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Paging Doctor Griff... and maybe a Molecular Grokologist

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  • Paging Doctor Griff... and maybe a Molecular Grokologist



    Hey Griff, I know you've covered a lot of this stuff for everyone already, but I just got back from my doctor's office, and my wheels are spinning.


    I'm on simvastatin (Zocor), and I really thought that I'd be getting off of it with this visit. I was all happy and pumped with the results from my last visit, but he deflated me, and I wimped out with my demand for reevaluation.


    My total cholesterol was 147, HDL 51 (the first time it's ever measured above 39), triglycerides 70, and LDL 82. And all of this was pre-Primal, but fairly Paleo. That's with the simvastatin, but the first real improvement that I saw after a year or so on it. I think the bulk of the improvement was dietary and exercise driven.


    There's a history of heart disease in my biological father's family that I just found out some details about. Many of them died young. My father is still alive, but he's had several heart attacks, the first one at 35. He's had 13 angioplasties (he's 59).


    In light of this information, the doctor want's my LDL below 70. He scheduled me for a coronary calcium score (I think it's a CT scan) to see the degree of blockages in my arteries. He says that if my LDL is below 70, and that test looks okay, we'll talk about getting off of the statins.


    My main concern is that now that I'm Primal, I'm eating a lot of coconut oil and significantly more fatty meat. I fear that my LDL may be higher.


    My insurance doesn't cover VAP tests (though I may decide to fork out the money for one on my own eventually), what do you think my odds are of getting that LDL level lower? I'm fairly convinced that cholesterol shouldn't be a big concern for me now, but I'm trying to placate the doctor (not to mention my nagging RN mother) so that he'll let me dump these stupid statins.


  • #2
    1



    Well, you should first bear in mind that you are the customer and are paying for his services. As such, YOU have the final say in whether or not you want to take statins.


    As for your numbers, LDL itself is not a very good predictor of CHD risk. Low LDL patients have heart attacks at nearly the same rate as high LDL ones. HDL/LDL ratio is a bit better as a predictor, but you have to bear in mind that this presumes that all LDL are the same. LDL particle size is an important predictor of CHD risk and particles tend to be larger and more difficult to oxidize in patients with high-fat diets, high saturated fat intake, low carbohydrate intake, and/or circulating ketones. As a result, you could have an LDL of 70 but have it all be Pattern B (small, dense) particles which oxidize easily and worm their way into your arterial lining or an LDL of 150 but have it mostly be the benign (and in many ways helpful) Pattern A type.


    If he insists on treating a number, you should also make your doctor aware that the traditional formula for calculating LDL (Total - [HDL + (Trigs/50] = LDL) is innacurate for persons with low trig levels (sub-100, which you likely have if you have a low carbohydrate intake). There is another equation called the Iranian Equation -- (Total/1.19) + (Trig/1.9) - (HDL/1.1) -38 = LDL -- which is far more accurate.


    Furthermore, statins have a pretty unimpressive track record as an intervention in the first place. Indeed, most of their effect, it's now emerging, may be due to an anti-inflammatory effect rather than their HMG COA reductase (a precursor step to ubiquinone and cholesterol synthesis) blocking activity. Ask him if, in light of the facts, he'd be comfortable with you taking low-dose asprin, niacin, and fish oil instead.

    Give me liberty. Exploration of other options will be vigorously discouraged.

    Wondering something sciencey? Ask me in my Ask a Biochemist Thread

    Comment


    • #3
      1



      Thanks! I think I may write some notes to take with me next time, and/or get the VAP test to determine the LDL balance. Anyone know about what that should run out of pocket?

      Comment


      • #4
        1



        The Wall Street Journal (2003) says $75-$175 out-of-pocket depending on where you are in the country. There may be some improved method or apparatus which has since brought this down.

        Give me liberty. Exploration of other options will be vigorously discouraged.

        Wondering something sciencey? Ask me in my Ask a Biochemist Thread

        Comment


        • #5
          1



          Molecular Grokologist, I hate to abuse your generosity, but another question (if you'd like me to ask on the other thread- for all to see- let me know) just popped up.


          I haven't been able to convince my wife to go fully Primal yet, but she's seeing a diet doctor, and it's pretty close to primal. The diet docs did a metabolic panel on her. Her progesterone, testosterone and HGH are very low, her estrogen and CRP are very high. They've had her on fish oil, vitamin D, a strong multi, B12 shots, and HCG (I'm not too happy with that, but she is). She's also hypothyroid for which she's been taking synthroid for a while. Her T3 is still too low, her TSH is virtually non-existent, and her T4 is high normal.


          To remedy the thyroid trouble, they diet docs are recommending switching to porcine derived thyroid meds. That doesn't bother me so much.


          What does bother me is that now she's going to be taking sermorelin acetate to up her HGH. My argument is that she should have waited to see if the changes in her diet and exercise (we both walk a lot, and just started CrossFit) brought up that HGH on its own.


          Any thoughts on any of this?

          Comment


          • #6
            1



            How old is your wife and is she pre- or post-menopausal?


            Is she overweight?


            Have you explored the possibility that her thyroid issues are autoimmune?


            Does she have any other health issues which might have bearing on the question?

            Give me liberty. Exploration of other options will be vigorously discouraged.

