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  • #16
    To be on the safe side, if you are going to do low carb, eat mostly fish and seafood and less red meat. Make sure you run your 23andme raw data through Dr Patrick's app. If it doesn't indicate any problems with saturated fat, then add more red meat into diet if you want to.

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    • #17
      Try to take some time every day to lessen your stress, and try to get at least seven hours of sleep a night. If you wanted to go further you could get a fitness wearable and track your sleep patterns to determine if you are having any issues like sleep apnea.

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      • #18
        Well this Lipidologist has declined my request for the tests that have been recommended in this forum. He also declined my request for Zetia. Continues to want me to move forward with Repatha. Does anyone have an opinion on this drug? I worry about the short amount of time that it's been on the market and the potential side effects. His goal is to drive down my LDL in a big way. Should that be my goal? Thoughts? So much conflicting information...

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        • Tom
          Tom commented
          Editing a comment
          I don't think that there is anything inherently wrong with taking Repatha, however that is just one piece of the health puzzle. If your doctor isn't willing to look for another cause of your cardiovascular issues such as Lp(a) and/or insulin resistance/cardiovascular inflammation, then perhaps you need a change to a different doctor if you can.

      • #19
        Thanks. I’d likely offer a different opinion. But I’d need to see you.

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        • #20
          Did a blood draw yesterday and it appears things are going in the right direction. Still taking Vacepa, 2 grams of Niacin, and 2.5 mg of Crestor EOD appears to be effective at knocking down Total Cholesterol and LDLs. Results attached below.

          If anyone would care to analyze and give me their thoughts you are welcome to. You can definitely see a difference with a lower carb lifestyle since in 2017, 2018, and 2019. Trigs are lowest during those periods but total cholesterol and LDL are highest. HDLs look better during those periods as well. GP did issue a script of Ramipril 2.5 mg at my request. He is worried I will develop a cough from this drug as am I.

          Still awaiting the results of my 23 and me genetic testing.

          After 3 attempts to get additional testing ordered from Lipidologist he responded with the following(before these latest blood tests came back yesterday):

          Hi Mr. Bruce;
          I hope all is going well.

          1) Based on the result note from 11/11/2019 I think we discussed having the labs and you told us that you will have them done that week. I do not seem them done yet (Or I missed them ?)
          2) Most of what you requested is included in the labs that we ordered. Some of what you have requested is of no clinical value and we do not do as the insurance will not cover and you will be charged with $$$ for these labs and I cannot defend them.
          3) We submitted a request for PCSK9I and it was approved for you as much as I can tell from the records (for Repatha)
          4) Prevention of further CAD is comprehensive approach that it start with the basic first which is understanding the labs that matters and lowering the LDL_C to the best possible.

          So
          Please let me know how do you want to proceed with the care ?
          A) I am very open to your thoughts but mychart msg ar typically not the right platform for discussions. So If you have more questions, I will be happy to meet with you again to discuss.
          B) Of if you would rather have the requested labs done then we can meet to review them if you want or go ahead with treatment then mee to review the effect of treatment
          C) Zetia will not be the next choice but PCSK9I after maximum clinically tolerated statin would be the right choice.

          Comment


          • sthubbar
            sthubbar commented
            Editing a comment
            Bruce T; for the 2g Niacin are you taking it 1g 2x/day?

        • #21
          I gather that you asked the lipidologist (or your primary doctor) for an Lp(a) test along with an inflammation panel. Given your history it is hard to believe that your health insurance wouldn't pay for those tests but will pay for Repatha (quite expensive no doubt). You need more data to make an informed decision. Perhaps you have other test results that would show more because the doctor seems to indicate that he was able to include most of what you requested.

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        • #22
          I'm very surprised at going to PCSK9I as well. I'm also surprised that Zetia/ezetimibe isn't indicated. Zetia-10mg + rosuvastatin-20mg took my LDL-C from around 130mg/dL to 15mg/dL. It's so low my cardiologist thought it was lab error until I responded that I've repeated the test and result over 7 times. I backed off from a full dosage of those meds actually. 5mg of ezetimibe seems to have equivalent efficacy.

