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Lipoprotein(a) - Friend or Foe?

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  • #16
    I have for approx three months been on a plant based only diet. I have had chicken twice and haddock several times. Inthe last month. I have stopped using eggs and olive oil. with all this my HDL is 39. My cholesterol has become BELOW recommended goals and my triglycerides have slipped into the higher end of accepted.. FAsting glucose is down to 96-99..wHAT DO I DO TO GET MY hdl up. IT HAS ALWAYS BEEN LOW.


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    • #17
      fatguy5: Thanks for joining our forum. Your comments suggest metabolic syndrome might be your cause. That's high blood glucose, high TG's, low HDL and increased abdominal fat. It's a highly inflammatory state that is strongly associated with CVD, Diabetes, Hypertension, Dementia and others. There is a lot you can do to help yourself.

      Suggestions:

      1. Look at following a strict low-carb diet. Eliminate all grains like cereals, bread, pasta, rice; starchy vegetables like potatoes; high glycemic fruits and fruit juices, soda, etc. It will help greatly in getting your fasting blood glucose to the low to mid 80's. Eat non-starchy vegetables, lean meats, berries and foods that do not spike your BG.
      2. Get a fasting 2-hour oral glucose tolerance test which will determine any existing insulin resistance or diabetes. This is VERY important to do. Don't rely on fasting blood glucose or HbA1c tests.
      3. Add back eggs, extra virgin olive oil, raw nuts, avocado, flaxseed, fatty fish like salmon, sardines, etc. The theorists that claim very low fat diets have been proven wrong repeatedly like Ornish, Esselstyn, Greger, Barnard, etc. Their diets all include the foods that spike BG.
      4. Exercise regularly. High Intensity Intervals, three times a week will do you do wonders. Your weight should drop quickly if you have any to lose. Get your BMI < 25. This takes time and perseverance.
      5. Test your 1-hour and 2-hour BG after each meal in the day. You will quickly see what foods should be avoided and what ones work for you.

      Do this religiously for 2-months and then get new labs and you will likely see significant progress. You can do all of the above without a doctor if you want. Ask questions here and members here will give you plenty of helpful advice on diet, lifestyle, how to get labs done without a doctors order, etc.

      If the above steps don't normalized your markers, the next step would be to consider adding niacin to your regimen.

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      • #18
        I thought that the below re-cap of the Phase II results of the AKCEA-APO(a)-Lrx drug trial was interesting and looks promising so far. Peter Attia recently indicated that he will likely have a future podcast with SamTsimikas, who is one of the investigators (employee of a pharma company).
        https://professional.heart.org/idc/g...ucm_502904.pdf
        Last edited by Tom; 11-28-2018, 05:17 AM.

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        • #19
          Thanks for posting that, Tom. 2,000 MG of Endur-Acin extended-release niacin dropped my Lp(a) 75% (219 to 55 nmol/L) for less than $20 per month. No need for expensive drugs.

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          • #20
            John,

            Wow, that drop in your Lp(a) value is quite remarkable if due only to niacin (75% vs ~25% from a study I read). Did you notice a significant difference between different kinds of niacin as far as your Lp(a) values vice other issues? If it is due entirely to a particular type of niacin, then Dr. Brewer should see this in multiple patients and let us know as it would be valuable info. I take 1 gm/daily of niacin for another reason, and so I can appreciate why you and many others do so. You mentioned earlier that your Lp(a) results have varied quite a bit over time, and so I wonder if there may be some aspect of your health that improved along with variations in testing among labs to give you that great result. I listed below a recent article noting the issues with Lp(a) testing results. There is also the dilemma with n=1 results, which are valuable but difficult to assess for the wider group who may be reading this forum when those results are well outside what has been shown in studies (which can have their own issues as Dr. Brewer has stated). No doubt almost any new drug in this area is going to be expensive. I didn't move from simvastatin to rosuvastatin until it became a generic. I had included the above info on the drug trial so that the wider group of readers can get a sense of what is happening. I don't have a soft spot for big pharma, but I am open to using their products when necessary. We should be well informed of all of the available valid info.

            https://www.aacc.org/publications/cl...form=hootsuite
            Last edited by Tom; 11-30-2018, 12:27 AM.

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            • #21

              The benefits of niacin in the form of nicotinic acid are many:

              1. Raises HDL cholesterol

              2. Lower LDL cholesterol

              3. Lowers Lp(a)

              4. Reduces total cholesterol

              5. Reduces triglycerides

              6. Reduces VLDL cholesterol

              7. Reduces arterial inflammation


              Many doctors don't believe in the value of niacin. The science is there but they don't choose to believe it.


              Yes, Niacin can be very effective. It can be purchased without a prescription. I've been taking it for 10 years. Dosages of 1,000 to 2,000 MG, once per day, of extended release formulas like Endur-Acin, Rugby, Slo-Niacin can work well.


              As far as niacin goes, be sure the base ingredient is nicotinic acid which is the only form of niacin that has a beneficial effect on lipids and Lp(a). Niacinamide and Inositol Hexanicotinate don't work for lipids. Start niacin at low doses and work up as it takes time to get used to it.


              There are three types:


              Instant-Release - Lowest possible concern for elevated liver enzymes. Highest level of flushing. Usually taken 2-3 times daily.


              Extended-Release (releases over 8-12 hours) - Low to moderate concern for elevated liver enzymes. Less flushing. Doses of 2,000 MG or less, once daily, are usually not a problem. Endur-Acin, Slo-Niacin, Niaspan are typical examples of ER Niacin.


              Sustained-Release (releases over 12+ hours) - Highest level of concern for elevated liver enzymes. Least flushing.


              That is a lot of bang for $8 to $16 per month.


              https://www.amazon.com/ENDUR-ACIN-Ni...pSrc=srch&th=1


              Start with 500 MG with dinner once per day. Add 500 MG more in 4 weeks until you get to 1,000 MG. Then after 4 weeks at 1,000 MG get your labs. The flush is mild and diminishes the longer you use it. Some people report drinking a large glass of ice water or taking an aspirin 1-hour before taking niacin helps to reduce the flush.


              You can add more from that point as dictated by your labs.

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