This is an odd one. Purely an anecdotal case study, but references a cohort study on a subclass of individuals who are “Lean Mass Hyper-Responders” (LMHR):
A recent cohort study of 548 persons on carbohydrate-restricted diets (CRDs) revealed inverse associations between triglyceride/HDL-C ratio (TG/HDL-C) and LDL-C change, and between BMI and LDL-C change, on CRD. This means leaner persons with lower TG/HDL-C ratios generally exhibit larger increases in LDL-C on CRD. Individuals with a particularly pronounced high LDL-C, high HDL-C, low TG ratio are termed "Lean Mass Hyper-Responders." This report provides a clinical vignette of a patient who exhibits the Lean Mass Hyper-Responder phenotype, with LDL-C as high as 545 mg/dl, despite normal pre-CRD LDL-C of 95 mg/dl and consuming a CRD with a high unsaturated/saturated fat ratio. Coronary CT angiography conducted after 2.5 years of extremely elevated LDL-C reveals no detectable plaque development.
This seems to correspond to the time when I was on the zero carb 'egg diet'. Although I didn't exactly meet the criteria for this phenotype - LDL-C ≥ 200, HDL-C ≥ 80, and TG ≤ 70 mg/dl, I was close:
March '21 - mean body weight about 138.5 lbs, likely about 9-10% body fat, LDL - 203, HDL -59, TriG - 71. Never had my HDL been that high at the same time my TriG were that low. My Trig/HDL was never better.
The case study "LM" was only in his 20s, but after having a LDL reading as high as 545, after two+ yrs on the diet, angiography showed he had accumulated zero plaque or heart disease.
Back to square one. It's all very individual and complex.
Very interesting paper/case study. But I disagree with your conclusion that it is highly individualized and confusing. Sure it is for those rare examples (outliers) but the vast majority of people the science is mature, correlations established and effective treatment recommendations can be made. Sure in your case you are also an outlier as your lab numbers suggest you should have some plaque at nearly 65 yrs but you had two zero calcium scores 7 years apart and clean carotid artery. I don’t see why that is “back to the drawing board”. It’s really good news, accept the result and the prediction of very low risk. There is really nothing for you to do other than keep the same lifestyle (a few months break in training doesn’t change anything especially if you get in the pool).
ReplyDeleteNot drawing board square one..
DeleteI ate a canolli in Dec. It's killing me. I can feel it.
DeleteLol. I had our yearly fudge (2 small cubes daily for 3 or 4 days, probably 250 to 300 kcal) and apple pie with ice cream x mas day. Skiing conditions are excellent.
DeleteAfter 6 months LDL-C had gone up just over 3x and HDL-C was up just over 2x. TG was down. So the `ratios` were not as bad as the absolute values, esp LDL-C. Not sure if this is a mitigating factor. The later value of 545 was not matched by a noteable increase in HDL-C over the longer period, Implying the issue may be more of a longer term risk.
ReplyDeleteOr else, current understanding (of most things) is just the result of current assumptions and does not become science until all variables are understood/eliminated !
Yea, 2 1/2 years does not make much of a trial or produce definitive conclusions.
DeleteBut there is no “trial” with case studies. A prospective trial defines the study objective, estimates the expected statistical variability (sigma), and determines sample size based on sigma and desired power. Imagine such a trial for this outlier condition. How do you convince healthy very lean muscular athletic people to sign up for a strict keto diet where your LDL might go through the roof? I did a vegetarian version of one for awhile very difficult to adhere to it. This guy was motivated because he gets sick if he eats carbs. About conclusions: there will be no solid conclusions about this for years in large part due to the difficulty in studying it. Little effort will be put into it as it affects a small subset of the population. This was a great Doctor who is very curious and did a great job documenting this case study. I’ve had complex rare complications from my urinary diversion construction and diet interactions that weren’t uncovered for years my Doctors could write a case study that might help others but they are too lazy. In science it’s very common for early hypotheses to be proved wrong but with each study they can refine the hypothesis and eventually come to a better understanding. Undoubtedly the researchers who tackle this will experience that. So I think you should find it as a curiosity but not try to apply it or think it applies to you or try to get much meaning from it. Also about no disease in 2.5 years that may just be because he is young. As you read in many of the other studies endothelial dysfunction is a key factor in whether or not LDL sticks. Young people may have some protection against this. So not only does your trial have to have sufficient recruits for statistical reasons but also sufficient recruits in various age groups.
DeleteYou have become a good sluether. I think you should use these findings simply for intellectual stimulation and entertainment and not put too much into it. I get satisfaction from reading papers when they do what I think are interesting methods to tease something out - kind of like what we do at my work. For instance using cirrhosis patients to measure whether cocoa nitric oxide doping affects blood pressure- cirrhosis causes portal hypertension which can be severe after eating. So it magnifies the effect and they used it to study the effects of cocoa on reducing it. Lots of examples with murine (rodents) studies. Enjoy studies for studies sakes. Many are boring though.
I like this study might be something actionable here (reduce meat and dairy to reduce phosphorus and don’t take phosphate supplements ) .
ReplyDeleteHigh dietary phosphorus intake is associated with all-cause mortality: results from NHANES III123
https://www.sciencedirect.com/science/article/pii/S0002916523049493
Lipitor is amazing. 4 months baby dose (10 mg) results
ReplyDeleteTotal 119 (prior 163)
Tri 69 (prior 110)
HDL 58 (prior 48)
Chol/HDL 2 (prior 3)
LDL 47 (prior 93)
Non HDL 61 (prior 115)
VLDL 13.8 (prior 22)
Over the last 8 years no matter how my total varied the ratio was always 3. Lipitor broke that correlation and is now 2.
Also I started eating eggs seems to have no effect.
Amazing drug. Just the baby dosage.