Worst Labs Ever

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Linda
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Worst Labs Ever

Post by Linda »

My doctor just called to discuss my latest test results. I thought I was on the right track, but I have to admit that I am in shock and starting to freak out. I know that I need to quickly figure out what's wrong and come up with a new game plan, but I'm panicking. For the past year, I've cut out processed foods, sugar, bad oils, and drastically cut my carbs. I use lots of avocado oil and EVOO, have lots of green leafy veggies, small amounts of grass fed beef and poultry, salmon every week, pastured eggs, and a few macadamia nuts a day. I exercise daily, take supplements, and am in nutritional ketosis every morning. My fasting blood glucose is usually between 70 - 90. I do, however, eat some butter and have cheese. I expected my cholesterol to be high, but the most concerning is my LDL particle number. As my doctor explained, "EVERYTHING is terrible." She suggested that I stop what I'm doing, give up Keto, cut out all oils and fats, start eating oatmeal every day, and she'll recheck me in a few months. My previous results when I ate the SAD were so much better! Also, my Homocysteine went from 8 to 13! I am at a total loss of what happened and what to do. Any suggestions would be GREATLY appreciated. Thanks so much!!!
LABS:
TC-371
HDL-91
Tri-85
LDL-260
LDL Particle Number-2071
LDL Small-238
LDL Medium-306
HDL Large-7461
Apo B-158
Lip (a) - <10
LDL Pattern- A
LDL Peak Size- 226.7

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TheresaB
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Re: Worst Labs Ever

Post by TheresaB »

I think those are horrible lab TESTS, not necessarily horrible lab results. A positive test result I see is your HDL to Triglyceride ratio, which is wonderful! Did she not see/mention that?

But where’s fasting glucose, insulin, HbA1c? Where are inflammation markers? You’re a 3/4 for goodness sake! Where’s ApoA1? ApoB alone is meaningless without knowing your B to A1 ratio. Where’s sdLDL or better yet, oxidized LDL? Omega 3? Homocysteine?

Remember from reading our Primer that glycemic control trumps lipids every time, I don’t understand your doctor’s fixation on cholesterol markers, especially the ones that don’t tell the full story.
Linda wrote:Any suggestions would be GREATLY appreciated.
I don’t know the relationship you have with your doctor, but if it’s a casual one, I’d fire her and get one that has a better grasp of realistic tests and diet.
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Re: Worst Labs Ever

Post by TheresaB »

One more thing, I'm not saying you need to get every single test listed, but there's a list of tests Dr Bredesen recommends along with target values in our wiki. The table of tests and values was taken from his second book, "The End of Alzheimer's Program" which did update tests and values from his first book. https://wiki.apoe4.info/wiki/Bredesen_Protocol
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Re: Worst Labs Ever

Post by DaleBru »

I second what @theresab said. Your lab results are very good. I hope you will study enough to reassure yourself that your doctor, like most doctors who are hopelessly behind current scientific understanding, is dead wrong.

Unfortunately, the word "dead" hits patients more than the doctors who kill them. Our only defenses are education, determination and persistence.
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Re: Worst Labs Ever

Post by Linda »

Thank you SO much for your responses! I appreciate it more than you can ever imagine!! I was actually expecting great lab results yesterday and truly panicked when I heard my doctor say that everything was terrible. Thanks to this site and all of you, I'm more hopeful today and plan to learn more and will continue to tweak my diet. I'm NOT going to give up Keto and start eating bowls of oatmeal, but I think I'll start by decreasing (or eliminating) cheese and dairy. Also, maybe I can add in more salmon and shrimp and reduce my red meat intake even more than I already have. I'm also wondering if organic psyllium husk might help. I am really glad that my TG:HDL ratio was good, and that my fasting glucose was 69. (My doctor said that was too low.) There was some good news. I do, however need to figure out why my homocysteine jumped up to 13, and might need to start taking B vitamins and TMG. (I have 2 heterozygous MTHFR mutations.)

Thanks again for sharing your knowledge and suggestions!
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Re: Worst Labs Ever

Post by TheresaB »

I think your fasting glucose is excellent, remember Dr Bredesen's range for ideal HbA1c is 4.0 - 5.3. I also think all the other things you're thinking are right on point.
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Re: Worst Labs Ever

Post by Nebo »

I'm trying to learn here but what is "good" about those labs? I have fairly similar numbers most recently though APOB/A1 ratio was bad (1.17) and LpPLA2 was very elevated and sdLDL was 60 mg/dl. All this has my lipid doc down on me hard wanting a statin (we tried Repatha to no response) and I was able to compromise with niacin and dropping my sat fat from 40-50g to sub 20g.

