PāNu Forum > LDL increase and hypothyroidism
You need to see an endocrinologist.
Kurt G. Harris MD
I will, thank you.
simona
This is a useful site, and the link mentions an NEJM article on T3/T4. Many physicians do prescribe combination products (including brands based on dessicated thyroid):
http://thyroid.about.com/cs/hypothyroidism/a/undertreated.htm
A list of physicians who do is apparently at:
http://thyroid.about.com/cs/doctors/a/topdocs.htm
HJK
I have some thyroid posts in the works
Kurt G. Harris MD
Thank you for the responses. I wasn't expecting any more. I'm aware of the about.com section on hypothyrodism. I'm going to see a consultant biochemist today to discuss my results. It takes a while to be seen by a specialist and they sent me to them first.
I've read that very low carb can cause low T3 or low calories, I'm not doing either of them. I've tried asking around on blogs, but I don't want to be too pushy (plus too much personal information and history necessary). At the moment I would like to know what causes high LDL and what to do about it. I would like to have a heart scan, an NMR and a lip (a) count. I'll see if I can have those tests.
simona
I saw a consultant chemical pathologist, the head of the Biochemistry Department in one of the hospitals here. A junior doctor took the case history, the consultant just looked at the notes and discussed them with the third doctor present that he called in to show the 'curious case of doubling of LDL in a year'. I felt like a circus monkey and the speed of the exchange didn't really allow for my participation. As he was in a hurry to leave he took me to the lab to have another set of tests done (to confirm and retest). They don't do NMR routinely, too much hassle, too expensive, he said he might infer the type of LDL from the rest of the lipids, but he agreed to do a Lip (a) All the time they were making fun of me, because I'm low carbing, as to say, see what happens when you eat all that sat fat and lose 32 kg in 14 months. They don't agree that the thyroid is a problem, say that the enzymes that influence the metabolism of cholesterol can't change that much in a year, so basically they don't know. He said he wants to investigate it thoroughly (because he finds it interesting, at least that should be a good motivation to do his best)
So nothing to report on the Eastern Front.
simona
Well i would not be worried if you have high cholesteral levels.According to Dr. Jan Kwasniewski.,cholesetral levels are best when they are higher....and there is no evidence/link with high cholestrol levels with decreased health of ones body/ cadiovascuar disease.....There is the international association of cholesteral sceptics right...
patryk c
http://homodiet.netfirms.com/disorders/cholesterol1.htm...read this, maybe this will calm your fears.....
patryk c
Thanks Patrik, I read the link.
Kwasnievski talks about cholesterol in general, not about LDL in particular. I get the point that maybe you have high cholesterol because your body is healing, I was thinking myself there was a reason for increased production of LDL, inflammation somewhere. One has to look at the production, causes of rise in HMGCoA and at the LDL receptors in cells. Chris Masterjohn and Stephan Guyenet have said that the more LDL there is the more it is prone to oxidation. So what I'm doing at the moment is take Coq10, fish oils, watch my PUFA, sugar and carbs, increase my sat fat.
Doctors (that I've met) are so dismissive of different opinions that don't come from their peers. I should know, in my family there are a few... Some of them don't even listen to you, because you're not qualified to comment. I felt very powerless. I tried to do my homework to understand how my body works and what the doctors are telling me, to figure out what can be the problem, so I know more than somebody who didn't have the time or the interest to do it, but it doesn't change anything, they're still going to ignore what I say. It seems I have to build a case for paleolithic nutrition with references to peer-reviewed journals to make them listen. And they're going to look at the numbers and go with what they learned anyway.
simona
Simona
To "investigate thoroughly", you need NMR lipoproteins with total LDL that high and that increased.
Free T3 and free T4 values would be useful too
I believe particle number and how much of the LDL is oxidized (related to PUFA consumption) are most important. Total LDL can go up on high sat fat diet for sure (mine has).
Kurt G. Harris MD
Doc H, I had this test done when my doc freaked out about my 187 chol. level. I have no idea how to interpret it, can you help.....
LDL-P 1129
Small LDL-P 0
LDL particle size 22.6
Large HDL-P 18.6
Large VLDL-P .3
LDL 197
HDL 79
TG 56
I am a 44 YO woman. Thanks, S.
S.
Doh, sorry, I meant 287 chol. level! -S.
S.
