If you recall, I'm the OP from the "Had a Heart Attack" thread. http://paleohacks.com/questions/68443/had-a-heart-attack-need-suggestions#axzz1Zimd5Kbd
Anyway, before going off on any of the suggestions, I thought a VAP might be helpful. Well, now I'm really unsure of what to do from here. I guess as suggested in the other thread I need to go down the Virus path and have that checked out. Anything else here that jumps out at you?
Glucose, Serum 95 mg/dL 65-99 01 Uric Acid, Serum 6.1 mg/dL 3.7-8.6 01 BUN 23 HIGH mg/dL 6-20 01 Creatinine, Serum 1.11 mg/dL 0.76-1.27 01 eGFR If NonAfricn Am 85 mL/min/1.73 >59 01 eGFR If Africn Am 98 mL/min/1.73 >59 01 BUN/Creatinine Ratio 21 HIGH 8-19 01 Sodium, Serum 138 mmol/L 135-145 01 Potassium, Serum 4.7 mmol/L 3.5-5.2 01 Chloride, Serum 102 mmol/L 97-108 01 Carbon Dioxide, Total 23 mmol/L 20-32 01 Calcium, Serum 10.0 mg/dL 8.7-10.2 01 Phosphorus, Serum 3.4 mg/dL 2.5-4.5 01 Protein, Total, Serum 6.8 g/dL 6.0-8.5 01 Albumin, Serum 4.6 g/dL 3.5-5.5 01 Globulin, Total 2.2 g/dL 1.5-4.5 01 A/G Ratio 2.1 1.1-2.5 01 Bilirubin, Total 0.6 mg/dL 0.0-1.2 01 Alkaline Phosphatase, S 39 IU/L 25-150 01 LDH 113 IU/L 0-225 01 AST (SGOT) 19 IU/L 0-40 01 ALT (SGPT) 25 IU/L 0-55 01 GGT 7 IU/L 0-65 01 Iron, Serum 82 ug/dL 40-155 01 Cholesterol, Total 232 HIGH mg/dL 100-199 01 Triglycerides 188 HIGH mg/dL 0-149 01 HDL Cholesterol 34 LOW mg/dL >39 01 According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a negative risk factor for CHD. LDL Cholesterol Calc 160 HIGH mg/dL 0-99 01 T. Chol/HDL Ratio 6.8 HIGH ratio units 0.0-5.0 01 TSH 1.300 uIU/mL 0.450-4.500 01 Thyroxine (T4) 8.3 ug/dL 4.5-12.0 01 T3 Uptake 35 % 24-39 01 Free Thyroxine Index 2.9 1.2-4.9 01 WBC 5.2 x10E3/uL 4.0-10.5 01 RBC 5.41 x10E6/uL 4.10-5.60 01 Hemoglobin 16.1 g/dL 12.5-17.0 01 Hematocrit 48.0 % 36.0-50.0 01 MCV 89 fL 80-98 01 MCH 29.8 pg 27.0-34.0 01 MCHC 33.5 g/dL 32.0-36.0 01 RDW 14.0 % 11.7-15.0 01 Platelets 267 x10E3/uL 140-415 01 Neutrophils 56 % 40-74 01 Lymphs 28 % 14-46 01 Monocytes 9 % 4-13 01 Eos 6 % 0-7 01 Basos 1 % 0-3 01 Immature Cells 01 Neutrophils (Absolute) 3.0 x10E3/uL 1.8-7.8 01 Lymphs (Absolute) 1.4 x10E3/uL 0.7-4.5 01 Monocytes(Absolute) 0.5 x10E3/uL 0.1-1.0 01 Eos (Absolute) 0.3 x10E3/uL 0.0-0.4 01 Baso (Absolute) 0.0 x10E3/uL 0.0-0.2 01 Immature Granulocytes 0 % 0-2 01 Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1 01 Hematology Comments: 01 LDL Cholesterol 156 HIGH mg/dL <130 02 HDL Cholesterol 29 LOW mg/dL >=40 02 VLDL Cholesterol 50 HIGH mg/dL <30 02 Cholesterol, Total 235 HIGH mg/dL <200 02 Triglycerides 190 HIGH mg/dL <150 02 Non HDL Chol. (LDL+VLDL) 206 HIGH mg/dL <160 02 apoB100-calc 132 HIGH mg/dL <109 02 LDL-R (Real)-C 116 HIGH mg/dL <100 02 Lp(a) Cholesterol 4.0 mg/dL <10 02 IDL Cholesterol 36 HIGH mg/dL <20 02 Remnant Lipo. (IDL+VLDL3) 66 HIGH mg/dL <30 02 Probable Metabolic Syndrome Yes Abnormal No 02 HDL-2 (Most Protective) 5 LOW mg/dL >10 02 HDL-3 (Less Protective) 24 LOW mg/dL >30 02 VLDL-3 (Small Remnant) 30 HIGH mg/dL <10 02 LDL1 Pattern A 22.4 mg/dL 02 LDL2 Pattern A 10.9 mg/dL 02 LDL3 Pattern B 62.3 mg/dL 02 LDL4 Pattern B 20.5 mg/dL 02 LDL Density Pattern B Abnormal A 02 C-Reactive Protein, Cardiac 0.93 mg/L 0.00-3.00 01 Homocyst(e)ine, Plasma 4.4 umol/L 0.0-15.0 01
