A few weeks ago I was stunned, when after being paleo for eighteen months, I’d seen my cholesterol, my ‘bad’ cholesterol – LDL – skyrocket. My primary care physician immediately wanted to discuss treatment. High cholesterol? Statins? Me?
The results were bad. So I had more tests. The results were still bad. My quest to live a drug-free life wasn’t looking like it would have a successful outcome.
But I hold the viewpoint as presented in Mark Sisson’s The Primal Blueprint that drugs are wonderful – in the case of emergencies – but I wasn’t clear at that point that this was an emergency. So I demurred.
As I detailed in my earlier post about having a huge increase in my cholesterol despite being paleo for eighteen months, I got a second opinion from a paleo-centric doc, a repeat of the basic lipid panel, which confirmed the results of the first, and developed an action plan. This is an update to that post.
Lifestyle dialed in
In my case, lifestyle changes had already been made: I’m not overweight, I eat healthily, exercise regularly and have minimal stress beyond the daily parking lot battle at school pick-up. There was nothing much to be done there.
So, faced with a situation about which I could, apparently, do nothing, I wanted to study the true nature of the ‘disease’ to examine if the risk it presented to me was as bad as conventional wisdom would have me believe.
However, I was not prepared to ‘play with fire.’ If it was absolutely necessary, I would take pills. But in this case, things just didn’t add up. How could I live the most healthiest of habits and yet be drug-dependent?
The test I had done after the basic lipid panel measured the types of LDL floating around in my blood. It was called a Vertical Auto Profile or VAP. My doctor and I were particularly interested in the cholesterol profile of the Pattern A and B particles. Pattern A are large and fluffy and considered mostly benign while Pattern B are small and dense and strongly correlated with heart disease.
Fit, healthy people often have a concentration of pattern A as did Chris Kresser. Turns out I did, too. Good, you’d think, huh?
Good news turns to bad
However, I had another marker that was concerning to my doctors. The cholesterol variant Lp(a) was more than twice what it should be. Lp(a) is sometimes called the ‘widow maker’ because of its role in heart disease. The recommendation was still to go on a statin. Bummer.
I had read so much in the intervening period between my first and second test results, I’d come to realize the controversy over cholesterol as a predictor for heart disease is simply raging. There is huge disagreement between paleo community leaders and the medical establishment over this and the situation is far from clear.
As part of my research, I read Chris Kresser, Mark Sisson, Chris Masterjohn, Peter Attia, William Davis and Kurt Harris. I synthesized it all as well as I could and applied it to my own situation. I devised courses of action based on different outcomes, weighed the risks and developed a plan. It wasn’t easy.
As a person with young children who tends to tread a moderate path, I wasn’t prepared to ditch conventional wisdom entirely, possibly playing Russian roulette with my heart. I wanted to make a decision that made me, and my doctor, happy. Taking a statin at this point wasn’t going to achieve that. I needed to know what the true risk of a heart attack in my case was.
The heart of the matter
My resistance to drugs being what it is, and my desire to really evaluate the picture being so strong, I had one other option offered to me: to have a CT heart scan. This would reveal whether I had calcium deposits (plaque) in my arteries, the stuff that clogs them up and leads to heart attacks. I didn’t think twice.
As I was being rolled into the scanner, my arms above my head, holding my breath for so long I thought I was more likely to die of suffocation than heart disease, I did wonder what the outcome would be. Maybe for all my lifestyle efforts I would still ‘live long and die’ – the phrase Mark Sisson uses to describe the idea of living healthily and independently until just before death – but perhaps not as long as I’d hoped.
Thoughts of mortality
Was I in danger of keeling over in just a few years? Was I at 48, entering the later stage of my life rather than the middle as I had thought? These thoughts might seem morbid and a little melodramatic but they are what went through my head. I had the scan, got dressed and went home to wait for my results.
