RE: The patient with a a worse cholesterol with a diet and weight loss!

[Guest guest]

Are you sure these are his labs? Maybe you should consider simply rechecking to make sure they are actually his. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone From: [mailto: ] On Behalf Of Sent: Wednesday, October 05, 2011 8:54 PMTo: Subject: The patient with a a worse cholesterol with a diet and weight loss! I would like anyone on the list to weigh in on a tough patient 39 y/o malelong standing history of high triglycerides, but is at least 20-30 lbs overweight for quite some timeno htnno cadsleep apnea controlled with cpapno diabetes or impaired fasting blood sugarno etoh use at allnon smoker had labs in feb 2011 fastingtotal cholesterol 197ldl-direct 69hdl 31triglycerides 454fasting blood sugar was 88 finally got him on a diet and he has lost nearly 20 lbs plenty of exercise-aerobics-kettlebells, pretty vigorousdiet is veggies/lean protein (chicken breast) beans/broccoli caufhlower/peas etc new labs with 12 hour fast of coursetotal cholesterol 236ldl is 155hdl 39triglycerides 212fasting blood sugar is 67 I think he wants to go back to his old diet as he prefered his lower LDL! limited fish intake, considered some omega 3 supplementation but often forgets to take his fish oil pill any opinions? I am thinking of a retest just to make sure this is screwy! Diet and broccoli made him worse? or just a bit different...tsh normal at 2.8cbc normal

[Guest guest]

I was wondering if it was maybe a different lab. Also, cholesterol is an acute phase reactant so if he had been sick it can go up.His current labs his nonHDL is 81 and in 2/11 it was 128. His TG were over 250 so LDL not accurate. So in actuality his numbers are much better. But the change is strange. My sister’s boyfriend went vegetarian and his cholesterol went much higher because of all the cheese he was eating. His doctor told him to go back to meat. But personally, I don’t know what you are beating him up for in the first place. His numbers were fine for his age and risks. If he doesn’t like the new diet, he isn’t going to stick with it. But he should be aware that if he goes back to his old way of eating he will put the weight back on. His choice. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Izquierdo MD PhDSent: Wednesday, October 05, 2011 9:09 PMTo: Subject: RE: The patient with a a worse cholesterol with a diet and weight loss! Are you sure these are his labs? Maybe you should consider simply rechecking to make sure they are actually his. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone From: [mailto: ] On Behalf Of Sent: Wednesday, October 05, 2011 8:54 PMTo: Subject: The patient with a a worse cholesterol with a diet and weight loss! I would like anyone on the list to weigh in on a tough patient 39 y/o malelong standing history of high triglycerides, but is at least 20-30 lbs overweight for quite some timeno htnno cadsleep apnea controlled with cpapno diabetes or impaired fasting blood sugarno etoh use at allnon smoker had labs in feb 2011 fastingtotal cholesterol 197ldl-direct 69hdl 31triglycerides 454fasting blood sugar was 88 finally got him on a diet and he has lost nearly 20 lbs plenty of exercise-aerobics-kettlebells, pretty vigorousdiet is veggies/lean protein (chicken breast) beans/broccoli caufhlower/peas etc new labs with 12 hour fast of coursetotal cholesterol 236ldl is 155hdl 39triglycerides 212fasting blood sugar is 67 I think he wants to go back to his old diet as he prefered his lower LDL! limited fish intake, considered some omega 3 supplementation but often forgets to take his fish oil pill any opinions? I am thinking of a retest just to make sure this is screwy! Diet and broccoli made him worse? or just a bit different...tsh normal at 2.8cbc normal

[Guest guest]

i would convince him he's actually doing better - i would be with ongoing consistency LDL goes down - plus with ongoing weight loss the CPAP will go away which I would expect is a motivating factor for him - plus I bet if you did an expanded lipid panel his LDL particle number or at least his LDL size would have improved (not actually suggesting you do that b/c waste of money at this point) but bottom line there is a lot more to one's cardiovascular health than LDL

I bet in 6-12 months with ongoing consistency, triglycerides continue to drop, HDL is in the 40's and ldl stabilizes around 100-120 - if checked i bet other cardiometabolic parameters also improve

 

I was wondering if it was maybe a different lab.  Also, cholesterol is an acute phase reactant so if he had been sick it can go up.

