New Blood Panel Results

(Danny) #1

Hey all,

I posted my initial journey a couple months back in which I explained how I’d been doing something of a pseudo keto with some weekend cheat meals and drinking more than I should. Here is that thread for reference.

Since that time, I’ve had no cheat meals and stayed completely away from beer as well as cut way back on my drinking. And I wouldn’t call my diet technically “keto” as my net carbs tend to be around 30-40/day on average but all from natural sources.

A typical day in the life for me, in terms of macros, looks like this:
Calories: 2,400
Protein: 160 g
Net Carbs: 35 g
Fat: 175 g

I’ve been feeling pretty dang good and have melted away pretty much any fat I had left on me, leaving behind a pretty defined 6 pack and an overall vascular build. Lends me a lot of confidence and my wife loves it. The goal isn’t vanity here but it’s a great added perk!

That said, I had a follow-up lipid panel and ApoB test, and did my first fasting Insulin test on 3/1 and just got my results back. Was a little surprised to see that my total and LDL cholesterol numbers had increased yet HDL stayed about steady… Trigs went down which is positive. But ApoB shot up quite a bit. And my Insulin was solid.

OLD 1/11/2023 Results
Total Cholesterol: 262
LDL: 172
HDL: 70
Trigs: 102
ApoB: 117

NEW 3/1/2023 Results
Total Cholesterol: 298
LDL: 210
HDL: 69.2
Trigs: 92
ApoB: 144

Also… On 2/3/23
Calcium CT Score = 0

I honestly thought getting more strict about my diet and cutting back on drinking would have a more positive impact on these numbers but, to my surprise, the positive changes (in Triglycerides only) were fairly insignificant and the “less positive” changes in total cholesterol, LDL and, especially, ApoB were much more pronounced.

All of this said, I think the biggest shocker was the ApoB number… I don’t know how to interpret that one as it seems to be a fairly hotly debated topic. Certain professionals like Dr. Paul Saladino say it’s nothing to worry about whereas others like Dr. Peter Attia says the opposite.

Still waiting to hear from my cardiologist, who is an advocate of keto and said he’d like to see my ApoB below 100. Not sure if he’s going to advise me to change course or stay on this path but I really don’t want to change my diet. We did do the Calcium CT scan since his comments about ApoB so I’m wondering if that’ll change his perspective.

In any case, would love to hear thoughts from the community on these results.

Apo E4 Heterozygous (Male) and Keto
(Bacon is a many-splendoured thing) #2

If you are losing fat, then your insulin is low enough for you to be in ketosis. So you are, in fact, eating a ketogenic diet, since that amount of carbohydrate is low enough—for you. Others who are more insulin-resistant might have to eat less than that; whereas others who are more insulin-sensitive than you might be able to eat somewhat more.

I notice your ratio of triglycerides to HDL has dropped from 1.46 to 1.39. That is excellent. Congratulations! :+1:

(Bob M) #3

That just means your LDL and ApoB should go up,as your carbs go down in particular. (You’re on your way…if you’re not there…to being a lean mass hyper-responder, LMHR.)

I find trigs to be noisy.

And ApoB is immaterial if your calcium CT score is zero.

(Joey) #4

Your risk of CVD is extremely low given lipid profile and CAC. If all of your cardiologist’s patients were like you, he’d be out of business.

And as @PaulL notes, you wouldn’t have lost weight and toned up if you weren’t running on ketones rather than carbs. 35 g/day is rather low - don’t be hard on yourself.

If you’re not already doing so, I’d suggest adding some regular aerobic and strength training into the mix and it’ll do wonders for both your psyche, your heart health, and your lipid profile. Your wife might like the results on you also. :wink:

Congratulations! (And yeah, as @ctviggen suggests, you sound like a LMHR to me, too.

(Danny) #5

Is being a LMHR considered a positive thing? I know it’s a thing, just unclear if it’s something to strive to be.

(Danny) #6

Thanks for the feedback!

As for the cardio and anaerobic exercise, I actually workout 5-6 days per week and employ a mix of both. It’s part of my daily routine and has been for quite some time.

(Joey) #7

That seals the deal. Welcome to the LMHR club. We’re a small but growing group who can improve our heart health as we spike our LDL in the end zone. :+1:

(Bacon is a many-splendoured thing) #8

Well, striving to be an LMHR is like striving to be 6 ft./183 cm tall. One either is or isn’t, and not much to be done, one way or t’other.

(Danny) #9

Haha… Indeed. The way I said that made it sound as though it’s something you can become. I meant is it something one would prefer to be?

(Bacon is a many-splendoured thing) #10

I still don’t think it’s anything to worry about, either way.

Although high cholesterol can have a protective effect, it seems. In one study of people with familiar hypercholesterolaemia, the half of the population that didn’t develop heart disease actually had a higher life expectancy. (The ones that did develop heart problems did so because of other factors than their cholesterol level.). Other studies have also shown associations between higher cholesterol and lower mortality.

Given that this is all epidemiological data, it wouldn’t be wise to read too much into these associations, because the real benefit might come from something other than cholesterol, but it does suggest that higher cholesterol is not anything to fear.

(Joey) #11

Great question - First, as @PaulL says, I wouldn’t want to read too much into epidemiological studies on human populations. There are so many unavoidable confounding factors that any “associations” unearthed are very often entirely misleading. Researchers torture the data until they confess.

But now, I’ll give you my personal, highly-biased take…

After the initial shock, fear, and concern, I now think being an LMHR is awesome.

