Hi all. In August 2009 I went into the ER in the middle of the night after waking with a massive headache and what I thought was indigestion. I remember the headache because I hardly ever get headaches and actually got out of bed to take an aspirin (something else I normally never do). Anyway my troponin levels were elevated and I was told I just had a heart attack.
Hard to believe, I was 34, 5'9, 155 lbs, ate what I thought was a healthy diet (SAD), and lifted weights frequently. I looked and thought I was in peak condition. I had a heart cath and was told I had no damage and no blockage (I will upload the video if there's any interest). My total cholesterol was 115 (HDL 16, LDL 74, TG 126). I was eventually put on 20mg pravistatin.
I have since been on a mission to learn as much as I can and make whatever changes necessary. This first led me to eating a very strict low fat diet and doing an insane amount of cardio exercise. This brought my cholesterol to 138 (HDL 31, LDL 69, TG 111) on 3/21/2011. I dropped to about 145-150 lbs.
Not convinced that this was any better than before I kept searching and eventually found Marks Daily Apple. Sometime in May I started to make changes to my diet (I still lift weights and do cardio occasionally) lowering carbs and eating more eggs, red meat, and vegetables. I did another lipid panel on 7/15 and and my cholesterol was 155 (HDL 39, LDL 90, TG 130). Later that week I committed to a much more primal diet.
Since then my typical breakfast is egg casserole (local farm pastured eggs, local farm sausage, organic vegetables) with a glass of milk (full fat, organic). Throughout the morning I drink a 2 cup mug of coffee that contains half/half and a tbsp of honey. Lunch is a salad with hard boiled eggs and or avocado with olive oil. Dinner is typically either salmon or grass fed beef with veggies. I also eat a few squares of 90% coca daily.
On 8/19 I (prematurely) did another lipid panel (I'm an accountant so its all about the numbers for me) and cholesterol was 159 (HDL 34, LDL 98, TG 135). This worried me but I eventually found that this is a normal liver defatting stage. At this time I weighed 142. I also had the following tested: Glusoce 97 hsCRP 1.2 A1c 5.5
Thinking another 6 weeks should be enough time to defat my liver I got another lipid panel done Friday (9/30). I'm down to about 140lbs. Total cholesterol is now 183 (HDL 39, LDL 120, TG 120). I realize I should have had a VAP/NMR done and will do this for my next test.
Are my numbers improving yet?
Should my numbers be improving yet?
Am I doing anything that is preventing my HDL from going up/TG's from going down? When should I do my NMR lipoprofile? Any other suggestions?
edit: ECG from cardiologist appointments: 4/09/10 rate 62 pr 132 qrsd 76 qt 376 qtc 382 axis p -20 qrs 85 t 24 normal ecg unconfirmed diagnosis 10/08/2010 rate 92 pr 140 qrsd 80 qt 332 atc 411 axis p 58 qrs 90 t 42 borderline right axis deviation qrs axis (90,110) otherwise normal ecg unconfirmed diagnosis 04/08/2011 rate 65 pr 128 qrsd 79 qt 360 qtc 374 axis p 12 qrs 84 t 52 normal ecg unconfirmed diagnosis.
Have another cardiologist appointment this Friday.
Actually, most mainstream cardiologists in the know would say that your low HDL is immaterial because your total cholesterol and LDL are also low. Remember, the Kitavans have very low HDLs but they are not known to suffer heart attacks. The Tarahumaras of Mexico, who live on three sisters (squash, beans, and corn) are known to have HDLs in the teens (and TC under 100). They also don't have heart problems. At least, that's the vegan-Castelli-Framingham argument: if your TC or LDL is low (~100; , you don't need a busy working crew of Roto Rooter (HDL). At least that was so until recently, when your TC went up and your HDL has been stagnant.