His current labs his nonHDL  is 81 and in 2/11 it was 128.  His TG were over 250 so LDL not accurate.  So in actuality his numbers are much better.    But the change is strange.

 My sister’s boyfriend went vegetarian and his cholesterol went much higher because of all the cheese he was eating.  His doctor told him to go back to meat.

 But personally, I don’t know what you are beating him up for in the first place.  His numbers were fine for his age and risks.  If he doesn’t like the new diet, he isn’t going to stick with it.  But he should be aware that if he goes back to his old way of eating he will put the weight back on.  His choice.

  Kathy Saradarian, MD

Branchville, NJwww.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90Practice Partner 5/03

Low staffing 

  

From: [mailto: ] On Behalf Of Izquierdo MD PhD

Sent: Wednesday, October 05, 2011 9:09 PMTo: Subject: RE: The patient with a a worse cholesterol with a diet and weight loss!

   Are you sure these are his labs? Maybe you should consider simply rechecking to make sure they are actually his.

  Izquierdo-Porrera MD PhD

Executive Director & Co-founderCare for Your Health, Inc

Phone  

From: [mailto: ] On Behalf Of

Sent: Wednesday, October 05, 2011 8:54 PMTo: Subject: The patient with a a worse cholesterol with a diet and weight loss!

   I would like anyone on the list to weigh  in on a tough patient 

39 y/o malelong standing history of high triglycerides, but is at least 20-30 lbs overweight for quite some time

no htnno cadsleep apnea controlled with cpapno diabetes or impaired fasting blood sugar

no etoh use at allnon smoker  

had labs in feb 2011 fastingtotal cholesterol 197ldl-direct 69

hdl 31triglycerides 454fasting blood sugar was 88 

finally got him on a diet and he has lost nearly 20 lbs plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli caufhlower/peas etc new labs with 12 hour fast of course

total cholesterol 236ldl is 155hdl 39triglycerides 212

fasting blood sugar is 67 I think he wants to go back to his old diet as he prefered his lower LDL! limited fish intake, considered some omega 3 supplementation but often forgets to take his fish oil pill

 any opinions?  I am thinking of a retest just to make sure this is screwy!  Diet and broccoli made him worse?  or just a bit different...

tsh normal at 2.8cbc normal  

[Guest guest]

As eluded in an earlier post, his LDL went up, but probably because he is trafficking his LDL in larger particles. Remember volume of a sphere is proportional to the radius. All LDL-c tells you is the cumulative volume of all LDL in the lipoproteins. The concern is that his nonHDL actually went up. NonHDL is a surrogate marker for apoB or LDL-p. He obviously is a cardiometabolic patient. He would probably benefit from a carbohydrate restricted diet (less the 100 grams a day).Did you do a 2 hour OGTT (fbg, 1hr, 2hr postload)? I am sure it would be abnormal. You could also do a glycomark if he did not want to do the 2 hour ogttRockySent from my iPhone4

I would like anyone on the list to weigh in on a tough patient39 y/o malelong standing history of high triglycerides, but is at least 20-30 lbs overweight for quite some timeno htn

no cadsleep apnea controlled with cpapno diabetes or impaired fasting blood sugarno etoh use at allnon smokerhad labs in feb 2011 fasting

total cholesterol 197ldl-direct 69hdl 31triglycerides 454fasting blood sugar was 88finally got him on a diet and he has lost nearly 20 lbs

plenty of exercise-aerobics-kettlebells, pretty vigorousdiet is veggies/lean protein (chicken breast) beans/broccoli caufhlower/peas etcnew labs with 12 hour fast of course

total cholesterol 236ldl is 155hdl 39triglycerides 212fasting blood sugar is 67I think he wants to go back to his old diet as he prefered his lower LDL! limited fish intake, considered some omega 3 supplementation but often forgets to take his fish oil pill

any opinions? I am thinking of a retest just to make sure this is screwy! Diet and broccoli made him worse? or just a bit different...tsh normal at 2.8cbc normal

[Guest guest]

