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LDL High, everything else normal?

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  • LDL High, everything else normal?

    Here’s a brief history of my labs. Comments and suggestions are welcome.

    Date Total HDL LDL TRG Weight Medication/Lifestyle

    12/2018 232 57 159 79 162 Crestor 5mg, 3 x week
    Std. American diet

    05/2019 223 59 147 70 145 Crestor 5mg Every Other
    Day (EOD). KETO with
    some Intermittent Fasting

    07/2019 130 59 57 63 142 Crestor 5 mg EOD, Zetia
    10mg daily (for 6 weeks),
    Niacin 1500 mg daily, low
    fat, very little meat, cheese,
    eggs, some Int. Fasting.

    09/2019 195 62 124 44 140 Crestor 5mg EOD, NO Zetia,
    No Niacin, low fat, very
    little meat, cheese, eggs.
    Some Int. Fasting.

    LP(a) = 25


    CAC score April/2019 = 379
    CIMT May/2019 = arterial age 57 (current age 65)

    I understand that the current belief is that LDL doesn’t matter, but everybody’s
    different and in my case I think it does matter because of my high CAC score.

    Inflammation markers are all normal except LP-PLA2 is high at 159.

    Also, my glucose, insulin and OGTT numbers are good and do not indicate insulin
    Resistance.

    Although Zetia helped to drop my LDL by more than 60%, I had to stop taking it
    because it elevated my liver enzymes (ALT, AST) and it also gave me terrible IBS. It’s
    been about 5 weeks and I’m still on a low FODMAP diet (never had digestive problems).

    I’m also at my maximum tolerance level of Crestor.

    And based on past experience, my numbers are lower when I’m on a low fat diet.
    Even though low carb is popular and works well for most people, I don’t react well
    to that diet.

    Any suggestions on lowering my LDL are welcome.

    Thanks,

    John G

  • #2
    Formatting of cholesterol numbers was kind of sloppy. Here's those numbers again:

    Date
    12/2018 Total 232 HDL 57 LDL 159 TRG 79 Weight 162 Crestor 5mg, 3 x week, Std American Diet
    05/2019 Total 223 HDL 59 LDL 147 TRG 70 Weight 145 Crestor 5mg Every Other Day (EOD). KETO with some Intermittent Fasting (IF)
    07/2019 Total 130 HDL 59 LDL 57 TRG63 Weight 142 Crestor 5 mg EOD, Zetia 10mg daily (for 6 weeks), Niacin 1500 mg daily, low fat, very little meat, cheese, eggs, some IF.
    09/2019 Total 195 HDL 62 LDL 124 TRG 44 Weight 140 Crestor 5mg EOD, NO Zetia, No Niacin, low fat, very little meat, cheese, eggs. Some IF.

    Comment


    • #3
      You had great numbers on 7/2019, so why did you stop Zetia and niacin?

      You also lowered your remnant cholesterol when you switched to a low fat diet (total chol - ldl - hdl). Do you have symptoms of leaky gut? You can have your doctor test zonulin which is a marker for leaky gut. A leaky gut can be a major contributor to heart disease and changing to a low fat diet helps reduce the damage from a leaky gut.

      Comment


      • #4
        Hi Rich,

        Thanks for the quick response. I had to stop taking Zetia because it raised my liver enzyme levels (AST and ALT) AND most importantly, it gave me IBS. I felt super bloated, gassy, and had diarrhea. It was to the point where I had a lot of sleepless nights. Pretty sure it's IBS because my symptoms are greatly reduced and I just feel a lot better if I follow a low FODMAP diet. I don't think it's leaky gut because I feel fine and I only get gassy and bloated when I eat something that's not low FODMAP. I'm going to confirm this when I meet with a gastro doc. I stopped the niacin because my liver enzymes were high and didn't know for sure if it was from Zetia or Niacin. I'm going to start niacin again after seeing the gastro doc. I suspect that the low LDL and remnant cholesterol were due to the Zetia. But maybe the niacin was a significant contributor. I'll find that out in the weeks ahead. Thanks again for your response.

        Comment


        • #5
          I think that you are doing pretty good all things considered other than the Lp-PLA2 level. If you have the money to burn as insurance wouldn't pay for it, you could ask for a PCSK9 inhibitor to lower your LDL-C. However before I would consider taking any additional medication/supplements, I would want to get an advanced lipid panel showing LDL-P and other subfractions as those are more insightful to future health risk than just an LDL-C number. If your hs-CRP looks normal enough, then the only thing that I could think of would be exercise regularly if you are not doing that now and can.

