cholesterol spike: 188 to 220 What am I doing wrong?

[Jguzz]

My husband and I have been following the Starch Solution for about 2 1/2 years.
My initial cholesterol was 227 (eating paleo). In 2020 it was 193. This this March it was 210 (eating wrong foods). I buckled down and followed the Starch Solution to a T. No caffeine, no supplements. I scrutinized each and every label. Nothing with a "glyceride/lecithen" etc entered the house or my mouth. In June, cholesterol dropped to 188. Today, it jumped to 220!!!! I have eaten the same foods; haven't changed a thing. No dining out. I cook every mouthful I eat so I know exactly what all the ingredients are. My husband's cholesterol is 114. We ate the same foods. I'm requesting a recheck.

In the meantime, I'm super depressed. Any suggestions/advice/thoughts would be most appreciated.

March chol: 210 HDL: 46 LDL: 131 TRI: 165 VLDL 33 weight: 122
June: chol: 188; HDL: 38; LDL: 131 TRI: 96 VLDL: 19 weight: 116
Aug: chol: 220 HDL: 43: LDL: 154 TRI: 116 VLDL: 23 weight: 116

[VeggieSue]

Relax! It's just a few points and triglyceride levels do change, even throughout the day.

Were both tests taken after fasting between 8-12 hours? Fast longer than 12 hours and levels start to rise on their own. Not fasting at all? Well, there's no way to compare one blood test to the other - it's just a random number taken at a random time of the day.

Also, you lost some weight, so in reality, you've been "eating" fat. This is why a lot of people whose weight was stable and suddenly start losing see elevated triglycerides.

Just keep at it and in time those levels will lower and stay put. Until then, expect to keep seeing fluctuating numbers.

[Jguzz]

To: VeggieSue,
I appreciate your reply. Yes, both these tests were fasting. A 22 point spread seems more than just a few points. Plus, the numbers spiked between June and August when my weight was stable. The numbers actually dropped during the time I lost a few pounds. Hence, my puzzling concern.

[pundit999]

We worry about cholesterol because we do not want to get heart disease.
The best way to know if you do have heart disease is getting the calcium score.
Get that test done and see what the score is.
If it is reasonably low, stop fretting about the cholesterol numbers.

A whole plants only diet lowers your risk of heart disease in myriad ways, cholesterol is only one such way.
Even if one path is obstructed, there are others.

[KillSwitch]

Wow, I can see why you are depressed over this. You are eating exactly like your hubby (March to now = approx 6 months). He gets the expected results from eating a strict WFPB diet but you do not. You are pretty lean also even with the small weight loss. Curious? What are you eating mostly? Why would the total go back up eating the same exact things? I would expect a continuous downward trend doing what you are doing. Did your husband start being really strict when you started? You said his TC = 114. Has his always been like this since you guys started following the Starch Solution 2.5 years ago? Dr. McD likes to say you should expect these results if you eat like this with no deviations. Maybe, there are exceptions.

[Eulalie]

I have been on the McDougall plan since April 1st. My Blood pressure has come down from 159/115 to 120/90, but my cholesterol has only come down 9 points and is 231. I haven't been eating processed foods, and I've only had 6 feast days (for birthdays) in 6 months. I eat oatmeal for breakfast, only Ezekiel 4:9 breads and lots of fruits, vegetables, whole grains, and good starches. I keep my nuts and seeds to 2 tablespoons daily. On the plus side, I have lost 19 pounds. My Dad (who was not overweight and ate practically a vegan diet with only smoked fish on Fridays) had to have by-pass surgery, and my genetic medical profile indicates that a high fat diet could lead to heart disease for me. My doctor thinks I need to be on a cholesterol-lowering medication, in addition to following my low-fat vegan eating plan. Any comments or suggestions?

[Ejeff]

Eulalia, are you overweight? If so, are you losIng weight? I have read that cholesterol numbers can be affected when losing weight. Great job in lowering your blood pressure. If I was in your position I would stop all nuts and seeds see if it makes any difference. Make sure you have eliminated all sources of oil.

Erin

[Eulalie]

I weigh 143 lbs, so I am somewhat overweight at 5'4". I will cut out all the nuts, but wonder if I still need the Chia and ground flax seeds for my omega 3 source fats? I only use 1 tablespoon daily.

[VeggieSue]

Cut out not just the nuts and seeds but restrict fruit to only 2 pieces a day, and maybe even flour products - that is, follow the MWLP version of the McDougall program. With the high blood pressure readings you had when you started there must be some cardio-vascular disease going on in your body, and it would be best if you got really clean and strict with the food and give it time - it may take months for your cholesterol markers to all go down and stay down.

And as for the seeds, you don't need them, as long and you're eating enough greens and other non-starchy vegetables in your diet.

https://www.drmcdougall.com/articles/nu ... -medicine/

[Eulalie]

Ejeff and Veggie Sue, thank you both for your imput! I will just be more stringent in following the program and cut out all nuts and seeds, and lower my intake of bread--and see if that will bring down my cholesterol levels.

[curcubit]

Have you had your lipoprotein (a) tested?

you may have genetically elevated Lp(a) that is contributing to elevated total cholesterol via LDL. Lp(a) does not respond to diet changes like other cholesterol particles.