All glycemic stuff is out the window for me with T1 diabetes. It's as good as it gets all considered.
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Re: Worst Labs Ever

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Nebo wrote:I'm trying to learn here but what is "good" about those labs?
Let’s start with Total Cholesterol (TC) – 371. I’m not going to say that’s good, it does seem to be high, but it’s also not telling us anything. Is it high because of inflammation? Is it high because she’s a hyper-responder, which is common in 4s. Total cholesterol really doesn’t tell us anything. It says nothing of the size, density, or damaging oxidation. Total cholesterol combines various markers, including “good” and “bad” cholesterol, how is that valuable? It also doesn’t take age into consideration, according to this interview with Tommy Wood, BM BCh (MD), PhD, http://www.nourishbalancethrive.com/pod ... nges-chol/ if she’s young, that TC level is bad, but if she’s older as a female, that level might be protective. My total cholesterol has remained static over the years, yet other lipid markers have made significant changes, in the right direction I might add, so what does Total Cholesterol tell us?

HDL 91 – excellent! Dr Bredesen recommends HDL >50 mg/dL.

Triglycerides 85 – Also excellent, Dr Bredesen recommends TG <150 mg/dL

TG to HDL ratio = 85:91. Also excellent. Dr Bredesen recommends <1.1

LDL – 260 suspicious, but again, not a good marker to actually tell us anything. LDL is not a direct measure of anything, (better is a Coronary Artery Calcium (CAC) scan which measures actual calcification). LDL is a proxy measure and many argue not a very good indicator of cardiovascular disease at that. I’ve heard respectable sources allege that the only reason doctors fixate on LDL so much is because there are drugs (statins) that can be prescribed to lower it. Dave Feldman, founder of the blog “Cholesterol Code” has brought his LDL to as high as 368 and to as low as 98 all within a 12 month period. (Reference: https://denversdietdoctor.com/dave-feld ... -a-driver/ ). ApoE4s do tend to run high LDL because we don’t recycle it very well in our liver which results in higher concentrations of LDL particles in the circulatory system for longer periods of time which in turn then has a higher chance of forming small dense LDL particles and undergoing inflammatory transformation becoming oxidized LDL, but again, LDL alone doesn’t tell the story, the measure of oxLDL tells that story, which we don't have here.

LDL Particle Number-2071, LDL Small-238, LDL Medium-306, HDL Large-7461, LDL Peak Size- 226.7 – my doctor pays no attention to these numbers so neither do I, I can’t comment.

Apo B-158 – that is high, but we don’t know the ApoA1 measure so we don’t know the ratio, the ratio is the focal point.

Lp (a) - <10 – Another excellent marker!

LDL Pattern- A – That’s the pattern a person wants! Pattern B is the "bad" pattern.

As for
Nebo wrote:All glycemic stuff is out the window for me with T1 diabetes
I wouldn’t say that at all. There are strategies you can pursue to minimize exogenous insulin dependence and to restrict further autoimmune progression.

Since you are trying to learn, I assume you've already read our Primer, viewtopic.php?f=33&t=1418, but are you familiar with our Wiki article, Cholesterol, Lipids and Treatments, including statins, https://wiki.apoe4.info/wiki/Cholestero ... ng_statins
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Re: Worst Labs Ever

Post by Nebo »

I should clarify with the diabetes, it means the labs are worthless. Fasting glucose means very little except if my basal dose is appropriate and even then it could be 80mg/dl one day and mg/dl the next. Same for measuring insulin. My metrics I care about I don't even need an endo for (last A1C was 4.6 with a SD of 20mg/dl).

On all the cholesterol, forgive me if this is too abrupt but nothing there suggests "good" but at best "unknown". This is what confused me is that many leading experts would strongly disagree with much of what you wrote. Dayspring/Attia have done hours saying that TC, LDL, LDL-P and APOB would all be considered quite high here even in APOE4 context. They put little stock in TG/HDL ratio. As far as I can tell that is something largely brought up in the Feldman circles which, not to bash him (I do respect him and have followed him for almost 5 years now!) is not proven to be protective. I mean, neither is low LDL but I digress. The "LDL is useless" seems rather radical to me (and as someone with LDL of 230mg/dl...) since historically we don't really see LDL go this high so something is up and I find that hard to write off.

I guess what I was hoping was some kind of learning on why you're so confident with that when there is so much dispute on the numbers. I was just recently told LDL-P can drive up LpPLA2 but even that I can find no concrete answers on.
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Re: Worst Labs Ever

Post by Linda »

Nebo, it looks like both you and I have a lot to try to figure out regarding our cholestrol results and which path to follow to get back on track. It's so challenging because there's so much conflicting information! Good luck to you. Thanks, everybody, for your comments!
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