            Wondering something sciencey? Ask me in my Ask a Biochemist Thread

            Comment


            • #7
              1



              She just turned 40 Saturday. She's on birth control, and has been on different types for many years. She is now on the Mirena IUD.

              Comment


              • #8
                1



                Oh, and she's overweight. We haven't explored autoimmune diseases any further than the normal tests. Should we, and how?

                Comment


                • #9
                  1



                  I'm not an endocrinologist, so any detailed response is going to take a while, but I've been meaning to read up on a lot of this stuff anyways.


                  For starters:


                  A test for thyroid antibodies (against thyroglobin and thyroid peroxidase) would be in order if she presents other symptoms.


                  As birth control goes, Mirena is a pretty solid lesser evil (it's what I've got my wife on) and is not likely to be the root cause of the pathology, but some people have long-term hormonal responses to stronger hormonal birth control methods.


                  You're right that weight loss, diet, and exercise should improve her hormone profile, but I don't like the sound of "very low" and I have to wonder if that's really going to be sufficient. Still, HRT isn't to be taken lightly.


                  Has she seen an endocrinologist yet?

                  Give me liberty. Exploration of other options will be vigorously discouraged.

                  Wondering something sciencey? Ask me in my Ask a Biochemist Thread

                  Comment


                  • #10
                    1



                    I'm going to do some research on the thyroid auto immune connection.


                    She saw an endocrinologist years ago when the thyroid trouble first presented itself.


                    I've just gotten the actual lab report myself, instead of just listening to what she said. Turns out her TSH is high, not low. TSH is 5.39, T4 is 8.2, T3 is 87, T4, free (direct) is 1.37. The way she explained what the doctor told her is that the synthroid is bringing her levels up, but the TSH number is telling us that it's not being utilized.


                    Her Insulin-like GF-1 is 76.


                    Is the sermorelin acetate HRT?

                    Comment


                    • #11
                      1



                      @ Grokologist


                      As for your numbers, LDL itself is not a very good predictor of CHD risk. Low LDL patients have heart attacks at nearly the same rate as high LDL ones. HDL/LDL ratio is a bit better as a predictor, but you have to bear in mind that this presumes that all LDL are the same. LDL particle size is an important predictor of CHD risk and particles tend to be larger and more difficult to oxidize in patients with high-fat diets, high saturated fat intake, low carbohydrate intake, and/or circulating ketones. As a result, you could have an LDL of 70 but have it all be Pattern B (small, dense) particles which oxidize easily and worm their way into your arterial lining or an LDL of 150 but have it mostly be the benign (and in many ways helpful) Pattern A type.

                      So how do pattern B particles worm their way into the arterial lining?


                      I was discussing with my PCP just last week and he thinks partical size does not matter if the arterial lining remains unscarred. He thinks the arterial lining becomes scarred by viral or bacterial mechanisms yet to be discovered. There also seems to be a strong correlation between gum disease and CVD.


                      What are your thoughts?

                      “It is a truism that almost any sect, cult, or religion will legislate its creeds into law if it acquires the political power to do so, and will follow it by suppressing opposition, subverting all education to seize early the minds of the young, and by killing, locking up, or driving underground all heretics.”
                      —Robert A. Heinlein

                      Comment


                      • #12
                        1



                        I've wondered about the dental/heart connection. I haven't really researched it, but could they be related because of the connection to refined carbohydrates and diseases of civilization rather than the mouth infection causing heart disease? I probably could have worded that better.

                        Comment


                        • #13
                          1



                          @Allbeef Patty

                          Shamefully, I'm afraid those numbers mean nothing to me yet. They don't really teach you a ton about symptoms/reading tests as a biochemist, so I have to self-teach myself these things and hormone panels aren't something I've had much of a chance to look into.


                          From what I understand, the doctor's explanation of what is going on is plausible, and the thyroid bone is connected to the steroid hormone bone, as it were, but I'm going to have to get back to you.


                          @ Asturian

                          Yes, an undamaged arterial lining isn't very vulnerable at all to infiltration by oxidized lipoproteins. I think the correlation between gum disease and CVD is systemic inflammation. An inflamed vascular endothelium is a permeable vascular endothelium.


                          As far as what causes the inflammation, I wouldn't be surprised if glycation from excessive blood sugar, improper triggering of growth factor receptors by hyperinsulinemia, and n-6 PUFA-derived cytokines are the primary culprits.

                          Give me liberty. Exploration of other options will be vigorously discouraged.

                          Wondering something sciencey? Ask me in my Ask a Biochemist Thread

                          Comment


                          • #14
                            1



                            Looks like she's not converting her T4 to T3. Synthroid is just not sufficient for most people, esp. if they're poor converters.


                            I have a good resource for thyroid and autoimmune research. Datis Kharrazian is so far ahead of everyone else on the subject of functional endocrinology and thyroid disorders.His book helps you to identify exactly what's going on by blood test patterns. Apparently, a large % of hypothyroidism in the US is actually autoimmune in nature and it is very underdiagnosed (and even when it is, it's not treated properly).

                            Kharazian has figured out how to treat the underlying immune system imbalance and says that very few people actually need thyroid hormone supplelmentation.


                            http://www.thyroidbook.com/

                            http://www.prettyinprimal.blogspot.com

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                            • #15
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                              Thanks, everyone!

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