The lipid distorting effects of weight loss

22. May 2007 William Davis (0)
Roger experienced a near-fatal heart attack 6 years ago. He survived thanks to the quick action of bystanders who initiated CPR and called 911. An emergency catheterization was performed and a stent implanted into the closed right coronary artery. But that's not why I tell Roger's story.

Since then, Roger has become comfortable with the idea that he has heart disease. His initial commitment to good nutrition and exercise has waned, as it often does in us distractable humans. So Roger gained about 30 lbs through a long winter, inactivity, eating frozen dinners, and the cookies and baked goodies his daughters made him.

As a result of the weight gain and inactivity, Roger's HDL dropped to 32 mg/dl, triglycerides rose to 211 mg/dl, blood sugar crept up into the pre-diabetic range of 116 mg/dl. Undoubtedly, small LDL was out of control beneath the surface. His tummy reflected the weight gain, flaccid and overhanging his belt.

I read Roger the riot act. I reminded him of what he had experienced and nearly didn't survive. Weight loss and a re-invigoration of his nutrition and exercise efforts was going to be crucial.

Roger listened and took it to heart. Over three months, he lost 24 lbs, a phenomenal result. However, his repeat lipid panel showed an HDL of 28 mg/dl, triglycerides 234 mg/dl, blood sugar unchanged.

"I don't get it! I lose all this weight and the number get worse?!" Roger was understandably upset after his enormous effort.

I told Roger that after a profound weight loss, lipids can go berserk for up to two months after weight has stabilized. Typically, HDL drops and triglycerides rise--the opposite of what we want. But wait another two or so months after weight has stabilized and the numbers begin to look beautiful.

Why does this crazy effect happen? I really don't know and I've never heard a satisfactory explanation for it. But it is very real and quite predictable.

The lesson: after a substantial weight loss, be patient. Check your lipid numbers too soon and you might be confused or disappointed. If you do check them, bear in mind that additional time may need to pass before you see the weight loss fully reflected.
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What's the best lipoprotein test?

What's the best lipoprotein test?

29. May 2007 William Davis (5)
This is a frequent question from Track Your Plaque Members and others interested in improving their heart disease prevention program beyond that of simple-minded cholesterol testing.

I obtain lipoprotein testing every day on patients. I can tell you with the confidence of having done thousands of these tests that plain, old-fashioned cholesterol testing is like relying on riding a scooter to work compared to an 8-cylinder modern automobile. The scooter might get you there, but any rain, snow, or long distance to travel and you can just forget it.

All too often, lipoprotein testing uncovers abnormalities that standard cholesterol testing simply fails to uncover.

So, among the various lipoprotein tests available, which is best?


There are three commercial tests available today:

1) Gel electropheresis (GGE)--often known by its "brand" name as the Berkeley lipoprotein profile, after Berkeley HeartLabs. GGE uses a gel with an electric field applied to cause lipoproteins to migrate, based on particle size and charge.

2) Vertical auto-profile (VAP)--a form of centrifugation, or high-speed spinning of blood plasma to separate lipoprotein particles.

3) Nuclear magnetic resonance (NMR)--the idea of putting plasma in an NMR (also known as MRI) device to characterize blood proteins.

All three tests do an excellent job. All are competitively priced. All have validating data--lots of it--to justify their broad use (though health insurers, in their vast wisdom, would still have you believe that the tests are "experimental").

But is one better?

Having done many of all three (though least of VAP), I am partial to Liposcience's NMR. (By the way, I receive no fees from Liposcience to use their test, nor to promote it in any way.)

I believe NMR is superior in a few ways:

1) I believe that the LDL particle number is the best way to truly quantify LDL, better than apoprotein B and "direct" LDL.

2) It provides what I believe to be more accurate small LDL measures.

3) It provides intermediate-density lipoprotein (IDL), a post-prandial, or after-eating, measure not available on the other two.

Perhaps I'm biased because I use the NMR most frequently. But I've used it because I felt it yielded superior, more clinically believable, data.

In truth, all three laboratories do an excellent job and you'd be served fine by obtaining any of the three. But my heart goes to NMR.
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Comments (5) -

  • Anonymous

    5/30/2007 3:41:00 AM |

    Thank you for clarifying which test to use.  

    I personally find this information very helpful.

    My previous testing was done at Berkeley.

    How often do you suggest retesting be done?  Yearly or ??

    Thank you.

    Marilyn

  • Dr. Davis

    5/30/2007 11:30:00 AM |

    Marilyn--
    In the Track Your Plaque program, we advocate lipoprotein testing at the beginning to diagnose the full extent of causes of coronary plaque, and then again when correction is believed to have been achieved. Standard lipids are used in between to assess response. Of course, this is just one way we've used that we've become comfortable with.

  • Anonymous

    1/24/2009 12:51:00 AM |

    The VAP does provide IDL on their profile.

    What sort of external validation does NMR have on their methods?

  • Charlotte jess

    9/27/2010 12:35:23 PM |

    Randox provide a kit which tests for the full lipid profile - a group of tests comprising triglycerides, total cholesterol, HDL and LDL cholesterol. The lipid profile is used, together with other risk factors, to assess a person's risk of cardiovascular disease (CVD).

    It is very important to get the balance between the protective HDL and the destructive LDL right in order to reduce the risk of CVD. This can be achieved either through dietary and lifestyle changes or treatment with cholesterol reducing drugs called statins.

    All Randox cholesterol tests, including small LDL, are direct enzymatic clearance tests, and as such are highly accurate even in lipaemic samples.

    For more information click here http://www.randox.com/lipid%20profile.php

  • buy jeans

    11/3/2010 2:56:03 PM |

    Having done many of all three (though least of VAP), I am partial to Liposcience's NMR. (By the way, I receive no fees from Liposcience to use their test, nor to promote it in any way.)

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