Lipid Panel Results

Diet and Nutrition
21

[quote]jwillow wrote:
OK, I’ve been meaning to post this stuff for a while.

My cholesterol and triglyceride numbers had been above normal for many years, and were getting worse. After my father died last fall, I decided to do something about it.

Here are before and after numbers (all tests run by Quest Diagnostics). The boldfaced numbers are “after”; normal range in italics.

Total chol. 304 195 <200mg/dL
HDL 49 66 >=40mg/dL
LDL 216 108 <130mg/dL
Triglycerides 194 104 <150mg/dL
Chol/HDL 6.2 3.0 <5.0

As you can see, these were fairly substantial improvements and my doctor was somewhat amazed - and is no longer suggesting that I need statins. For reference, I’m 45. The “after” numbers are from a recent lab test, after about three months on the program described below.

So here’s a quick overview of what I did. Note that the diet and exercise changes are nothing new for T-readers, but I had been slacking off in these areas. The supplementation changes might be the only novel area (by novel, I mean not part of a typical training program).

Diet changes
Less carbohydrates, more protein
More fruits and vegetables
Healthier fats
Carbs mainly after workouts
Fish every day (at least one serving)
No processed or fast food
Less alcohol
(I could have summarized this by saying “just follow Berardi’s 7 Habits”)

Supplementation changes
Megadose folic acid, B6 and B12
High dose pharmeceutical-grade fish oil
Lecithin
Flax seeds, hemp seeds
Cinnamon
Lots of supplemental fiber (oat bran, wheat bran, psyllium, pectin)

Exercise
Weights: 3 days/week, legs/push/pull split
Running: 3 days/week, 12 miles/week, 8 min/mile (fast pace)
[/quote]

Pretty similar to what worked for me. Bummer about the booze though. I was quite upset to learn that Guiness wasn’t the panacea I was looking for:)

22

[quote]greatgro wrote:
PharmD Pete wrote:
Re: you cholesterol levels, Niacin has been shown to be effective in reducing LDL, cholesterol and TGs while increasing HDL. Some people experience facial flushing when taking it, it has happened to me before, not real pleasant. You should take ASA about 30 min prior to help reduce the flushing. Also the slow release forms may reduce the SE associated with niacin.

Pete

I TOTALLY DISAGREE with this advice. Inositol hexaniacinate is the only form of niacin to produce no or very little flushing and it shown to be very safe for the liver. Many companies originally came out with a slow-release niacin to help reduce the flushing BUT THIS HAS BEEN SHOWN TO BE THE MOST DAMAGING TO THE LIVER. So please do not use slow-release Niacin unless you’re going to get regular liver function tests done by your doctor. Even then, you are much better off with a fast-release inositol hexaniacinate.

[/quote]

I think he meant that slow-release niacin has reduced side effects (implying the ones that actually make the person stop it). The flushing and pruritus can be VERY, VERY, VERY uncomfortable. First time I took standard niacin I look like I had third degree burns and could not have stopped scratching if I had been ordered at gun-point.

With meals, smaller divided doses makes this far less of a concern. The ASA can heal with the flushing/pruritus.

It is however true that slow-release niacin has been associated with increased liver enzymes (more so than niacin which also does this to some extent).

One could also look into the elevated glycemia (no hyperglycemia here but elevetad somewhat) that often accompanies regular niacin medication.

Niacin was generally a great medication both for cholesterol (LDL down, HDL up and triglycerides down) but a medication is only has good has patient compliance. And that was not so good for niacin.

Personnaly, on statins, I like this months Current Atherosclerosis Report:

Optimal Low-density Lipoprotein Levels: Evidence from Epidemiology and Clinical Trials.

Todd J, Farmer JA.

Curr Atheroscler Rep. 2006 Mar;8(2):157-62.

Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, MC 523D, Houston, TX 77030, USA. jfarmer@bcm.tmc.edu.

