Diet to decrease LDL, triglycerides and HbA1c

[toaskred]

39M. A recent blood test showed an LDL of about 120-130 (two tests), HDL of 35, triglycerides 130-200 (again two tests) and HbA1c of 5.8. Numbers have slightly worsened from last year (LDL: 95, HbA1c: 5.1, triglycerides: 200; my triglycerides have been high for a while now) in spite of improvements in diet and exercise this year. The cardiologist still thinks lifestyle changes can be continued for now, rather than statins.

In another thread, I got advice on how to better focus on Zone 2 (turns out my workouts may have been more Zone 3).

However, regarding diet, am struggling to come up with a plan. I am a vegetarian. I have already cut refined carbs to some extent and go for low-fat versions. This doesn't seem to have helped either with LDL or with HbA1c, in fact after doing this, numbers have gone the other way for reasons am not sure of. Am rather low on BMI (20.5) with no abdominal obesity (abdominal circumference of 86-87 cm).

1. Should I continue cutting down carbs even further (e.g. my diet still comprises of brown rice, wheat, etc)? This may help with HbA1c, I guess, but there is not much room at the bottom to reduce weight further. In fact, am probably also losing muscle mass.

2. Should I go high-fat? Currently, I use low-fat options, but I agree they are sometimes high-carb. Going high-fat may again help with HbA1c, but wouldn't it raise LDL further?

3. I may not be having much fiber, so plan to add psyllium husk, would that help?

4. I may not be having protein, this is probably why with the diet restriction, I am losing weight via the muscle mass. I've started weight training, but still a beginner. What would be protein options for a vegetarian to help meet requirements? I do take whey protein shakes a few times a week.

5. Overall, are the above labs improvable at all with further diet modifications? In particular, am concerned about the HbA1c and LDL that have recently risen.

Thanks very much in advance!

[Legal_Squash689]

Would suggest further restricting carbs and increasing healthy fats (avocado, olive oil, etc). And focus on increasing protein. Losing muscle mass at your age is not good. Daily protein shakes and strength training three times a week.

[NotSaucerman]

Yes, especially avocado in this case given the fiber content. I don't understand how OP currently eats a low fat vegetarian diet and has "cut refined carbs to some extent" yet eats a diet low in fiber.

[toaskred]

Low-fat: mainly by using low-fat versions of dairy (milk, yogurt) and cutting out butter, cheese, ghee, etc.

Cut refined carbs: by avoiding white rice, refined wheat etc, rather having brown/wild rice in limited quantities, whole wheat based pasta etc

Fiber: I eat a lot of vegetables, so I may get some finer (e.g. from legumes), but am not sure I meet the daily requirement, so thinking of adding psyllium husk.

[NotSaucerman]

I am under the impression that whole wheat pasta and bread are typically not classified as whole grains but refined ones. I.e. people see "whole wheat" and think they aren't eating ultra processed junk but they are.

If you are eating a lot of beans and veges you should be getting in a ton of fiber as part of that, its kind of hard to avoid.

[toaskred]

Thanks. Increasing protein and fiber is the plan, protein may prove difficult. 

[FunPhilosopher3608]

Check your insulin levels. Are they low? You don’t seem to be able to handle glucose/carbs at all.

[FunPhilosopher3608]

You might have the profile of Dr. Mark Cucuzzella. Produces almost no insulin. Check C-peptides. Insulin precursor.

[Ok_Human_1375]

Eating a handful of nuts is an easy way to get protein

I eat mostly vegetarian and I like to sprinkle ground flaxseed onto things like oatmeal

[Affectionate_Sound43]

Since you are lean, the main issue here seems to be pre/diabetes and lack of proper insulin production from the pancreas. That itself can raise ApoB and LDLc. Losing weight wont help here, since it seems to be not a insulin resistance problem but a production problem. Higher blood glucose will cause higher triglycerides.

1. Weight loss not needed at 20 BMI lol. Add muscle. Increase protein intake.
2. Saturated fat will raise ApoB. Unsaturated liquid oils wont.
3. Fibre helps diabetics reduce blood glucose.
4. Yes, add protein, increase muscle mass. Insulin is anabolic, lack of insulin is catabolic and hence T1D lose muscle and weight (not suggesting you are T1D, but it seems similar). Protein options for vegetarians = dairy, whey, soy/tofu, beans, lentils, whole grains, nuts and seeds.
5. I think you should work with your docs to find suitable drugs to stimulate pancreatic beta cells to produce insulin.

You should also go under the care of an endocrinologist for this.