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          • #23
            @sthubbar I take the Niacin in the evening all at once. I've been increasing my dosage for the last few months. Have mostly been on 1-1.5 grams and now up to 2 grams in the last couple of weeks since the wonderful members of this forum have educated me on that being a more optimal dosage.

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            • #24
              Originally posted by kinpatu View Post
              I'm very surprised at going to PCSK9I as well. I'm also surprised that Zetia/ezetimibe isn't indicated. Zetia-10mg + rosuvastatin-20mg took my LDL-C from around 130mg/dL to 15mg/dL. It's so low my cardiologist thought it was lab error until I responded that I've repeated the test and result over 7 times. I backed off from a full dosage of those meds actually. 5mg of ezetimibe seems to have equivalent efficacy.
              Great info kinpatu , thanks.

              Perhaps Ford Brewer could comment on this since he is a doc but I wonder if their could be compensation from the pharma company that produces Repatha that is motivating him. Repatha makers paid for a genetic test as well (attached) for me. When I tested negative, he still wanted to put me on it.
              Attached Files

              Comment


              • Tom
                Tom commented
                Editing a comment
                I am not sure if Dr. Brewer can respond if it appears that he is giving specific medical advice to one individual (who is not his patient) vice general advice to the broader audience. In the end for whatever reason if you aren't comfortable with this lipidologist, can you change to another doctor? I do find it a bit strange that the lipidologist doesn't want to try and rule out other potential issues beyond high LDL-C. Even given that is true, a good number of people show discordance between their LDL-C and LDL-P (particle number) or apoB measurement, and so that is why I say that you really don't have enough info for an informed decision. If I were you I would try to rule out Lp(a) being a problem as a start and then look at inflammation. Just knocking down your LDL-C will help to a degree, but there is a lot more to consider. This stuff isn't rocket science.

            • #25
              Thanks, Tom. I cannot give individual advice ( as you know) in a public Forum, unless there are specific conditions ( such as stated consent in a video or meeting). But I do see patients. and this issue of psck9I use comes up a lot. I'd be happy to advise. If anyone would like to see me for that type of 1-on-1 advice, please call Cliede at 859-721-1414

              Comment


              • #26
                Guys, you misunderstood. I was asking his thoughts on the parent co of Repatha comping a physician.

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  I understood what you meant. In the end what matters is if you are happy with your doctor and get the care that you want when you have enough information for an informed decision. I wouldn't expect one doctor to speculate in a public forum on the motivations of another doctor relative to one patient. It could well be that your lipidologist has had good success with patients taking Repatha, and he/she truly believes that Repatha will likely provide the best outcome for your particular health circumstances. Without knowing more data, it is hard to judge otherwise. Having said that Repatha is only one of two drugs that I am aware of which reduced cardiovascular risk in people taking a long-term high-dose statin (the other drug being Vascepa). It is just that there is no inflammatory panel data that I have seen nor anything on Lp(a). If I had to make a choice under the limited data without the ability to get additional data then Repatha is a pretty good choice. Given more data, you can get more clarity.
                  Last edited by Tom; 12-20-2019, 11:44 PM.

              • #27
                Tom commented 11-27-2019, 01:36 AM

                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.
                Tom, just saw this question you had posted.

                Logic says HS-CRP should be high, but in my case HS-CRP has always been extremely low. I can't explain why, but leaky gut does not seem to raise hs-crp.

                I recently learned of this lab and I think it might be the best for leaky gut as it also tests for lipopolysaccharides (LPS). It was recommended by Dr David Perlmutter, author of Brain Maker.

                Cyrex Labs Array 2
                Intestinal Antigenic Permeability Screen
                Actomyosin IgA ( CPT CODE : 86256 )
                Occludin/Zonulin IgG ( CPT CODE : 86256-59 )
                Occludin/Zonulin IgA ( CPT CODE : 86256-59 )
                Occludin/Zonulin IgM ( CPT CODE : 86256-59 )
                Lipopolysaccharides (LPS) IgG ( CPT CODE : 86256-59 )
                Lipopolysaccharides (LPS) IgA ( CPT CODE : 86256-59 )
                Lipopolysaccharides (LPS) IgM ( CPT CODE : 86256-59 )

                Comment


                • #28
                  Bruce, it sure looks like you are doing the right things. I bet in a couple of months your total cholesterol and ldl will be down from just the crestor and 2 g of niacin. Maybe focus on raising your hdl. Krill oil might be a good option if you are not taking omega-3 or eating a lot of fish.

