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Back in 2011, I started eating Paleo, and briefly became famous with my story Quitting Rice. While I was pretty hardcore at first, I've been more 80/20, now. Perhaps, the first thing you'll notice is that I've hardly any made any gains in 5 years ☹. Such is the sad life of a natty lifter. I'm actually significantly stronger, but it doesn't show. I'm actually about 15 lbs heavier in that July 2016 picture.

Now, on the plus side, I have achieved long-term weight loss. According to this article from the The American Journal of Clinical Nutrition, only about 20% of people that lose weight keep it off. It's not clear whether that's because the diets stop working, or people can't adhere to them long-term. Despite significant life changes, I've found this diet rather easy to maintain, however.

Doing yard work

May 2013: doing some yard work

Since I've started Paleo, I've had 3 different jobs, earned a graduate degree, and lived in 3 different cities: Boston, Philadelphia, and Seattle. I've taken plenty of vacations, which include Vietnam, Thailand, and Australia. Even when I barely lifted one year, I managed to stay lean.

At the beach

2014: at a beach in Australia

Thus, in my $N = 1$ experiment, I've decided that Paleo works long-term. Cooking is not so hard, and I find that I can pretty much each as much as I want and not even think about it. Despite availing myself of Google's limitless food, I haven't really gained weight, here, in Seattle.

Of course, there's the other problem of eating all that cholesterol and saturated fat. It would seem that I've headed towards coronary heart disease. And depending on how you interpret my lipid panel, you may be right.


From August 2016

While my triglycerides and HDL are great, that red LDL certainly doesn't look good. I'm not a doctor, so I don't really know what to make of it. There are some studies saying that LDL number may not even be correct because my triglycerides are so low (see: The impact of low serum triglyceride on LDL-cholesterol estimation). It's strange that eating lots of trigylcerides leads to very low trigylcerides. I probably get 60% of my calories from fat, with most of that fat being saturated.

Moreover, in Comparison of serum lipid values in patients with coronary artery disease at 70 years of age, they say that:

Triglycerides and ratio of triglycerides to HDL cholesterol were the most powerful, independent variables related to precocity of CAD.

According to their model, my risk of coronary artery disease should be very low, so who knows? Is it not common knowledge that lots of LDL is bad?

I guess my insulin levels are fine, too? Blood pressure was 110/72 for what it's worth.

Anyway, if you've never given Paleo a try. I highly recommend it. Besides the weight loss, there are plenty of other benefits like not being hungry as often and more stable energy levels. I'm not a medical professional or dietician, but I'd be happy to answer any questions about the lifestyle. Looking at all these pictures of myself, I've realized that the light plays cruel tricks on the eye.

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Alex Maione

I have done a lot of reading on nutrition, etc, because it really interests me. I'm obviously not a doctor, but I could comment on your labs. Probably some of this you already know, but regarding your lipid profile:

-Your total cholesterol is high, obviously...but I wonder if your cholesterol has always been that high? Cholesterol levels aren't significantly affected by dietary cholesterol intake for the majority of people (I've read figures that range from 70% to 90%, so 10-30% people are "cholesterol-sensitive" in a sense). On a daily basis, we make 3/4ths of our cholesterol, and the rest we get from diet. (Good graphic with effects of diet, etc. on cholesterol levels)

-Serum cholesterol levels are more often related to saturated fat intake, overall caloric intake (cholesterol is regulated by insulin and glucagon), and carbohydrate intake.

-Triglyceride levels directly correlate to amount of carbohydrates consumed. Your triglycerides are really low...I have some personal experience with this, too; started cutting carbs and my triglycerides as well as my cholesterol dropped by a fair percentage. (Good article with sources on this.)

-In terms of CAD risk, HDL levels seem to be a stronger negative risk factor than LDL levels are a positive risk factor. That is, having lower HDL is worse than having higher LDL levels, ceteris paribus.

Everything else is pretty unremarkable...CMP is WNL. The lipid panel is remarkable only for elevated LDL and total cholesterol. Everything else jives with what your diety is, pretty much!

Philip Pham

Thanks for the input. Yes, my cholesterol has always been pretty high. Before I started eating Paleo, my HDL numbers and trigylceride numbers were worst. Eating this way hasn't really changed my LDL at all.

Kam Lam

Hey Phil, I just happened to be in the cardiovascular module this month in medical school so I guess I could try to comment on your labs.

Sorry for the long post. Just go to the TLDR if you don't want to read.

From what I understand from dietary lipid metabolism, both cholesterol and TG comes from your dietary intake. Your dietary lipid will consist of a higher % of TG than cholesterol. From there, TG goes to the tissues for energy (hence the source of fuel from your diet) and the cholesterol will be sent to your liver for storage/whenever your body needs more fuel.

Your lipid panel shows that your body is really good at using TG as it's source of fuel and that is why the number is so low. But what about the excessive cholesterol? Well normally when your liver takes up cholesterol from your diet, it stores it and when your body is in it's fasting state later, it would release it as VLDL for fuel to extrahepatic tissues. VLDL gets converted into LDL in your capillaries and tissues and thus your LDL-cholesterol levels are very much increased.

Well the problem starts when your LDL levels are excessively increased. LDL with the cholesterol as a complex is suppose to be brought into tissues for metabolism but at the same time, the more cholesterol your tissues begin to uptake it, the synthesis of the LDL receptors will be downregulated. So you are going to get a huge amount of floating LDL with cholesterol without a place for it to go.

Although your HDL level is high, it is not always enough to bring all the cholesterol back. There is always a rate limiting step such as hepatic excretion into bile or reuptake of it.

According to UptoDate, LDL-C is the single most well established risk factor for development of CHD. I don't really think the subtype matters that much but what happens is that circulating LDL has a huge propensity to be oxidized by free radicals or any ions in your blood (eg. Fe in blood). As it is oxidized, it will cause inflammation and damage to the tissues around but you aren't going to obviously feel it because our immune system takes care of it immediately. Macrophages uptake LDL and the cholesterol via SR-A receptors and just eats it all up until it gets "fat" and it is called a foam cell. These macrophages also don't circulate so they are the ones that stays in your tissues. But what happen when they get so bloated and they die? Well you guessed it. All that fat and debris they consumed are going to stay there and initiate the beginning of plaque formation. You may think that you are okay now but as you get older, your blood would be more static and the risk of plaque formation is way higher later. Besides CHD, you would also be at risk for any vessel damage which may include aneurysms or dissections.

Also with just lab values alone, you very much mimic type II familial hypercholesterolemia which over time may cause you to develop xanthelasma or xanthomas.

TLDR: WITHOUT A DOUBT, LDL increases your chances of atherosclerotic plaque. (source: UptoDate, and unsound medical advice from 2nd year med student who probably don't know anything).

Philip Pham

Interesting. Good information, so what would be your recommended course of action?