Saw new doc today and I explained it am doing keto and fasting to lose weight. She didnt say anything about fasting but she said shes not a fan of keto as a lifestyle, specifically the eating lots of fat part. I did tell her that I am more on keeping carbs low and trying to hit protein than trying to hit fat.
Anyway, we talked about bloodwork and she doesn't do the particle blood work but she she does look at ldl and hdl but I guess the deeper level are the sizes. She says in her pov, you either take medication or not in dealing with high cholesterol, independent of size.
Is she right in that way of thinking or I need to push for a doctor who does the particle stuff? We are meeting again in 3 months to compare and contrast so I guess from that perspective we shall see how the numbers are...
I guess how much "leeway" is it for higher numbers when particles are different etc.
did get labs back:
egfr 112 so its good, throid and other markers good except:
Cholesterol total 230
Try 320
Hdl 30
Vldl 60
Ldl 140
So its a baseline and she said we can revisit medication after 3 months. Definitely gonna go hard on fasting and keto naturally for 3 months.
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Your Doctor is typical of many. Why? Maybe old school or uneducated in Lipid technology and there is the business of selling of statins that influences many. The mere fact she won't dig deeper into your bloodwork should be a big red flag.
My LDL is sky high. Like the kind that traditional doctors are begging me to go on a statin. But I found a functional cardiologist that looks at my particle sizes and he really thinks there is no issue with my numbers and I tend to trust him. My small LDL was <90 when I had it checked last year which is amazing. He even had me do a CTA and I have 0 signs of buildup. So high LDL is not (IMHO - I am not a medical professional) by itself a useful metric of CVD risk.
I also think context is important - are your inflammatory markers elevated? My CRP is 0.2.
I second the CAC test. Paid about $100 out of pocket at a local lab (I called around because it’s not covered by insurance unless you live in Texas) and scored a zero which took my cardiologist off my back forever! He said he was surprised.
I said I wasn’t.
is there any indication of how the cac test would be like ? any symptoms or just you have it or dont
You get a coronary calcium ‘score’ - many doctors use LDL as a kind of proxy for heart disease, even though they really shouldn’t. Anyway, a CAC score indicates any calcification in your heart's arteries, revealing plaque buildup (atherosclerosis) and helping to assess cardio risk. It’s actually a far better predictor of heart issues than LDL. I have a feeling eventually insurance will cover it, but in the meantime, it’s great for pharmaceutical companies peddling cholesterol meds.
So what you want is a zero score.
Zero here as well. I pursued it because as an adoptee, I have no information about my medical history. And to answer your question OP, you either have it or you don’t, and then if you do, it’s a matter of degrees. An alternative would be that you have it so badly that you do have some symptoms, but that would be an extreme case and you would be aware of them if that were your case. It would have been diagnosed another way most likely.
Not a doctor but I recommend a CAC test.
Fun fact: statins only lower cardioprotective pattern A cholesterol, not CVD-risky pattern B cholesterol.
Your Trigs:HDL ratio says a lot on its own, though note that HDL will take a while to raise and weight loss will raise trigs. Particle size tests help as well, while CAC tests look at the progression (or not) of heart disease itself.
I'd focus on the weight loss itself at the moment -- that is going to make the biggest difference with cardiovascular health. Weight loss takes months or years, while CVD takes decades to progress so the urgency isn't warranted. If your doctor is insistent, find a new one.
LDL isn't the boogeyman it's been made out to be, unless you also have other markers for metabolic syndrome (insulin resistance, high visceral fat, bad ratios and particle sizes), all of which keto stymies.
yeah she did mention cac tests as an alternative way to determine health. She did say if theres calcification then its medicine time- not sure if that's the norm?
RN on keto here. That’s been the old school approach, and the CAC isn’t yet considered a standard diagnostic/rule out. (When I had mine a few years ago, there was no insurance coverage. I paid fully OOP. I agree with those suggesting you find a different doc. My guess is that you’ll have an uphill slog with this one as long as you’re keto.
what would she needs to change is we meet 3 months later to stay with her vs going to another?
hypothetically I lose some weight 3 months later and cholesterol numbers relatively the same, is that cause for concern and we need to look at particle sizes or cac? obviously inam hoping numbers go down.
Sure, see how that goes.
out of curiosity, what would be prescribed by a doctor who is more into modern practices? Just way to compare and contrast
I’m unable to answer that truthfully - but what I can say is that the metabolic health program I work for focuses on nutrition first rather than medications.
thsts cool. what do you measure as markers for success? and i am assuming its keto leaning?
Bio-markers tracked are weight, blood glucose, ketones. Macros are established
so cholesterol and tri are not considered at all?
