I’m so sorry to hear of your frustrations, but let me start by reminding you I am not a medical professional, I have no formal background, I just read and research, and am fortunate to have a good doctor. Also remember when I talk about my markers, I’m just one datapoint, we’re all different.
Jan18 wrote:I finally returned from traveling and met with my doctor, for whom I have mixed feelings...but that's a topic for another day.
Feeling comfortable and confident with your doctor is important. I know you’re not made of money, so it can be a difficult decision to fire one’s doctor. You have mixed feelings, but the decision is one only you can make.
Did your doctor go strictly by the reference ranges from the lab report? When you say “optimal” is that the doctor’s range or the lab’s range? Reference ranges on lab reports are a statistical construct. Earlier this year a paper reported that only 12% of the population in the US are metabolically healthy, that means that the reference ranges are being established with a population that is overwhelmingly unhealthy. So a person may be in company with many other people, but those people aren’t healthy. With certain markers, my doctor will see that I’m green but he may want me to do better. With others I’ll be red and he won’t be the least concerned. We tell him when there’s been a recent fasting period that or that or there’s been a lot of stress lately, etc. that can explain why some markers are the way they are. Also when one marker seems off, he’ll look at others to put the pieces of the puzzle together. There have been times when one marker is odd, he’ll look at others for a better understanding. A doctor needs to understand lab tests and the patient, not just read a report.
Jan18 wrote:LDL-P went from 2589 to 2030 (but needs to be under 1100, so it's still 2x what it should be.)
VLDL-P is 343 (2x what it should be) since optimal is under 150.
Jan18 wrote:My sdLDL-C got worse! It went from 35 (mildly elevated) to 57! (Didn't I read somewhere that it can go up as you lose weight and not to be freaked out or am I mistaken?)
My doctor (Dr Gundry) doesn’t pay attention to many of the lipid markers on my lab results. My LDL is always high, he’s never said anything about it, it’s one of the markers he passes over. Likely it’s high because I’m ApoE4/4. He says most of those markers are on lab tests an effort to sell statins. (I’ve heard that just about all markers are drawn only if a drug can be prescribed). But I guess he can’t just pick the tests he want, it’s like buying cable, you have to get the set for the one you want.
Lastly, he doesn’t concentrate on just my lipid markers. If your doctor is emphasizing them, I’d say that’s a red flag. Remember what the primer emphasizes about glycemic control trumping lipids every time despite the fact that ApoE4s do tend to run high. You didn’t say anything about HbA1c, fasting glucose, or fasting insulin, if they weren’t tested I’d be very concerned. Let me say again, I’m not a doctor nor do I have any formal training in this area, but the “vibe” I get from how you’ve described your situation centers around insulin resistance and those are key markers for insulin resistance.
My doc likes HDL to Triglyceride ratio, (I also understand ratios are far more telling than individual biomarkers). The desired outcome of HDL to TG is 1:1 or with HDL being higher than Triglycerides. Was this taken? I’m very curious as to what they are. A person with high triglycerides, low HDL, and small dense LDLs is likely to have a fatty liver even if they are a lean/normal weight person. You have high sdLDLs, from what you’ve said in the past, you do seem to be insulin resistant and Non-Alcoholic Fatty Liver disease (NAFLD) is a common result of insulin resistance. This leads to abnormalities in liver function and when people with fatty liver wake up in the morning they tend to have high glucose even though they haven’t eaten for 8-10 hours. Do you happen to have a glucometer to test your morning glucose (or a dual meter that will also measure ketones)? Did your doctor test your liver (hepatic) enzymes?
Jan18 wrote:ApoB is 137 (high) and ApoA-1 is 146 (optimal) and the ratio is .94 and it should be less than .60.
My ApoB is always high, probably because I’m ApoE4, but my ratio is always good. My doc has never looked at my ApoB in isolation, he looks at the ratio. In your case it is high, so that’s something to work on.
Jan18 wrote:My Lp-PLA2 Activity went from 325 (high) to 175 (optimal.) I don't get how this measure of vascular inflammation is great, if my oxidized LDL is still so high. Can anyone speak to this?
My Lp-PLA2 activity has been high on a number of occasions accompanied by an oxLDL in a good range, so I don’t think there’s a direct correlation. Here’s what my doctor said from the transcript of my last consult:
So Lp-PLA2 Activity, that’s the stickiness of your blood vessels popped up as well, so that’s why I was trying to figure out if there was something right around the time of this test. And it doesn’t look like it from reading your notes. Hmm, okay. Yeah your CRP isn’t up, so that’s good, let me jump forward to your myeloperoxidase, no you myeloperoxidase is phenomenally good. Okay, forget I asked.
Jan18 wrote:And here's one she is freaked about: Uric Acid is 7.1 (high) and could mean a gout attack in the future.