          Interesting in that your CIMT showed a significantly lower arterial age, and that is a very positive indication that in the near past you have been making positive changes to your health. Did you have any discrete plaques above 1.3mm?
          Last edited by Tom; 09-22-2019, 01:14 AM.

          Comment


          • #6
            Originally posted by John G View Post
            Hi Rich,

            Thanks for the quick response. I had to stop taking Zetia because it raised my liver enzyme levels (AST and ALT) AND most importantly, it gave me IBS. I felt super bloated, gassy, and had diarrhea. It was to the point where I had a lot of sleepless nights. Pretty sure it's IBS because my symptoms are greatly reduced and I just feel a lot better if I follow a low FODMAP diet. I don't think it's leaky gut because I feel fine and I only get gassy and bloated when I eat something that's not low FODMAP. I'm going to confirm this when I meet with a gastro doc. I stopped the niacin because my liver enzymes were high and didn't know for sure if it was from Zetia or Niacin. I'm going to start niacin again after seeing the gastro doc. I suspect that the low LDL and remnant cholesterol were due to the Zetia. But maybe the niacin was a significant contributor. I'll find that out in the weeks ahead. Thanks again for your response.
            I'm not familiar with Zelia, but I am with niacin. Niacin lowered my LDL significantly. With the gut problems I would suspect leaky gut. Leaky gut is simply your tight junctions aren't tight. Gluten is a major culprit. When one has leaky gut, all kinds of nasty stuff from your gut leaks directly into bloodstream, the worst being LPS (lipopolysaccarides) which trigger massive inflammation and can cause LDL oxidation.

            Comment


            • #7
              I too tried to lower my LDL with ezetimibe (generic Zetia), with the standard dose of 10mg. After only four weeks, it worked spectacularly and lowered the LDL from mid-70s to 23mg/dL. However, as with you, my AST/ALT increased significantly. I stopped the ezetimibe entirely, although I could have tried a lower dose. I am not going to take any medicine that may create a dysfunctional liver. There are other ways to reduce inflammation and I'm redoubling those.

              Comment


              • #8
                Thanks everyone for responding.

                Rich: Thanks for the tips on leaky gut. I'll ask the GI doc about the zonulin test. Neither IBS or leaky gut are much fun. I don't have any other symptoms other that gas and bloating. No fatigue, headaches, joint pain, skin problems, etc. Hopefully the GI doc can figure it out. In the mean time, I'll stick to low FODMAP diet. That has made a big difference. Also, anxious to start niacin again.

                Tom: I haven't had an advanced lipid panel since May. The numbers from that lab are: LDL 147, LDL-P 1425, LDL small 186, LDL med 322, LDL large 4397. Those numbers have hopefully improved since I dropped LDL from 147 to 124. I exercise regularly: Spin class (45 minutes and includes some HIIT training): 4 x week, Resistance training (20 minutes): 4 x week, Yoga (60 minutes): 2 x week, golf 5 x week, some weeks I'll jog 1-2 x week. Here's my CIMT numbers: Right CCA .7; Bulb 2.1 H; Internal Carotid 1.5 H Left CCA 1.0; Bulb 2.6 E; Internal Carotid .8.

                fatmax: looks like we had similar experience with Zetia. I agree about any medicine that may create liver problems. It seems like your LDL in the mid-70s is a pretty good number, but you must have other things going on if you're trying to get it even lower.


                Thanks again to all.

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  In general you should try to lower your LDL-P, but you have a limited set of options. Perhaps your low FODMAP diet will resolve any long standing GI issues that you have had. Since your triglycerides are fairly low, that results in fewer VLDL particles being produced and thus fewer sdLDL particles which hang around your bloodstream and ultimately get stuck in the intima-media space (the ultimate meaning of the remnant thing that is discussed in a nutshell).

                  So, if you can get your cardiovascular inflammation down a bit, then your LDL-P/C level might not matter as much. I would say try 500 mg of niacin daily to try to reduce your Lp-Pla2 if you can tolerate that amount. Sometimes people have an adverse side effect to a standard dose of a medication or supplement, but then can experience a much reduced reaction to a lower dose. You could ask your doctor if you could split a Zetia 10 mg tablet to see if that might work well enough for you. While some increase in liver enzymes due to taking a variety of drugs and supplements is not atypical, gauging whether it is worth it in the long run needs some careful thought and obviously consultation with your doctor. I have heard lipidologists advise doctors to let liver enzymes more than double given the risk factors of not taking a medication.
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