Dr. Harris,
thank you for reading and responding. From your reactions until now, I think you have the impression that I'm looking for a diagnosis over the internet. I know it's not feasible, you're not allowed anyway to do that, you even mentioned it in one of your main posts, so what I was rather looking for was to understand the mechanisms behind certain things, what one probably finds in medical textbooks and something that a doctor would definitely know. I understand that you are busy with your job, that there are many questions on the site, that maybe the way I presented myself wasn't appropriate. I tried to get an NMR and couldn't. I will try to show him, next time I see him, a couple of posts from Dr. B.G. to make him realise why it is important. She has a lot of references to actual studies. Yes, there is the issue of atherosclerosis and cardiac risk and there is the issue of the actual cause and treatment.
S
Your total LDL doesn't seem that high to me ;) Your trigs are good and your HDL seems ok.
You might check Dr. Davis' Track your plaque program and Animalpharm for more information, maybe you find some examples from other people.
simona
S
Your numbers are not worrisome in my opinion. They are typical on a high fat diet.
All
Try not to obsess too much over these lipid values. As long as trigs are low and HDL is high, they indicate you are eating plenty of good fat but are otherwise fairly meaningless.
I agree with Peter at hyperlipid - the meaning of these numbers as abstracted from populations on the SAD and the meaning they have on a high fat diet are two different things.
Stop damaging your gut, creating autoimmune diseases through molecular mimicry, and damaging your insulin sensitivity by eliminating wheat and other gluten grains from your diet.
Lower your HbA1c and fasting insulin levels with low fructose and carb consumption.
Reduce the oxidized LDL by eating fewer PUFAs (ox LDL is not even measured by these lipid tests)
Restore your 6:3 ratio with elimination of plant oils from your diet.
Make sure your D levels are adequate.
Make sure your thyroid function has not been compromised by the SAD. If so correct it.
That's it. Stop obsessing about lab values once you have proved you are not a mutant and your thyroid gland works.
Don't even to bother to measure your total cholesterol once you have proved it's below 300 (to prove you don't have familial hypercholesterolemia)
If you don't believe the lipid (diet/heart) hypothesis (I don't), why are you having your total cholesterol even measured more than once?
As far as "Track your Plaque" goes, I can only say there is no evidence that supplements or specific interventions beyond what I have mentioned to target specific lipid lab values has any beneficial effect on actual health endpoints - like taking niacin or pharmacalogic doses of fish oil, etc. This philosophy ascribes more meaning to these lipid values than they deserve, IMO. Dr Davis does have some good info on thyroid in some of his posts, though.
All the ammunition you need to bring to your doctor - well, it's all over the place, but I find Peter at Hyperlipid and Stephan at whole health source the most scientific and unassailable sources. Check out Nephropal as well.
I use them and you should , too.
Kurt G. Harris MD
Thanks Doc, I wil check out these resources. I should have mentioned I am hypothyroid and on Armour. My Doc checks my chol. as a general rule when I get blood drawn to monitor my thyroid. I thought when I showed him my NMR results it would prove to him my cholesterol was big and fluffy and not an issue, but he looked at the results and just said, mmmhmm yes, but we still need to bring LDL down! Doh! But as least for now he has stopped pushing statins at me.
When you say "as long as HDL is high and TG are low" can you give a range of what fits this parameter? Thanks, S.
S.
So, it's the SAD (let's say high fat, high sugar) that causes the thyroid to malfunction, not the VLC diet. Can you point towards a reference, study, explanation?
simona
S
LDL-P 1129
Small LDL-P 0
LDL particle size 22.6
Large HDL-P 18.6
Large VLDL-P .3
If these are your NMR numbers, you are at very, very low risk. Your doctor's comment indicates he may not understand how to interpret NMR numbers. LDL-P of 1129 is your true LDL particle number and it is already quite low. In your case, calculated LDL is about 75% higher than your true particle number. In large trials like WHI, LDL-P was a much better predictor of events than calculated LDL. You also have zero small dense LDL particles which is excellent.
Incidentally, your NMR profile numbers are about the same as mine, with the exception that my LDL particle size is slightly larger. if I had your numbers I would not choose to poison my cholesterol manufacturing machinery with statins.
Regarding proper levels of HDL and triglycerides, I view the main significance of these parameters as how they have changed for you personally and not necessarily as indicators of your future risk. For instance, when converting to a high-fat diet from high carbohydrate diet, and when correcting elements of metabolic syndrome, we expect triglycerides to go down dramatically and HDL usually increases. The main significance of measuring these numbers is simply to see that they move in the direction we expect and that this serves as a check on whether our attempts to achieve the evolutionary metabolic milieu are successful.
Once again, I would like to emphasize that our ideas about the predictive value of any of these lipid parameters is based on observational studies on a population eating the standard American diet. In the same way that having a high calculated LDL does not predict death in a person getting 70% of calories from fat, it may not be the case that a sky high HDL is something to be " toproud of" either.
