Making sense out of lipid changes

27. January 2009 William Davis (9)
Maggie had been doing well on her program, enjoying favorable lipids near our 60-60-60 targets (HDL 60 mg/dl or greater, LDL 60 mg/dl or less, triglycerides 60 mg/dl or less). Last fall, her last set of values were:

Total cholesterol: 149 mg/dl
LDL cholesterol: 67 mg/dl
HDL cholesterol: 73 mg/dl
Triglycerides: 43 mg/dl

The holidays, as with most people, involved a frenzy of indulgent eating: Christmas cookies, cakes, pies, stuffing, potatoes, candies, etc.

Maggie returned to the office 6 pounds heavier with these values:

Total cholesterol: 210 mg/dl
LDL cholesterol: 124 mg/dl
HDL cholesterol: 57 mg/dl
Triglycerides: 144 mg/dl

In other words, holiday indulgences caused an increase in LDL cholesterol, a reduction in HDL, an increase in triglycerides, an increase in total cholesterol.

What happened?

At first glance, many of my colleagues would interpret this as fat indulgence and/or a "need" for statin drug therapy.

Having done thousands of lipoprotein panels, I can tell you that, beneath the surface, the following has occurred:

--Overindulgence in carbohydrates from the goodies triggered triglyceride (actually VLDL) formation in the liver, released into the blood.
--Increased triglycerides and VLDL triggered a boom in conversion of large LDL to small LDL (since triglycerides are required to form small LDL particles) via cholesteryl-ester transfer protein (CETP) activity.
--Increased triglycerides and VLDL interacted with HDL particles, causing "remodeling" of HDL particles to the less desirable, less protective small particles, which do not persist as long in the blood, resulting in a reduction of HDL.

The critical factor is carbohydrate intake. This triggered a domino effect that is often misintepreted as excessive fat intake or a genetic predisposition. It is nothing of the kind.

I discussed this phenomenon with Maggie. She now knows to not overindulge in the holiday snacks in future and will revert promptly back to her 60-60-60 values.
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Comments (9) -

  • Rick

    1/27/2009 4:37:00 AM |

    Wow. I hadn't realised that a short period of over-eating could trigger such big changes.

    Is there any danger from triglycerides going much below the target of 60?

  • Diana Hsieh

    1/27/2009 5:23:00 AM |

    Dr. Davis --

    What might cause a substantial rise in LDL, while triglycerides and HDL are lower than ever?

    Here's what happened with my tests over the last year and a half:

    ** Summer 2007, eating the standard American diet **
    Total Cholesterol: 266
    Triglycerides: 109
    HDL: 79
    LDL: 165

    ** Summer 2008, just a few weeks into my new diet (no processed foods, no grains, no sugars, no vegetable oils) **
    Total Cholesterol: 225
    Triglycerides: 63
    HDL: 72
    LDL: 140

    And now, January 2009 (same diet as before):
    Total Cholesterol: 341
    Triglycerides: 55
    HDL: 99
    LDL: 231

    My triglycerides and HDL are better than ever, but my LDL has gone way up.  I didn't overindulge over the holidays, but I was losing weight (slowly) when I got that latest test.

    I know -- thanks to your blogging -- that inferred LDL values are highly unreliable.  And I also know that there's a difference between small LDL (bad, caused by eating high carb) and the bigger, fluffier (okay) LDL.  The LDL number doesn't differentiate between those values.  Or might something else be the cause?

    My doctor wants to do a cholesterol recheck next month -- and I'm thinking that I ought to ask for a measured LDL value and a particle size test.  Does that seem reasonable to you?  

    BTW, my heart scan from six months ago is totally clear.  So I don't care how much my doc pushes, I absolutely refuse to go on any kind of cholesterol-lowering medication.

    Also, thanks to you, I got a vitamin D test -- and my values were excellent.  (I do supplement.)  Yeah!