Your Trigs are high and remain elevated even on a whole foods diet. Your CRP is also high for someone eating whole foods. Your A1c isn't too good for a nondiabetic and you're insulin resistant. How are your liver enzymes? Do you have some underlying issues like autoimmune diseases? I think you would need a whole host of inflammation markers (homocysteine, etc.) to be tested. Your numbers don't seem to be improving, despite eating healthy. They're actually getting worse, except for some HDL increase but that's negated by TC going up.
The issue is largely suggested by your elevated Trigs, in relation to HDL, and despite your avoidance of processed carbs. Something is preventing your Trigs to drop and your LDL is going up: it might indeed be ApoEE. If you're taking calcium supplements, I would stop. Consider taking fish oil.
Are you male or female? If female, the most important marker is your LP(a), which could be elevated, as it is genetically determined. Forget LDL/HDL/Trigs, if that's the case.
I would suspect a parasitic infection, perhaps trypanosomes.
First, your serum cholesterol is way too low and the most likely cause is a parasitic - protozoal - infection. You might read the various posts in this series, especially the ones about hunter-gatherer serum cholesterol levels: http://perfecthealthdiet.com/?cat=140.
Second, indigestion and headache may be more consistent with a parasitic infection than a heart attack.
Third, parasitic infections can cause cardiac damage and high cardiac troponin levels. For trypanosomes doing this see http://www.ncbi.nlm.nih.gov/pubmed/21283741, http://www.ncbi.nlm.nih.gov/pubmed/16075261. Some parasites also produce proteins that closely resemble troponin, eg http://www.ncbi.nlm.nih.gov/pubmed/19090648.
There's no obvious reason for a young, healthy, atherosclerosis-free person to have heart damage apart from an infection, so I would look carefully into this. The low cholesterol is a great clue that your infection is protozoal.
I would go for the something that can only help and almost certanly not hurt. Since you had heart attack, lets boost the heart first:
My bet is you have a very leaky gut that needs a good hack and few other things to think about.....apoE4 allele is in play, low vitamin D levels, suboptimal free and total testosterone, low thyroid function, low dhea-s, low pregnenolone levels, and poor sleep.
Get those labs and i bet some trends appear. Your low HDL is a major clue.
You mentioned a prodromal viral-like syndrome in the days prior leading to the ACS?
Have you considered being tested for Parvo B19 antibodies?
The inflammatory damage simulate coronary spasm/damage and NSTEMI 'infarctions'. http://content.onlinejacc.org/cgi/content/full/52/7/523
Avoiding saturated fats, eating high refined carbs (high glycemic index, gluten-related gut dysbiosis, vast omega-3 deficiencies, excessive canola/corn oils products, blah blah blah) put you in a good spot for a viral syndrome and hugely impaired immunity to tackle a virus.
HDL of 16 OMG WTF???! You are lucky you discovered resources on the net and now on a more decent diet and lifestyles.
Personally I have a lot of anti-statin material I am too lazy to post here but consider the value of ignoring the LDL count but consider the quality (buoyancy) and other biomarkers of health (gut testing, get digestion perked up, optimal/perfect hormones, CoQ10, etc)
Good luck and please keep us posted on your continued progress and learning!
Did you see THIS or the NACB diagnostic guidelines?
• Trauma (including contusion, ablation, pacing, ICD firings including atrial defibrillators, cardioversion, endomyocardial biopsy, cardiac surgery, after interventional closure of ASDs)
• Congestive heart failure–acute and chronic
• Aortic valve disease and HOCM with significant LVH
• Hypotension, often with arrhythmias
• Postoperative noncardiac surgery patients who seem to do well
• Renal failure
• Critically ill patients, especially with diabetes, respiratory failure, gastrointestinal bleeding, sepsis
• Drug toxicity, e.g., adriamycin, 5-fluorouracil, herceptin, snake venoms, carbon monoxide poisoning
• Abnormalities in coronary vasomotion, including coronary vasospasm
• Apical ballooning syndrome
• Inflammatory diseases e.g., myocarditis, eg. parvovirus B19, Kawasaki disease, sarcoid, smallpox vaccination, or myocardial extension of BE
• Post PCI patients who appear to be uncomplicated
• Pulmonary embolism, severe pulmonary hypertension
• Burns, especially if total surface burn area (TBSA) 30%
• Infiltrative diseases including amyloidosis, hemachromatosis, sarcoidosis and scleroderma
• Acute neurological disease, including cerebrovascular accident, subarchnoid bleeds
• Rhabdomyolysis with cardiac injury
• Transplant vasculopathy
• Vital Exhaustion
1Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 2005;173:1191–202.