Aggressive lipid lowering was initially controversial due to evidence from epidemiologic studies that implied an increase in total mortality with low cholesterol levels combined with equivocal results from early trials utilizing bile acid resins or fibric acid derivatives. The advent of statin therapy allowed significant reductions of circulating lipid levels and clearly reduced cardiovascular morbidity and mortality.

Additionally, in adequately powered trials, total mortality was also reduced. The optimal level of circulating low-density lipoprotein (LDL) has not been definitely established. However, recent clinical trials with aggressive lipid goals have established that LDL cholesterol can be significantly lowered below 100 mg/dL with improvement in both surrogate measurements and hard clinical endpoints.

Ongoing clinical trials have been initiated that will determine the optimal level of LDL cholesterol that will insure cardiovascular benefits and establish the risk-benefit relationship of aggressive pharmacologic lowering of circulating lipid levels.

It is hard to understand the massive denial of statin benefits that is seen on this and other websites despite large and well designed studies showing the contrary. Detrators pick a couple of studies with conflicting results and discard the hundreds of others that show some benefits. Some side effects are picked and demonized when they are largely insignificant (like slight enzyme elevation, both for statins and standard niacin).

Others refer to Baycol mentioning the example that statins are the devil incarnate. Others go so far as saying that cholesterol is a super cool dude and is all beneficial, even that more cholesterol boost testosterone.

This is all understandable to some level, but it should also be clear that somethimes pharmaceutical companies, despite being evil multinational corporations, can come up with good medication. Yes, it sucks that nothing natural comes close to the new synthetic third generation statins, but hey, that’s life I guess.

Also it should be remembered that it is quite possible that despite being quite healthy, doing cardio and eating very well, cholesterol still remains high. So either make less cholesterol or excrete more out (most people do not enjoy medication that do that). Exercise helps somewhat but generaly gives poor results (when compared with medication for LDL/HDL purposes).

Then again, that cholesterol debate is old and dated.

Good luck on your health endeavors.
AlexH

23

[quote]CHF wrote:
jwillow wrote:
OK, I’ve been meaning to post this stuff for a while.

My cholesterol and triglyceride numbers had been above normal for many years, and were getting worse. After my father died last fall, I decided to do something about it.

Here are before and after numbers (all tests run by Quest Diagnostics). The boldfaced numbers are “after”; normal range in italics.

Total chol. 304 195 <200mg/dL
HDL 49 66 >=40mg/dL
LDL 216 108 <130mg/dL
Triglycerides 194 104 <150mg/dL
Chol/HDL 6.2 3.0 <5.0

As you can see, these were fairly substantial improvements and my doctor was somewhat amazed - and is no longer suggesting that I need statins. For reference, I’m 45. The “after” numbers are from a recent lab test, after about three months on the program described below.

So here’s a quick overview of what I did. Note that the diet and exercise changes are nothing new for T-readers, but I had been slacking off in these areas. The supplementation changes might be the only novel area (by novel, I mean not part of a typical training program).

Diet changes
Less carbohydrates, more protein
More fruits and vegetables
Healthier fats
Carbs mainly after workouts
Fish every day (at least one serving)
No processed or fast food
Less alcohol
(I could have summarized this by saying “just follow Berardi’s 7 Habits”)

Supplementation changes
Megadose folic acid, B6 and B12
High dose pharmeceutical-grade fish oil
Lecithin
Flax seeds, hemp seeds
Cinnamon
Lots of supplemental fiber (oat bran, wheat bran, psyllium, pectin)

Exercise
Weights: 3 days/week, legs/push/pull split
Running: 3 days/week, 12 miles/week, 8 min/mile (fast pace)

[/quote]

Just for people’s interest. Cinnamon has compounds that inhibit HMG-CoA Reductase and acts exactly like statins.

