help interpreting markers - Julie? George? anyone else?

[Tincup]

Kitano,

As I posted here, my meter seems to do a decent job comparing to labs: https://www.apoe4.info/forums/viewtopic ... =765#p6952 and it is pretty internally consistent. If I have high urine and/or serum ketones, I have blood sugar in the 60's or low 70's according to my meter. Of course, I can have sugar in that range and modest, but still ketotic ketones. My original generic meter was awful and the error range was very large. I remember the white paper on it. Basically the attitude was (from a diabetic perspective), if you have an 80, eat sugar, if you have 180, take insulin. If the meter discriminated between those two points, it was good enough. They had graphs to that effect in the paper. As noted in my link, Dr. Bernstein has tested meters and tells what he thinks is best. http://diabeteshealth.com/read/2013/09/ ... bernstein/

MISTAKE #4: Pricking your finger the wrong way. If you use a glucose meter, your doctor will probably tell you to wipe the site with alcohol before pricking it. I disagree.

First, it isn’t necessary to wipe your finger with alcohol—this dries out the skin and can lead to calluses, which makes it difficult to get a blood sample. Neither my patients nor I have ever developed an infection from not using alcohol.

However, you should wash your hands before drawing blood. This is especially true if you’ve been handling food or glucose tablets or applied hand cream—all of which can cause false high readings. Helpful: Rinse your finger with warm water to get the blood flowing, and prick the back of your finger between the joints—this area may produce more blood and cause less pain.

http://www.bottomlinepublications.com/c ... l-diabetes

There is an email address to get his recommendation here http://thelowcarbdiabetic.blogspot.com/ ... -been.html

Mine works well enough for my purposes. So I've not bothered to get the absolute best.

As to CIMT testing frequency, I'm not sure. Maybe at 4 months to see what has happened.

[Julie G]

Stavia, apologies for briefly hijacking your thread, but I wanted to throw a few ideas out for George. Your results are unusual for sure, my friend. I hear your frustration. I've been poking around, trying to figure out what might be contributing to your high TGs. I've come up with a few ideas...

-Are you fasting for 12 hours before testing TGs. From what I've read, if you don't; results will be unreliable.

-Elevated TGs can be an indication of excess energy/calories. I know you've played around with IF, but that MAY be exacerbating the problem if you eat more to compensate for the fasting period. Perhaps consistently eating 15-20% less for a few days/weeks will bring those numbers in line as opposed to yo-yo fasting/feasting.

-Lastly, have you measured your VLDLs? They have a strong correlation with TGs. My guess is that something is going wrong with your lipid metabolism to cause this abnormality. VLDLs function fairly upstream in the process, transporting lipids. Yours seem to be hanging on to their cargo- not performing their job well. Here's an interesting blog that examines this phenomenon: http://healthcorrelator.blogspot.com/20 ... trial.html

Now, back to Stavia I'm not attempting to fully explain her high glucose results on an LC diet, but I just wanted to share my experience to contribute to our general understanding. I hear that your BG is very low when you're in ketosis, George. FWIW, mine is not. My BG is typically quite low: 60s-70s unless I'm in ketosis. My BGs have surprised me a few times with measurements in the low 90s with ketones around 1.8 mmol/L. That would be the highest BG I've caught- but it's not an unusual phenomenon for me for BG to rise with ketone production. I have a few other ideas about what might have been going on with Stavia... but this could have been a contributor.

[circular]

Posted this by accident in another thread - second forum demerit for the morning! ...

Thought this is worth posting for some context on CIMT. The article was written in 2012:

"In a recent analysis of 14 studies involving over 45,000 men and women, Dr. Hester M. Den Ruijter and associates found that the test did very little to change an individual’s calculated risk for heart disease over 10 years. In their study, published in the August 22, 2012 edition of the Journal of the American Medical Association, less than one percent of people undergoing the test would have their cardiovascular risk status reclassified on the basis of their CIMT. The test was only slightly more effective if just those at intermediate risk were evaluated.

What this means is that the risk factors we can easily and cheaply identify are the most powerful predictors of heart disease and stroke. The CIMT is not harmful, but it it’s not cheap. Typical costs run around $150 to $500, and insurance does not generally cover the test.

The CIMT should not be confused with a carotid Doppler exam. This is a much more detailed ultrasound study of the neck arteries, and is generally performed when a blockage is suspected. "

http://www.healthline.com/health-blogs/ ... h-the-cost

[Stavia]

No worries Julie. Its all fascinating

[Julie G]

Quickly, before I sign off...thanks for bringing this up, Circ. My Hubs and I just did ours. We both got preliminary results of no plaque- phew, but we're awaiting the detailed measurements that may be more telling.