This explains it well.
Since the structure of Lp(a) includes a particle of LDL cholesterol, your Lp(a) level contributes to the level of LDL-C that is measured by blood tests. The cholesterol portion of Lp(a) is referred to as Lp(a)-C. On average, every 10 mg/dL of Lp(a) in the blood increases levels of LDL-C by 3 to 4 mg/dl. If your Lp(a) level is low, its impact on total LDL-C is minimal. But in patients with high or very high Lp(a), their LP(a)-C can account for much or most of their LDL-C test results.
https://www.amgenscience.com/features/10-things-to-know-about-lipoproteina/

If you do have this genetic condition (I have it myself), following a WFPD diet is one of the best things you can be doing. Currently no approved drug for this, although they are working on clinical trials for an ASO (Antisense Oligonucleotide) drug that downregulates the mRNA that codes for the LPA gene. Fancy stuff.

Also, a zero to low CAC score is not a clean bill hill of health for heart disease. A CAC score of zero does not mean absence of plaque. The score reflects the total area of calcium deposits and the density of the calcium in plaque. A score of zero means no calcium is seen in the heart. It suggests a low chance of developing a heart attack in the future. However, “about one-fourth to one-third of the total incident cardiovascular disease (CVD) events occur in those with a CAC of zero, despite some use of lipid-lowering therapy at baseline or during follow-up (in MESA [Multi-Ethnic Study of Atherosclerosis] ≈15% at baseline and 44% during follow-up).” https://pubmed.ncbi.nlm.nih.gov/32897743/. Zero Coronary Artery Calcium Score: Desirable, but Enough?

If you want to see if your elevated cholesterol has had some negative impact, then a hsCRP (highly sensitive C-reactive protein) is a good place to start. And for about $100 you can get a non-invasive carotid intima media thickness ultrasound in most urban areas that can gauge the health of your arteries. If they find plaque their...then you have it everywhere, even your coronary arteries. This test picks up the soft plaque that CAC misses and it has no exposure to ionizing radiation.

[JeffN]

Have you had your lipoprotein (a) tested?

The whole Lp(a) issue is fascinating and diet has had little to no impact on it (I have seen ~10% change).

To assume that this diet will solve the issue 100% is at best naive and at worst, potentially harmful. It doesn’t currently solve every genetic issue.

It is why I made my comments here <https://drmcdougallforums.com/viewtopic.php?f=1&t=61981&p=628172#p628172> in regard to Dr Esselstyn’s recent video and his comments on FH and why I wrote my earlier article on the Myths of Medication and why I wrote my critique of Dr Lisle’s “Continuum of Evil” lecture (which he has since retired).

It is also why recommendations to do as little as possible to achieve results may also backfire. We should do as much as we possibly can to follow the program in its entirety as we don’t always know what is going on beneath the surface.

But yes, do a through examination of your lifestyle and make sure your diet (And lifestyle) is as adherent as can be.

In Health
Jeff

[curcubit]

HI JeffN,

I too find Lp(a) fascinating. I have learned alot from cardiologist Sam Tsimikas @Lpa_Doc from https://twitter.com/Lpa_Doc.
For instance, in the placebo arms of this trial, intra-individual variation up to +25% .

Temporal variability in lipoprotein(a) levels in patients enrolled in the placebo arms of IONIS-APO(a) Rx and IONIS-APO(a)-L Rx antisense oligonucleotide clinical trials
Santica M Marcovina 1, Nicholas J Viney 2, Steven G Hughes 2, Shuting Xia 2, Joseph L Witztum 3, Sotirios Tsimikas 4

https://pubmed.ncbi.nlm.nih.gov/29174389/
 DOI: 10.1016/j.jacl.2017.10.024 
Abstract
Background: Lipoprotein(a) [Lp(a)] levels are primarily genetically determined, but their natural variability is not well known.
Objective: The aim of the study was to evaluate the short-term temporal variability in Lp(a) in 3 placebo groups from the IONIS-APO(a)Rx and IONIS-APO(a)-LRx trials.
Methods: The placebo groups comprised 3 studies: Study 1 with 10 subjects with any Lp(a) concentration; Study 2 with 13 subjects with Lp(a) ≥75 nmol/L (∼30 mg/dL); and Study 3 with 29 patients with Lp(a) ≥125 nmol/L (≥∼50 mg/dL). Lp(a) was measured in serial blood samples (range 7-12 samples up to 190 days of follow-up) and analyzed as absolute change and mean percent change from baseline. Outliers were defined as having a > ±25% difference in Lp(a) from baseline at any future time point.
Results: No significant temporal differences in mean absolute Lp(a) levels were present in any group. However, among individuals, the mean change in absolute Lp(a) levels at any time point ranged from -16.2 to +7.0 nmol/L in Study 1, -15.8 to +9.8 nmol/L in Study 2, and -60.2 to +16.6 nmol/L in Study 3. The mean percent change from baseline ranged from -9.4% to +21.6% for Study 1, -13.1% to 2.8% for Study 2, and -12.1% to +4.9% in Study 3. A total of 21 of 52 subjects (40.4%) were outliers, with 13 (62%) >25% up and 8 (38%) >25% down. Significant variability was also noted in other lipid parameters, but no outliers were noted with serum albumin.
Conclusion: In subjects randomized to placebo in Lp(a) lowering trials, modest intra-individual temporal variability of mean Lp(a) levels was present. Significant number of subjects had > ±25% variation in Lp(a) in at least 1 time point. Although Lp(a) levels are primarily genetically determined, further study is required to define additional factors mediating short-term variability.

[JeffN]

I have followed him for awhile and take his twitter classes and tests.

I've been trying to get the program to focus more on Apo-B and less on LDL and have written it up a few times in my forum. LDL has worked for a very long time and has good data supporting it but it seems Apo-B is much better, simpler and gives a better answer.

In health
Jeff

[curcubit]

Thats so funny! We are both taking his twitter tests! Yes, CVD is so much more than LDL. Although I do roll my eyes at keto followers who say their LDL of 190 is totally safe because LDL does not cause heart disease.