Also, other prefer to supplement their diets with red yeast rice, which generally containg the coumpound found in Mevacor (first generation statin) monacolin K, named lovastatin. Appropriate research should be undergone before selecting such natural products because standardization is lackin and some can contain contaminants.

It should be noted that most supplements that reduce cholesterol in any signifcant way do so through the cholesterol systhesis pathway, of which HMG-CoA reductase is one of the main players.

Another way is to up soluble and insoluble fiber consummation to sequester cholesterol and bile salts within the GI lumen and substracting them from the entero-hepatic cycle allowing cholesterol to be excreted. Cholestyramin (Questran) works be that pathway but offers only mild cholesterol reduction and uninteresting GI side effects.

Ezetimibe (Zetia, Ezetrol) also blocks cholesterol reabsorption without being itself absorbed. It is now offered as adjuvant therapy with statins to further reduce cholesterol levels.

Here is a little table of relative drug efficacy at approved doses that I shamelessly stole from the web.

Crestor and Lipitor are the two current competitors and offer similar results (but Crestor has a slight advantage in that most of the improvements are seen at its lowest dose, 10 mg)

Drug Dose(mg)
TC Decrease
LDL Decrease
HDL Increase
TG Decrease

Altocor 10-60mg D
18-29% D
24-41% D
9-13% I
10-25% D

Crestor 5-40mg D
33-46% D
45-63% D
8-14% I
10-35% D

Lescol 20-80mg D
17-27% D
22-36% D
3-9% I
12-23% D

Lescol XL 80mg extended release D
25% D
33-35% D
7-11% I
19-25% D

Lipitor 10-80mg D
25-45% D
35-60% D
5-9% I
19-37% D

Mevacor 10-80mg D
16-34% D
21-42% D
2-9% I
6-27% D

Pravachol 10-80mg D
16-27% D
22-37% D
2-12% I
11-24% D

Zocor 5-80mg D
19-36% D
26-47% D
8-16% I
12-33% D

Also, nothing stops someone to take both medication, do cardio and eat clean to have an even better lipid profile. (But Hey, I’m Canadian, this stuff is basically free here…I’d be poppin’ those like M&Ms…)

AlexH.

24

[quote]Dandalex wrote:
CHF wrote:
jwillow wrote:
OK, I’ve been meaning to post this stuff for a while.

My cholesterol and triglyceride numbers had been above normal for many years, and were getting worse. After my father died last fall, I decided to do something about it.

Here are before and after numbers (all tests run by Quest Diagnostics). The boldfaced numbers are “after”; normal range in italics.

Total chol. 304 195 <200mg/dL
HDL 49 66 >=40mg/dL
LDL 216 108 <130mg/dL
Triglycerides 194 104 <150mg/dL
Chol/HDL 6.2 3.0 <5.0

As you can see, these were fairly substantial improvements and my doctor was somewhat amazed - and is no longer suggesting that I need statins. For reference, I’m 45. The “after” numbers are from a recent lab test, after about three months on the program described below.

So here’s a quick overview of what I did. Note that the diet and exercise changes are nothing new for T-readers, but I had been slacking off in these areas. The supplementation changes might be the only novel area (by novel, I mean not part of a typical training program).

Diet changes
Less carbohydrates, more protein
More fruits and vegetables
Healthier fats
Carbs mainly after workouts
Fish every day (at least one serving)
No processed or fast food
Less alcohol
(I could have summarized this by saying “just follow Berardi’s 7 Habits”)

Supplementation changes
Megadose folic acid, B6 and B12
High dose pharmeceutical-grade fish oil
Lecithin
Flax seeds, hemp seeds
Cinnamon
Lots of supplemental fiber (oat bran, wheat bran, psyllium, pectin)

Exercise
Weights: 3 days/week, legs/push/pull split
Running: 3 days/week, 12 miles/week, 8 min/mile (fast pace)

Just for people’s interest. Cinnamon has compounds that inhibit HMG-CoA Reductase and acts exactly like statins.