That said, your HDL and triglyceride numbers are excellent in the conventional sense.
Again, I agree with Peter at hyperlipid that seeing these numbers move in the right direction merely confirms that you're eating correctly.
Kurt G. Harris MD
Simona
The standard American diet contains wheat. By causing a leaky gut, wheat and other gluten grains potentiate molecular mimicry, where foreign proteins enter the bloodstream and encourage an autoimmune reaction against the body's own tissues. The most common target for this molecular mimicry is the thyroid gland. When this happens to the thyroid gland it usually results in Hashimoto's disease, by far the most common cause of hypothyroidism. For reasons that are not clear, all of these autoimmune disorders occur more commonly in women.
Interestingly, hyperthyroidism (Graves disease) is also an autoimmune disease. In this case the inflammation results in excess release of thyroid hormone rather than deficiency.
I believe it is scientifically plausible that complete elimination of gluten grains from the diet will substantially reduce the likelihood of either thyroid disorder. I would encourage anyone converting from the standard American diet to paleonutrition to have their thyroid function evaluated. Only people with zero history of wheat consumption should skip this step.
Kurt G. Harris MD
Thank you, Dr. Harris. Looking forward to your post on thyroid. Are you going to look into the possible mechanism of the increase of T3 with low carb for certain people? (heard of some cases on Dr. Bernstein's forum)
simona
meant to say 'decrease' not 'increase'
simona
What is the point in seeing a doctor, even consultant biochemist, head of the department? He believes in the diet-heart hypothesis, and he can't find any cause for my rise in LDL, besides eating too much sat fat. He says in an e-mail after I sent him links to posts by dr. BG, dr. Eades, dr. Briffa, Peter, Chris Masterjohn and Stephan:
'I support the cholesterol hypothesis in relation to the causation and management of CVD, as I believe there is compelling peer-reviewed data to do so. I am aware that there are still those who are highly regarded in the medical sphere and who hold a contrary view. That is the nature of debate and I agree that such debate should not be stifled, However, in my practice, I advocate a specific line of investigation and management which is in widespread use in routine medical practice'. and earlier 'in clinical practice, doctors must adhere, more or less, to evidence based decision making and guidelines and in this regard the gold standard by which clinical management decisions are judged is peer-reviewed publication. In addition, doctors working in the public health care environment are restricted by limited resources at their disposal to address their patient workload.'
When asked about 'other tests' he says 'while there are many tests that are coming on stream which have been mooted to potentially add some value to the overall clinical assessment of patients from a CVD perspective, in many cases the exact application and role for these tests has not yet been clearly established in routine clinical practice. What we offer is limited but is generally effective and allows us to manage the majority of patients effectively within evidence-based guidelines. However, I am sure that there are situations where more in-depth testing, if it were routinely available, might provide more information to enhance decision making, but we are currently not in a position to offer this level of testing in the public health service.'
So much for the public health service in the whole of Europe. The doctors argue and the patient dies. So I'm not in the majority then. Good to know.
BTW, my TC is 426. Does that mean that I have FH? Low T3 and elevated androstenedione and they still say there is nothing wrong with my hormones. I'm angry and sad and confused.
simona
simona, I feel bad for you and can sympathize somewhat because my T4 readings (2 wks ago) came back at 4.5, below the normal cutoff at 5.0. I see your T3 is low, but what about your T4?
I have my exact values on my T4, T3, triglycerides in a blog post. The triglycerides look OK.
What is your diet like exactly? Calories, meal frequency, protein, fat, carbs - exercise?
My carbs are at < 10g per day. The only time I've cheated on carbs this past year has been when I thought I may have been going hypoglycemic. I've picked up my exercise, and subjectively I can say it helps me.
Explore your options? I've been pretty disappointed with my in-network PCP, so I'm considering going for an out-of-network, low-carb-sympathetic doctor for my next visit even if it costs more. I googled my way to this list.
MCT
Thank you MCT.
I live in Dublin, Ireland and even if I go private, I don't think there are any doctors that know about low carb more than from the most recent studies published. (the research versus clinical practice debate) I think that dr. Briffa in London has a private pratice and he has a blog where he talks about the advantages of low carb diets.
My T4 is in the upper level, in range.
Well, exactly I don't know what my food intake is. I tried to put it into Fitday once and it was too complicated. I need exact quantities, that means I have to measure to grams of oils and all ingredients if the specific item is not on the list. For example I love aubergine paste, I know it's not high in carbs, but their entry had huge amounts of carbs/100 grams. My carb intake is under 60 definitely and sometimes very low. I intend to do a food diary because I'm going to see a clinical nutritionist (I know, waste of time to listen to them) and she might want a breakdown of nutrients. Blah, blah.
