Ever consider changing your paradigm, as we long-term lob carbers are using markers levels for general populations who eat mostly SAD.
Instead of measuring and interpreting SAD bio-marker levels as proxies for probable risk, why not actually verify if you have the disease itself. For example, (hat tip to Dr. Rakesh Patel) carotid intima-media thickness (CIMT) measures occlusion or arterial plaque buildup in one’s carotid artery. According to a quick Google, a CIMT runs about $200.
An NMR runs about $100 and Lipid panel $60. These results are surrogates of health, not health itself. Aren’t we wasting our $$?
This is a question I’ve gotten a few times before and brings up many good points. I planned to do a post on this but never got around to it because I hadn’t quite fleshed it all out in my mind. Even now I still feel like there is a lot of it I haven’t quite figured out yet, but I’ll to write down some of the thoughts that I’m having. Please excuse the haphazard, rambling format of my answer.
1. High LDL-C and LDL-P in SAD:
- We can all agree that in people who eat a standard american diet, elevated levels of these means something. I don’t think the science is quite out on what the order is: something bad is happening which is causing a high LDL, OR if the high LDL itself is the culprit that is causing something bad. Science is still working on this (and vice versa with HDL: whether its’ actually a good guy OR if it’s simply a marker signalling that something good is happening.
2. High LDL-C and LDL-P in Low Carb-ers / Paleo:
- I don’t think we know enough of what’s going on to change my paradigm.
- Why do some people have picture perfect numbers and others have numbers that are extremely out of whack? There are enough people out there with out of whack numbers that this is a thing that comes up frequently on message boards and forums.
- Until we can explain what is happening, the best we can do is interpret these numbers through the lens of what we know, and what we know right now is that high LDLs are either bad or are signals of something bad happening.
- My case is an example of why I’m not quite ready to change my paradigm. In my case the high LDL-C’s reflected an underlying hypothyroidism or subclinical hypothyroidism that arose due to eating very low carb. The moment I addressed the hypothyroidism by increasing my carb intake, my LDL-C began to normalize (I will get an NMR soon to see what my LDL-P’s did).
- If I just accepted the fact that it is normal for some low carb-ers to have high LDL-C’s, and that this is the new paradigm, I wouldn’t have unmasked the underlying thyroid issues.
- Again, just because this is the case for me doesn’t mean this will be the case for everyone else.
- When I see convincing enough evidence to shift my paradigm, I’ll be more than happy to jump!
3. CIMT and other imaging exams:
- I completely understand your point about measuring health markers themselves rather than surrogate markers.
- Since I am 32 years old and relatively active without any significant medical history, I can pretty much guarantee that if I were to get a CIMT scan or even a Calcium Scoring Scan (CAT Scan to determine how many calcifications are in your coronary arteries), these tests will be negative. The capacity I work in within the medical field has allowed me to see the results of these tests in others and gives me the confidence that someone in my age group, with my activity level, and history won’t really show much on these tests.
- Paying for these tests at this moment would be a waste of money for me. If I were in my 40s or older, or if I had a medical history of severe obesity, or some other condition such as diabetes, then I probably would have gotten these tests long ago… and blogged about them!
- The other issue is that if you get these tests and they show a thickened carotid intima or calcifications in your coronary arteries, things are already too far along in the inflammatory cascade. Damage has been done. It takes a long time(years) of being exposed to inflammation and cellular insults for these things to appear. By this point, the only thing you can do is to prevent more damage from being done.
- Changes in surrogate markers such as cholesterol and thyroid levels can reflect changes in your lifestyle in mere days and weeks.
- Also my goal is to make positive changes in my life BEFORE they become apparent on the imaging exams, and the surrogate markers are the best thing we have to do track this.
4. Other surrogate markers I’ve used in the past and will probably use in the future:
- CRP – This is a marker of overall body inflammation. I have measured them but haven’t reported it in my posts because each time I’ve measured it, it’s been normal. Some people think that even though your LDL-C or LDL-P is high, if you don’t have inflammation, it’s nothing to worry about. Having cholesterol in your system is ok… it’s the presence of inflamed cholesterol that causes the problem. Like almost everything else I’ve discussed, the jury is still out on this, but CRP is still a valuable tool.
- ESR – Another inflammatory marker to follow.
- HBA1c – A marker I wrote about before (Part 1, Part 2) that reflects how much sugar you’ve been exposed to over the past 3 months. A metabolism that uses sugar primarily for fuel is exposed to more inflammation. More carbs in the diet = cells being exposed to more sugar = higher HBA1c. Although as I’ve written previously, a higher HBA1c can also reflect a healthier metabolism while eating a very low carb diet.
- Triglyceride:HDL Ratio – More literature is coming out now about how this is actually more accurate in predicting cardiac disease than any other measure of cholesterol. Since mine is well within the optimal range (under 2.0) I haven’t been too overly concerned with my LDL-C numbers.
Hope this helps to clarify where I stand on these issues.
Thanks for all the comments! Keep them coming in. I really enjoy answering them when I can and thinking about them when I can’t.