  • Jenny

    1/27/2009 2:19:00 PM |

    Dr. Davis,

    While it is true that overindulging in carbs causes all the changes you cite here, if your patient really wants to stick with the program life-long, she'll do better learning how to carb up a bit at the holidays, and then correct afterwards, rather than getting into a lifestyle of self-denial that will build up an undercurrent of feelings of deprivation that will eventually blow her completely off course.

    I've been there, done that. Three family holiday seasons without eating any of our traditional foods left me depressed and miserable. Food is a complex issue with deep emotional roots.

    Something like a family death or a cancer diagnosis can trigger binges that derive from that deprivation and really derail the diet.

    I have found it much better to build in safety valves into the diet, here and there.  The lipids will recover very fast once she goes back to eating the low carb diet.  

    I've been doing a low carb lifestyle for going on 11 years now, and I attribute its success to the safety valves. Yes, I do gain a few pounds over the holidays, but I take them off in January.  

    The psychology of successful dieting is often to accept "good enough" rather than perfect. Perfect has a nasty way of ending up in disaster.

    If you doubt this, just read the low carb diet boards where for every person who has maintained perfectly for 5+ years there are 25 people back after catastrophic regains caused by being too stringent.

  • Alan S David

    1/27/2009 3:36:00 PM |

    Is it carbs in general or should we be more consciously eliminating the wheat and corn products?  
    I eat quinoa,oatmeal,  buckwheat,beans,brown rice, etc. Not to excess but as a part of my usual diet.
    Just wondering?

  • Grandma S.

    1/27/2009 4:51:00 PM |

    Question: I understand no wheat and what it does to the LDLs, but does that include potatoes? Thank you!

  • Anonymous

    1/28/2009 5:57:00 AM |

    Dr. Davis,

    I have a similar issue as Diana Hsieh.  

    My Total Cholesterol: 258
    Triglycerides : 60
    HDL : 61
    LDL- 181

    I've been on a low carb diet avoiding wheat, rice, starches, sugar, high fructose corn syrups and fruits for the last 6 months.  I've lost 35 pounds and reduced my triglycerides from 296 to 60.  Taking fish oil and slo-niacin. I have been eating alot of saturated animal fats (rib-eye steaks, baby back pork ribs, eggs) Is eating the saturated animal fat causing my total cholesterol to be too high?  Is total cholesterol above 200 dangerous if Triglycerides and HDL are in the 60's?

  • vin

    1/28/2009 10:11:00 AM |

    I am trying for last three years to get my HDL numbers high. So far without success. I have tried exercise and cutting out wheat but without significant improvement. I have now added 4000iu vitamin D. Will do a follow up blood test after about two months to see if HDL level increases.

    Any other tips?

  • Jmuls

    1/28/2009 12:34:00 PM |

    Dr. Davis,

    Is there often a direct correlation between low triglycerides and a greater proportion of large LDL particles?  Thanks

    - John

  • Trinkwasser

    2/8/2009 2:08:00 PM |

    Here were my lipids on a Heart Healthy (sarcasm) Diet

    Trigs 380
    HDL 25
    LDL 165

    Add simvastatin

    Trigs 185
    HDL 33
    LDL 75

    Here they are on a low carb diet with my BG more or less normalised
    (70 - 90 and postprandials mostly below 110 and seldom over 120)

    Trigs 39
    HDL 47
    LDL 105

    Adding more saturated fat

    Trigs 62
    HDL 55
    LDL 94

    Spot the reversal of HDL to LDL

    IME low carbing decimates the trigs and tends to increase HDL and LDL both, tinkering with the fat content and type adjusts the balance between these BUT there's a lot of individual variation as to exactly how this works. Some people just seem to have high LDL whatever they do, maybe a long term change from years of insulin resistance and hyperinsulinemia, maybe genes which would respond to a different balance of fat types in the diet.