Also, other prefer to supplement their diets with red yeast rice, which generally containg the coumpound found in Mevacor (first generation statin) monacolin K, named lovastatin. Appropriate research should be undergone before selecting such natural products because standardization is lackin and some can contain contaminants.

It should be noted that most supplements that reduce cholesterol in any signifcant way do so through the cholesterol systhesis pathway, of which HMG-CoA reductase is one of the main players.

Another way is to up soluble and insoluble fiber consummation to sequester cholesterol and bile salts within the GI lumen and substracting them from the entero-hepatic cycle allowing cholesterol to be excreted. Cholestyramin (Questran) works be that pathway but offers only mild cholesterol reduction and uninteresting GI side effects.

Ezetimibe (Zetia, Ezetrol) also blocks cholesterol reabsorption without being itself absorbed. It is now offered as adjuvant therapy with statins to further reduce cholesterol levels.

Here is a little table of relative drug efficacy at approved doses that I shamelessly stole from the web.

Crestor and Lipitor are the two current competitors and offer similar results (but Crestor has a slight advantage in that most of the improvements are seen at its lowest dose, 10 mg)

Drug Dose(mg)
TC Decrease
LDL Decrease
HDL Increase
TG Decrease

Altocor 10-60mg D
18-29% D
24-41% D
9-13% I
10-25% D

Crestor 5-40mg D
33-46% D
45-63% D
8-14% I
10-35% D

Lescol 20-80mg D
17-27% D
22-36% D
3-9% I
12-23% D

Lescol XL 80mg extended release D
25% D
33-35% D
7-11% I
19-25% D

Lipitor 10-80mg D
25-45% D
35-60% D
5-9% I
19-37% D

Mevacor 10-80mg D
16-34% D
21-42% D
2-9% I
6-27% D

Pravachol 10-80mg D
16-27% D
22-37% D
2-12% I
11-24% D

Zocor 5-80mg D
19-36% D
26-47% D
8-16% I
12-33% D

Also, nothing stops someone to take both medication, do cardio and eat clean to have an even better lipid profile. (But Hey, I’m Canadian, this stuff is basically free here…I’d be poppin’ those like M&Ms…)

AlexH.

I would never say that statins don’t work, my cholesterol dropped quite a bit while I was taking lipitor, I just didn’t like the side efects that I experienced. I realize that these side efects are rare, but like I said it scared that crap out of me. I don’t have a background in pharmacology and designed my diet by sifting through a lot of garbage on the net, consulting with my docs, and reading some of Berardi’s work. My belief is that if I can make myself healthier by eating real food as opposed to meds, I’ll choose real food anytime. It may not be the best choice for others but it did work for me. Obviously a very simplistic response to a well researched and intelligent post, but hey, I’m a simpleton!

25

[quote]CHF wrote:
Dandalex wrote:

I would never say that statins don’t work, my cholesterol dropped quite a bit while I was taking lipitor, I just didn’t like the side efects that I experienced. I realize that these side efects are rare, but like I said it scared that crap out of me. I don’t have a background in pharmacology and designed my diet by sifting through a lot of garbage on the net, consulting with my docs, and reading some of Berardi’s work. My belief is that if I can make myself healthier by eating real food as opposed to meds, I’ll choose real food anytime. It may not be the best choice for others but it did work for me. Obviously a very simplistic response to a well researched and intelligent post, but hey, I’m a simpleton!

[/quote]

Hey CHF,

I am all for the clean nutrition, hell I’m doing an M.Sc. in it.

Its just that sometimes people who try to maintain healthy lifestyles forget that the vast majority of their neigbhours are fat, sendentary, lazy, amotivated, self-pitying, whiny, uneducated pieces-of-sh*t.

