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So, you kept up with 40 mg atorvastatin throughout this test? And you exercised 5x/week, kept your carbs at 30 grams per meal while only eating one meal per day yet also keeping saturated fat to a minimum. Did I get all that right?

I am wondering why you didn’t get an NMR lipid panel that shows particle counts and measures the actual number of LDL particles instead of using an equation to calculate them.

While it’s impressive that LDL-C went down from 95 to 59 mg/dL, the small dense pattern B is concerning, although, at the low levels measured, maybe LDL size does not matter. On the bright side, your triglycerides dropped from 96 down 63. I see your HDL also dropped but was still landed at a decent level of 59. Your triglyceride:HDL ratio, at 1.07, is desirable. In fact, the last Quest test put that ratio at 0.74, an ideal result.

I would just get the hsCRP tested again as that looks like a total outlier considering you detected no inflammation symptoms.

Are you going to try to reduce your statin dose to see what happens? I’m curious to hear what your doctor concludes from this, if you don’t mind sharing.

I agree that we diabetics are not in sync with the general population but I think people like you are not in sync with the entire diabetic population. I remain skeptical of using statins to depress LDL under some arbitrary level but a small part of me wonders about the so-called pleiotropic good effect that statins might have in fighting cardiovascular disease.

Interesting comment; keep up the good work.

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So, you kept up with 40 mg atorvastatin throughout this test? And you exercised 5x/week, kept your carbs at 30 grams per meal while only eating one meal per day yet also keeping saturated fat to a minimum. Did I get all that right? - Yes that is correct and when you look at my weekly home testing you will see some variations as I tested different foods, polyphenols, Chromium Picolinate (See other thread) and increase in Vitamin C/E as well as different levels of hydration. Each one of these takes some explanation but my post was long enough as is for starters.

I am wondering why you didn’t get an NMR lipid panel that shows particle counts and measures the actual number of LDL particles instead of using an equation to calculate them. - I did not go the NMR route because NMR/MRA, GGE, VAP tests are all based on relative concentrations which are good but I don’t totally trust. My results were done by Quest using ION Mobility test which are the actual numbers without any calculations using absolute concentration which should be more reliable. We can explore this further but here is a quick basic read:

http://education.questdiagnostics.com/faq/FAQ134

the small dense pattern B is concerning - Yes, that is the most concerning LDL indice along with LDL Peak size but I think in time that can be managed into tolerance over time. I just had to throw everything I could at my LDL-C to keep my doctor from increasing my statin from 40-80mg and since I easily beat her 70 mg/dL requirement, I have advised her that I soon plan to cut my dose from 40mg-20mg and then re-test in a few weeks.

I’m curious to hear what your doctor concludes from this, if you don’t mind sharing. - I sent all my results including home test and Quest to her this morning and should hear back early next week and of course, I am always willing to share anything that might help this community that has helped me so much in our united goal to help each other improve where able. I also always post my profile stats because that gives an individual a better idea if what I try may be applicable to him/her.

I would just get the hsCRP tested again as that looks like a total outlier considering you detected no inflammation symptoms. - This one freaks me out so probably will re-test within 1 week - 10 days.

I remain skeptical of using statins to depress LDL under some arbitrary level - I totally agree and believe there are no studies that show a decrease in LDL-C actually has more than a very minimal possible impact on LDL-P. That is the next test I proposed to my doctor to cut my statin from 40mg-20mg and look at the resulting changes in LDL-P. My guess is that LDL-P will not noticeably be affected and the statin industry knows this so kept that information to themselves in order to keep pushing the LDL-C relative risk looking good for their product sales. Their all cause mortality results don’t support taking statins for most patients which is why we don’t see much of any trials after the September 2004 legal changes in how trials are done and supported.
I also agree that for some patients pleiotropic effects kick in which is why you can’t just say don’t take statins.