Yes, uric acid can go up with fasting and can indicate a future gout attack, but it can say other things too.
Uric acid is also another marker to determine insulin resistance. Go to the wiki on insulin resistance, https://www.apoe4.info/wiki/Insulin_Resistance scroll down to the large graphic “Diagnosis Diet – Insulin Resistance Tests” that shows tests for Insulin Resistance. You might also want to read the article that’s linked in the caption.
I’m curious, do you eat a lot of fruit or foods with fructose corn syrup? Fructose corn syrup can be found in many foods that come in packages, even if they’re not sweet. Fructose elevates uric acid. Fructose also contributes to Non-Alcoholic Fatty liver disease (NAFLD). The only organ that can metabolize fructose in significant amounts is the liver and so if overloaded, it will turn the fructose into fat. Of course, NAFLD can occur just from eating too many carbs/sugars, not just fructose, and is a common pre-Type 2 Diabetes condition.
Jan18 wrote:said to increase my magnesium to combat the constipative effects of iron.
Magnesium does help with constipation and many of us do tend to have low levels of magnesium. But I’m curious if there was any discussion on gut biome? Gut dysbiosis will also make it hard to lose weight. Those bad gut bugs love bad foods, makes us crave bad foods. They crowd out good gut bugs. The gut is connected to so many things, including a strong gut to brain connection. Any discussion on increasing soluble fiber to try to encourage more good gut bugs? Prebiotics and probiotics (Dr Gundry discusses gut biome and foods with prebiotics and probiotics in his Plant Paradox book). This is something I’ve personally been trying to work on more lately. A healthy gut also results in more regular, comfortable bowel movements and a happier brain.
Jan18 wrote:Ferritin (20 optimal.)
That’s great!!! Ferritin is a good marker for inflammation and heart disease. I learned about ferritin from Ivor Cummins. He couldn’t get reasonable answers from doctors about his high ferritin, so he dug into the research, and has been able to lower it. I googled Ivor Cummins and ferritin, you may want to read this: Iron is the New Cholesterol.
Jan18 wrote:Free fatty acids went from .86 (high) to .53 (optimal.)
This test is usually done to reflect the acid content in the blood from rancidity of edible fats and oils. But it can also reflect the acid environment that comes with ketosis. My free fatty acids are typically high because I’m typically in mild ketosis. You’re intermittent fasting and I presume you’re calorie restricting, so it’s interesting that the FFA test indicates you’re not making ketones, but if you’re insulin resistant, the insulin resistance can prevent the body’s fat tissue from releasing the fatty acids that are used to make ketones.
Jan18 wrote:My T4 Total and Free, T3 Total and Free and Reverse T3 are all optimal, but my TSH is mildly elevated. She didn't even speak about that. Anyone?
When my TSH started creeping up despite the other thyroid markers looking good, my doc just said he’d keep an eye on it, Sometimes it's best not to react to just one test result, but to see how it trends. When my TSH kept creeping up, he ordered a set of anti-thyroid tests. Fortunately those were negative and I’m now taking 200 mg (four 50 mg pills a day) of organic Spirulina and I add iodized salt to my food, keeping my fingers crossed that my TSH is good on my next test.
Jan18 wrote:I am kind of confused by all of the results and how fast she goes through them and always think of lots of questions AFTER our appointment. She'll take an email or two of questions, but then suggests I come in again to talk and at insurance-UNcovered $360 an hour, that can get really expensive fast. <sigh>
That is expensive. So are our consults that are not covered by insurance, although the lab tests are partially, here’s what we do to maximize our consults. We get the results of the tests before the consults and study them, do some research on the outliers to generate quality questions/areas of concern BEFORE our consult. Before the consult we submit a written summation of dietary practices (like for this next consult we’ll address our gut biome strategies) and a list of supplements (prescription drugs if we took them, because they can distort some results too) so our doc has the whole picture not just the lab results. For the consult, we ask if it’s okay to record the conversation, then I transcribe the recording of the consult for reference later since ears and memory are unreliable, this eliminates, “So what did the doctor say about XXX?”
Jan18 wrote:Every time we do blood tests, they seem to include different tests and I'm not sure why. I wish she would just focus on Bredesen's cognoscopy (is that the word?) and I'm wondering about getting a different doctor. What do you all think?
Purpose of cognoscopy is to identify areas that need to be addressed, you work on first things first, then go to the next layer. Sometimes there are good reasons for adding a new test or a new test gets developed. The tests and labs I've had are different than when I started 5 years ago. We’re always tweaking, us and our doctor, there is no finish line, the body changes, research learns new things, labs discover new, more precise/predictive tests, or the medical director at a lab changes and the doctor doesn't like his/her approach, many things.