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[steve58]

Greetings,
My name is Steve and here is a little bit about me and what I am hoping to learn.
I love researching, reading books, blogs etc and watching youtube and digesting as much as I can.
I am a 3/4 I learned that from a 23 & me test a few years ago. At the time it only mentioned the AD risk and didnt hint at heart issues.
Almost a year ago I ended up in the heart institute near where I live with angina jaw pain and palpitations as well as PVC's. They did an angiogram and I have a 60% and a 40% on my LAD. My father smoked and was diabetic for a few decades and eventually got a heart transplant after many heart attacks and bypasses. About a year ago I was 260 lbs and I am 6ft1. My ideal weight from when I was 21 is 180 lbs so I could use to lose 80 lbs. I have lost 30 lbs so far. When I was in the heart institute they put me on 40mg of Crestor and it ended up being a train wreck for me and I discontinued it. Side effects were extreme fatigue, muscle and back pain, dark urine and I was on the verge of becoming full blown diabetic. Recent blood work is as follows...
I had NMR LDL-P is very high at 3152, LDL size is 20.5, small LDL-P is 1601, Trig 119, HDL-C 32. homocysteine is 6 umol/L, CRP 1.4 mg/L, fasting insulin is 119 pmol/L. It would seem that I am a hyper responder?
Vitamin D 155 nmol/L Needless to say I am very concerned from the NMR data. It is my first NMR type of test so I can't compare to previous reports. Usually my regular LDL C tests are as follows. 6.13 mmol/L
I have been on a keto LCHF or LCHP diet in the past so I know all about how to do it properly. I do check my blood ketones to ensure I get into ketosis. I find though that it is difficult to get into deeper ketosis and I am wondering if it is due to the insulin resistance? I usually aim for about 20 grams of total carbs but it sometimes is a bit higher but no higher than 30 grams most days unless there is a special occasion such as birthdays xmas etc. I also struggle with my glucose and it can vary from 7.9 to 6.6 post prandial and I don't even bother checking first thing in the morning as it is never good. I am assuming the counter regulatory hormones are affecting it in the morning?
I am losing weight very very slowly less than a lb a week on average it seems. I don't want to cut back my total calories too much so that I don't reset my metabolism lower and make things worse. I eat about 1600-1800 calories a day. I also do time restricted eating usually having breakfast around 1-2 pm and finishing supper by 6-7 pm. I also have dabbled with extended fasting of 48-72 hours and think I should probably up that to help drive my insulin and glucose down?
I exercise on my treadmill for about 30 minutes and sometimes 45-60 minutes. I want to get much more consistent with that 6 days a week.. I know it is good for improving insulin resistance. I do have high blood pressure and I keep it around 120/80 or better with meds. I have been slowly reducing meds with weight loss.
I do get the odd flutter feeling in my chest with absolutely no pain or discomfort at all. I also do get the odd discomfort in my jaw.. more specifically in the area of my teeth.. no pain just an awareness. I have had a holter monitor test and MAny EKG's with everything ok. I am getting another holter this coming week. I have done stress tests before as well when they were checking everything last year. I had an ultrasound of the heart but I forget the name of the test.

My immediate concern is heart attack potential with my crazy high NMR test and what should I worry about and not worry about and what tests should I do and any drugs or supplements that would help. Also should I adjust my diet since my NMR test is so high? Any thoughts or suggestions or questions please ask

Steve

If I forgot anything I will add it when I remember

[NF52]

Greetings,
My name is Steve and here is a little bit about me and what I am hoping to learn.
I love researching, reading books, blogs etc and watching youtube and digesting as much as I can.
I am a 3/4 I learned that from a 23 & me test a few years ago...It would seem that I am a hyper responder?...Needless to say I am very concerned from the NMR data. It is my first NMR type of test so I can't compare to previous reports...
I am losing weight very very slowly less than a lb a week on average it seems...I exercise on my treadmill for about 30 minutes and sometimes 45-60 minutes. I want to get much more consistent with that 6 days a week...I had an ultrasound of the heart but I forget the name of the test.

My immediate concern is heart attack potential with my crazy high NMR test and what should I worry about and not worry about and what tests should I do and any drugs or supplements that would help. Also should I adjust my diet since my NMR test is so high? Any thoughts or suggestions or questions please ask
Steve

A warm welcome Steve!

I hope for many reasons that you wrote this somewhere warm (at least inside) and don't have to deal with shoveling a foot or more of snow! You have come to a great place with your love of researching, reading, and digesting as much info as possible. But like a good diet, which becomes more of a long-term eating plan than a crash diet, it can help to take small bites out of this forum--otherwise people sometimes find it feels a little overwhelming to have so much to digest!

You deserve enormous credit for your perseverance and patience with the difficult task of losing weight (something I have struggled with as well). It's never simply "calories in/calories out". Our bodies come equipped with many devious ways to hold onto that extra weight, and so losing 30 lbs in a year sounds great--you have shed more than 10% of your weight! I think your doctors would tell you that a slow, even sometimes uneven loss is more likely to be sustained and to avoid loss of muscle, than a fast weight loss.