Rocky – what is a glycomark?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

‘You could also do a

glycomark if he did not want to do the 2 hour ogtt’

Rocky

Sent from my iPhone4

On Oct 5, 2011, at 5:54 PM,

wrote:

I would like anyone on the list to weigh in on a tough patient

39 y/o male

long standing history of high triglycerides, but is at least

20-30 lbs overweight for quite some time

no htn

no cad

sleep apnea controlled with cpap

no diabetes or impaired fasting blood sugar

no etoh use at all

non smoker

had labs in feb 2011 fasting

total cholesterol 197

ldl-direct 69

hdl 31

triglycerides 454

fasting blood sugar was 88

finally got him on a diet and he has lost nearly 20

lbs

plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

new labs with 12 hour fast of course

total cholesterol 236

ldl is 155

hdl 39

triglycerides 212

fasting blood sugar is 67

I think he wants to go back to his old diet as he prefered

his lower LDL! limited fish intake, considered some omega 3 supplementation but

often forgets to take his fish oil pill

any opinions? I am thinking of a retest just to make

sure this is screwy! Diet and broccoli made him worse? or just a

bit different...

tsh normal at 2.8

cbc normal

[Guest guest]

I think he means an hga1cthe patient has never had an impaired fasting blood sugar, and his last blood sugar was quite low with recent testingI'll wait a bit and repeat the lipids with an hga1c.  I suppose we could do a 1 hour or 2 hour glucose tolerance test...but low carb diet seems to be the best intervention at this point.

I suppose with the reduction in weight and lower triglcyerides, I'm surprised  the total cholesterol and ldl increased so much..At this point given weight loss the patient is going to remain on a lower carb diet and continue to see how much lower weight can go, and recheck.

I find it fascinating that there could be such a variation with ldl. Especially given no fried foods, mostly grilled chicken  as the protein, water only or rare milk but  certainly no soda...

The patient--ME!!!----the toughest patient one  might say--will recheck and see what happens.I never figured after losing weight my ldl would go up, but  I've always been...special I guess.

 

Rocky – what is a glycomark?

 

 

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

 

 

 

‘You could also do a

glycomark if he did not want to do the 2 hour ogtt’

 

Rocky

Sent from my iPhone4

On Oct 5, 2011, at 5:54 PM,

wrote:

 

I would like anyone on the list to weigh  in on a tough patient

 

39 y/o male

long standing history of high triglycerides, but is at least

20-30 lbs overweight for quite some time

no htn

no cad

sleep apnea controlled with cpap

no diabetes or impaired fasting blood sugar

no etoh use at all

non smoker

 

 

had labs in feb 2011 fasting

total cholesterol 197

ldl-direct 69

hdl 31

triglycerides 454

fasting blood sugar was 88

 

finally got him on a diet and he has lost nearly 20

lbs 

plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

 

new labs with 12 hour fast of course

total cholesterol 236

ldl is 155

hdl 39

triglycerides 212

fasting blood sugar is 67

 

I think he wants to go back to his old diet as he prefered

his lower LDL! limited fish intake, considered some omega 3 supplementation but

often forgets to take his fish oil pill

 

any opinions?  I am thinking of a retest just to make

sure this is screwy!  Diet and broccoli made him worse?  or just a

bit different...

tsh normal at 2.8

cbc normal

 

 

[Guest guest]

I can guarantee that this patient had a glucose abnormality at the start (and probably still does). Remember fasting BG is the LAST to be abnormal. 1hour and 2 hour PP numbers are elevated YEARS before FBG elevates. Please see attached study from Diabetes Care. Glycomark is a test that gives you a 2 week snap shot of how those PP numbers have been (http://www.glycomark.com/). Cheaper yet is hand the patient a glucometer and have him check PP for 1-2 weeks. A1C is not a good test in these patients because it can miscategorize up to 70-90% of patients with dysglycemia. Again his nonhdl actually went from 166 to 197 (not a good thing). His higher ldl could be from shifting his particle size. Remember LDL-C really does not mean a whole lot, nonhdl is much better predictor

of risk (surrogate for apoB). The decision to treat this patient should be based on his higher nonHDL (because of his insulin resistance and likelihood of making small ldl). It seems he has been taking his therapeutic lifestyle changes seriously and probably deserves 3 more months of TLCrocky

Rakesh C. Patel, M.D.Twitter: @drrcpatelArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com From: To:

Sent: Wednesday, October 5, 2011 9:31 PMSubject: Re: The patient with a a worse cholesterol with a diet and weight loss!