One day I wrote things down. Nov 10
Breakfast
scrambled eggs (possibly 2) with few pieces of smoked salmon for taste, few slices of cucumber, mascarpone about two big tablespoons with about 10-15? blueberries and about 10 grams 85% chocolate
Lunch
ham slice 25 grams?
butter 25 grams
pork pate with stilton 20 grams
cherry tomatoes, small 6
scallions 2
aubergines roasted, with olive oil and condiments 4 tsp
Dinner
hearts in ghee with paprika and onion about 250 grams hearts
two tbsp cooked peas
Obviously if I open a box of pate I have to eat it in 2-3 days or it goes off, (I like loads of cold butter with it and gherkins), the same with bought green salad. I'm the only one who eats it in the house.
I don't know if it seems a lot or too little, sometimes I even eat after I feel full because of the portion that I cut or taken out for myself. I have 'portion control' and 'chewing' written on my fridge to remind myself so no danger of eating less anyway. But sometimes, I only eat my first meal at lunch time. Today, for example, it's 12.46 pm and I only had a cup of white tea. I wanted to fast until dinner but my husband prepares the breakfast for himself at 6 am and he makes it for the 4 of us and today he made scrambled eggs so I have to eat it before he comes home or he's going to be cross.
I don't know if this is helpful.
Exercise? Zero, if we leave out the odd dancing when there is a good song on the radio or sprinting when I'm late to collect my kids from school. I did some half squatting in a wide position the other day for about 5 minutes because I was copying some kind of exercise on youtube (tiger squats I think) and I felt it for a day afterwards, so, not very fit.
BTW, my LDL is gone up to 421! and my TC to 529 in the last two months. Go figure. It was funny when the doctor said that it's dangerous walking around with this kind of cholesterol, as if I'm going to drop dead any minute.
simona
From your T3/T4 levels and lifestyle compared to mine I've got to admit we're coming from two different backgrounds. I'm also not sure what your history is with diet and exercise. Secondly, I haven't done a second test on my T3/T4 levels so I don't know if they're improving, though my triglycerides are good.
So I'm not qualified to suggest to you what to do, but I can tell you what I'd do. I'd keep my diet as simple as possible, sort of like Dr. Harris, and make sure everything I ate had a nutrition facts label on it with ingredients. Eliminate all carb sources to where I'm only getting trace unavoidable carbs such as the 0.7g per serving of egg. Watch the condiments. Read the label - really! Personally, I don't believe any vegetables are necessary at all. If there's even the slightest doubt that my insulin or carbs are too high for my sat. fat level, I'd just replace the fat with more protein. Where could the risk of CVD possibly come from with this degree of caution? I'd do that, and though I know it's not in fashion to say this right now - I exercise, including both aerobic and resistance training.
With some mild to moderate CR and exercise (leading to fat loss) I've noticed that I feel better that 2 wks ago.
Unfortunately that may mean a noticeable lifestyle shift, and I can see with your household that might not be so easy. However with a simple diet such as this - with no unnecessary extras - I don't see how anyone could be cross if you're eating less AND cheaper.
MCT
I've had a shock today. I got my blood results back. After a year of low-carb, semi-paleo life style (with some diary) my LDL cholesterol concentration went from 148 to 320 (my conversion from mmol/l) and my TC went up to 426! from already high 274. Last year I smiled and I said it's going to go down with low carb, but now I'm worried. Something is terribly wrong. Last year, they didn't check T3 and T4 and TSH were within range. But this year I asked especially for HbA1C and vit D and T3. Well T3 came back very low, 0.9 surprise, surprise. HbA1C is ok at 5.2 and vit D is ok at 147 nmol/L (a bit under 60) and TG are under 60, which is fine, and HDL is 80, which is OK, I gather from Dr. Davis.
I will get a referral to see an endocrinologist but I'm not holding my breath. It is highly controversial, I gather, to supplement with T3, doctors don't prescribe desiccated thyroid, so I don't know when I'm going to get better. Not even dr. Davis knows why the conversion of T4 to T3 is inhibited. At least now I have proof for what I thought all along based on my symptoms and internet 'education'. But what can cause such an increase (I know that hypothyroidism is characterised by hypercholesterolemia and a marked increase in LDL and apolipoprotein A) and what can be done to reverse it seeing that my risk of CVD is very high? Does anybody have any ideas or heard any stories?