Sunday, November 24, 2019

Retrospective #281: HDL-C and Triglycerides

“A picture is worth a thousand words,” the saying goes. Well, I have three “pictures” that I think will get your attention. They are graphs of my 70+ lab tests for HDL cholesterol and serum triglycerides between 1980 and 2014. By definition, they are n=1 (me only), and therefore could be dismissed as “anecdotal.” Alternatively, you could consider them a “case study.” I tend to think that Fig. #1, the “early years, “are illustrative of the general population for people eating the Standard American or “Western” Diet. Fig. #2, the “middle years and Fig. #3, the “later years” reflect the changes that can – and did occur in my case – with a dramatic change in what you eat.
Figure #1 (below) shows my HDL-C as the almost perfectly flat blue line from 1980 through September 2002, eating as I did the Standard American Diet. The first 11 tests (from 1980 until 12/01) are all in the high 30s and low 40s (range 37 to 42; average 39), which is “low,” i.e. just below “normal” range for 40 for men (50 for women).
Do you know what your HDL cholesterol is? You should. HDL and triglycerides are more important than your Total Cholesterol (TC) and LDL scores. The reason your doctor tracks your Total Cholesterol is that, by prescribing a attain, he or she can lower LDL and TC. My doctor put me on a statin in December 2003.
The upper line, in red, tracks 17 triglycerides (TG) over the same period. They are more variable (TGs usually vary from 20 to 23 percent, and can range as much as 40% (fasting vs. non-fasting). Note that they are not “high” (>200), but they hover around the “borderline” level of >150. The average is 143 (range 107 to 187). Neither of these tests would get your average doctor too exercised. He would say he’s going to “watch” them and to “continue taking the statin.”
Figure #2 shows HDL-C after I started eating Very Low Carb (20g of carbs a day!) I followed it faithfully for 9 months, then a “sort of” maintenance for the next three years. I then went “off plan” in the summer of 2006, and to get back on track, I started Richard K Bernstein’s 6-12-12 plan for diabetics (30g of carbs a day) for a year (9/06 to 9/07). Note that during this 5-year period (9/02 to 9/07) my HDL-C slowly increased from 43 to 60. TGs were lower (average 84, range 36 to 157 with one aberrant (222). Most doctors would be very pleased with these HDL and triglyceride lab tests, but would still tell you, “keep taking the statin
Figure #3 is by far the most interesting because it is totally “aberrant” to the clinician. It is, in fact, paradoxical.
Note that the blue and red lines are inverted. The HDL-C in virtually every case is greater than the triglycerides! The average of 25 HDL-Cs is 75 (range 52 to 98). The average of 25 TGs is 49 (range 21 to 65). Note also that there is definitely an inverse relationship between HDL-C and TG: when HDLs are high, the corresponding TG is low.
The inversion of HDL-C and TGs) began long after I began eating Very Low Carb. It began while I was in the middle of Bernstein and starting to take fish oil supplements (April 2007) and eating a can of sardines for lunch (July 2007).
I started taking 2 fish oil capsules a day (each 1-gram capsule containing 300mg of EPA and 200mg of DHA). I had read on the Mayo Clinic website that, “There is strong scientific evidence from human trials that omega-3 fatty acids from fish and fish oil supplements (EPA + DHA) significantly reduce blood triglyceride levels. Benefits appear to be dose-dependent, with effects at doses as low as 2 grams of omega-3 fatty acids per day. Higher doses have greater effects, and 4 grams per day can lower triglyceride levels by 25-40%. Effects appear to be additive with...statin drugs…”
In 2007 I was still on a statin. I had lost 170 pounds and my Type 2 diabetes was in remission. Then, on day, when my doctor observed how my HDLs had skyrocketed and my triglycerides had plummeted and concluded that I was no longer at “high” risk of Cardiovascular disease. In 2008, without any “coaching,” my doctor took me off statin drugs. 

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