Announcement

Collapse
No announcement yet.

1st Post-Best Protocol for me?

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • 1st Post-Best Protocol for me?

    Hoping some of you fine folks can help me. I am 53 yrs old and had a stent placed at 43 in the widow maker. Inherited trait from birth father. I've done Calcium Channel Scores several times since then and first one was 28 after the stent and since then the last one, about 2 years ago was 26. I've avoided sugar for about 5 years and my labs below were done while on a very low carb high fat diet for 2 years. I have slipped off my low carb diet this year though and have picked up some weight (stressful job). Currently 5"10" and about 230 lbs.

    I've tried to take 5mg of Crestor but it causes a blotchy breakout on my face and forehead so I'm not taking a statins at this time.

    I only take Vacepa, Amlodipine, Levothyroxine, and 1 gram of Niacin.

    I recently saw a very bright Endo who is also a Lipidologist and he would like to put me on Repatha injectable (due to the high LDL) and Zetia. He had a genetic test done for the LDL and it came back negative as for me having the bad gene. Here are my labs from March 2019. I'm pulling some new labs next week I hope. I started the Vacepa after these results below. Let me know your thoughts please.

    Glucose: 95
    Total Chol: 327 mg/dl
    Trigs: 80 mg/dl
    HDL: 42 mg/dl
    LDL: 269 mg/dl
    Non HDL-C: 285

    Thanks,
    Bruce
    Last edited by Bruce T; 11-23-2019, 02:15 PM.

  • #2
    Ezetimibe (Zetia) is underutilized and a good recommendation in my opinion. Efficacy depends on the patient, but for me it drives my LDL way down. I am a bit surprised though at going to Repatha without trying other statins. Have you tried atorvastatin? Myopathy is also highly patient dependent. For me atorvastatin (40mg) causes pain in my right shoulder blade. Rosuvastatin (20mg) has no observable side effects. It's worth rotating through the generic statins to see if one works better, assuming you have a budget to consider.

    Comment


    • #3
      Beyond what kinpatu said, have you had your Lp(a) level checked? It seems like you got a stent at an awfully young age just for high cholesterol. Perhaps if you smoked for years or had some other health issue, like an elevated Lp(a), that would help explain what drove the cardiovascular disease process so quickly. The best thing health wise that you can do for yourself is to lose weight. Your triglyceride level indicates that you went back on a lower carb diet before this blood test. Stress and lack of quality sleep will tempt a person to eat more carbs than they might otherwise do, and so a little exercise after eating might help if you can walk for 30 plus minutes preferably after dinner (or whenever you can). Was there a specific reason why your doctor put you on a calcium channel blocker (Amlodipine)? If it was primarily for hypertension, you might want to look at an ACE inhibitor (e.g. ramipril) as an alternative as an ACE inhibitor will lower cardiovascular inflammation. Since you can't take even a low dose of rosuvastatin/Crestor (which also specifically lowers cardiovascular inflammation), then you should consider what you can to decrease cardiovascular inflammation as that in turn promotes cardiovascular disease. The Calcium Channel Scores you mention are likely the CAC (coronary artery calcium) score. It is also interesting that your scores are really low for needing a stent (which also makes me wonder about your Lp(a) level). Another way to look at cardiovascular disease progession is using a CIMT (carotid intima media thickness) test. Here is one of Dr. Brewer's many videos on this topic. https://www.youtube.com/watch?v=KQdplHWQ9ZU

      Comment


      • #4
        Originally posted by kinpatu View Post
        Ezetimibe (Zetia) is underutilized and a good recommendation in my opinion. Efficacy depends on the patient, but for me it drives my LDL way down. I am a bit surprised though at going to Repatha without trying other statins. Have you tried atorvastatin? Myopathy is also highly patient dependent. For me atorvastatin (40mg) causes pain in my right shoulder blade. Rosuvastatin (20mg) has no observable side effects. It's worth rotating through the generic statins to see if one works better, assuming you have a budget to consider.
        Thanks for your thoughts on the Zetia, I will give it a try. With regards to the Repatha and statins in general, I've mostly avoided them due to the side effects I've read about. The lipidologist told me I needed to go on one to "stabilize" soft plaque to prevent a possible clot. This information was new to me but in questioning him further he told me going on the statins would cause my calcium channel score to actually go up as those plaques stabilized/hardened. Having hardened arteries kinda scares me....shouldn't it?

        Perhaps I've taken to much comfort in my calcium channel score results getting progressively worse over the last decade? Know one can really know what is happening inside the stent itself however so that is concerning, especially since it resides in a major artery.

