5 Steps to prevent Heart Disease

Tuesday, May 8, 2012

Post World Cruise Lab Results

I returned home from my 112 day world cruise yesterday.  I weighed in on my home scale at 251.5 pounds.  I attribute the weight loss to taking Victoza injections.  I also attribute the improvement in my Hgb A1c down to 8.1 to Victoza as well.  I tried to walk two hours a day on sea days.   I tried to stay on a low carbohydrate diet.  I drank at least one glass of wine a day.  I was never hungry.

The LDL particle number is the most important lipid metric to prevent heart attacks and strokes.
Berkley Heart Lab does an excellent apo B test.
My apo B before the cruise was 62.  After the cruise on May 2, 2012 my apo B was 47.

The routine lipid panel was also done on 5/2/12:
Total Cholesterol          109
HDL-C                           45
Tubby Factor                  64
LDL-C                            50
Triglycerides                  72

This data is not included in my book, The Tubby Traveler from Topeka as that manuscript is at the printers.


It is very important to focus on the fact that this excellent lipid profile is obtained while eating 60% fat. 

CONFOUNDING COVARIABLES:
I lost 5-7 pounds while on the cruise.
My Hgb A1c improved.

 I switched from Crestor 5 mg to Atorvastatin 20 mg to save money.
 I stopped Endur-acin because I found I had an asymptomatic peptic ulcer.
  I increased my exercise and continued my actos.
  Off the niacin my HDL-C fell, however I don't know what my HDL-P is.   But does it matter?


Dr. Dayspring has always taught that the main goal is the particle number.  We don't treat HDL-C or triglycerides.  The AIM HIGH TRAIL confirmed this.  Particle size is also not important.  I have included as many lipid results in my book because it is a case study.
For the average patient going on a low carbohydrate diet.  Get your CAC, CIMT and Tubby Factor (non-HDL cholesterol).  If you have plaque go on a statin.  If you can afford a baseline LDL-P or apo B, I strongly advise it to make certain you do not have discordance.  As you eat 60% fat in your low carbohydrate diet, please check your Tubby factor or LDL particle number every four months if you are on a statin.

Much of the Low carb promoters push that the LDL-C may go up but the particles are larger.  The HDL-C goes up and the Triglycerides go down.  I try to bridge this point of view to the lipidologist viewpoint that it is the LDL particle number that we have to keep our focus on.

Vegans point out that Ornish had regression of plaque.  Similar to the lipid neutral trials of Gardner and Sachs, the CONFOUNDING COVARIABLE of weight loss obfuscates the interpretation.

In any vegan diet that is low calorie, the total carbohydrates are also reduced.

I hope my case study brings some clarification or at least a reduced fear of going on a high fat diet if you follow your LDL particle number. 

In 2011 I did not gain or lose weight by the end of the year.
My Hgb A1c was worse as I went off actos for a few months.
My exercise was zero to 40 minutes a day.
I tried to minimize the CONFOUNDING COVARIABLES in 2011.
My lipid panel remained quite good during most of  the year and I have no increase in plaque on my serial CIMT.  My CAC increased a little but was done while I was in Atrial fibrillation and was still lower than my highest CAC of 20 before I got my LDL-P below 750.


2 comments:

  1. 109 TC is rather low. If you are taking a statin, I would highly recommend reconsidering your options. Low cholesterol is associated with all kinds of bad things, including cancer (yes, I know association doesn't prove causation, but...). I recommend some books, beginning with "The Cholesterol Delusion" by Curtis, Ernest N., M.D. The author is a cardiologist and does a great job of deconstructing most or all of the studies that have been done on statins, cholesterol, and sat fat. A similar analysis of the studies has been done by Uffe Ravnskov and published in "Fat and Cholesterol are Good for You" which is an updated version of his first book, "The Cholesterol Myth." Dr. Malcolm Kendrick's "The Great Cholesterol Con" is another great expose of the myths surrounding statins and cholesterol. And Dr. Duane Graveline has a couple of books out specifically discussing the effect of statins on cognitive function and why it's pretty much guaranteed that, if you take a statin, you will experience some degree of cognitive impairment. You are clearly doing the right thing by following a low carbohydrate, high fat diet. Why do you think you even need a statin? I'm not a doctor, so don't take my word for it. Read works by doctors. All of the books above are written by medical doctors.

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  2. I see you are a doctor, as well. Sorry. I didn't read your profile before. No offense intended. Still skeptical of statins and still recommend those books by other doctors.

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