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The idea of LDLc hyper-responders is well established in the grey literature around low carbohydrate diets. A lot of this is anecdotal, but people have spent a lot of time and energy documenting it. I have seen one patient who pushed his total chol up to 12 with LDLc around 10 mmol/l. Never seen anything this high though. You may find this link interesting (see below). The author is an engineer who has developed a very strong interest in this area as a citizen-researcher and is a prominent figure in the low-carb community: https://cholesterolcode.com/are-you-a-lean-mass-hyper-responder/ Best wishes Ian Ian S.Young Professor of Medicine Queen's University Belfast [log in to unmask]<mailto:[log in to unmask]> Tel: 02890632743 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Paul Collinson Sent: 30 April 2019 12:44 To: [log in to unmask] Subject: Puzzling patient I would be interested in the collective wisdom of the mailbase users especially those with a particular interest in lipid disorders. I have an 18-year-old girl with a cholesterol of 21.1 mol/L triglyceride 1.5 mmol. History is slightly complicated as she previously had anorexia nervosa diagnosed as due to an autonomic dysfunction which made her feel full easily. She remains underweight however. In addition, she does not tolerate carbohydrate very well and has a diet which is predominantly meat and dairy. Genetic testing excludes familial hypercholesterolaemia with a high likelihood of polygenic hypercholesterolaemia. Carotid imaging shows no evidence of early atherosclerosis. Any suggestions would be most gratefully received as I am very puzzled as to what is going on. My current working hypothesis is a combination of diet plus the underlying polygenic hypercholesterolaemia. ________________________________ Professor Paul Collinson T: +44 (0)208 725 5934 sec (0)208 725 5923 Consultant Chemical Pathologist and Professor of Cardiovascular Biomarkers F: +44 (0)208 725 5868 Clinical Blood Sciences E: [log in to unmask]<mailto:[log in to unmask]> St. George's Healthcare NHS Trust W: www.stgeorges.nhs.uk<http://www.stgeorges.nhs.uk/> ________________________________ P Save Paper - Do you really need to print this e-mail? ________________________________ Disclaimer: This e-mail and any files transmitted with it are confidential. If you are not the intended recipient, any reading, printing, storage, disclosure, copying or any other action taken in respect of this e-mail is prohibited and may be unlawful. If you are not the intended recipient, please notify the sender immediately by using the reply function and then permanently delete what you have received. Incoming and outgoing e-mail messages are routinely monitored for compliance with the Department of Health's policy on the use of electronic communications. For more information on the Department of Health's e-mail policy click here http://www.doh.gov.uk/emaildisclaimer.htm ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual who posts and they are solely responsible for all message content. The ACB does not monitor posts. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual who posts and they are solely responsible for all message content. The ACB does not monitor posts. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/