First let me say that my doctor and RXs are from the dept Veterans Affairs hospital and free for me, so I cant complain. I am a very healthy, paleo eater and crossfitter and NEVER get sick. My sole use of the VA Hospital is to get prescriptions for Insulin, as I am a type 1 diabetic. Im a very well controled T1D, thanks to a low carb diet.
Me- I'm 32 years old, about 8% bodyfat, paleo diet 90% of the time, and low carb. I take very little insulin- 10 units of nighttime lantus, and 1-3 units of fast acting novalog with meals.
I recently got bloodwork done and these were my results--
hA1C - 6.1
My doctor says my hA1C was great. I say, no way! I usually have my a1C in the low 5's. I said its probably a bit high since, Ive been traveling the past few months and not eating right. But this wasnt the issue...
My doctor said my LDL is too high and she wanted to think about putting me on a statin drug. Ha! Shes never even asked me anything about my diet, or suggested I first try to bring it down without drugs. I think my cholesterol looks pretty good, am I right?
From what I've read, my LDL is probably OK.. its most likely large harmless LDL particles not the dangerous dense ones, right? Id like to get this checked, but not sure that the VA Hospital will do it. I explained this to my doctor, but she didnt understand any of that, and had never heard of different sized LDLs. She said she needed to speak with an endocrinologist. She wasnt sure if i'd be able to get a particle size test ("if it exists"... her words!), but would ask the endo.
I'm supposed to see her again on monday. What can I say or provide to my somewhat stubborn doctor to get her off my back? Maybe after she talks to the endocrinologist it will be OK... are Endos usually knowledgeable on this kind of stuff?
Ideally I want to be able to call for new RXs and get them quickly, with her confident that I am a healthy diabetic.
Also,just to note, she is an MBBS, not an MD. I had to look up what an MBBS, apparently the equivalent of MD in other countries (especially India). Not sure if this makes a difference.
Ask her for a comprehensive cholesterol panel that breaks out VLDL as well. This is what you're concerned about, and is the term she will understand. "Dense," and "fluffy" are colloquial terms we use to get around complex biochemistry in our discussions.
And greymouser is right: just say no to the statins. If you want to get her off your back real hard, eat a ton of fat over the weekend and try to amp your HDL above 60 on further tests ... the American Heart Association's guidelines state that HDL >60 is a -1 risk factor for heart disease. It effectively counteracts any other risk factors.
You might also point out to her that recent longitudinal studies of statin use show that there is only one population in which statin use is associated with improved cardiovascular outcomes: males over the age of 55 with at least one previous cardiovascular incident. ALL other populations show either no positive effect on cardiovascular outcomes or, in some cases, a negative effect.
You might also print out and give her this article:
You can say "no". You can choose not to take the pills, or even fill out the prescription if given.
However, I think one's relationship with a doctor is rather important -- I wouldn't try to "educate" or "convince" the doctor - hopefully your questions opened their eyes a bit, and they will educate themselves. You have every right to politely decline taking drugs when you feel healthy, and you have every right to explain to the doctor that you are concerned that they are not using all available tests (for cholesterol) before prescribing drugs.
Personally, I'd find a different doctor. Not necessarily a "paleo friendly" one, but one that is open to tests and lifestyle changes (if needed) before drugs.
I don't really think you can ever change your doctor's mind. It's partially because you don't have any authority in their minds and partially because they get punished when they don't follow standard advice and then something bad happens.
Meaning -- if you go on statin and something bad happens, they are ok. If they tell you you are ok, and then you have a heart attack and have 90% blockage of arteries, they are in trouble. It's not really their fault, but the system is just all wrong.
But, if you want to try, here's my totally ignorant advice (I AM NOT A DOCTOR)
Your LDL is within the error bar of optimal, which I have read is 20mg/dL. Ask the doctor -- how accurate is the reading? Go look up this information and have it ready.
Tell them you are going to try diet and exercise first. Don't ask -- tell. You are responsible for your own health.
Next test, make sure you are hydrated. You have to fast, but you need water. I had a really bad reading on a day when I was obviously dehydrated.
Increase your ingestion of soluable fiber: I have this on my fridge, with paleo choices highlighted http://huhs.harvard.edu/assets/File/OurServices/Service_Nutrition_Fiber.pdf
Yor numbers are superb. Your ratios are superb. My goal is to have your lipid numbers.(if I actually cared!:) The doctor is ignorant. Worst case senerio, put the script in your pocket, never fill it ..........You are the cholestorol rock star. The doctor is twenty years out of date, even within her foolish "STATIN"paridigm . Wow.Talk about the blind leading the 20/20 sighted!
Paul of the PHD has some great posts on Biomarkers. If I were you I would educate myself first and then go forward with the doc. I'm not sure I would try to educate my own doctor.. that seems like a practice in futility, but whatever flips your skirt. Here is a good place to start.. Paul talks about blood lipids and their connection to infectious disease. http://perfecthealthdiet.com/?p=3836
PS. Your markers look good to me.
Endocrinologists are not educated in cholsterol. Maybe a cardiologist might be a better option. What you want is a VAP test. http://www.atherotech.com/vapcholtest/ VAP tests directly measure LDL, whereas what you have is a calculated LDL. And it was likely oversetimated because the Iraninan study showed that when you have triglycerides under 100 the Fryenwald equation overstimates LDL pretty much every time (compared to VAP test measurements).
Once you have VAP ressults, you can begin to discuss LDL particle size and relative risk.
You can also talk about how statin usage greatly increases in incidence of diabetes. It won't help you but it might save someone else in the future.
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