Its always important that the first thing every med student his thaught is
Encourage:
1)Patients to quit smoking
2)Patients to eat better
3)Patients to exercise

It is also important to know what every med student learns while entering clerkships

Realize:
1)Patients will do none of those things

So generally speaking, the main reason many docs don’t even mention diet and exercice anymore and jump directly to statins is that, either through clinical experience or exercice/diet compliance studies, they know that for basically nobody does it (actually there’s been a study on this, but I haven’t reinstalled my university connection).

So what used to be done was: Tell patient to diet and exercice and come back in six months.

After six months…cholesterol is same or worse. Now they just skip that and save 6 months.

But there also is increasing evidence that quite low (not pathologically low) cholesterol still has M&M sparing effects (less of course than the high risk groups, but epidemiologically sufficient to tell doctors to lower the cut-off for cholesterol medication).

Its actually interesting that that thread came up since I just finish a course on Lipoprotein Metabolism last week.

There are of course to many people who despite all their best efforts, would still be above or near the high cut-off.

Personnaly, I can’t really blame the pharma industry. The food industry is in my opinion a far greater culprit to the obesity pandemic (with the associated societal factors of course).

Truth be told, every doctor now knows that exercice and diet have significant overall benefits to many, many health outcomes that tend to act synergically. Besides the fact that some people might sstill be unable to reach their targets, you have those fat jackasses (yeah, its society’s fault I know) that come in and should you ask the the following:

Bob, you cholesterol is through the roof, your blood is more butter than anything else, the diabetes is chewing your kidneys, your retinas show hemorraghea, you are not eve feeling that your shoes are 2 sizes too small, that grey toe you’re complaining about is not fugus, its gangrene…Bob, BOB, PUT THE DANISH DOWN BOB!..And no you can’t light up a quick one, its a freaking clinic here…Damn!..Ok, well, where was I…oh, right…and I am pretty sure those 52’ pants are getting to be a little too thight on you my friend. And that ECG you’re hooked on is telling me you’re having a heart attack right now.

So I’ll level with you Bob. You can either start eating healthy, stop the beers, cut the cigarettes, start walking and…I SWEAR TO GOD BOB, IF YOU PICK UP THAT DANISH I’LL KILL YOU WITH MY BARE HANDS!..You can just start being healthy!

Or, I can just pump you full of drugs!

So which is it?

Pump me full of drugs, Doc.

Honestly, think this is exagerated? Hell, I see guys who start getting their toes, feet and lower legs being progressively chopped off, their dick doesn’t work anymore, they’re starting to loose visual acuity and they still keep at it. Its like they are asking to see if they could become torsos, no legs, no arms, just torsos with a big sternal scar and fistulas for their dialysis.

And then I come here and see the total opposite.

The old notion of taking the middle road is what I feel is missing.

Sorry for the pseudo-ranting near the end, its was a rough week.

AlexH

26

I have never heard of 204 cholesterol being high enough to warrant medication, except for people who already have heart disease. I’m frankly a little concerned that your doctor immediately started pushing the drugs, unless you have some crazy risk factors that you didn’t mention.

27

[quote]Dandalex wrote:
CHF wrote:
Dandalex wrote:

I would never say that statins don’t work, my cholesterol dropped quite a bit while I was taking lipitor, I just didn’t like the side efects that I experienced. I realize that these side efects are rare, but like I said it scared that crap out of me. I don’t have a background in pharmacology and designed my diet by sifting through a lot of garbage on the net, consulting with my docs, and reading some of Berardi’s work. My belief is that if I can make myself healthier by eating real food as opposed to meds, I’ll choose real food anytime. It may not be the best choice for others but it did work for me. Obviously a very simplistic response to a well researched and intelligent post, but hey, I’m a simpleton!

Hey CHF,

I am all for the clean nutrition, hell I’m doing an M.Sc. in it.

Its just that sometimes people who try to maintain healthy lifestyles forget that the vast majority of their neigbhours are fat, sendentary, lazy, amotivated, self-pitying, whiny, uneducated pieces-of-sh*t.

