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  • Bruce T
    replied
    Thanks Tom and everyone that's pitched in to offer thoughts. You've all be a big help!

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  • Tom
    replied
    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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  • Bruce T
    replied
    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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  • rich
    commented on 's reply
    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.

  • Tom
    commented on 's reply
    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.

  • Bruce T
    replied
    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
    commented on 's reply
    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

  • sthubbar
    commented on 's reply
    Bruce, the best way to find out about the service is to visit the website.

    Custom online demo: https://www.insidetracker.com/#homezone-steps

    Product tour: https://www.insidetracker.com/tour/?...1-b755629970ef

  • Bruce T
    replied
    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?

    Leave a comment:


  • Bruce T
    replied
    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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  • sthubbar
    commented on 's reply
    Bruce T; thank you for sharing. Have you checked out InsideTracker.com DIY product for tracking and advising on all of these labs?

  • Tom
    commented on 's reply
    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.

  • Bruce T
    replied
    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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  • Bruce T
    replied
    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.

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  • Ford Brewer
    replied
    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.

    Leave a comment:

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