I think he means an hga1cthe patient has never had an impaired fasting blood sugar, and his last blood sugar was quite low with recent testingI'll wait a bit and repeat the lipids with an hga1c. I suppose we could do a 1 hour or 2 hour glucose tolerance test...but low carb diet seems to be the best intervention at this point.

I suppose with the reduction in weight and lower triglcyerides, I'm surprised the total cholesterol and ldl increased so much..At this point given weight loss the patient is going to remain on a lower carb diet and continue to see how much lower weight can go, and recheck.

I find it fascinating that there could be such a variation with ldl. Especially given no fried foods, mostly grilled chicken as the protein, water only or rare milk but certainly no soda...

The patient--ME!!!----the toughest patient one might say--will recheck and see what happens.I never figured after losing weight my ldl would go up, but I've always been...special I guess.

Rocky – what is a glycomark?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

‘You could also do a

glycomark if he did not want to do the 2 hour ogtt’

Rocky

Sent from my iPhone4

On Oct 5, 2011, at 5:54 PM,

wrote:

I would like anyone on the list to weigh in on a tough patient

39 y/o male

long standing history of high triglycerides, but is at least

20-30 lbs overweight for quite some time

no htn

no cad

sleep apnea controlled with cpap

no diabetes or impaired fasting blood sugar

no etoh use at all

non smoker

had labs in feb 2011 fasting

total cholesterol 197

ldl-direct 69

hdl 31

triglycerides 454

fasting blood sugar was 88

finally got him on a diet and he has lost nearly 20

lbs

plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

new labs with 12 hour fast of course

total cholesterol 236

ldl is 155

hdl 39

triglycerides 212

fasting blood sugar is 67

I think he wants to go back to his old diet as he prefered

his lower LDL! limited fish intake, considered some omega 3 supplementation but

often forgets to take his fish oil pill

any opinions? I am thinking of a retest just to make

sure this is screwy! Diet and broccoli made him worse? or just a

bit different...

tsh normal at 2.8

cbc normal

1 of 1 File(s)

defronzodc310.pdf

[Guest guest]

Sometimes fish oil can increase ones LDL

> I think he means an hga1c> > the patient has never had an impaired fasting blood sugar, and his last

> blood sugar was quite low with recent testing> > I'll wait a bit and repeat the lipids with an hga1c. I suppose we could do> a 1 hour or 2 hour glucose tolerance test...but low carb diet seems to be

> the best intervention at this point.> > I suppose with the reduction in weight and lower triglcyerides, I'm> surprised the total cholesterol and ldl increased so much..> > At this point given weight loss the patient is going to remain on a lower

> carb diet and continue to see how much lower weight can go, and recheck.> > I find it fascinating that there could be such a variation with ldl.> Especially given no fried foods, mostly grilled chicken as the protein,

> water only or rare milk but certainly no soda...> > The patient--ME!!!----the toughest patient one might say--will recheck and> see what happens.> > I never figured after losing weight my ldl would go up, but I've always

> been...special I guess.> > > > > >> **>>

>>>> Rocky – what is a glycomark?****>>>> ** **>>>> ** **>>>> Eads, MD****>>>> Pinnacle Family Medicine****>>

>> Colorado Springs, CO****>>>> www.PinnacleFamilyMedicine.com****>>>> ** **>>>> ** **>>>> ** **

>>>> ‘You could also do a glycomark if he did not want to do the 2 hour ogtt’**>> **>>>> ** **>>>> Rocky****>>>>>> Sent from my iPhone4****

>>>>>> ****>>>> ****>>>> I would like anyone on the list to weigh in on a tough patient****

>>>> ** **>>>> 39 y/o male****>>>> long standing history of high triglycerides, but is at least 20-30 lbs>> overweight for quite some time****>>