The “lean mass” part is indicative of a physique on the trim side of the spectrum - not a guarantee of health, but a hell of a lot better than being grossly overweight, high blood pressure, lethargic, lacking in exercise habits, etc.

The “hyper-responder” part is a bit of a misnomer. An LMHR’s LDL rises sharply (especially at first) even as HDL (higher) and Trigs (lower) settle into the healthiest of healthy ranges. The rise in LDL is most likely all about energy transport, with ketones doing the lifting instead of glucose. That’s an entirely healthy response (in my admittedly biased view). And it’s almost entirely of the “light fluffy” Pattern A type - not the somewhat more concerning “small dense” Pattern B type.

Of all the modern serious studies have shown:

  • HDL and trigs matter
  • Total LDL is not the cause of CVD
  • “Pattern A” LDL particles are the sign of insulin sensitivity, not insulin resistance.

In other words, it’s all good stuff.

As noted above, one cannot do anything about their body’s reaction to carb restriction any more than one can change one’s height. But if you were playing the biomarker lottery, you just won.


(Denise) #12

From what I’ve learned here, mostly get here :smiley: you are doing great!! Congratulations for sure. My cholesterol is something I no longer think much about, but the trigs divided by HDL ratio, I keep an eye on. Someone here will know about ApoB # as I don’t but want to look it up.

So great you have a cardio that believes in Keto! I think my MD is becoming a believer :grinning::grin:

(Kirk Wolak) #13

As a reference, my wifes LDL Cholesterol is ~ 300
Her CT Scan = 0

And the doctor loved it, because he was able to stop pushing Statins at her!

I know this is hard to imagine… But CONSIDER that MAYBE LDL is not the cause of heart disease, and that NHANES shows that mortality goes up as it goes down… Then, just maybe you can IGNORE all the hype (from a $trillion drug=statins, industry) that has a product to sell, and (GASP) Fear to use to sell it. (And imagine they know that a ZERO CT Scan means you do not need it. Now ask yourself why the doctors don’t say… Well, lets do a CT Scan on you to see if you need this?)…

Now, I don’t want to sound like a Conspiracy Theorist… But methinks this is more about $$$ than health… Besides… They also don’t like to talk about their track record!

(Danny) #14

I’m right there with ya… Especially after I asked this question and got this response.


No, not a positive thing, Especially if your LDL breakdown is mostly sdLDL.

(Danny) #16

Good thing mine isn’t mostly sdLDL then. I’m pattern A

(Bacon is a many-splendoured thing) #17

My understanding is that lean-mass hyper-responders have good ratios of triglycerides to HDL, which predicts Pattern A in an NMR analysis and also indicates minimal cardiovascular risk.

(Kirk Wolak) #18

First, I would mention that there is no need to medicate for LDL only, especially with a CT = 0.
Then I would ask, what’s his CT Score?
Then I would ask, what is the NNT to prevent 1 heart attack on statins?
And, What is the extension of life from people on Statins (with years of data in). (1-2 days!)
finally, ask if the risk of T2D for people taking statins is in the same (relative risk as the benefits are, or are they in absolute risks, and if absolute risks, please compare it to the NNT).
If you do that, we can have a SERIOUS discussion, because that should cover the risk benefit side of the equation on the drugs. (BTW, I believe it’s a 10% increase in T2D, so that’s 1 in 10, and the NNT ranges from 100 to like 550 depending on the study. So 10 to 50 times more likely to be damaged).
Finally, I would ask him to run All of those numbers through a risk calculator.
Your risk has improved. He can verify that. Despite the number.

Oh, and ask him if he knows who Dr. Diamond is… And send him a copy of “Lies my Doctor told me”, and make sure he knows it was written by a doctor.

FWIW, my doctor doesn’t wanna play these games with me. But it actually helped him, with his insurance company. They want you medicated… He can make entries showing these numbers, and between the two of you, you can decide it is medically inappropriate to follow the standard of care. (forcing these drugs down peoples throats with fear)

(Alec) #19

I have a simpler and quicker method: when my Dr suggests I need to be on a statin (as they regularly do because my LDL is sky high) I state: “I respectfully refuse to take statins, and this is an informed choice”.

By all means try to persuade your Dr with reasoned questions and argument, but I have been down that road a few times and it never ends well. My statement above has always resulted in end of conversation, which makes me believe that there is a solid minority of the population who refuse statins and doctors are half expecting it. I reckon quite a few of them get it, but they know they have to prescribe statins if your LDL is over a certain level because that is the “standard of care” and if they don’t and something bad happens, they are then held culpable. They do not want this, so they just toe the line.

(Kirk Wolak) #20

I understand. And it’s NOT that they get punished if something bad happens.
Our doctor explained that the AMOUNT he gets paid is affected by the compliance level to the rules (standard of care).

So, he said, if I had only 10% of my high Cholesterol patients on statins, not only do I risk them getting rid of me as a doctor in their network, but they also pay me a lot less. That’s the real punishment, because they consider me under-performing. He didn’t give me exact details.

He said that the CT of 0 was easy. That’s considered proper treatment (the wife). Even for you, I have to discuss it, but it’s a borderline case, and I’m clean.

Meanwhile, my brother had his heart attack with LOW Cholesterol numbers, High HDL… And his doctor actually said “But you have the bad kind of Cholesterol”, without running the NMR… Just because he had a heart-attack. (never mind the smoking, and alcohol… It was his special “bad” cholesterol).