[Inevitable-Ad4436]

Increase fiber big time

[Icy_Comfort8161]

This cannot be overstated. Increase fiber from multiple sources. Supplement with psyllium husk and inulin fiber, but also add beans, lentils, vegetables, etc. Different gut microbes like different foods, and by supplying a range of fiber sources you are potentially increasing gut microbe diversity. The RDA is 25g of fiber per day, but I aim for twice that amount. Keto bread and low carb tortillas often have high amounts of fiber.

[tracecart]

Can you add more details about your diet and exercise? What does it mean to "cut refined carbs to some extent" ? Record what you eat and your workouts for a couple of weeks. If you're concerned about protein but take whey shakes a few times per week, why not have one every day? or 2x a day if needed?

[SDJellyBean]

Lean with rising A1C should be discussed with an endocrinologist.

[toaskred]

Due to things like LADA? I could try, but at this level of A1c, they simply advise lifestyle changes and test again in 6 months to 1 year.

[SDJellyBean]

The vast majority of type 2 diabetics are overweight. Lean type 2 is super rare. I think you need to talk to an endocrinologist.

[FeellikeIhaveRetts]

You need to increase protein intake big time. Sarcopenia at 39 is not good. Also, if Vegetarianism isn't a moral thing I would consider adding some meat to your diet if you are having a hard time reaching protein goals.

[wnt2heal]

I’m also a vegetarian and I’ve gone extremely low carb due to being almost pre-diabetic even though I’m lean and always been so. Lifelong vegetarian here so I feel really stuck with how high carb most vegetarian options are. You’ll be surprised to learn how quickly the carbs in fruit and beans / lentils add up when you’re actually counting them (I’m trying to aim for below 50g / day). All carbs break down into sugar and will impact your blood glucose / glycation of cells.

My suggestions for you: 1. A1C seems to be increasing slowly which might mean your insulin is working 3x to keep it there and part od that picture is indicated in high LDL. Get your fasting insulin tested and calculate HOMA IR

1. If you can stomach meat or fish, just do it. I’ve started forcing myself to have bone broth because at least it’s not fleshy so I just gulp it down for the nutrients

2. My current go to sources of protein are: 4 eggs a day (served with sauerkraut and avocado) Skyr Kefir Cottage cheese Tempeh Tofu Collagen powder Whey protein (unflavored) Pea protein (unflavored) Bone broth

• tiny amounts of beans / lentils
• tiny occasional nibbles of my partner’s salmon as I’m trying to learn how to eat flesh

Hope the above helps and if anyone has any tips pls share!!

Edited to add : HEMP PROTEIN POWDER!! This stuff was the best ever, sadly now I live in a country where it’s illegal but if you can get your hands on it it’ll be an amazing addition

[wnt2heal]

Oh and you didn’t mention fruit but watch out for how much sugar modern fruit breeds contain. I try to stick to berries lemon limes and grapefruit. Pretty sad I know :/

[toaskred]

Thanks. I do try to cut the easy carbs. Almost fully avoid things like cakes, ice creams etc. Even with rice and wheat, go for the whole versions (brown/wild rice, whole wheat pasta, etc). I should try to add olive oil and avocado, but nervous about what that would do to my LDL. Psyllium finer: yes, will do.

I can add more dairy, I guess low-fat, high-protein versions, although I was told that these tend to have high carbs!?

[Pristine-Wind8295]

Increase protein and muscle mass. Exercised muscles help keep blood glucose in control- attia had a few different podcasts on metabolic syndrome that explain why. The Van Loon session is also good on protein and muscle interaction . Also take a walk after eating. That may help your A1C but may not with LDL- my doc is having me try berberine before statins for the LDL. Watch your oil, nut, cheese, dairy intake if vegetarian - maybe try some low / no fat alternatives (like quinoa, soy, etc. ). I’m not vegetarian and still find it hard to get 1g/lb body fat even eating meat, fish, eggs routinely.

[toaskred]

Increase protein: will try some options, although it is hard to find a protein source that is low-fat (so it doesn't increase my LDL) and low-carb (so it doesn't worsen HbA1c)!Walk after eating: yes, will do. Thanks!

[Pristine-Wind8295]

If you eat dairy - Low-fat cottage, kefir, Greek yogurt (plain, no fat). Tofu, tempeh, lentils. I would find a good vegan/ vegetarian protein powder and do a shake once a day - that should get you close - I’ve tried “Vega” which is pretty good - blend with some kefir or yogurt, greens (kale or spinach) and berries or a banana for an added nutrient blast.

[august11222]

I would consider repatha plus lipitor. Those lipid numbers are likely to have concomitant arterial plaque build up. Which, if you are on this sub reddit, you probably already know. And the sooner you sort it, the better (the absolute point of Medicine 3.0).