        Comment


        • Tom
          Tom commented
          Editing a comment
          Yeah, there are a lot of opinions on the Internet about statins. Most people can tolerate a small dose of one of the statins, and most of the side effects are from higher doses. However, a small number of people cannot tolerate any statin. I agree with kinpatu that you should try to find a minimal dose of one of the statins given the long-term health benefits that a statin can offer. I say can because taking a statin is not a good substitute for a healthy diet/lifestyle. Livalo (pitavastatin) has no insulin resistance as a side effect that occurs with the other statins. However livalo can be a bit pricey depending upon insurance coverage, etc.
          On your question about statins increasing your CAC (coronary artery calcium) score, that is true and is a good thing actually. I know that concept is a bit counter-intuitive for people who have been told to keep the CAC score as low as possible, but soft plaque is what causes strokes and heart attacks. Calcified plaque is stable and generally doesn't cause an issue. Ironically most heart attacks come from arteries that are less than 60% blocked. The most important point to take away is that you don't want to go through round after round of soft plaque deposition which the body will calcify over time (statins will definitely speed that process up but I am not sure about PCSK9 drugs such as Repatha). Dr. Brewer has done several videos on this aspect and what to focus on to lower the risk of future soft plaque rupture https://www.youtube.com/watch?v=Sm-MApD8EKY&t=32s
          Last edited by Tom; 11-24-2019, 08:58 AM.

      • #5
        Originally posted by Tom View Post
        Beyond what kinpatu said, have you had your Lp(a) level checked? It seems like you got a stent at an awfully young age just for high cholesterol. Perhaps if you smoked for years or had some other health issue, like an elevated Lp(a), that would help explain what drove the cardiovascular disease process so quickly. The best thing health wise that you can do for yourself is to lose weight. Your triglyceride level indicates that you went back on a lower carb diet before this blood test. Stress and lack of quality sleep will tempt a person to eat more carbs than they might otherwise do, and so a little exercise after eating might help if you can walk for 30 plus minutes preferably after dinner (or whenever you can). Was there a specific reason why your doctor put you on a calcium channel blocker (Amlodipine)? If it was primarily for hypertension, you might want to look at an ACE inhibitor (e.g. ramipril) as an alternative as an ACE inhibitor will lower cardiovascular inflammation. Since you can't take even a low dose of rosuvastatin/Crestor (which also specifically lowers cardiovascular inflammation), then you should consider what you can to decrease cardiovascular inflammation as that in turn promotes cardiovascular disease. The Calcium Channel Scores you mention are likely the CAC (coronary artery calcium) score. It is also interesting that your scores are really low for needing a stent (which also makes me wonder about your Lp(a) level). Another way to look at cardiovascular disease progession is using a CIMT (carotid intima media thickness) test. Here is one of Dr. Brewer's many videos on this topic. https://www.youtube.com/watch?v=KQdplHWQ9ZU
        Thanks for your input. My history of blood test results and what I know about my birth father (I'm adopted) indicate I have FH in the genes.

        I've only smoked for about one year in my early 20's but I have had blood pressure issues my entire adult life and I put on weight easily. My weight has ping ponged around a lot in my life. Just 2 years ago I was down to 190 lbs but that was from doing a lot of hard intermittent and multiple day fasting with a low carb diet. My weight in this morning was at 226 lbs. I'm a manager in the housing development business overseeing employees, contractors, and projects and it's about as stressful a career as one could be have I suppose. I took on some major projects this year that had a major impact on my stress and weight. I'm now ready to retrench and get the weight back down and get my exercise back up.

        I take the Amlodipine because some of the ACE inhibitors gave me a nagging wheezy cough that was intolerable. I don't seem to have any issues at all with Amlodipine.

        I will ask the doc to add the Lp(a) test to my lab tests. He and I have already discussed the CIMT and I will be getting that done soon. Any other specific labs I should ask for? Historically my C-reactive protein has been around .50 or below. My LDL is usually elevated between 150-325. HDL usually are low in the 25-40 range....you know, backwards from what it should be!




        Comment


        • Tom
          Tom commented
          Editing a comment
          You have some challenges and potential options. First things first because stress can drive sleep and hunger patterns. Try to get some exercise every day even if that is just walking. One thing that I wish that I had known earlier in my life about is the benefits of a sauna on stress reduction. You can find a lot of information on the health benefits of sauna use from Rhonda Patrick's website foundmyfitness, but for you stress reduction is the obvious focus. She actually noticed that result when she was a post-grad student years ago working in a lab on her PhD (a very stressful environment). If you can do some light exercise followed by a sauna session, you should get some stress reduction benefit. I do that myself, and it definitely relaxes me. The sauna needs to be hot, and infrared saunas typically don't get as hot as would be optimal (but those are better than nothing). You could also try some meditation as people under stress such as you mention have a hard time turning off at the end of the work day (been there, done that myself).