I think you need to work on increasing HDL and decreasing TG via a high volume of low intensity exercise and cutting out all fructose from your diet. It's the oxidation of VLDL (the transporter of endogenous TGs) or LDL that likely played a role in your heart attack. So long as you have elevated TGs, you likely have a Pattern B particle size since the synthesis of VLDL in the liver soaks up cholesterol and results in LDLs that contain less cholesterol and are thus smaller in size. These smaller lipoproteins can much more easily become trapped in the arterial linings.
You should also make sure that you're taking vitamin K2 in order to pull any calcium that may be in your arteries out and deposit it in bone. Additionally, you probably should not consume dairy until you do this, as more dietary calcium is working against you. That may have been a factor in your heart attack. As far as the rest of your diet goes, I would increase fat from grass-fed red meat and shoot for a total cholesterol of 200-240.
Edit: That walking would be far more advantageous if it were in the fasted state.
Your HDL is very low, your triglyderides are way too high. Low HDL is indicative of Leaky Gut Syndrome. The following from Dr. Kruse, The Quilt.
[quote]It appears when your plasma HDL is low, so is your level of paraoxonase. So HDL is a type of a clinical marker for paraoxanase (and perhaps Vitamin K2 levels by extrapolation). This should explain to you why I use HDL as a measure of how leaky our gut is (and why your Vitamin K2 is likely low too) to endotoxins that then are able to oxidize our LDL molecules. The absolute level of LDL is of little consequence to me in clinical evaluation. The level of oxidation of the plasma, however, is hugely important. So when one has a low HDL, high HS-CRP and a high ferritin level you have the “trifecta of a highly inflammatory serum plasma” and one that causes all kinds of neolithic diseases. This was explained in detail in my VAP and leaky gut posts here.[/quote]
You need to be on Dr. kruse's Leptin Reset Protocol to get you back to a healthy state. Many are now reaping the benefits of his protocol. Look for it Leptin Prescription. You can prevent another heart attack but you must change your lifestyle in what you eat and how you think.
Takotsubo cardiomyopathy --> google it
The condition is transient and presents as a NSTEMI (Non-ST elevation myocardial infarction) heart attack with typical heart attack physical symptoms and a small rise in troponins. Coronaries are usually 100% clean.
Slang name is "Broken Heart Syndrome" because it is sometimes brought on by stress. It causes a ballooning of the apical region of the heart due to a weakening in the muscle of that area of the heart.
More common in women.
Any recent stressful events in your life?
Have you been tested for obstructive sleep apnea (OSA)? It is a common cause of unexplained heart attacks and affecting roughly 1/4 of men it is not rare. You aren't overweight but that's only a risk factor - visit the OSA forums and you'll find plenty of otherwise healthy sufferers, myself included. Some people get daytime tiredness but not all, I think less so at your age. My AHI was 50 and I only discovered that I had it because I was chasing down a mildly elevated serum CO2, which was probably unrelated. My father in law is the same but only discovered it after a heart attack like you, though he's older. Nighttime and morning headaches are one of the hallmark symptoms of sleep apnea. Hyopia leads to CO2 retention, which may not last to the day when your doctor checks it, which causes the headaches. To diagnose it you just get a sleep study, which isn't too bad.