My long term goal, as in the next 6-8 months continues to be to totally eliminate my statin while at the same time reducing cardio vascular risk. The problem is mostly that statins are promoted as one size fits all and even more than YDMV, cholesterol has even more variables. What I have also learned in this process is how closely Blood Glucose relates to Cholesterol and the importance, I believe, of standard deviation as it appears that the nasty small dense particles reek havoc every time BG rises rapidly which is what I am testing with flatlining after meal(s) see:
CHROMIUM PICOLINATE FLAT LINES AFTER MEAL SPIKE

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Congratulations on your LDL drop CJ. That is impressive! My last week numbers are LDL 116, Trigs 57, HDL 57. My cardiologist thinks those are fine numbers for a non diabetic, but not for a diabetic with 2 10 yr old stents.

He thinks that I am a walking time bomb. He doesn’t pay attention to my 20 yr period of non diabetic A1c’s. Maybe partly because my A1c was 4.6 when I suddenly needed stents.

He thinks I am foolish to not take REPATHA. I have studied the conclusion of the 3 yr study on this drug and the results were very disappointing. I have read and watched everything I can about Repatha. He would not believe that the drug only helps one out of 69 people. He didn’t believe the statistics that I found showing that this isn’t a great drug. He couldn’t tell me if the drug reduces inflammation.

I said that I wasn’t sure nor were many cardiologists whether having a low LDL for many years would be healthy for other parts of my body. He believes that a LDL of 30 would be ideal. I said that I don’t want to take such a new drug and he said that it was approved by the FDA. I laughed.

I am making myself sick over this decision. My GP doesn’t think I should take it if I am not comfortable with the idea. He definitely thinks that an LDL of 30 is way too low. He said that his partner who is a huge fan of statins, recently went to a medical convention in San Francisco where it was stated that it has been found that statins increase the life span by 30 days.

My husband will be seeing this doctor very soon and since my husband is on statins, he is going to ask to be taken off statins even though he has high LDL. Statins have increased his glucose levels. But because his doctor was such a fan of statins, my husband stayed on them. I will get the name of the convention that this doctor attended and find out more about the study.

I recently remembered that not only did my grandfather have a stroke or heart attack that killed him in his 60’s, but my father had a slight heart attack in his mid to late 60’s. He immediately stopped eating fat and lived until he was 89. I don’t know if not eating fat had anything to do with his longevity. He never ate junk food in his life.

I exercise an hr most days, weigh 105, rarely eat anything processed, eat vegan and low fat. I can’t seem to get my LDL any lower with out statins. I can’t take statins nor do I want too. I also don’t want to die any time soon.

I really admire all the work you do CJ to track everything.

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Marilyn,

What was your cardio-related diagnosis before and after you got your stents? I ask because I see you referring more to the fact of the stents rather than the underlying problem they were placed to correct. That’s the part that I don’t have a good sense of. Obviously, stents are meant to correct blocked arteries. I’m trying to remember - and maybe you’ve said it already, I apologize if so - which ones and how much they were blocked. I vaguely recall your mentioning something about presenting with some very concerning symptoms just before the stents were placed, but I’m not quite certain of the details. Question: was LDL your only risk factor, at that time, aside from T1D? Did you also have uncontrolled hypertension at the time, and if so for how long?

On the other hand, I don’t want to push, if you’d rather not discuss it, and will understand no problem if so.

I don’t mind talking about this. I had been eating 30 carbs daily for several years. During this time my BP was normal. My A1c was 4.6. Before the event my total cholesterol had risen to over 300. Both my HDL and LDL were quite high. My Trigs were very low. I had been a type 1 for 50 yrs. I wasn’t well controlled during the urine testing years. I was well controlled after that.

My grandfather died in his 60’s from a heart attack and my father had a slight heart attack in his late 60’s. I was 60 when I received 2 stents.

I feel that stress had something to do with my arteries closing but the cardiologists don’t give that any weight.