          For any other labs, getting a comprehensive inflammation panel would be helpful. Here is a video that Dr. Brewer made on what he recommends - https://www.youtube.com/watch?v=-p2wR8FwcC8&t=4s

          When you say that your hs-CRP is 50 or below, it is hard for me to understand. Generally the numbers quoted are less than 10 mg/L with less than 1 mg/L listed as ok. Take a look at the video above and then review your test result to confirm it is what you think it is. If it really is as high as 50 mg/L, that is a sign of something causing inflammation (could be a combination of several things and not just cardiovascular disease). If you do have a good bit of cardiovascular inflammation going on reducing your LDL-C will help, but reducing the cardiovascular inflammation is necessary to better health. Your HDL-C being on the low side is usually due to high triglycerides. It is important to not eat more carbs than your body can adequately process, and your weight is a direct reflection of that. If you can keep your triglycerides down through diet and exercise, then your HDL-C will likely rise. The niacin that you are taking will help this to a degree. Take that niacin after your dinner meal and then don't eat anything until the next morning. Some people transition to a keto diet to help them lose weight, and you might want to check to see if you think that is right for you.
          Last edited by Tom; 11-24-2019, 11:27 PM.

        • Ford Brewer
          Ford Brewer commented
          Editing a comment
          Just as an FYI. I often get that nagging cough with the ACE inhibitors as well. And I speak for a living. And I still take the ACE inhibitors. Here's why. The ACE inhibitor has an additive effect with the statin and lifestyle to decrease CV inflammation.

      • #6
        Today I tried cutting a 5 mg Crestor in half thinking surely I could tolerate 2.5 mg two to three times a week but much to my chagrin, even on 2.5 mg I had inflamed flushing under my eyes. I would appreciate any suggestions you might have.

        Comment


        • #7
          I think that you should talk to you doctor to see if you could change to a low dose of another statin. A PCSK9 medication like Repatha would be an alternative if you can't tolerate any statin, and likely your doctor would like you to take as large a dose of statin as you can tolerate in order to reduce your LDL-C. If you can make significant changes to your diet and lifestyle, a lower dose statin or Repatha might be enough. A statin or PCSK9 drug won't fix a poor diet/lifestyle in the long-term, but it will help regardless.

          Comment


          • #8
            Thanks Tom, my last C-Reactive Protein test was in 12/27 and it was 0.48 mg/L. I have tested this a number of times over the years and it's always under 1.0 and near 0.50 mg/L.

            It's clear to me I need to go back to a low carb lifestyle and get more exercise so that is what I will be doing. I've gained 36 lbs in the last 24 months roughly and most of that was in this year when I stopped low carb. This has been a massive gain, especially when you consider I've usually only eaten once or twice a day. I must be very insulin resistant is all I can figure.

            Comment


            • Tom
              Tom commented
              Editing a comment
              Sorry my eyes aren't as good as they used to be. I didn't see the . before the 50 for your hs-CRP level. Yes, 0.50 is ok.

          • #9
            I suggest you look at niacin. I think 1 g is too low and 2 g might be a better target. I take endur-acin which I believe is 1 of the 2 brands recommended by Dr Brewer.

            I probably sound like a broken record to some on here, but I would also bet you have a leaky gut which is causing the high ldl and weight gain. Try avoiding all grains for a while, especially those that contain gluten. I would also change to a low saturated fat diet and see if that helps. If you have a leaky gut and if you are eating a lot of saturated fat, it is a double whammy.

            Toxins, undigested food, and bacteria can leak through the gut wall into the liver and blood stream. The big trouble maker is lipopolysaccharides (lps), They are the outer shell of gram negative bacteria and are very toxic. The 2 ways they can get into your blood stream are 1) leaky gut, and 2) attaching to saturated fat when it is absorbed through the gut wall. I find this raises my blood pressure as well as increasing my ldl and ldl particle number.

            I've read 2 different explanations for this. 1) LPS binds to port on sdLDL that is used by ldlp (ldl port) and 2) LDL is needed to remove LPS. They seem complementary to me, so maybe both are true. If either are true, then minimizing lps in blood stream should also reduce ldl.
            Last edited by rich; 11-25-2019, 07:24 AM.

            Comment


            • Tom
              Tom commented
              Editing a comment
              Rich, would you expect to see inflammatory markers elevated for a person with significant leaky guy syndrome? Bruce T indicated that his hs-CRP has always been fairly low.