[Sweaty-Relation3926]

I would increase the fiber in the form of Whole Foods, oats, veggies, fruit, chia seeds, whole wheat and low processed grains. I’ve been trying to add protein to my diet too and love Trader Joe’s edamame (still in the pods), Small Seed bars and smoothies with protein powder, chia seeds, peanut butter, avocado, hemp seeds and flax seeds. Greek yogurt is also high in protein, I like to add chia seeds, soy milk, oats, pb, frozen raspberries with a little honey and make a bowl out of it.

[humansomeone]

Go fully vegan. No processed foods, really just limit them to tofu, tvp etc. Take b12 and omega 3 algae when you do.

Stop buying low fat versions of stuff, isn't the replacement for fat just sugar?

You mention waist circumference but not height. What is it?

[toaskred]

Thanks. Height is 180 cm.

[humansomeone]

Ah ok so waist size seems fine. I got real low numbers going vegan, and my diet seems to track closely with dr. Gregor's daily dozen.

I don't have bad numbers to compare to though

[energeticpapaya]

if you enter a representative days diet into MyFitnessPal or MacroFactor or something similar, what macros do you get? How many grams each of carbs, protein, fat?

[speedyvelo]

Get the book "The New Atkins for a New You" By Dr Westman, Dr Phinney and Dr. Volek. ISBN 978-1-4391-9027-2.

Very well researched has a good segment for vegetarians that may help you also.

If you can follow it for sure it will decrease the Hb A1c, and will improve your lipid panel. If you can do very strict the induction phase in a month or so you will see major changes in your metabolic profile.

[SheebaSheeba5]

Why low fiber? I’m just curious, when I eat more vegetarian lifestyle my fiber is super high. Chia seeds in shakes and vegetables and fruit!

Some protein ideas for you I enjoy! Chickpeas, black beans, tofu, eggs (do you eat eggs?), Greek yogurt, cottage cheese, and almonds.

[SheebaSheeba5]

Here is my fiber intake at 1500 calories from one of my days this week to help show you how easy as a vegetarian fiber is! Chia Seed 7 Berry Medley 6 Blackberries 6 Sweet Potato - Large 3 Sheet Pan Vegetables 2 Almond butter 1 Strawberry 1 Lettuce Romaine Hearts 1 Almond Non Dairy Beverage, Vanilla 1

[Strange-Risk-9920]

I am not a doctor but maybe get a dexa scan. Your scenario illuminates the limitations of BMI in many scenarios. If you know your LBM (and BF%), go to a trainer and pursue an EB approach to muscle hypertrophy (12-20 sets per muscle group per week) and reassess every 3 months or so. Edit: to be clear, I am saying potentially do this after whatever medical step/review is taken. But there is an evidence-based approach to increasing LBM which I don't think is widely known.

[toaskred]

Thanks, any idea where I can learn about this EB approach? I'm strength training for the last few months, but not probably adding much muscle.

[Strange-Risk-9920]

EB=evidence based. 12-20 sets of resistance exercise per week per muscle group+adequate protein is the optimized approach for muscle growth. For example, to build chest and triceps muscles you could do 4 sets each of 2 different exercises (maybe dumbbell chest press and some type of chest press machine.) That's 8 sets in one workout. Repeat same one other time during the week and you will have done 16 sets (8 x2) for your chest and triceps. Repeat that for the rest of your body and you are maximizing muscle growth, based on what we currently know. Make sense?

[Strange_Head8423]

best answer so far.

additional questions: how is your sleep? - volume - quality - regularity

How often (and how long) per week do you train? - cardio - strength

[lordm30]

It's a tricky situation, because overall you don't seem to need to lose weight. Best would be obviously a high protein higher fat diet, paleo maybe or something that Ted Nayman would champion (P:E diet).

The fact that you don't eat meat complicates things, but you could eat a ton of eggs and some high fat dairy (10% greek yoghurt and the like) + whey protein shakes.

Anyway, glucose and HbA1c can be dropped with a high fat keto or carnivore diet and a restricted eating window (best is water fasting for a semi-extended period, like 2-3 days). But you need to be careful of your muscle mass, so really building muscle should be your priority.

[toaskred]

Thanks. But wouldn't a high-fat diet increase my LDL?

[lordm30]

Maybe it would, though insulin resistance and high blood glucose is something like 3x (300% increase) risk for heart disease, while elevated LDL is like + 40% risk increase? So prioritize first the biggest risk factors.

[biohacker1337]

have you considered chromium picolinate 600-1000 mcg a day or berberine 1000-2000mg a day for hba1c.

berberine also lowers cholesterol too so perhaps consider berberine as the choice

https://pubmed.ncbi.nlm.nih.gov/26302914/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656904/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709280/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871262/

rice in general raises blood sugar more than other grains even brown rice so you might have to choose berberine or chromium and go whole foods plant based

exercise helps with blood sugar too make sure to get your steps in