I had been working part time and taking care of my aging parents part time. During this time a good friend suddenly died, a week later I was with my father as he died. A week after that I had a kidney stone which had to be removed. During surgery bladder cancer was discovered. The cancerous tumor was tiny and was removed.

For the next 3 months I took care of my mother who slowly lost her mind and then died. A week later I was starting a hike with my family when suddenly I became very tired and my arms became very heavy. I googled heart attack and my husband took me to emergency. My EKG was abnormal, but I wasn’t having a heart attack.

I don’t have much info about my stents but probably do somewhere. I carry a picture which shows a blockage of 70% to 90% on the RCA and 80% on the PDA. The letters DES are used in notation.

I did not do much research about the placement of the stents because I was worn out and my husband was soon diagnosed with esophageal cancer and all my energy went into researching ways to help him.

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Wow @Marilyn that’s a lot to go through. I’m so sorry that happened. Personally I think stress has a lot to do with everything concerning our health. But we can’t always escape it either.

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After my dad died, he greatly reduced his fat intake. I remember him drinking black coffee and eating plain toast. He stopped eating desserts. Because of a leaky heart valve he had angioplasty at 83. The cardiologist and nurses couldn’t believe the condition of his arteries which were in great shape with almost no plaque.

I have no idea if his slight heart attack had anything to do with plaque, but he never needed stents. He died when he was 89 because of his leaky valve which is good, because he would have been lost without my mom.

You went through a lot. Your post is a cautionary tale for us all - but how do we do self-care in the middle of several emergencies?

I was curious because I find it’s unusual to hear of a blocked artery, with high LDL being the only sign/symptom, that’s why I was asking about how controlled your blood pressure had been at that time. Not that you had much time in between crises to step into a CVS or drug store to get your BP measured - but probably all the stress, lack of sleep, and emotion did increase your BP, and/or increase cortisol levels. I’m guessing you’ve never smoked. DES means that the stents contained a drug that contributes to the artery’s overall health and functioning.

I have home tested my BP for a long time. When low carbing my blood pressure tended to be normal to low.

No, I never smoked, never did drugs, never drank a lot. My diabetes kept me from trying most of what my generation at least tried a few times.

I assume that plaque builds up for other reasons than high blood pressure which I didn’t have. I did not have a heart attack. The only reasons I was given were high LDL levels and diabetes. The fact that I was very well controlled didn’t seem to make a difference. The only thing that stood out was high LDL. High HDL and very low triglycerides did nothing to protect me.

Some people can eat a very low carb diet and have normal LDL levels. Dr. Bernstein is an example of this. I couldn’t. My LDL levels rose a lot when low carbing. I continued low carbing for several years after needing stents. My body started objecting in other ways that I couldn’t ignore. I wish I would have stopped eating low carb much, much sooner.

I spent 11 yrs eating no more than 30 carbs a day, but for my body, it was a huge mistake. The only good thing it did for me was to make me aware that for me I need a quite low A1c. It has protected me from getting any other complications of diabetes over the past 20 yrs.

From my work experience, I have recently come across a patient whose BP is generally ok, however when she gets upset or stressed it soars. Do these “flash” episodes of elevated BP do arterial damage? There are a few supporting studies out there on coronary studies in children; and on soldiers during the Korean War (average age of study participants was 22), 45% of whom who had some evidence of atherosclerosis with 5% showing gross evidence of severe coronary atherosclerosis. So this process can start in the very young. All of this can present a prescribing conundrum. Thankfully I am not a prescriber. Speaking of, you say your BP is controlled and always has been – but are you taking Losartan?

Your case is for me a definite puzzler. For example, I’ve never really heard of LDL being the only risk factor for a blocked artery. Wouldn’t the cell wall need to have been damaged first, in order for plaque to collect there? That’s what I would think, at any rate. (Is it possible that being on keto or low carb, one would need to be even more particularly mindful of stress, and possibly of insulin as well?) But I have no real experience with this.