    My #1 weapon has been BG testing

    http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

    which is deprecated in the UK. Lipid breakdowns are often unavailable and Full Lipid Panel is deprecated in favour of TChol which is pointless but cheaper. The money saving is probably to pay for the blanket prescription of statins, and it also serves to conceal the toxic nature of the diet

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    here's the diabetic version

    http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Food_and_diabetes/Balancing_your_diet/

    I feel like part of a eugenics experiment

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How to Give Yourself Hashimoto's Thyroiditis: 101

How to Give Yourself Hashimoto's Thyroiditis: 101

25. January 2009 William Davis (18)
I borrowed this from the enormously clever Dr. BG at The Animal Pharm Blog.


How to Give Yourself Hashimoto's Thyroiditis: 101

--lack of sunlight/vitamin D/indoor habitation
--mental stress
--more mental stress
--sleep deprivation... (excessive mochas/lattes at Berkeley cafes)
--excessive 'social' calendar
--inherent family history of autoimmune disorders (who doesn't??)
--wheat, wheat, and more wheat ingestion ('comfort foods' craved in times of high cortisol/stress, right? how did I know the carbs were killing me?)
--lack of nutritious food containing EPA DHA, vitamin A, sat fats, minerals, iodine, etc
--lack of play, exercise, movement (or ?overtraining perhaps for Oprah's case)
--weight gain -- which begins an endless self-perpetuating vicous cycle of all the above (Is it stressful to balloon out for no apparent reason? YES)


If you haven't done so already, take a look at Animal Pharm you will get a real kick out of Dr. BG's quick-witted take on things.


We are systematically looking for low thyroid (hypothyroidism) in everyone and findings oodles of it, far more than I ever expected.

Much of the low thyroid phenomena is due to active or previous Hashimoto's thyroiditis, the inflammatory process that exerts destructive effects on the delicate thyroid gland. It is presently unclear how much is due to iodine deficiency in this area, though iodine supplementation by itself (i.e., without thyroid hormone replacement) has not been yielding improved thyroid measures.

I find this bothersome: Is low thyroid function the consequence of direct thyroid toxins (flame retardants like polybrominated diphenyl ethers, pesticide residues in vegetables and fruits, bisphenol A from polycarbonate plastics) or indirect toxins such as wheat via an autoimmune process (similar to that seen in celiac disease)?

I don't know, but we've got to deal with the thyroid-destructive aftermath: Look for thyroid dysfunction, even in those without symptoms, and correct it. This has become a basic tenet of the Track Your Plaque approach for intensive reduction of coronary risk.
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Comments (18) -

  • Bad_CRC

    1/25/2009 7:07:00 PM |

    Hmm, really?  So if I eat wheat (or was it 'carbs' generally?) and not enough animal fat, drink coffee, don't sleep enough, etc., Hashimoto's autoantibodies will start showing up in my blood?  And when I reverse the above, the antibodies will disappear and TSH, etc., will revert to normal?

    Any support for this in the literature?

  • dubyaemgee

    1/25/2009 8:12:00 PM |

    I suspect there needs to be some reeducation as to what is considered "normal" within the medical community as a whole. My TSH was last measured at 4.32, and is considered well within the range of normal, even though I've been complaining of hypothyroidism for a while now. Seems like we have to go into the doctor's office with steely determination to have these problems addressed.

  • mike V

    1/26/2009 2:03:00 AM |

    Drs Davis and BG:
    I think you are both on target with the attention you pay to hypothyroidism in relation to heart disease, and other related diseases such as obesity, diabetes, kidney and other hormone related problems.

    Question please:
    In your opinions:
    1 Is the high incidence of hypothyroidism in the population throwing 'off' the lab  norms for TSH, FT3, FT4 or can we assume the numbers used by most labs are based on world wide or historical values?

    2 Is 'Subclinical Hypothyroidism' real, or could it simply be a function of #1, or inadequate vitamin D3/iodine etc. I understand that 60% of the US population may be in that category.

