Larry’s done a phenomenal job so far. He has lost 44 pounds, dropped his fasting glucose by 30%, and his average glucose by 10%. He has almost reversed his pre-diabetes. More importantly, he no longer has metabolic syndrome! Amazingly, he has managed to do all of this while putting on the best Medicine X conference to date!
Larry’s triglycerides have dropped an amazing 70%. Triglycerides are a type of fat (lipid) found in your blood that store the unused calories you eat. Because of their unique role, high triglycerides are a sign that your body is struggling to deal with energy(calorie) excess indicating both insulin resistance and increasing adipose/visceral fat (unhealthy fat storage). Larry clearly has done phenomenal job in reversing this process.
Some of you who are following Larry’s data may be wondering what’s going on with Larry’s LDL (bad cholesterol). While his triglycerides have drop 70%, his LDL has actually risen 18%.
Basic pathways tell us that excess triglycerides turn into VLDL which can transform into LDL in the blood (Learn more here).
So how we explain Larry’s labs? What does Larry’s rising LDL mean? And is this something we have to worry about? The answer is that without getting advanced LDL testing or lipid subfractions we can not tell. Studies show that VLCD regimens that are not low in fat, can lead to a 9-15% increase in LDL. However, despite this increase, studies have shown that the VLCD shifts the LDL particle distribution to a larger diameter with less particles. This is important because it is actually the smaller and more dense LDL that actually predisposes you to a higher cardiovascular risk. By making LDL particle size larger and the number of particles lower, VLCDs are actually modulating and decreasing that risk. So the higher LDL, may not be ‘risk’ significant in Larry’s case if his LDL-P (particle number) is lower. Patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease. In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P.
We will be testing Larry’s LDL particle number and size in one more month and depending on those results we may or may not shift his nutritional plan. If he continues to have an LDL-C in 140s with a high LDL-P and small particle diameter, we will move towards a more plant-based diet. If his particle number is on the smaller side, then we will likely maintain his current strategy as it seems to be working well for his insulin resistance.
Please feel free to ask any questions in the comment box and please remember that this blog is not to be considered medical advice and you should always consult with your doctor.