Its always important that the first thing every med student his thaught is
Encourage:
1)Patients to quit smoking
2)Patients to eat better
3)Patients to exercise

It is also important to know what every med student learns while entering clerkships

Realize:
1)Patients will do none of those things

So generally speaking, the main reason many docs don’t even mention diet and exercice anymore and jump directly to statins is that, either through clinical experience or exercice/diet compliance studies, they know that for basically nobody does it (actually there’s been a study on this, but I haven’t reinstalled my university connection).

So what used to be done was: Tell patient to diet and exercice and come back in six months.

After six months…cholesterol is same or worse. Now they just skip that and save 6 months.

But there also is increasing evidence that quite low (not pathologically low) cholesterol still has M&M sparing effects (less of course than the high risk groups, but epidemiologically sufficient to tell doctors to lower the cut-off for cholesterol medication).

Its actually interesting that that thread came up since I just finish a course on Lipoprotein Metabolism last week.

There are of course to many people who despite all their best efforts, would still be above or near the high cut-off.

Personnaly, I can’t really blame the pharma industry. The food industry is in my opinion a far greater culprit to the obesity pandemic (with the associated societal factors of course).

Truth be told, every doctor now knows that exercice and diet have significant overall benefits to many, many health outcomes that tend to act synergically. Besides the fact that some people might sstill be unable to reach their targets, you have those fat jackasses (yeah, its society’s fault I know) that come in and should you ask the the following:

Bob, you cholesterol is through the roof, your blood is more butter than anything else, the diabetes is chewing your kidneys, your retinas show hemorraghea, you are not eve feeling that your shoes are 2 sizes too small, that grey toe you’re complaining about is not fugus, its gangrene…Bob, BOB, PUT THE DANISH DOWN BOB!..And no you can’t light up a quick one, its a freaking clinic here…Damn!..Ok, well, where was I…oh, right…and I am pretty sure those 52’ pants are getting to be a little too thight on you my friend. And that ECG you’re hooked on is telling me you’re having a heart attack right now.

So I’ll level with you Bob. You can either start eating healthy, stop the beers, cut the cigarettes, start walking and…I SWEAR TO GOD BOB, IF YOU PICK UP THAT DANISH I’LL KILL YOU WITH MY BARE HANDS!..You can just start being healthy!

Or, I can just pump you full of drugs!

So which is it?

Pump me full of drugs, Doc.

Honestly, think this is exagerated? Hell, I see guys who start getting their toes, feet and lower legs being progressively chopped off, their dick doesn’t work anymore, they’re starting to loose visual acuity and they still keep at it. Its like they are asking to see if they could become torsos, no legs, no arms, just torsos with a big sternal scar and fistulas for their dialysis.

And then I come here and see the total opposite.

The old notion of taking the middle road is what I feel is missing.

Sorry for the pseudo-ranting near the end, its was a rough week.

AlexH[/quote]

Sad but true I guess. I hope the Docs out there keep trying to push the healthy lifestyle thing first, then drugs if absolutley necessary however I can understand your frustration if you deal with “Bob” everyday. The positive for me in your rant is I have some cash tied up in a “Health Sciences” Fund and all of the “Bobs” will be good for business.

28

I have no risk factors that I know of.

[quote]Leafblighter wrote:
I have never heard of 204 cholesterol being high enough to warrant medication, except for people who already have heart disease. I’m frankly a little concerned that your doctor immediately started pushing the drugs, unless you have some crazy risk factors that you didn’t mention.[/quote]

29

Sorry Blaiser, your thread has sort of gone off track a bit. Back to your original question; I found introducing psyllium fibre (in the form of AllBran Buds)really helped. I also was hooked on fruit juice in the morning and a beer after work. Getting rid of those two really seemed to help my triglycerides.