    Thank you
    Mike V

  • Anne

    1/26/2009 2:26:00 PM |

    You mention the connection between wheat and thyroid. If you want to read more about that, go to The Gluten File. www.theglutenfile.com There you will find a section on thyroid disease.

    It is known that about 4-6% of those with Hashimoto's have celiac disease. I am sure that percentage would go even higher if one included those with non-celiac gluten sensitivity. There has been at least one study showing that thyroid antibodies disappear with the use of a gluten free diet.

  • Nameless

    1/26/2009 8:46:00 PM |

    Are there any studies showing wheat, vitamin D, etc. causing Hashimoto's? I suspect there isn't, but if population studies are looked into, perhaps you could find a correlation? Look at populations that generally don't consume much wheat, and see what their rates of Hashimoto's are. Or populations at upper latitudes vs those near the equator, and their rates of Hashimoto's.

    However, if wheat, lack of sleep, poor diet, etc. does cause Hashimoto's, wouldn't it alter the male/female ratio of who gets the disease? Why would women still be more likely to contract Hashimoto's, if the cause is diet?

    And in my case, several years ago I went to a low carb diet, restricted wheat, desserts consist of fruits/berries only, corrected my vitamin D levels, took fish oil, etc. I also tested negative for Celiac. Before these changes my thyroid tested normal (TSH in the low 1s). I was never overweight and exercised regularly too.

    And this past month I was  diagnosed with Hashimoto's (high antibodies, TSH in the 3s, thyroid scan all lumpy). So... if there is a correlation, shouldn't my thyroid have improved, not gotten worse?

  • G

    1/26/2009 10:00:00 PM |

    Bad_CRC,

    I think you need to have the genetic susceptibility. On the animal pharm blog, I've listed a few that scientists have already correlated to Hashimoto's
    --VDR polymorphs
    --HLA polymorphs

    I'm certain there will only be dozens others b/c these things (autoimmunity) don't happen alone.

    Add'l, perhaps these things are also just signals for 'hibernation'...??  Perhaps we are only inducing ancient signals that are meant to protect and increase survival (low melatonin, high carbs, wheat/stress, fructose (from the Italian sodas I forgot to mention!), gaining weight, slowing down to Eat-Eat-Eat/stress, etc).

    Any thoughts?

    There are a few links in the literature regarding higher TSH, lower T3/T4 during winter months and lower vitamin D in the serum. Of course!

    -G

  • mike V

    1/27/2009 2:32:00 AM |

    G
    I have no personal doubt that how well you choose your parents is of primary importance.
    My late mother, and two brothers and sisters have all been  hypothyroid.
    As in most diseases, I think other immune factors can be involved, some in the womb, some exposures in early childhood, while the immune system is still being 'programmed', others from bacterial or viral exposures.
    It is said that vitamin D is quite important in a balanced immune system, but it starts very low in typical breast milk, and in very young children, and can remain low throughout life in much of the population.
    Iodine deficiency was a critical factor in people not living near the coasts, until iodized salt was introduced in the early 20th century.
    Lack of timely exposure to bright light is well known to "mess" with our biological clock, moods, and immunity.
    I did not become aware that I was hypothyroid until my forties, and since have not found nutrition a major factor, until perhaps vitamin D.
    With the exception of vitamin D, I have not personally been aware that other nutrition has affected my treatment.
    Is there any co-relation between Hasimoto's, and other auto-immune conditions?

    MikeV

  • Dr. William Davis

    1/27/2009 11:53:00 AM |

    Mike V--

    The newest data, e.g., the HUNT Study, are analyses of events based on TSH. It therefore factors out the effect of population distributions.

    You are correct, however, in pointing out that previous analyses were flawed precisely for this reason.