Your LDL is predominently small dense LDL pattern B meaning you have the type of LDL that causes heart disease.
Your triglycerides are quite high at 190. Should be at 60 or under. Again this is a marker of heart disease.
And your HDL is quite low. For a man should be above 70...This indicates you have a leaky gut meaning toxins you take into your gut are leaking past the junctions in the lining of the gut and get into your blood vascular system.
Heart disease has nothing to do with high total cholesterol....it is the subfractions that are important.
It is no wonder you have had previous heart events.
What to do.
I would recommend you immediately read and follow Dr Kruse's Leaky Gut Posting as well as follow his Leptin Reset protocol. Especially following a strict ketogenic diet with almost zero carbs. http://www.jackkruse.com Dr Kruse would prescribe for your to purchase either Sisson's Primal Blueprint book, or Robb Wolf's The Paleo Solution.
You can change all of your markers of heart disease. You can get to all large bouyant LDL particles...the good kind and you can reduce your triglycerides and you can raise your HDL, but you must be very strict in your elimination of all wheat products and sugar products and you must fuel your body with copious amounts of coconut oil and moderate protein.
The supplements talked about on the other thread are fine...but all the supplements will not do a thing for you if you do not alter your diet. Supplements are great to assist your diet in your goal to reducing your markers for heart disease.
With the markers you have, you are living on borrowed time.
I don't quite understand why your TGs are so high when your bodyfat is so low and your diet, as posted in the other thread, doesn't really contain anything that would spike it (I doubt 1 TBSP of honey is going to do it). Combining a high fat diet with fructose, ethanol, or MCTs seems to have the ability to spike TGs, especially if one is sedentary, but you don't match that profile at all, as far as I can tell.
I suppose you could be right about the reversal of fatty liver occurring, which should purge all of that fat into the blood stream as TGs.
VAPs usually take a couple weeks to come back, so I'm guessing that you hadn't been doing too much of the fasted walking before this test. I think it's important to do it, even if it's something of a crutch that simply depletes TGs that are being generated from some underlying problem. Either way you need to keep them around 50 or so, so this would be the best route.
Your diet is so low in carbohydrates that you shouldn't be encountering any fuel selection issues with your muscle mitochondria. As such, they will readily accept and oxidize VLDL-TGs.
The good news is that the reason your HDL is so low is that your TGs are so high. In manufacturing VLDL, the liver soaks up so much cholesterol that it impacts HDL production. When you solve the TG problem (which may simply be a matter of time) you will solve the HDL problem as well. Should shift your LDL particle pattern to "A" as well since the VLDL production is soaking up cholesterol from LDL production as well.