30

[quote]CHF wrote:
Pretty similar to what worked for me. Bummer about the booze though. I was quite upset to learn that Guinness wasn’t the panacea I was looking for:)[/quote]

I said less alcohol. Not no alcohol. :slight_smile:

It’s embarrassing to admit this, but in the interests of scientific accuracy and full disclosure: I drank a six-pack of Guiness two nights before that most recent labwork.

I’d rather not quantify my prior alcohol consumption.

However, my lipid panel numbers were out of whack in 1998 when I wasn’t drinking at all, so I don’t want anyone to draw the conclusion that all I really had to do all along was cut back on the alcohol.

31

[quote]jwillow wrote:
CHF wrote:
Pretty similar to what worked for me. Bummer about the booze though. I was quite upset to learn that Guinness wasn’t the panacea I was looking for:)

I said less alcohol. Not no alcohol. :slight_smile:

It’s embarrassing to admit this, but in the interests of scientific accuracy and full disclosure: I drank a six-pack of Guiness two nights before that most recent labwork.

I’d rather not quantify my prior alcohol consumption.

However, my lipid panel numbers were out of whack in 1998 when I wasn’t drinking at all, so I don’t want anyone to draw the conclusion that all I really had to do all along was cut back on the alcohol.[/quote]

Interesting. I have always consumed Guiness on tap. Perhaps a move to the cans might improve my lipid profile?? If so we need to move this discussion over to one of the religious threads - Guiness in the can good for cholesterol is proof that we are all God’s children and his love for us is incomprehensible:)

32

If you really want to learn what’s going on with your blood lipids you need to have the VAP panel drawn. This goes way beyond just the numbers, but many doctors still are not aware of this important test. So make sure you request it next time.

33

Those who are interested in what are the accepted diagnostic and treatment protocols for polygenic hypercholesterolemia, might consider this webpage which contains a very nice overview and is relatively easy to understand for anyone that can read T-Nation.

Basically you have a disease that you wonder about…Gooble : Emedicine ‘‘disease in question’’ and you’ll get the associated page.

A very very usefull site for questions that creep up on T-Nation forums.

AlexH

34

[quote]Dandalex wrote:
Those who are interested in what are the accepted diagnostic and treatment protocols for polygenic hypercholesterolemia, might consider this webpage which contains a very nice overview and is relatively easy to understand for anyone that can read T-Nation.

Basically you have a disease that you wonder about…Gooble : Emedicine ‘‘disease in question’’ and you’ll get the associated page.

A very very usefull site for questions that creep up on T-Nation forums.

AlexH[/quote]

I concur with alex here. Emedicine is a GREAT website for info on all sorts of medical problems. I use to help me write some of my presentations at work. It is very well done. Good info there.

Alex I enjoyed reading your posts. You should post more often. Its always nice to read something that someone in the medical field wrote, especially when it a) makes sense and b) is accurate.

35

[quote]Dandalex wrote:
Those who are interested in what are the accepted diagnostic and treatment protocols for polygenic hypercholesterolemia, might consider this webpage which contains a very nice overview and is relatively easy to understand for anyone that can read T-Nation.

Basically you have a disease that you wonder about…Gooble : Emedicine ‘‘disease in question’’ and you’ll get the associated page.

A very very usefull site for questions that creep up on T-Nation forums.

AlexH[/quote]

Good link. Interesting that Ornish is mentioned. I’ve read some of his stuff but thought his recommendations would be nearly impossible to follow on a day to day basis.

Question for discussion; while on lipitor, I experienced pretty serious symptoms of myopathy yet CK values were normal. Same thing with Pravastatin. The symptoms disappeared when I stopped the drug. Any thoughts? Some sort of allergic reaction perhaps?

36

[quote]CHF wrote:
Dandalex wrote:
Those who are interested in what are the accepted diagnostic and treatment protocols for polygenic hypercholesterolemia, might consider this webpage which contains a very nice overview and is relatively easy to understand for anyone that can read T-Nation.

