Tuesday, 20 November 2012

The Daily Paleo - musings on cholesterol - Day 15

Wow - 15 days already! No cravings, hardly ever hungry. We even had lunch at the food hall at Henderson's Westfield Mall on Sunday. Chinese buffet: chicken and veges, with a bit of sweet and sour pork. No onion. No bad after effects. "I'm loving it!"

Cholesterol has been bothering me. Well, the contradictory information I’ve been reading has, really.

My last lipid tests were done on 4 October: (non fasting)

Cholesterol mmol/L = 3.5
Triglycerides mmol/L = 2.7
HDL = 0.90
LDL = 1.4

Chol/HDL ratio = 3.9

"For established CHD risk (including diabetes) NZGG optimal levels are:
Cholesterol: less than 4 [less than 5]
Triglycerides: less than 2
HDL: greater than 3

LDL: less than 2.0 [less than 3]
Chol/HDL ratio:  less than 4

LDL calculation will be inaccurate if patient was not fasting."

* Triglycerides - 2.7 - well, that's a bit high, isn't it.
* HDL ('good cholesterol') 0.90 - that's not high enough!
* Why didn't they require a fasting blood test - "oh, it's not necessary" - but then the LDL (the 'bad cholesterol') figure is inaccurate - so, it may be higher or lower than 1.4. It’s also recommended that Triglycerides be tested in a fasting state too, as levels remain high after eating. So, 2.7 may or not be accurate as well.

Total Cholesterol – there are actually several blood lipid fractions that are partly proteins used to shuttle fats and cholesterol around the body, but they’re lumped together under the general term cholesterol. They include VLDL’s (very low-density lipoproteins), LDL’s (low-density lipoproteins – the ‘bad’ guys) and HDL’s (high-density lipoproteins – the ‘good’ guys).

So, where did that cholesterol come from? Conventional sources say it comes from your diet – the saturated fat in meat, eggs, some seafood, etc. The more fatty stuff you eat, they say, the more cholesterol you’ll have. But hang on a minute. Those same (conventional) sources also say: However, most ingested cholesterol is esterified and esterified cholesterol is poorly absorbed. The body also compensates for any absorption of additional cholesterol by reducing cholesterol synthesis.[7] For these reasons, cholesterol intake in food has little, if any, effect on total body cholesterol content or concentrations of cholesterol in the blood. Biosynthesis of cholesterol is directly regulated by the cholesterol levels present, though the homeostatic mechanisms involved are only partly understood. A higher intake from food leads to a net decrease in endogenous production, whereas lower intake from food has the opposite effect.

Let’s move on to the Triglycerides. This is what has to say:

“There is evidence that carbohydrate consumption causing a high glycemic index can cause insulin overproduction and increase triglyceride levels in women.” So: Triglycerides are a measure of circulating blood fats that indicate dietary carbohydrate and insulin sensitivity. High carbs + poor insulin sensitivity = high triglycerides. Eat less carbs?! Triglyceride levels are also reduced by exercise and by consuming omega-3 fatty acids from fish, flax seed oil, and other sources.

What’s next? HDL – not enough of those babies floating around. Trans-fats and lack of exercise can result in low levels. Where are the trans-fats coming from?

“By far the largest amount of trans fat consumed today is created by the processed food industry as a side effect of partially hydrogenating unsaturated plant fats (generally vegetable oils). These partially hydrogenated fats have displaced natural solid fats and liquid oils in many areas, the most notable ones being in the fast food, snack food, fried food, and baked goods industries. They can only be made by cooking with a very high heat, at temperatures impossible in a household kitchen.”

Ok. Let’s stay away from processed foods, and hydrogenated vegetable oils – not that I have ever eaten much of that anyway. And do some more exercise!

LDL – well, depending who you read ... it may or may not be a bad guy. Let’s agree that you probably don’t want too much of it, but what causes it to rise? Well, for one thing, high insulin levels. What causes high insulin levels? Oh, hang on, too many carbs. So, if I eat less carbs, will my insulin levels go down? And if my insulin levels go down, will my LDL readings go down? Also, turns out that there’s two types of LDL’s. Type A – big fat fluffy particles, and Type B – small, dense LDL’s. It’s those small, dense guys that have been linked to being artheogenic (plaque causing), not the type A’s.


* Avoid simple and refined carbohydrates. In fact, let’s avoid most carbohydrates, for at least 30 days. (Carbs increase insulin levels)

* Avoid cereal grains, legumes etc. Partly a FODMAPS thing, partly a Paleo thing.

* Eat lots of vegetables. Avoid fruit, fruit juices, stuff that contains sugars. (sugars in fruit increase insulin levels)

* Eat lots of fresh meat and seafood. (no carbs, so no effect on insulin levels, however, may affect cholesterol levels) Also try and drink stuff like pro-biotic rich kefir, and take digestive enzymes to aid my crappy digestive process.

* Exercise more. Trying to take a ‘bike ride’ – 15 minutes on the exercycle – every night, plus walking. As things settle down, I’ll start doing Interval training. I should probably be doing it already, but there’s only a certain number of hours in the day. (Exercise increases HDL levels, and insulin sensitivity – a good thing)

* Stop taking Statins. What? Why? I hear you say. Don’t you need those to control your cholesterol?

Statins common, less serious side effects: Muscle and joint aches (most common) – all the time!!!; Nausea (not often); Diarrhea – yeah, when I’m not ... Constipated!

Potentially serious side effects: Liver damage; muscle problems (pain and tenderness – see above!); Increased blood sugar or type 2 diabetes. (hey, hang on – don’t I now have a problem with increased blood sugars?); Neurological side effects – ie memory loss or confusion.

* Stop taking blood pressure tablets (Zapril 0.5mg). My blood pressure is great – 110/90.

Side effects: may decrease your body’s supply of potassium, leading to symptoms such as weakness, leg cramps, tiredness; gout; People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.

Hang on again – what was that last one?! May increase blood sugar level!
* Stop taking Omeprazol - that was the gastric reflux proton-pump inhibitor. Why: Taking a proton pump inhibitor such as omeprazole may increase your risk of bone fracture in the hip, wrist, or spine. This effect has occurred mostly in people who have taken the medication long term or at high doses, and in those who are age 50 and older. It has some other cool side effects too, like nausea!

* Keep taking the Gliclazide: Gliclazide is used for control of hyperglycemia in gliclazide-responsive diabetes mellitus of stable, mild, non-ketosis prone, type 2 diabetes. It is used when diabetes cannot be controlled by proper dietary management and exercise or when insulin therapy is not appropriate

* Keep taking the Metformin: Metformin works by suppressing glucose production by the liver. It is the only antidiabetic drug that has been conclusively shown to prevent the cardiovascular complications of diabetes. It helps reduce LDL cholesterol and triglyceride levels, and is not associated with weight gain. When prescribed appropriately, metformin causes few adverse effects (the most common is gastrointestinal upset) and is associated with a low risk of hypoglycemia.

Now, I’m not saying anyone else should do this – especially not you, my wonderful reader. But, this is what I’m going to try. I’ll go back for a FASTING blood test in, probably, mid-December, or maybe January, when the Paleo lifestyle has had a chance to take effect.

Already, after only a fortnight, I’m seeing my weight drop, my body-shape improve, my blood sugars leveling out. I am less tired and achy, and seem to have a little more energy.

And if it doesn’t work? Well, then we’ll have to look at Plan C ... but not for a wee while yet.

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