Speaking personally, I am appreciative of the new way we are looking at things – with processed food being the “real” culprit as opposed to the automatic demonization of fat. This has made me more aware and I aspire always to do better with the processed carbs, and reading all about it has in general helped me a lot as I tinker here and there with a few pounds lost and other markers. However, at the same time, I’m mindful of the humongous sex bias – too strong a word? - in this new way of thinking/clearing the air. The keto community is overwhelmingly male, or so it seems to me in my forays online. There’s a lot more to be learned regarding keto/low carb and females. (I am female.) Also, I have read that you think fat is indeed a problem. So – I “get” that.

As Peter Attia has said on the role of arterial inflammation, “There is no perfect way to answer the question, there’s no experiment we can design in humans. So you have to look to natural experiments. People with a super human immunity (rare genetic mutation) to atherosclerosis/heart disease have an unbelievable ability to clear LDL from the body. They’re taking more of the boats out of the river. Their LDL is between 5-40. Conversely, there’s familial hypercholesterolemia – which is a paucity of LDL clearance capacity. They are more susceptible to atherosclerotic disease.” It’s a “gradient driven process.”

What it lately is coming down to for me is: We know that what’s conventionally known is that dyslipidemia causes heart disease.
What’s not conventionally known or accepted and needs more research is the role of higher levels of insulin vis a vis the damage it can do to the endothelial lining, and the role of stress on vascular wall damage.

I was on the extremely low carb diet when I suddenly needed stents. While on that diet my BP was normal. Unfortunately after years on that diet, I started passing out when getting out of bed. We called an ambulance several times. My glucose level was good, my BP had fallen drastically.

I quit this woe because of passing out one too many times and because I was getting horrible migraines. Once I cut out dairy and then several months later started a low fat plant based diet, the headaches and periods of passing out stopped.

After more than 3 yrs on my present diet I recently passed out again, so no more hopping out of bed for me. On my present diet my BP rose and I now take 50 mgs of losartan and a supplement. For most people this woe lowers BP, but I am an exception. I did not take a med for BP until about 3 yrs ago. I recently lowered my dose from 100 down to 50 mgs, because my BP dropped much too low 89/43. I fainted during this period of time.

My other risk factor for stents was and is diabetes. All of the cardiologists have told me diabetes and high LDL. Cardiologists see many diabetics, but many of the diabetics are uncontrolled.

When low carbing my A1c was 4.6 and the highest level was 5.3 for 11 yrs. I normally took 17 to 23 units of insulin. I had no working beta cells. I weighed about 10lbs more than I do now.

My life has had long periods of times that were extremely stressful. Our son had severe Tourette’s Syndrome and early onset bipolar disorder. We didn’t send him to school because most professionals medical and others did not understand his behavior which was severe. I spent all my efforts, when possible, trying to find experts in these two illnesses. My husband and I were stressed and exhausted for more than a decade. Then I switched to taking care of my parents.

My husband has had cancer 4 times in the last 10 yrs. after I received stents. Stress has done a number on us, but the cardiologists ignore that factor.

Omg, I thought you were male. LOL What does that say about me??? That is hilarious on my part. So much for being a feminist!

You are right, men are the low carb advocates. One man wrote a book about the cholesterol myth during the time I was low carbing. He said that LDL could be ignored. He is very well educated and he quoted many cardiologists. Several of the cardiologists have said that he misquoted him. His book helped make me ignore my cholesterol numbers, I didn’t do more in-depth research about the book until a few yrs ago. From now on I am very careful about believing what I read. These doctors and researchers especially ones who are making money from books and YouTube videos can be very persuasive, and they can be wrong.

As a child I took 40 units of insulin after the age of around 30 the amount has been steadily coming down. I haven’t taken more than 30 units in many years.

I eat very, very few processed foods. I eat out very seldom and try to stick to my woe. I eat 250 to 275 healthy carbs a day, I exercise an hr a day. I normally use 23 total units of insulin daily. I have heart stents but no other complications of diabetes. I have had numerous problems but by keeping a very low A1c they have all reversed. The only neuropathy i have had was caused by a statin.