Basically you have a disease that you wonder about…Gooble : Emedicine ‘‘disease in question’’ and you’ll get the associated page.

A very very usefull site for questions that creep up on T-Nation forums.

AlexH

Good link. Interesting that Ornish is mentioned. I’ve read some of his stuff but thought his recommendations would be nearly impossible to follow on a day to day basis.

Question for discussion; while on lipitor, I experienced pretty serious symptoms of myopathy yet CK values were normal. Same thing with Pravastatin. The symptoms disappeared when I stopped the drug. Any thoughts? Some sort of allergic reaction perhaps?

[/quote]

Thanks PharmD Pete, I try to be as informative as I can be without going into full litterature review mode…(I try to have a life!) Still, it gets pretty hard sometimes for someone who’s had some research training not to start trying to reference everything and when you don’t you get called on it by someone who won’t even try to Google on the topic. So I try to balance my irritation, giving information and time. (Still trying to manage the irritation sometimes, I start ranting without knowing it!)

Emedicine for presentions? Hell yeah, it makes me think of the 5 Minute Consult that I have on my PDA. Clear, succint and well explained. And it does tend to contain a lot of info.

Its good to see other fellow health care professionals getting involved in these forums.

Hey CHF, your muscle pain complaints while on statins are pretty frequent (even if studies show really really small differences from placebo). Still, cases such as your (pain, no CK) are really not uncommon.

I was reading up on statins for a lecture and myopathy was an intriguing issue.

Research wise you’ll find that there are quite a bit of studies trying to figure out the how much and how come of statin-related myopathy.

On the down side, results are mostly not that informative. We are still stuck with a bit ? mark for the cause.

We know that 1) it is fairly rare, 2) some other medical conditions may make you more prone to myopathy and 3) its seems to be drug-specific for individuals.

Basically there is like three degrees of muscle issues that can occur with statins (it’s on a continuum but I like these categories): 1) muscle aches and pains, nothing really bad with no CK elevation. This is supposed to resovle itself pretty rapidly in the couple of weeks that follow drug cessation. 2) stronger muscle pains, mild weakness and mild CK elevation. This can take much more time to resolve and is due to some mild muscle inflammation. It can take months to resolve. And lastly, there are the scarrier massive muscle inflammation, severe muscle weakness and CK elevation that show extensive muscle damage with kidney damage risks.

Some have tried to link the myopathy with CoQ10 but no real clear answer came out of that. CoQ10 levels were for most of the people with pains (on statins) were barely different from the people with pains on placebo.

But, some people have tried CoQ10 supplementation and say that it help them but that’s mostly anecdotal. There is some limited evidence showing that Co10 supplementation may help resolve the symptoms/signs faster.

Its funny that one of the first pharma company that brought statins to the market thought about including CoQ10 but decided agains it, probably because of marketing difficulty. (Its always tougher to get your message across when its more complicated than : Take X to reduce Y.)

Also, I was saying above that its seems to be person-drug specific, its not unheard of to switch medications 2-3 times and then fall on on that does not cause these pains.

Technically its a good thing you didn’t CK elevations because that could mean that in the future should you end up really needing statins for some reasons (who knows you might look up in the mirror and see Bob one day) you could probably be put on a different statin and experience nothing at all. Or you could even do it right now.

That’s what one of the biochemist where I was doing a project did. Zocor and Lipitor both gave him muscle pains at the high doses he needed. Now he’s on the lowest dose of Crestor with very well controlled cholesterol and no side effects.

That happens a lot but more often then not many people when they try 2 meds that do the same thing, don’t want to try a 3rd one. Maybe if you decide to go on a third try, try to have some CoQ10 handy, just to see if the muscle pain come back, start taking it, and if they go away, you’d have your answer.

Anyway, its always good to see someone do diet/exercice first and succeed. Doesn’t happen a lot.

AlexH.