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Thread: Paging Doctor Griff... and maybe a Molecular Grokologist page

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    Allbeef Patty's Avatar
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    Primal Fuel


    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.


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    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

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    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?


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    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

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    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?


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    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

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    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.


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


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    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

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    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?


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