Both of my parents had normal LDL levels when they both died at 89. Neither took statins. I do remember that when my mother was about my age that her cholesterol levels were not good. I have no idea what enabled her to have a very decent LDL level in her later years. My sister who is 73 is in perfect health. No diabetes or hypothyroidism. She has a decent LDL number and definitely has no heart disease, her BP is good. I am the diabetic, and she is the extremely healthy one. She eats what she wants.

I can only go by my own experiences. This is what has happened to me.

Thanks so much for reading this.

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@The_Senator_From_Glu I have what they call white coat syndrome. I have read in the past this puts you more at risk of strokes. Same with if you get migraines or flush easily. So some rise in BP for short periods of time puts you at risk for certain events. Now whether it’s a genetic factor that makes these things happen and it is also what puts you in the category of more at risk of stroke, or if it’s the fact you do and that puts you at risk I don’t remember if they have figured that out.

I’ve definitely heard of white coat hypertension, which is one reason some clinics give out automatic BP cuffs so patients can measure it in the comfort of their own homes. I haven’t delved deeply into its effects, though, so I can’t comment beyond referencing what I said above, meaning that likely it has effects. I’ve also heard others say it’s (white coat htn) truly not a thing, but I tend to believe that it probably is.

It definitely is a thing and much more recognized now. I used to have to explain and now they know what it is and I’ve even had a few nurses say they have it.

I always joke it is the test I will always fail as soon as I see the BP cuff coming! When I moved my new doctor of course didn’t actually know I had it, just what I said. She had me bring in my BP meter to check it’s accuracy then take a bunch of readings before I went in the next time. I don’t blame her at all as I would be in doctors sometimes with a 160 over 90 readings. So sure enough I brought it in showing a 117 over 77 average. but testing right at that moment 156 over 86…She documented the average and some of the readings.

I have a tendency for my levels to get better as I get used to the doctor.

I have kept daily records of my BP for several years. I will skip a day or two here and there. I always take the records with me when I see my GP. My doctors, both allopathic and naturopathic don’t mind when I adjust my BP meds since I keep good records.

My BP is almost always higher in the doctor’s office. The doctors and nurses recognize it as white coat syndrome. It will stay high if I am disagreeing with the doctor, and it will go down if we are getting along well.

When I was in the hospital with an undiagnosed problem, and lots of stress fighting to keep my insulin, my BP went through the roof.

Latest update now that another 3 months have gone by and I have updated lab reports that are in line with my weekly cholesterol home testing results which I will be happy to share if interested. I continue to be able to keep my LDL-C low and have improved many indices on my LDL-P results that did not look so good in my February Lab Reports. In Fixing some of this, it appears that my protein levels dropped a little below standard and they should be easy to fix. I was supposed to go for a CAC CT Scan a little over 1 week ago but the hospital postponed claiming it is not yet safe enough for those procedures. That has been rescheduled for June 2. On June 4th I will have my telehealth appointment with endocrinologist and ask her to cut my atorvastatin dose from 40 mg to 20 mg per day. I want to totally ditch the statin but still too early as it does reduce inflammation and want to wait until I have my CAC score to determine my next enhancement. Rather than go into a lengthy discussion of how I tweaked all my various Cholesterol numbers, I have posted the report here and will answer any questions. Overall, the key to the LDL-C reduction was a massive increase in Vitamin C.

Order 135889 - Results By Category - Cumulative - Ulta Lab Tests - Redacted.pdf (81.0 KB)

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Very good! I am impressed with the reduction of your LDL particle number. I have been researching lately and learned that the VLDL size and the LDL particle number are the most important numbers to keep track of. I don’t see a VLDL size here, but I may be overlooking it.

