Triglycerides & HDL Improving, But Not LDL...

Medical Q&A [Moderated]
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Greetings Doctors,
Some brief background information:
Age: 39
Weight: 201 lbs
Height: 70”
Waist @ Umbilicus: 38 1/2 “
BP: 117/72
Race: Caucasian
Sex: Male

Between 2017 and 2018, while following the advice of Barbell Medicine for nutrition and weightlifting, I experienced some amazing results in my health and bloodwork. During this time I lost 30lbs and 3.5” off my waist measurement. Major improvements in my cholesterol/lipid panel as well. Between 2018 and 2019, I continued to follow a similar regiment, but saw a surprising trend in the opposite direction concerning my LDL. My HDL and Triglycerides continued to improve, but my LDL went the opposite direction. The only notable changes I can state, are I haven’t kept my diet as “low fat” in the recent year, and it has been the most stressful year of my life. When my blood work was drawn in 2018, my weight was still declining, and has held steady – around 200lbs – since then and during the 2019 draw.

Total Chol Tri HDL LDL LDL C Non HDL
2007 247 284 38 151 179 209
2009 221 343 38 114 160 183
2018 163 108 40 101 104 123
2019 222 79 47 159.2 157 175

When my PCP saw this, he didn’t seem concerned. Just recommended “keep exercising and watch the animal fats”. The recommendation left me really curious and desiring more substantial feedback.

Any feedback/recommendations would be greatly appreciated.

Sincerely,

Lee

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What was the trend of your waist measurement alongside these trends? A 38.5" waist is still in the “elevated risk” category, and we would recommend getting that down below 37".

Additionally, we will need some more specifics about your diet: What are the typical amounts fat sources / breakdown in your diet, and how much dietary fiber are you consuming on a daily basis?

Do you have a family history of blood lipid issues or cardiovascular disease?

It seems you were in the best place in 2018s, when your non-HDL-C was below 130 (which is a typical target for people without an established history of CVD).

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1.) What was the trend of your waist measurement alongside these trends? A 38.5" waist is still in the “elevated risk” category, and we would recommend getting that down below 37".

  1. Additionally, we will need some more specifics about your diet: What are the typical amounts fat sources / breakdown in your diet, and how much dietary fiber are you consuming on a daily basis?

Here are my weight, waist, and nutritional trends alongside the lipid profiles. I don’t have accurate enough data pre-2018 for the nutrition, but the data for the past 2 years is very accurate (tracked daily and food weighed/measured every time possible). My protein sources are primarily chicken breast, 93/7 beef, and whey protein. It was your recommendation via an IG Q&A to keep refined carbs/sugar down to improve triglycerides.

Total Chol Tri HDL LDL LDL C Non HDL Weight Waist kCal Carb Protein Fat Sugars Fiber
2007 247 284 38 151 179 209 240 43"
2009 221 343 38 114 160 183 230 42"
2018 163 108 40 101 104 123 195 37.5" 2150 211 194 59 46.3 33
2019 222 79 47 159.2 157 175 205 38.25" 2502 240 226 75 53 30

3.) Do you have a family history of blood lipid issues or cardiovascular disease?
My maternal grandfather had a triple bypass from heart disease that was associated with diabetes. My father has afib and takes statins.

4.) It seems you were in the best place in 2018s, when your non-HDL-C was below 130 (which is a typical target for people without an established history of CVD).
After I dug the historic data out of MFP, it appears I have been consuming more calories overall, as well as greater quantities of each macronutrient category.
What seems to baffle me the most, and I have been unsuccessful in researching an answer online, is how HDL and triglycerides both improved, while LDL worsened?

Thanks again for your help, Dr. Baraki!!

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It appears you may be particularly sensitive to the changes in energy intake (and its effects on your weight/waist circumference), as it seems things are tracking in line with those variables.

The triglycerides and HDL may have improved due to a combination of weight loss (and improvements in insulin sensitivity) and decreased intake of refined carbohydrates. The LDL-C (and thus the more important parameter, non-HDL-C) does seem to be tracking with your weight/waist circumference, and potentially with your dietary fat intake. There may be some genetic predisposition to this, given the family history.

You mentioned your protein sources, but you did not mention your fat sources. It seems you are currently consuming about 75*9/2500 = 27% of your total calories from fat. It may be helpful to know, if possible, what proportion of this comes from saturated versus unsaturated sources. Replacement of calories from saturated sources with unsaturated sources does have the effect of lowering these blood lipoprotein levels (and thus, CV risk).

Your dietary fiber intake looks pretty good, but there is also a dose-response effect with fiber consumption there, so that if you were to increase it further I’d expect a reduction in your non-HDL-C levels as well.

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Here is the breakdown of fats.

Total Chol Tri HDL LDL LDL C Non HDL Weight Waist kCal Carb Protein Fat Sugars Fiber Sat Mono Poly
2007 247 284 38 151 179 209 240 43"
2009 221 343 38 114 160 183 225 42"
2018 163 108 40 101 104 123 195 37.5" 2150 211 194 59 46.3 33 28 10 5
2019 222 79 47 159.2 157 175 205 38.5" 2502 240 226 75 53 30 23 12 7
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That breakdown looks pretty good.

Overall this seems to be an issue of total energy intake (and thus, your bodyweight / waist circumference), likely influenced by some component of genetic susceptibility.

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So next steps would be to reduce overall energy intake, increase fiber and get waist circumference < 37”?

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That would be our recommendation, yes.

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Thanks so much for your help and advisement, Dr. Baraki!!!

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https://www.google.se

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Dr. Baraki,

Since our last discussion, I have reduced my body weight to 188, waist size to 36.5, and increased daily fiber. I don’t get more blood work done until later this year, so I’m unsure of its effect on my lipid profile. I’d like to gain some lean muscle mass in order to drive up lifts and add some hypertrophy. Is there any way to gain weight without it being deleterious to my lipid profile? As I turn 40 this year, my bloodwork and health definitely trump aesthetics or haphazardly chasing PRs. Thanks in advance for all your advice.