My thoughts are a little different than those expressed by Dr. Ruijter. He's evaluating the CIMT Test from a cost/benefit perspective based on a large population pool. As a 4/4, already at increased risk of CAD; I'm looking at the test as an opportunity to have one more biomarker to add to my full clinical picture. Depending on which research I believe, my diet strategy may put me at an even higher risk. This test demonstrates actual plaque in carotid arteries that correlates well with coronary plaque in younger patients with NO risk of radiation. The results may modify my strategy moving forward. Coronary artery disease is preventable, quantitatively definable, and treatable- if caught early. I could follow Dr. Ruijter's advice (typical of 99.9% of physicians) and just wait for an event, and then make changes... if I survive. Or, I can proactively quantify my risk and make adjustments as warranted- hence my decision.

BTW, insurance covers the carotid Doppler exam that Dr. Ruijter describes. It DOES check for blockages, but the standard applied recommends NO action (NORMAL result) before a 70-80% blockage. If you get an "all clear," it may not mean much. I got great results (really low pressures,) but one side was different than the other- hmmm. In a CIMT, actual measurements of the carotid intima-media thickness are taken on both sides. The patient is given actual numbers and an indication of how those compare to peers of your same sex/age.

[circular]

Juliegee I get going ahead and doing it too. Anyone can be the one it does make a difference for. But I didn't read her suggesting people just wait for an event, but rather saying that standard biomarker tests, or at least "risk factors we can easily and cheaply identify", are darn near equivalent according to the study cited.

I may do it too, but I think it points up the possibility that someone tight on funds may not need to feel they're missing much if they can't or don't want to spend on it at a given time?

[Julie G]

I hear you, Circ. You make a good point re. the financial aspect. I would propose that the problem with relying on other biomarkers, (in this case- one's Framingham's risk score) is that they are mere correlations. The CIMT and EBT measure actual plaque. One could still argue (and rightfully so) that the CIMT is also a correlation; carotid plaque as an indication of coronary plaque.

I tracked down full-text of the actual paper: http://jama.jamanetwork.com/article.asp ... id=1352111

[KatieS]

Guess, I should look at the actual study, but I think it means that only 1% needed an intervention such as carotid artery surgery, not looking at the IMT 0.8 and above and considering statins or other preventative interventions.

For insurance coverage, my justification was the visual migraines, which does put you at higher stroke risk. I would think hypertension, high cholesterol or the HFLC diet could also justify.

Julie, my pressures were not symmetric and 0.6 and 0.7mm measurements. The tech acted like my carotids were like hoses, (I could see it too ) and even reassured me before the full report.

[circular]

Oh Juliegee, thanks. I googled the Framingham risk and found a calculator. Rather superficial, isn't it! I came out with a .2 10 year risk, but maybe I'll do the CIMT one of these days. My doctor stopped working with that fabulous HDLabs before I could get my second sample in last spring, so I have to figure out where to get all those good values and get my new doc on board with those labs first.

[Tincup]

Julie

"-Are you fasting for 12 hours before testing TGs." Yes, usually 11 or 12 when I test on my own machine, more like 14 when I get a lab NMR.

"-Elevated TGs can be an indication of excess energy/calories." I don't think so, I worry about getting enough. I usually eat 1 to 2x/day. Usually VLC/HF. My protein intake is modest for my size and activity level - 50-60g/day I'm 6'0" 174#. As I've posted, the odd thing is that the TGs are stellar when I go for excess carbs/calories. In the 50 range after a carb nite vs. 94 for fasting and most other scenarios. I just got an NMR back from a post carb nite test. I need to organize all my tests & post, along with comments about lifestyle/food input before the tests. It is puzzling to me that my responses seem the reverse of the standard. I'd be willing to bet that I could fast for a week and not get my TG's as low as after a carb nite.

"-Lastly, have you measured your VLDLs? They have a strong correlation with TGs. " All the VLDL's on my tests are calculated, even the NMR's.

Circ,

As to standard risk factors. I know how to make them perfect, for me. Just eat a high carb diet. I did this for decades and had decades of great TG/HDL/TC/LDL. I also watched my weight creep up and my postprandial glucose get worse. I know this is a bad plan. I know what eating this way consistently does to my blood sugar and insulin. As Stavia points out, glucose always trumps lipids. I also know that the lipid correlations with CVD do not always hold with food input other than SAD. So where does that leave me - with a CIMT. I can get them done for $125 US, so well worth it to me.