He had me at ‘zero’
I received an email from my doctor later that night. My calcium test, known as a ‘CT Heart without contrast’ or EBCT, came back with no discernible calcium deposits at all. It is possible that there are microscopic elements that cannot be picked up but for all intents and purposes, I am clear. The recommendation to take statins was dropped for at least 5 years and I was waved on my way.
Was I a happy bunny? I do believe I punched the air and gave a little scream which for a reserved Brit is quite a departure.
This is my story.
These are my results; this is my outcome. I had access to a paleo-aware (but not anti-drug) doctor who was willing work with me and to test until I was satisfied. I have excellent health insurance. I, in no way, want to leave you with the impression that if you have lipid panel results with a profile similar to mine, you can project my situation onto yours and rest easy.
Please don’t make assumptions for yourself based on my case study. That would be reckless.
Avoid passive patient syndrome
Taking responsibility, being proactive, researching and testing as thoroughly as possible to build up a picture from a number of angles are essential for great health in my opinion. I call it avoiding ‘passive patient syndrome.’ If I hadn’t gone through this investigative process and had instead blindly followed my first doctor’s advice, I’d be on statins for (and this is what particularly irked me) the rest of my life. By doing my due diligence, I have been able to avoid that for 5 years at least.
Dr. Davis says on his Track Your Plaque blog:
“The followers of the Track Your Plaque program who…
- get a heart scan that yields a coronary calcium score (for long-term tracking purposes)
- identify the causes such as small LDL particles, lipoprotein(a), vitamin D deficiency, and thyroid dysfunction
- correct the causes
…enjoy virtual elimination of risk.”
- Find a doctor who is willing to partner with you
- Do your due diligence, reading and researching, know what you need to know
- Test as far as it makes sense to do so.
- Implement and experiment with lifestyle factors and other methods that are relevant to you
- Keep your eye on the prize – a long and healthy, vibrant life
- Develop a plan to achieve that
(Have you noticed that preparing a plan seems to feature in nearly every paleo blog post I write? It is key.)
Interpreting the results
The controversy around cholesterol and the unclear nature of the role it plays in heart disease means that my results could be interpreted in a number of ways. Some might say I have a genetic predisposition to produce cholesterol and my healthy lifestyle prevents there being any fallout from that. Others would say that cholesterol is a complete red herring especially for women. But I think there is a clue in what Dr. Davis says which indicates my next move – thyroid dysfunction.
I have long suspected a problem with my thyroid. I have a family history of thyroid problems, a low body temperature and despite having normal thyroid results over many years, I have felt very tired, sick even, for extended periods.
Eventually I discovered my reverse T3 number was too high (this was well before I went paleo and considered at the time to be the result of my continually fighting the Epstein Barr virus.) Compounded, slow release T3 never helped though and I turned back to working on my diet.
Good initial results with paleo passed after a time and although I have not gone back to the listless, exhausted, toxic state I was in two years ago, as I wrote last month, some of my symptoms returned (my interstitial cystitis was rapidly despatched, however, after I realized that the HCL I was taking as a digestion aid was the culprit – doh!)
I’m now speculating that my high cholesterol number might be the canary in the coalmine for my sleepiness and an under-performing thyroid the reason behind both the low energy and high cholesterol. A two-fer. That would be cool.
Paul Jaminet examines high LDL on paleo and the role of the thyroid on his Perfect Health Diet blog and suggests that:
“The proper solution, I think, is simply to eat more carbs, to provide other thyroid-supporting nutrients like selenium and iodine, and allow the body to adjust its T3 levels naturally. The adjustment might be quite rapid.”
So I continue to celebrate my drug-free status and marvel at the turnaround of events while experimenting with those two supplements over the next couple of months. Lucky I wanted to be a detective when I was a kid, huh? I’ll let you know how I get on – why not subscribe in the box below to make sure you don’t miss anything?
Do you have thyroid issues? How have you turned them around? Tell us in the comments!
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