Karelena's NMR

[Stavia]

my 2 cents worth: I would be concerned about pushing up your LDLp even though your calcium score is zero because as a 4/4 woman your AD risk is greater than your CVD risk. And Dr Kraus mentioned the risk association.
I would also not increase your saturated fat because it will drive increased larger LDL through down regulation of LDL receptors and hence decreased clearance.
Have you seen the paper linking saturated fat with dementia risk?
http://www.sciencedirect.com/science/ar ... 8014003558

[Tincup]

Stavia,

I wouldn't want to push it up much, but would accept a little bit. It is always the tradeoff between serum glucose elevation (A1C) vs lipid elevation. Most of us are all trying to lower both - hence our high intake of EVOO. Reading a full copy of the paper you linked http://www.neurobiologyofaging.org/arti ... 0355-8/pdf, the association seems pretty weak. It is not like the diets are controlled, just what people remember they eat: "All studies assessed dietary intake using food frequency questionnaires, except for the CAIDE study, which as noted previously, used a 20-item dietary questionnaire limited to questions about dairy
products and spreads". Dr. Barnard is a strident vegan and pushes a very low fat vegan diet. Barnard's diet is a (IMO healthier) variant of Dr. Walter Kempner's "rice diet." Kempner, starting in the late 1930's, was able to put Type II diabetics in remission with a diet of zero added fat and very low fat carbohydrate foods such as rice, sugar and fruit (though he is known for literally whipping his patients to keep them on his diet!). Interestingly, if Kempner's patients even added 1 tsp of oil to their diets, he had to put them back on insulin.

[Stavia]

It's really hard walking thru our minefield huh George. I wasn't aware of the possible bias in the sat fat paper, thanks so much for telling us. Sigh. So hard.
Bredesen did say his number one target was IR. We need to keep our eye on the main target.

[karelena]

Thank you all so much for your advice!

I have been on no-flush niacin but I am now starting regular niacin and I have ordered TMG, grape seed oil and pycnogenol. I will retest homocysteine in 1 month.

I can order any test imaginable through direct labs or walk in labs and labcorp. What else should I test? Dr. Bredesen mentioned vit B12 level, rbc magnesium, zinc, copper, hormones when I had a very brief conversation when we first met.

Should I check my insulin level?

Thank you again for all your help!
K

[karelena]

Also I have been on N-acetyl cysteine but not every day so I am now taking 600mg every day.
K

[Russ]

Stavia,

It is always the tradeoff between serum glucose elevation (A1C) vs lipid elevation. Most of us are all trying to lower both - hence our high intake of EVOO.

I know y'all are tired of my variability thing, but just want to note that even though I truly enjoy my EVOO and Avocados pretty much every day, I remain concerned that that may not be the right approach? Is it possible to resolve the glucose/lipid challenge through variability? Feels like an interesting N=1 experiment, but hard to resolve, and not sure I have the time and patience to do.

[Stavia]

Karelena I have always thought that IR was paramount and Dale confirmed this when I asked him at lunch what his hierarchy was. He said immediately IR then inflammation
HbA1c as you know is a crude tool (as it is dependent on RBC lifespan and other factors) but a good indication. I feel fasting insulin is a must. You should aim for 5 or less. Yes I know "eeeek" but I promise it's doable. Mine is 3 to 4. It was 8 a year ago.
Random capillary glucose with a home glucometer IMO are just to keep you honest and their main utility IMO is to let you know what exactly your glucose is an hour after that little cheat with cake or pizza or a high carb meal. I personally don't feel that it is necessary to drive fasting glucose rock bottom, but its a good secondary indicator. You shouldn't be waking at more than 5ish mmol/l.
But to take a step back, your first measurement to target should be waist circumference. Visceral fat is a direct cause of both IR and inflammation.

Then there are all the fabulous inflammatory markers you guys can do. I personally wouldn't worry about them yet until you have sorted your IR. Because IR will be directly causing inflammation.

He also said TSH should be less than 2. Dunno what to do if its not, I guess supplement. You might want to do antithyroid antibodies to make sure you don't have subclinical Hashimotos. If you do, you need to watch your TSH like a hawk every 3 to 6 months for life.

[Tincup]

A note on niacin. Once I started on 1g/day of Slo-Niacin, my fasting insulin went from ~3.3 to 5.

[Tincup]

Is it possible to resolve the glucose/lipid challenge through variability? Feels like an interesting N=1 experiment, but hard to resolve, and not sure I have the time and patience to do.

Along the lines of Kiefer's Carb Nite & Carb Backloading, I presume. His sidekick, Dr. Rocky (Patel), probably has more experience with this approach clinically than anyone. Rocky doesn't worry about ApoE unless they have a bad family history.

My home tester (CardioChek) will go off scale low for Tg's (<50) the morning after a Carb Nite. Some serial Tg testing after eating fat suggests a longer time to clear Tg's from my system than normal (normal is a spike followed by a decline). Most normals will be at baseline after 12 hours. I can take 16 to 20 hours. The results from an NMR after a Carb Nite were essentially the same as from a 36 hour fast - LDL-P ~1300 small LDL-P 230. My most recent NMR after six months on the high EVOO, no animal or dairy fat except omega 3 eggs, shell & white fish and 3 months on 1 g/day Slo-Niacin was LDL-P 1289, small LDL-P <90 (off scale low).

This probably means I could do a very low fat vegan diet with higher carbs and have good results, though I have autoimmune issues with grain & legume proteins.

[Stavia]

hmm...5 still excellent! I really think as low as 3 is just for bragging rights (I am at fault here, I'm very competitive. When I was talking to my software engineer son about my results he said "so...are your numbers better than everyone else's numbers?" He knows how competitive I am lolol).
5 is really really stellar IMO