                  The way my brain works, I would obsess over why LDL had gotten so high. What was driving it? There's a reason for everything.

                  Comment


                  • #29
                    RE: pharma compensating doctors. That has been a challenge for a very long time. I never allowed my docs to have pharma reps bring lunch for my clinics. This is a very big, very complicated issue, though. It must be considered in each situation.

                    Comment


                    • #30
                      Here are my latest labs. There were quite a bit of thyroid labs, metabolic panel, iron and some more I am not posting. Everything was in normal ranges on those.

                      Seems I'm making excellent progress on TC, HDL, and Trigs. LDL is quite stubborn as you will see. I am still taking 2 grams of Niacin, now up to 2.5 mg of Crestor per day, and 3 Vacepa capsules twice a day. I have been totally unable to lose any weight or stay in ketosis unless my Ketonix is broke. I am probably eating less than 10 carbs a day which is so puzzling to me. Makes me think the Crestor is interfering with that progress. My fasting glucose was 111 which was the highest it's ever been which is also puzzling eating so few carbs and zero processed foods. I'm usually between 95-100 so I'm wondering if Crestor elevates blood sugar. If so I find this to be a problem I need to solve.

                      Should I add baby asprin to my daily supplementation? I figured with 6 grams of Vacepa a day the likelihood of clots would be quite small.

                      Doctor did agree to give me a script for Metformin which I am waiting on from Express Scripts. I'm starting with 500mg XR 1 x per day.

                      I have an appointment with Lipidologist again on Thursday. I assume he will resume pushing Repatha unless I can convince to try Zetia first.

                      Thanks in advance for any comments or suggestions!
                      Attached Files
                      Last edited by Bruce T; 01-11-2020, 07:40 AM.

                      Comment


                      • Tom
                        Tom commented
                        Editing a comment
                        A good number of people going on a keto diet experience a significant rise in cholesterol values. There is a lot of debate on whether this is a problem healthwise or not. It appears that saturated fat metabolism might be the issue for these people, and some of those people have noted a drop in cholesterol when they change from mainly saturated fat consumption to mono and poly unsaturated fats while still in a keto state. Your TG/HDL-C ratio looks ok now. I would wonder why your total testosterone dropped so much. To a certain degree testosterone production is controlled by insulin signaling. If you eat very few carbs, then you ironically might not be producing enough insulin to maintain a higher level of testosterone. I don't think that taking such a small dose of Crestor likely has much effect on your blood glucose levels. One other issue can cause both higher fasting blood glucose and lower testosterone, and that is high cortisol levels from stress and/or lack of quality sleep. While your hsCRP level looked good, you don't have anything specific to cardiovascular inflammation. That would be helpful given your history of getting a stent at such a young age. Evidently none of your doctors ever heard of Lp(a) which is an independent risk factor for 20% of the population (most of whom and many doctors have no clue of). Given your history I would think that your doctor would tell you to take a baby aspirin daily. You should ask if they haven't mentioned it. They might consider the Vascepa as sufficient. If you are not losing weight, consider your portion control as it is possible to gain weight on a keto diet if the portions are big enough. Look at the amount of meat that you are eating. You could also do intermittent fasting by eating all of your food during a smaller number of hours. Some people are able to reduce their eating window to 10 hours or less and even skip breakfast. Try to eat your last meal of the day at least three hours before you go to sleep. Also try to get some light exercise in each day with walking after dinner being a great start.
                        Last edited by Tom; 01-11-2020, 09:07 AM.

                      • sthubbar
                        sthubbar commented
                        Editing a comment
                        Bruce T; thank you for sharing. Have you checked out InsideTracker.com DIY product for tracking and advising on all of these labs?
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