stuff.

I will list out the categories and results for my last 3 NMRs. Any help with clarification would be greatly helpful. They represent April, then June and finally September. I was taking 20mg of Crestor daily during this time and had started that in March when I went to the doctor with no meds in my system for months.

LDL Particle Number (nmol/L) - 924 - 1,049 - 1,582
LDL Cholesterol (mg/dL) - 61 - 66 - 93
HDL-C (mg/dL) - 30 - 33 - 39
Triglycerides (mg/dL) - 76 - 77 - 66
Cholesterol (mg/dL) - 106 - 114 - 145
HDL Particles Total (umol/L) - 21.3 - 24.3 - 24.8
Small LDL Particles (umol/L) - 643 - 755 - 1,056
LDL Particle Size (ng) - 20.0 - 19.9 - 20.0

Large VLDL-P (nmol/L) - 1.2 - 1.5 - 1.2
Small LDL-P (nmol/L) - 643 - 755 - 1,056
Large HDL-P (umol/L) - <1.3 - 1.4 - 2.0
VLDL SIZE (nm) - 46.9 - 42.7 - 41.9
LDL SIZE (nm) - 20.0 - 19.9 - 20.0
HDL SIZE (nm) - 8.7 - 8.6 - 8.5
LP-IR SCORE - 55 - 54 - 54

Thanks in advance for any clarification on this stuff.

(Candy Lind) #2

EEK!! Don’t wait until the night before to ask this stuff! LOL :exploding_head:

Tagging the experts, @siobhan and @DaveKeto to help with this. I would start reading on Dave’s website, http://cholesterolcode.com or look up Dave Feldman and Ivor Cummins on YouTube to get an idea of how the thinking on cholesterol and it’s meaning (or lack thereof) has changed in the last few years. IIRC, the HDL:tri ratio is good if it’s under 2, and yours is under .5.

Siobhan and Dave can tell you more about the LDL but since you’ve been keto for under 6 months, I think they’ll say “don’t worry and test again in a few months.” If the docs are totally freaked, ask if they would be OK with doing a CAC and CIMT to get a factual look at whether you’ve got any CAD or CHD going on, and go from there.

(Todd Batitis) #3

Thanks Candy :slight_smile: And yeah, I know it is bad form to do it the night before. :slight_smile: I have been meaning to do it since I got the results back last week but was trying to simply figure it out on my own. :slight_smile:

I have listened to Ivor speak many times on podcasts and have a couple by Dave Feldman lined up as well. The things you speak specifically about are what some of the things that were throwing me were. The HDL/TRIG ratio is indeed great but other aspects were throwing me. And regardless of what is brought up, my intent was to keep calm and keto on and see where we are at every 3 months going forward.

I believe I have had a calcium score done a few years back when I had some other heart tests done (nuclear stress test, CT coronary angiogram, etc) but I will certainly ask about it and request another one gets done.

Luckily I have doctors who are not the “there is no need for that test” kind of people. If I want a test done (like my omega3/6 ratio or CoQ10 or Fasting Insulin) they will happily put it in but let me know the cost and that insurance may not cover it and let me decide.

Thanks again :slight_smile:

(Todd Batitis) #4

So overall the visit went fine. In general they do that when you go in 3-4 months after your last visit and your doctor barely recognizes you because you have lost so much weight. :smile:

He was a bit confused about the way some of the lipid numbers came back and asked “So how do we explain this?” pointing to the rise in LDL-P and Small LDL-P since I was on Crestor during that period. I told him that I wasn’t sure yet and that it was something I was looking into.

We talked briefly about my decision to stop the statin. I explained to him that there are multiple studies going back to the 90’s and earlier even that show that while statins do indeed do a great job at reducing you cholesterol, there is no evidence they help prevent heart attacks or CAD and even all cause mortality. I talked about the results of the study that showed 50% of patients admitted for heart attacks (I believe it was the Minnesota study) had normal cholesterol levels so clearly it wasn’t the cholesterol that was the problem and that the vast majority of the cholesterol in our blood isn’t dietary but rather that which is made in the body. He nodded in agreement.

Today is the cardiologist and I am going to talk to her about getting a Calcium Score and see what she thinks of a CIMT. When I had my CT Angio a few years ago there was minor plaque in one area so nothing major but I don’t think we did a Calcium Score at that time since we were doing that procedure.