          • #10
            Yes. I agree on both points. Thanks.

            Comment


            • #11
              Originally posted by rich View Post
              I suggest you look at niacin. I think 1 g is too low and 2 g might be a better target. I take endur-acin which I believe is 1 of the 2 brands recommended by Dr Brewer.

              I probably sound like a broken record to some on here, but I would also bet you have a leaky gut which is causing the high ldl and weight gain. Try avoiding all grains for a while, especially those that contain gluten. I would also change to a low saturated fat diet and see if that helps. If you have a leaky gut and if you are eating a lot of saturated fat, it is a double whammy.

              Toxins, undigested food, and bacteria can leak through the gut wall into the liver and blood stream. The big trouble maker is lipopolysaccharides (lps), They are the outer shell of gram negative bacteria and are very toxic. The 2 ways they can get into your blood stream are 1) leaky gut, and 2) attaching to saturated fat when it is absorbed through the gut wall. I find this raises my blood pressure as well as increasing my ldl and ldl particle number.

              I've read 2 different explanations for this. 1) LPS binds to port on sdLDL that is used by ldlp (ldl port) and 2) LDL is needed to remove LPS. They seem complementary to me, so maybe both are true. If either are true, then minimizing lps in blood stream should also reduce ldl.
              Interesting information, thanks Rich. I have found my ability to gain weight to be somewhat extraordinary considering the low frequency of my meals. I can typically keep weight stabilized on a low carb diet but can only really lose weight by fasting. When breads and starches are introduced the weight just piles on. Like I said earlier I don't eat sugar at all and have not for about 6 years or more. Is there a way to test for leaky gut or to remedy a leaky gut? I've taken quite a lot of probiotics over the years and always try to reestablish gut flora after taking antibiotics.

              I will begin raising my dosage of the Niacin until I get to 2 grams over a couple of weeks. Thanks for the tips!

              Comment


              • #12
                I'm interested in getting some genetic testing to delve deeper. I see 23 and me mentioned a bit. Is the Health+Ancestory Test the proper test to order? https://www.23andme.com/compare-dna-tests/?vip=true

                Comment


                • #13
                  Originally posted by Bruce T View Post
                  I'm interested in getting some genetic testing to delve deeper. I see 23 and me mentioned a bit. Is the Health+Ancestory Test the proper test to order? https://www.23andme.com/compare-dna-tests/?vip=true
                  23andme is on sale. I would get the health and ancestry as it is now $99. After you get the results, run the raw data through Dr Rhonda Patrick's app https://www.foundmyfitness.com/genetics. It cost $25 but well worth it.

                  Your story parallels mine which is why I think you might have a leaky gut and problem with saturated fat. Rhonda's app will show you if you have a problem with sat fat.

                  The test for leaky gut is to test for Zonulin or Zonulin antibodies. These tests are not the most accurate, so treatment is often based on symptoms. This article is the best I have found at explaining testing options. https://www.functionalnutritionanswe...for-leaky-gut/

                  This is an in-depth article on leaky gut that even includes SNPs you can look up when you get your 23andme data. It also includes symptoms, related diseases, treatment, etc.


                  Comment


                  • #14
                    https://chriskresser.com/the-pitfall...dr-tommy-wood/

                    Comment


                    • #15
                      Ok, so making some changes based on what I'm learning:

                      I've started taking Crestor again. 2.5 mg in the evening several nights per week is being tested with hopes the flush/blotchy patch side effects will be gone by morning.

                      Niacin (ER) is being increased up to 2 grams per night.
                      Vacepa-2 grams per day.

                      Inquiring with the doc about changing Amlodipine for Ramapril and adding Ezetimibe (Zetia).
                      Still taking Amlodipine and Levothyroxin.

                      I ordered the Genetic testing from 23 and me so I'm sure that will be a few weeks to see what I learn there.

                      I'm back to to a low carb lifestyle and will be working on weight loss and with brisk walking 1 hour daily 5 days per week. Once I'm back to a ketogenic state I will begin fasting to drop the poundage.

                      Any other thoughts or suggestions? I'm pushing the doc for the following tests:

                      a. 2-hour fasting oral glucose tolerance test (3 draws; fasting, 1-hour and 2-hour)
                      b. Hemoglobin A1c
                      c. Cleveland HeartLab Inflammation Panel
                      d. Comprehensive metabolic panel
                      e. Coenzyme Q10
                      f. Vitamin D
                      g. Quest Cardio IQ Report www.questdiagnostics.com/hom...rdio-iq-report
                      h. Complete thyroid panel including TSH, Free T3 and FreeT4
                      I. CIMT.

                      Comment

                      Working...
                      X