Does the heart center that treats you offer cardiac rehab classes with exercise advice? I have known people who have really enjoyed that, and felt they learned lots about how to safely get their heart to a level that could give them aerobic and fat-burning benefits. If not, there may be a local gym that offers sliding scale fees, or even programs that your health insurance pays for that might give you some social company as well as some variation from the treadmill.

I too had a high LDL-P, and a similar LDL-P size of 20.5 (which isn't into the smaller, more dangerous size). My guess is that those numbers will come down as your body adjusts to a new size. You don't say what your doctors did about the blockages, but I'm sure it was a time with a lot of questions and fears for you. Medical professionals know now that almost any kind of unexpected medical emergency can cause what is called "acute stress disorder"--worry, difficulty concentrating, anxiety, irritability, anger, replaying incidents, etc. The best 'treatment" for acute stress disorder is to let patients know it is normal, and usually self-limiting, and to give patients lots of ways in which they can feel like they are doing things that give them some control and a sense that they can focus on the positives.

It sounds like your heart center did that for you, but since you are now worried about your NMR scores and the upcoming tests, you may want to call the cardiologist's office and ask if they have any social workers or counselors on staff who could meet with you. (I'd be surprised if they didn't have someone who is available.) I would also be sure to mention those fluttering sensations in your chest and jaw. Who knows, may be you just have a wisdom tooth that is acting up--but it helps to cover all the bases!
By the way, is it an echocardiogram that you had of your heart? That's a test that shows the valves and chambers of the heart--I know because my son, who had heart surgery at age 5, had one at age 8--that was the soonest they could count on him to stand still! Today he is a healthy 37 year old, so even severe heart issues can often be improved with the patient and doctor working as a team.

As for your ApoE 3/4 status, you didn't mention how old you are, but your risk of any cognitive impairment is a bit higher than the 10-15% of people with no ApoE 4, but with your brain surging along with reading, research and engagement in the world, you should plan to enjoying both heart and brain for a long time.

[steve58]

Thanks for the response... Well I am up in Ontario and its a balmy minus 38 right now and we got about a foot of snow yesterday lol.
We have a world class Heart Institute up here in Ottawa and I did the rehab program. I didn't actually have a heart attack and when they did the angiogram they said there was no need for a stent with a 60% blockage. They stated that there is more risk than reward at that level. Yes it was an echocardiogram that I had. I am 58 years old.
Steve

[NF52]

Thanks for the response... Well I am up in Ontario and its a balmy minus 38 right now and we got about a foot of snow yesterday lol.
We have a world class Heart Institute up here in Ottawa and I did the rehab program. I didn't actually have a heart attack and when they did the angiogram they said there was no need for a stent with a 60% blockage. They stated that there is more risk than reward at that level. Yes it was an echocardiogram that I had. I am 58 years old.
Steve

Oh Canada! I have spent most of my life on the other side of Lake Ontario, as well as a stint in Minnesota, so know exactly how balmy -38 is!! I've been to Ottawa just once--enough to know it's a beautiful city! Glad to hear you're in such good hands. I probably didn't answer your important questions, so feel free to raise them again, or to search for info on those topics.

Here's some helpful links: How-To" Get the most out of the ApoE4.info website has tips and shortcuts for searching, quoting members so that they are notified of your reply, "subscribing" to topics to be notified of new posts, etc.
Primer: Written by Stavia, a doctor with ApoE 4/4, it's good for both a quick browse and a deep-dive--and everything in between!

I hope you will keep posting; many members have dealt or are dealing with similar issues. And at 58, you are well-positioned to enjoy many years of good life now that you and your doctors have a peek into the inner workings!

[CoachJD]

Welcome Steve58!

First let me compliment you on your focus and follow through attending to weight loss and your heart health. Celebrate the progress you're making--you are on the right road indeed. You've asked some very specific questions about changing your diet and/or adding supplements. Any advise we could give you would be general, and I'm sure you've already found a lot of it on line. I think you would benefit from working with a trained professional who can look at your whole situation and can make responsible recommendations and track progress with you.

As already mentioned, this site is full of relevant helpful information and I hope you benefit from it, and keep us posted on your progress.

Stay warm and be well!

[mike]

I also have dabbled with extended fasting of 48-72 hours and think I should probably up that to help drive my insulin and glucose down?
I exercise on my treadmill for about 30 minutes and sometimes 45-60 minutes. I want to get much more consistent with that 6 days a week.. I know it is good for improving insulin resistance. I do have high blood pressure and I keep it around 120/80 or better with meds. I have been slowly reducing meds with weight loss.

Steve, I was in much the same shape as you, but better Cardio. I'm also 58 and was 270 lbs on 6'3" frame. 20 year diabetic with a small brainstem clot about 5 years ago. I've been doing a series of extended fasts (13 day, 17 day and 19 day) over the last couple of years, along with following a LCHP diet, and I lost 70 lbs. It is easier than you might think. Also (assuming it is okay with your doctor) if you are doing a steady pace on your treadmill, switching to interval training increases effectiveness, especially at our age.