As a side note, the slightly elevated TSH might mean that iodide and selenium supplementation are in order. You could just do small doses like 100mcg of iodide and 100mcg of selenium per day. T4 is in range, so you may have low T3, which would probably be a selenium deficiency.
See my post regarding this frequent phenomemon:
Here's what the ApoE4 theorist (Joel Goldstrich from Michael Eades's blog) says about the best way to diet if you're ApoE4:
I believe the low carb, higher fat diet is the best diet for around 75% of the population. However, about 25% of the population carry the Apo E4 allele. These individuals will increase their LDL-C, LDL-P and sdLDL as they increase their fat intake. I am Apo E3/4 and have been eating low carb for the past 5 years and at the same time struggling with LDL issues. I recently began limiting fat (especially saturated fat) as well as carbs and lost approximately 15 pounds over a 10 week period while concomitantly cutting my LDL-P and sdLDL in half with little change in my LDL-C. My LDL particles got bigger and hopefully less atherogenic. My weight has now stabilized. One diet apparently doesn’t fit all.
One size does not fit all. We find this over and over again. That's why there's so much strife among us. High fat Paleo might not work for some people.
What about ApoE4? Over the past month or so I have started eating more (and consequently more fat) in an attempt to gain a little weight.
According to Dr Davis "Apo E4–If Frustrated has one or two apo E4 genes, then increased dietary fat will serve to exaggerate measures like small LDL despite the reduction in carbohydrates, LDL particle number, and triglycerides. This is a tough situation, since small LDL particles and high triglycerides signal carbohydrate sensitivity, while apo E4 makes this person, in effect, unable to deal with fats and dietary cholesterol. It gives me the creeps to talk about reducing fat intake, but this becomes necessary along with carbohydrate restriction, else statin drugs will come to the “rescue.”"
Were you fasting for this lab for 12 hrs?
if not, some are irrelevant (LDL, TG HDL).
To me the labs indicate insulin resistance (mildly hypothyroid, mildly elevated liver enzymes, high TG/HDL ratio, pattern B). Extra energy whether fat or carb can increase TGs sometimes.
In addition to the potential viral component, consider an autoimmune panel (ESR, hsCRP, ANA, etc) and a FULL THYROID panel (anti thyroid antibodies, free T3, free T4, etc).
You mentioned stress right? How is your sleep? Energy? Digestion? Your doc probably isn't aware but you may self order a cortisol salivary x4 to determine how the adrenal gland is functioning. Low adrenal function is caused by stressors over time or acute stresses and it's very common in this day and age (esp if you crossfit, do ketosis or do intermittent fasting or are sleep deprived or 'stressed' to any degree). ZRT offers the cortisol x4. Low cortisol can cause low thyroid, insulin resistance and high TG/low HDL patterns. It happens in both skinny and fat folks... no one is immune.
I dont want this to get buried in a reply (that was cut short) so tell me what you think of this.
I have lost weight in the last 6 months. I've gone from a size 30" pants to 28" pants fitting loose. My wedding ring nearly falls off my finger. I've lost about 10-15 lbs over this time. One possibility I'm beginning to consider is that maybe I've lost significant fat (15-20 lbs?) and have put on 5-10 lbs of muscle. While losing 10lbs is probably not considered "significant" losing 20lbs of fat might be. I would have started eating paleo in the 145-150lb range. I seem to have hit a bottom in the last week or so around 136.
This answer would seem to make sense of all the suggestions below, and maybe explain Kronks situation as well.
Homework for you Berger6696:
Just wanted to put this up here to those who asked. My cardio CRP (which from what I can tell is the same thing as hsCRP) is 0.93 on the VAP test in the OP. Is this a pretty good drop from the 1.2 in August? does this change the leaky gut rx?
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