I won’t be getting any labs drawn for quite some time because I am isolating myself from everybody but my husband. I am working hard trying to get my particle number down and my VLDL size down. I took your advice and I am taking more Vit C. I am up to 3,500. Do you take more than that? I also lost about 5 lbs and am aiming to lose two more lbs. VLDL size is lowered by weight loss, lowering triglycerides, and exercise. My triglycerides are 49 and I already ride my exercise bike 7-10 miles a day. I have no idea why my VLDL is so high. Maybe because I already have stents and because I have had type 1 since I was a child.

Again congratulations on your lab improvements. Oh, great A1c too.

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Chol1.docx (303.8 KB)

I have uploaded this chart so we don’t get too quickly technically into the weeds. The Apolipoprotein B100 VLDL which comes from the liver is what we are all trying to forever manage better because that is the one that most of the time causes issues with atherosclerosis and other heart related problems. The Apolipoprotein B48 is generally not measured as those Chylomicrons travel through the body within hours and rarely cause havoc. The B100 starts as VLDL and as it delivers triglycerides and other goodies to the muscles and other organs it shrinks into an ILDL and continues on its journey and finally gets to be an LDL and that is where nasty stuff tends to happen. In a perfect body, the HDL scrubs it out and returns some portion to the liver.

It is at the LDL size that we are really concerned. If the peak size LDL is bigger than 222.9 angstrom, we are in good shape. Although mine has increased from 206.8 to 218.8, I am not quite there yet. This improvement, I believe is due to a higher intake of avocado (1/2 per day). The problem with a below standard peak size is that those small particles stay in the blood and they keep looking for yummy glucose to oxidize them which then gives them the opportunity to bust through the endothelial cell and cause plaque. (this is the 25 cent tour as it is a little more complex than that). This is where I realized that my A1C was really no where near as important as my Standard Deviation. When blood sugar flat lines, these poor small LDL’s have no glucose to grab onto and create havoc in the arteries. As I seriously clamped down on my standard deviation, my A1C dropped which was just a bonus. I think we are all talking about the same numbers, just in slightly different terms.

My lower particle numbers, again I believe is due to a combination of staying away from all trans fats, virtually all saturated fats, and an increase in Vitamin C. The Vitamin C had the biggest impact on LDL-C, but the really bad stuff we need to follow and control is our LDL-P particles.

For my February blood tests, I was taking 6000 mg per day of Vitamin C which seemed pretty scary but highly touted as no problem by top physicians around the world. For my may tests I had increased to 10,000 mg per day and saw a small incremental improvement but not sure it is really necessary. Vitamin C should be based on weight and for it to really have impact my understanding is that we need to take between 5000-10000 mg per day. They are pretty cheap bought in bulk at Amazon. So I eat 1 meal a day + a snack like a hard boiled egg for dinner. I take 3000 mg Vitamin C when I get up, 4000 with lunch and 3000 at bed time.

I get all my blood drawn at Quest Diagnostics as they are very friendly, professional and they are results I can trust. Their offices nationally normally open at 8 AM and they take appointments starting at 8:15. I book an 8:15 appointment but get there just before 8 so I can get in while the place is spotless and nobody else is yet around as the second appointment is normally at 8:30 and I am out of there by 8:20. They also give me my own exam room so that I can concurrent test with my equipment to make sure my weekly home tests are valid. It is safe and works perfectly.

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All oh so interesting. My LDL Size last time I checked in March of 19 was 216. I have decided to try to flat line more or at least not rise as much after meals by riding my exercise at least 15 min after all meals. I already ride an hr after breakfast. I have no desire to cut down on meals as they are a very enjoyable part of the day for my husband and me. I don’t fast either except for 12 or 13 hrs between dinner and breakfast.
Of course, I will try something different if I can’t bring down my VLDL or particle size with what I am doing now. I will see how much more Vit C my body will tolerate.

My numbers were quite a bit better when I was taking a very small dose of a statin, but it also gave me neuropathy so I will never try another statin. Repatha really messed with my hip, so I am no longer taking that.

I live in a small college town with only a hospital to use for lab tests.