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  • #31
    Here is a graph of my progress over the years. Keep in mind the last couple of years have been low carb for the most part and I just started adding the meds in the last few months.
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    • #32
      Thanks Tom, appreciate your comments and suggestions. Strangely enough I do have a restricted eating window and typically only eat once or twice a day. My last meal is generally around 6pm and I'm in bed by 8:30-9 pm most nights. Seems so radical to have to do multi day fasting to lose weight these days but I can and have done it before, I just want to know when is enough enough. I've been fairly stressed and sedentary over the last year so perhaps that's part of the problem. I will have to start exercising more vigorously and see how that impacts the weight loss.

      My GP doesn't want to get involved with Lipids so that's why no LDL-C, he is deferring me to the Lipidologist in the same provider network and I will see him Thursday. Perhaps we can get some additional tests after the meeting.

      At least the good thing is my weight isn't increasing. Eating low carb does gives me very a controllable appetite to chose to eat or not to eat a meal most of the time without feeling starved. Hoping the Metformin may have a positive impact and will also discuss with the Lipidologist who is also an Endo about maybe adding some T3 to my meds to boost my metabolism a little.

      I didn't find the 23andme results to offer much clarity other than it indicated I was more likely to be susceptible to diabetes and maculer degeneration. Oh and I found out through 23andme I have a half sister in California and we were both born 3 weeks apart by different mothers(we are both adopted)! That was an interesting conversation!

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      • Tom
        Tom commented
        Editing a comment
        Your LDL-C (calculated value) was listed in the table as LDL. Its unfortunate that people use terminology so loosely as LDL might also mean LDL particle number. If you have hypothyroidism, then that could account for some of what you see in your test results and not being able to lose weight. You should ask your lipidologist for an Lp(a) test to see if that is a driving factor in your cardiovascular disease pathway. I would think that a lipidologist would be much more aware of Lp(a) than a GP. You should also ask for at least a couple of inflammation panel tests (LP-PLA2 aka PLAC2 and MACR). The MACR is a urine test by the way that measures the amount of albumin that your kidneys leak into your urine. See this video by Dr. Brewer on inflammation panel tests.
        https://www.youtube.com/watch?v=-p2wR8FwcC8

    • #33
      sthubbar I have not tried Inside Tracker. Did you find it useful? If you've done this would you mind sending me the report they provided you so I can evaluate?

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    • #34
      Some new blood test results rolled in this morning that I didn't know were pending. I've not had these before so if those experienced could help me I would be grateful.


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      Last edited by Bruce T; 01-12-2020, 06:12 AM.

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      • Tom
        Tom commented
        Editing a comment
        OK, looks like your lipidologist did follow through on a couple of important tests. Your Lp(a) result shows that it is not a problem for you, and you shouldn't need to ever get it tested again. That means that your need for a stent likely was a result of FH (familial hypercholesterolemia). The other result for apoB shows the overall number of LDL family of lipid particles with the apoB-100 protein (VLDL, LDL and any IDL that might be present). The apoB number has been shown to be a more precise marker of cardiovascular risk than LDL-C or even non-HDL-C. Your apoB at 118 mg/dL is higher than preferred. For most people an apoB <100 mg/dL is considered ok. For you with your history of cardiovascular disease I suspect that <80 mg/dL would be preferred. Your lipidologist will likely want to do something to bring it down. If you don't like to give yourself injections, which I think is the case many times for Repatha, then ask for Zetia. Ask your lipidologist for inflammation tests I mentioned before (LP-PLA2/PLAC2 and MACR). Those will tell you whether you have cardiovascular inflammation sufficient to worry a lot about your apoB/LDL levels.
        Last edited by Tom; 01-12-2020, 06:31 AM.

      • rich
        rich commented
        Editing a comment
        It might be worth looking at homocysteine level. That's the one I can't seem to lower. Folate and B12 are supposed to help, but possibly lowering with supplements doesn't help reduce risk.

    • #35
      Here are my most recent test results and full history. As you'll see, my total cholesterol and LDL dropped significantly with the addition of the 10mg of Zetia. So here is my current protocol:

      Zetia 10 mg
      Crestor 5 mg
      Vacepa 3 grams x 2 times per day
      Niacin 2 grams at night
      Amlodipine 5mg and Ramapril 5mg mg for BP

      Unfortunately I've not been compliant with eating low carb these last couple of weeks. I still avoid sugar and have for about 6 years but usually only eat once or twice per day.

      C-Reactive protein is 0.46 and Vitamin D is 69. My Lipidologist is happy with all of these levels, and he thought perhaps I was taking the Repatha samples he gave me which I was not. Initially he said Zetia would not provide more than a 20% reduction in LDL. He was certainly wrong about that. Been taking the Zetia for about 6 weeks. Should I have concerns about total cholesterol this low?

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      • #36
        No, I don't think that your cholesterol numbers are too low. Those levels look good especially given the numbers from a couple of years ago. People vary in how much cholesterol that they absorb/re-absorb, and Zetia can be particularly helpful for those who naturally re-absorb a good bit of cholesterol. Hopefully an inflammation panel will also reflect such good results.

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        • #37
          Thanks Tom and everyone that's pitched in to offer thoughts. You've all be a big help!

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          • #38
            Would like to get some opinions. While my blood work is very good now, the way I am feeling these days is off. I have mellowed out substantially different from my former self. I've always been somewhat amped up in the past but now I feel mellow to the point my staff is saying I'm different. I also have a difficult time focusing and feel a bit of a fogginess in my brain and I have less drive. Which of the drugs or combination of the drugs might be causing this? I suspect it's Ramapril or Zetia. Could my BP be too low? This mornings 2 BP readings were 114/81 and 119/78.

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            • #39
              I suppose that it might be possible that ramipril or Zetia could cause the issues you note, but I would also consider other potential causes. Do you feel dizzy when you stand-up? If not, then the cause is probably not blood pressure. Is it possible that you had a "mild" case of COVID-19 as there are some similar issues with people who had COVID-19? If none of that seems likely, then ask your doctor to also check your thyroid levels.

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              • #40
                Tom, I don't have any dizziness when standing. Don't believe Covid is the culprit either as it's been going on for months. I do wonder if dropping my cholesterol has dropped my testosterone levels too low however. When eating low high fat/low carb my levels were up to over 800 (quite high for a 53 year old). When I started straying from low carb they dropped to just under 400. Since starting this medication protocol I'm wondering if there has been an additional drop since there would be less material for my body to make testosterone from. I guess that could be said for a lot of hormones however.

                I already supplement my thyroxine and my levels are normal.

                Perhaps it's time to run some new hormone panels since I haven't since starting this medication protocol. I am curious if others have tracked the impact of taking the cholesterol lowering meds on their hormones.

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                • #41
                  Crestor/rosuvastatin isn't thought to cross the blood brain barrier to a significant extent, and the cholesterol made in the brain doesn't cross the blood brain barrier either. There are people who naturally have very low LDL-C levels (20-30 mg/dL) without seeming to have issues, but changing from a quite high to a quite low LDL-C level over a short-term might have some effect on testosterone production. Another potential issue for those on a strict ketogenic diet could be that very low insulin levels over a period of time can also suppress testosterone levels. Beyond that, there is the generic problem of men in their 50s who begin the sort of modifications that you are mentioning and end up with ED. That aspect, which may or may not be relevant to your situation, is covered in another topic, "Houston, We Got a Problem".

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