>> no htn****>>>> no cad****>>>> sleep apnea controlled with cpap****>>>> no diabetes or impaired fasting blood sugar****>>>> no etoh use at all****

>>>> non smoker****>>>> ** **>>>> ** **>>>> had labs in feb 2011 fasting****>>>> total cholesterol 197****>>>> ldl-direct 69****

>>>> hdl 31****>>>> triglycerides 454****>>>> fasting blood sugar was 88****>>>> ** **>>>> finally got him on a diet and he has lost nearly 20 lbs ****

>>>> plenty of exercise-aerobics-kettlebells, pretty vigorous****>>>> diet is veggies/lean protein (chicken breast) beans/broccoli>> caufhlower/peas etc****>>>> ** **

>>>> new labs with 12 hour fast of course****>>>> total cholesterol 236****>>>> ldl is 155****>>>> hdl 39****>>>> triglycerides 212****

>>>> fasting blood sugar is 67****>>>> ** **>>>> I think he wants to go back to his old diet as he prefered his lower LDL!>> limited fish intake, considered some omega 3 supplementation but often

>> forgets to take his fish oil pill****>>>> ** **>>>> any opinions? I am thinking of a retest just to make sure this is screwy!>> Diet and broccoli made him worse? or just a bit different...****

>>>> tsh normal at 2.8****>>>> cbc normal****>>>> ** **>>>> ** **>>>> ****>>>> ****>>

>> >>

[Guest guest]

,Congratulations on making such significant improvements in your lifestyle. You are a model for "practice what you preach", which we in the medical profession could probably use a little bit more of.I agree with re-testing as my first thought would be that one of the two labs is wrong, but is it the first one or the second? Secondly, I see that one LDL was done as a direct LDL, while the other was mostly the calculated LDL. I would think that there might be some variability just because the methods used were different.I agree that you should get a HbA1C because I think is is a more sensitive screening test for prediabetes than a fasting blood glucose. I routinely order HbA1Cs in any patient who is at risk for diabetes or prediabetes, since it doesn't require fasting. Here is a link from the ADA advocating its use as a screening test for DM:http://www.diabetes.org/for-media/2009/cpr-2010-a1c-diagnostic-tool.htmlFinally, keep in mind that LDL is only a surrogate for overall health status, and that even with a higher LDL, you are still probably better off following your lower calorie diet, exercise regimen and continuing to lose weight. As someone who recently lost 10 lbs over 4 months through a reduced calorie diet, I now appreciate how difficult it is to actually lose weight. Good luck! SetoSouth Pasadena, CA

I think he means an hga1cthe patient has never had an impaired fasting blood sugar, and his last blood sugar was quite low with recent testingI'll wait a bit and repeat the lipids with an hga1c. I suppose we could do a 1 hour or 2 hour glucose tolerance test...but low carb diet seems to be the best intervention at this point.

I suppose with the reduction in weight and lower triglcyerides, I'm surprised the total cholesterol and ldl increased so much..At this point given weight loss the patient is going to remain on a lower carb diet and continue to see how much lower weight can go, and recheck.

I find it fascinating that there could be such a variation with ldl. Especially given no fried foods, mostly grilled chicken as the protein, water only or rare milk but certainly no soda...

The patient--ME!!!----the toughest patient one might say--will recheck and see what happens.I never figured after losing weight my ldl would go up, but I've always been...special I guess.

Rocky – what is a glycomark? Eads, MDPinnacle Family MedicineColorado Springs, COwww.PinnacleFamilyMedicine.com

‘You could also do a

glycomark if he did not want to do the 2 hour ogtt’

Rocky

Sent from my iPhone4

On Oct 5, 2011, at 5:54 PM,

wrote:

I would like anyone on the list to weigh in on a tough patient

39 y/o male

long standing history of high triglycerides, but is at least

20-30 lbs overweight for quite some time

no htn

no cad

sleep apnea controlled with cpap

no diabetes or impaired fasting blood sugar

no etoh use at all

non smoker

had labs in feb 2011 fasting

total cholesterol 197

ldl-direct 69

hdl 31

triglycerides 454

fasting blood sugar was 88

finally got him on a diet and he has lost nearly 20

lbs

plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

new labs with 12 hour fast of course

total cholesterol 236

ldl is 155

hdl 39

triglycerides 212

fasting blood sugar is 67

I think he wants to go back to his old diet as he prefered

his lower LDL! limited fish intake, considered some omega 3 supplementation but

often forgets to take his fish oil pill

any opinions? I am thinking of a retest just to make

sure this is screwy! Diet and broccoli made him worse? or just a

bit different...

tsh normal at 2.8

cbc normal

[Guest guest]

Good job!

