A Return to Some Biochemistry: Part 2

Hello, readers, and thanks for tuning in to this weeks stunning conclusion: What All That Stuff I Was Talking About Last Time Actually Means!

This entry will be pretty short, because there's only so much blabbering about lab tests that I can actually do in one sitting before I start repeating myself.

Let's review what I talked about in my last post.  Your body uses molecules called lipoproteins (which vary in size based on the amount of cholesterol and lipids inside the molecule).  LDL (low-density lipoprotein) extract triglycerides and cholesterol from fat cells, and HDL (high-density lipoprotein) takes fat and cholesterol into the target cell.

Vacuum cleaners were involved.

HDL and LDL will look and act differently in a healthy person than a person with insulin resistance/metabolic syndrome.  To see this, we can use lab tests to see a bunch of different variables that could indicated that someone is insulin resistant.  Dr. Walker uses lab results from a company called the Health Diagnostic Laboratory (it may or may not be a coincidence that this spells out "HDL"), which provides a huge amount of data regarding metabolic processes, along with some treatment algorithms based on the lab's findings.  One of the things tested for is the size of HDL and LDL particles.

As HDL and LDL travel through the bloodstream carrying cholesterol and fatty acids, they tend to grow in size.  While this is only by a few nanometers, physicians can detect these small changes.  When a healthy person has a lot of fat being oxidized (as I went through in my last post), their HDL and LDL are relatively large.  Dr. Walker likes to call this "big and fluffy."

Pictured: actual HDL and LDL.

When a person suffers from insulin resistance, they cannot burn fat easily, since the body continues to make Malonyl-CoA in the presence of insulin, shutting down the CPT1 gate long chain fatty acids take into the mitochondria.  Therefore, a person will not transport much fatty acid, meaning the sizes of HDL and LDL are relatively small.

Not so big and fluffy.

Let's put in some numbers here.  In this instance, the patient is unquestionably insulin resistant.  While they are not considered a type 2 diabetic (since their HbA1c, which I'll talk about later, was less than 6.5), they scored a perfect 100 out of 100 on the sliding scale of insulin resistance.  So, while not considered a diabetic, this person was certainly considered pre-diabetic, and was extremely insulin resistant.

This person's first test results showed an LDL size of 20.4 nm (at around the 25th percentile and within a high-risk range), and an HDL size of 8.5 nm (below the 25th percentile and well within a high-risk range).  Healthy individuals have LDL and HDL sizes of larger than 21.2 nm and 9.6 nm, respectively. For those of you whose eyes just glazed over, these numbers are really small, which means that the patient has a high risk of developing diabetes, as well as eventual cardiovascular disease and other metabolic problems.

After a few months on a low-carb diet, the numbers have changed significantly.  The size of the LDL particles has grown from 20.4 nm to 21.1 nm, which is almost to the 75th percentile and is considered at a low risk for cardiovascular disease.  HDL size has grown from 8.5 nm to 9.1 nm, which, while only almost at the 50th percentile, is a much better number, and a marked decrease in risk for developing cardiovascular disease.  Sweet!

Go science!

Even better--the insulin resistance score has decreased from a huge 100 to a low 25, well below the 25 percentile and in optimal range to prevent cardiovascular disease and the development of type 2 diabetes.

The patient's HbA1c (a number used primarily to diagnose diabetes) has also decreased significantly as well.  Originally a 6.1 (0.4 away from being considered diabetes), the number has dropped to 5.2, well beneath the threshold of diabetes and pre-diabetes.  This indicates that diabetes really shouldn't be considered a chronic disease any more--problems with insulin resistance, HDL, HDL, and other metabolic processes can be regulated by using medications and good, old-fashioned understanding of scientific principles, and possibly even cured completely.

And if that isn't a good way to end, I don't know what is.  Thanks for reading!