  • mike V

    1/27/2009 5:13:00 PM |

    As usual thanks to all for the education, and for all you do to penetrate the blood brain barrier between the specialties, Big Medica, and us (the great 'unwashed'. Smile)

    MikeV

  • Pat Elliott ND

    1/27/2009 5:44:00 PM |

    Hi Doc,
    We are seeing a very high % of our patients with zinc deficiency - similar to the whole vitamin D thing. Just wanted to share this with you since zinc is also correlated to blood sugar and cholesterol problems. Would love to see what you find in your patients with regard to this nutrient as well.
    Regards,
    Pat Elliott ND
    www.elliotthealthcare.com

  • Anonymous

    1/28/2009 3:51:00 AM |

    Pat Elliott  --

    How do you define a zinc deficiency? I've read that serum zinc is pretty inaccurate (as is copper or magnesium serum testing).

    Looking at other biomarkers, or a zinc taste test?

  • Lou

    4/1/2009 11:54:00 PM |

    I'm guessing that when "Nameless" took up the low-carb eating plan, they may have also increased eating soy.  Soy can really mess up the hormones.  I think we can blame soy for all this thyroid trouble and fibromyalgia and fatigue related troubles.  Add to that inadequate fish oils, butter, after years of telling us to avoid fats and sunlight (vitamin D) and you get a nice picture of what has happened to far too many of us.

  • scall0way

    11/10/2009 8:35:12 PM |

    I know this is an old post but I'm just going through all the thyroid-related posts. My TSH got flagged at a 9 when I went for a physical a couple weeks ago, and further tests came back with a Hashimoto's diagnosis.

    I just don't know. I follow a gluten-free diet, in fact I avoid all grains. I avoid all sugars, I don't consume any high-PUFA vegetables oils. I have not eaten any sort of soy (except for rare splashes of fermented soy sauce here or there) in a dozen years. I always cook any veggies I might eat  that call into the goitrogenic category. I supplement with 5000 IU of D3 in gelcap format daily. I consume most of my fats as sat fats/animal fats. I take fish oil, cod liver oil. I love to eat sardines.

    Yet my thyroid apparently has slowly been getting worse over the last couple years. My TSH is definitely higher than it was in 2007, and that was higher than it was in 2006 - slowly been climbing over the last few years until finally the doctor red-flagged it.

  • Anonymous

    7/29/2010 10:42:48 AM |

    I have Hashimotos. Was diagnosed at 15. Had it long before then. I am convinced it is genetic when I look at other family members (although no-one else has been diagnosed). I am on 'correct' dosage of thyroid hormones but many of the symptoms still exist and I would LOVE to blame my GP but the fact is that they are overworked and are doing the best with what they have - like the rest of the population. Recently diagnosed with anxiety by a psychologist. Does this cover the hashimotos symptoms completely or partially? Who knows? All I know is that I am drunk now as I am bone tired from trying and failing from everything from relationships to work - alcohol seems to be the only way out...although my psychologist has told me it isn't - just being tired and weak I guess. I'm sure you will delete this post as soon as you see it blog owner, but before you do, I hope a few Hashimotos/anxiety sufferers see one person struggling to be better despite the messy interference of life. Having a temporary failure right now but will be back on the horse again tomorrow like every other day.

    Love you all.

    XXX.

  • buy jeans

    11/3/2010 6:58:15 PM |

    JMC at the blog animal pharm has linked some fantastic resources from Loren Cordain and how the Paleo diet reverses autoimmune diseases (incl JMC's own rheumatoid arthritis). Wheat is not the ONLY culprit. Legumes, Dairy/casein, nutr'l deficiencies, excessive fruit/HFCS, lack of exercise, lectins, etc are part of the equation for autoimmunity disorders as well.

  • PureAlan

    1/24/2011 10:46:15 AM |

    What a brilliant idea! Thanks for sharing this information. I have hypothyroidism for almost 4 years and it was terrible. I am currently taking porcine thyroid .  Now I'm gaining back my normal life.

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