Treat the patient, not the blood tests. Everyone is pre-diabetes and pre-death.

Look at all the risk factors and treat the patient. NNT and cost effectiveness

of treating " pre- " stuff is not where the money is. You know the lifestyle

changes you need. Press on doing what you are doing and recheck your labs in

2-5 years ... unless there is a change. I know I'll get flack for that one but

we get lost in labs. Treat yourself and if you are exercising, eating well,

maintain or getting to a health weight, wearing seat belts, etc ... you are

fine!

NNT for Trigs <500 or 1000 is nearly infinity. NNT for statins for isolated

elevated LDL (no other risk factors except sex and age) is also very, very high

despite what the drug companies promote. If fact, the evidence favors no statin

for women without hx of MI. Again, not what the commercials (TV or the Crestor

rep) say.

NNT for glucose in T2DM is infinity as lowering glucose prevents DKA,

hyperosmolar coma, and some microvascular dz. Metformin has some help but

likely not from it's glucose lowering effect. I don't rx A1c's below 8. I do

lifestyle but I likely already knew that about the patient.

So, look at the whole picture, modify risk factors (rarely with rx for primary

prevention but it certainly easier to do it that way), and enjoy life. There is

an actual syndrome of lab-dynia where patients focus so much on their abnl lab

that their perception of health and quality of life declines. This is best

studied in PSA-dynia (aka abnl test but nl patient).

The most common cholesterol result for someone with an MI is NORMAL.

The most common outcome for someone with high cholesterol is dying from old age.

Isolated hypercholesterolemia is not a disease. It is one of several risk

factors and not enough, by itself, to rx.

A male with an 3 MIs, FHx of early cardiac deaths, HTN, smokes, and has a pre-rx

LDL of 80 needs high dose statin to modify risk.

Rarely is further testing needed if you know your patient.

Just my 4 cents.

Craig

> >

> >

> >

> > I would like anyone on the list to weigh in on a tough patient

> >

> >

> >

> > 39 y/o male

> >

> > long standing history of high triglycerides, but is at least 20-30 lbs

overweight for quite some time

> >

> > no htn

> >

> > no cad

> >

> > sleep apnea controlled with cpap

> >

> > no diabetes or impaired fasting blood sugar

> >

> > no etoh use at all

> >

> > non smoker

> >

> >

> >

> >

> >

> > had labs in feb 2011 fasting

> >

> > total cholesterol 197

> >

> > ldl-direct 69

> >

> > hdl 31

> >

> > triglycerides 454

> >

> > fasting blood sugar was 88

> >

> >

> >

> > finally got him on a diet and he has lost nearly 20 lbs

> >

> > plenty of exercise-aerobics-kettlebells, pretty vigorous

> >

> > diet is veggies/lean protein (chicken breast) beans/broccoli caufhlower/peas

etc

> >

> >

> >

> > new labs with 12 hour fast of course

> >

> > total cholesterol 236

> >

> > ldl is 155

> >

> > hdl 39

> >

> > triglycerides 212

> >

> > fasting blood sugar is 67

> >

> >

> >

> > I think he wants to go back to his old diet as he prefered his lower LDL!

limited fish intake, considered some omega 3 supplementation but often forgets

to take his fish oil pill

> >

> >

> >

> > any opinions? I am thinking of a retest just to make sure this is screwy!

Diet and broccoli made him worse? or just a bit different...

> >

> > tsh normal at 2.8

> >

> > cbc normal

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

>

[Guest guest]

Two books and you'll cut your rx prescribing by 90% and understand one part of

why we have a costly medical system with poor outcomes:

Overdosed America: The Broken Promise of American Medicine

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing

Rise of Mental Illness in America

Craig

> > >

> > >

> > >

> > > I would like anyone on the list to weigh in on a tough patient

> > >

> > >

> > >

> > > 39 y/o male

> > >

> > > long standing history of high triglycerides, but is at least 20-30 lbs

overweight for quite some time

> > >

> > > no htn

> > >

> > > no cad

> > >

> > > sleep apnea controlled with cpap

> > >

> > > no diabetes or impaired fasting blood sugar

> > >

> > > no etoh use at all

> > >

> > > non smoker

> > >

> > >

> > >

> > >

> > >

> > > had labs in feb 2011 fasting

> > >

> > > total cholesterol 197

> > >

> > > ldl-direct 69

> > >

> > > hdl 31

> > >

> > > triglycerides 454

> > >

> > > fasting blood sugar was 88

> > >

> > >

> > >

> > > finally got him on a diet and he has lost nearly 20 lbs

> > >

> > > plenty of exercise-aerobics-kettlebells, pretty vigorous

> > >

> > > diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

> > >

> > >

> > >

> > > new labs with 12 hour fast of course

> > >

> > > total cholesterol 236

> > >

> > > ldl is 155

> > >

> > > hdl 39

> > >

> > > triglycerides 212

> > >

> > > fasting blood sugar is 67

> > >

> > >

> > >

> > > I think he wants to go back to his old diet as he prefered his lower LDL!

limited fish intake, considered some omega 3 supplementation but often forgets

to take his fish oil pill

> > >

> > >

> > >

> > > any opinions? I am thinking of a retest just to make sure this is screwy!

Diet and broccoli made him worse? or just a bit different...

> > >

> > > tsh normal at 2.8

> > >

> > > cbc normal

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> >

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[Guest guest]

Congrats on your tremendous efforts, ! Keep up the awesome

work! What a great job you are doing of leading by example for your patients!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of

Sent: Wednesday, October 05, 2011 10:31 PM

To:

Subject: Re: The patient with a a worse

cholesterol with a diet and weight loss!

I think he means an hga1c

the patient has never had an impaired fasting blood sugar,

and his last blood sugar was quite low with recent testing

I'll wait a bit and repeat the lipids with an hga1c. I

suppose we could do a 1 hour or 2 hour glucose tolerance test...but low carb

diet seems to be the best intervention at this point.

I suppose with the reduction in weight and lower

triglcyerides, I'm surprised the total cholesterol and ldl increased so

much..

At this point given weight loss the patient is going to

remain on a lower carb diet and continue to see how much lower weight can go,

and recheck.

I find it fascinating that there could be such a variation

with ldl. Especially given no fried foods, mostly grilled chicken as the

protein, water only or rare milk but certainly no soda...

The patient--ME!!!----the toughest patient one might

say--will recheck and see what happens.

I never figured after losing weight my ldl would go up, but

I've always been...special I guess.

Rocky – what is

a glycomark?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

‘You could also do a

glycomark if he did not want to do the 2 hour ogtt’

Rocky

Sent from my iPhone4

I would like anyone on the list to weigh in

on a tough patient

39 y/o male

long standing history of high triglycerides, but is at least

20-30 lbs overweight for quite some time

no htn

no cad

sleep apnea controlled with cpap

no diabetes or impaired fasting blood sugar

no etoh use at all

non smoker

had labs in feb 2011 fasting

total cholesterol 197

ldl-direct 69

hdl 31

triglycerides 454

fasting blood sugar was 88

finally got him on a diet and he has lost nearly 20 lbs

plenty of exercise-aerobics-kettlebells, pretty vigorous

diet is veggies/lean protein (chicken breast) beans/broccoli

caufhlower/peas etc

new labs with 12 hour fast of course

total cholesterol 236

ldl is 155

hdl 39

triglycerides 212

fasting blood sugar is 67

I think he wants to go back to his old diet as he prefered his

lower LDL! limited fish intake, considered some omega 3 supplementation but

often forgets to take his fish oil pill

any opinions? I am thinking of a retest just to make

sure this is screwy! Diet and broccoli made him worse? or just a

bit different...

tsh normal at 2.8

cbc normal