It does not sound like your doctor is keeping up with the research, but is instead following the guidelines in her practice. That is the way the vast majority of doctors practice medicine. It's hard to blame them when so much of what they do is focused on checking boxes on forms to ensure reimbursement. Practicing outside those guidelines can have negative consequences for them.
But what is a patient to do? You can educate yourself and learn how to read and analyze the research so you can choose what advice from your doctor to accept or reject. Or you can look for, and hopefully find, a doctor who is keeping up with the research and who is open to troubleshooting outside the corporate medicine box when that is appropriate.
yeah... I think i will gove it a 3 months trial and see how it goes. she says she will comment on blood work and see after 3 months. so shes not pushing pills or anything yet. if she goes super aggressive 3 months later AND I have lost a bit of weight then maybe reconsider.
btw, is it worthwhile to subscribe to those blood metrics services like your entire health?
I'm not sure there is any good reason to delve into greater testing until you have exhausted the testing available through your doctor and then, after that, only if you are looking for an answer to a specific question. There are services like Own Your Labs where you can order a specific test without needing to subscribe to anything. Again, see how things go and then decide if you need more information.
yeah I think I am probably overreacting. the cac thing i never considered but we shall see how the difference is after 3 months. I will try to zone out any numbers I see now and work hard and see 3 months later
Keto is not mainstream, but it’s also not fringe conspiracy theory levels of crazy. I would say it’s one of those things that is subjective and results vary by person.
I’m not one to advocate for doctor shopping to find one that will tell you what you want to hear, but at a minimum I would want to find one that at least understands the mechanics of Keto so that they can offer you proper medical care and advice.
This sounds to me like a case where that doctor is not a good fit.
I’ve had 1 doctor specifically put me on a keto diet, 1 tell me to avoid keto because they prefer balanced diets, and another that told me “hey if that works for you and you lose weight great!”
As far as the specifics on the blood panel. No idea. I’m waiting to do my first one next year just to see. No idea what I should be looking for. Would like more info as well.
I absolutely don’t want a doc who’ll tell me what I want to hear. But if a new physician isn’t familiar with and receptive to new ideas and knowledge that I find value in through careful research, I don’t have the energy to do battle over my philosophy vs theirs. There are more and more doctors who see the science. Hell, I work with many of them.
Nutrition has not historically been a focus in medical school. Even my own doctor, who is my age, seemed hesitant about it at first. But he’s seeing the progress, and it’s becoming more commonly discussed in medical literature.
My doctor just does the particle sizes as well, its a stronger indication of cardio health/risk.
Ive never had high ldl or cholesterol when doing keto though but my vldl is very low (which is good)
Did you have high cholesterol before starting keto??
How long have you been doing keto/working on losing weight? It seems smart to me to at least give weight loss some time to work before starting drugs. 3 months sounds like a fair trial. (Your doc has probably seen hundreds of patients come back even heavier at these 3 month check ins, so… you have to actually do the work here).
Finally, keep in mind that high cholesterol can be genetic, and if that’s you, you’re gonna need both statins and diet/exercise to address it.
It is taking time for the old drilled in “knowledge “ fade and the new information to settle in. Particle size matters.
The cholesterol testing is geared toward the Standard American diet with all the problems it has caused.
I will say this my cholesterol numbers have improved significantly once I got to maintenance caloric intake. HDL up, LDL down, triglycerides down. Quite lean now and BP medication more than cut in half.
Now I will confess to a balanced macro set for fat and protein, just slightly more fat than protein and 20 ish on carbs.
I see.. would you say the particles played a role in the end of the numbers or the numbers would look good even if no particle size is considered. I guess first step is to do if and keto again then worry about numbers or doctors.
Big fluffy good small sticky bad. Without a particle size analysis the information isn’t truly informative. More of a guesswork opinion.
May I suggest that you, and your doctor, read Dr. Mark Hyman's book 'Eat Fat, Get Thin'? Or, Dr. Ken Berry's book 'Lies My Doctor Told Me'.
Basically, for someone that's on a keto diet, you need to know how large or small your LDL particles are. If most, if not all, are large, then you are fine. The dangerous LDL particles are the small ones. In Dr. Hyman's book he explains which tests you should have done to make sure that you are on the right track.
That said, it looks like your new doctor is old school, and still believes the 1950's BS that fats are bad for you and carbs are good. It is the other way around. I don't understand why these doctors are still clinging to old ideas.
yeah it was better than last doc who just went straight for meds.... the doc before who did the particle test used some idk shady blood work service charging me 1k for it...she even told me to ignore the "collection letters". i think 3 months is fine. if anything,
I know about the large and small particles that's why I asked if she was going to do that. I think she said there has to be a reason for it...maybe its more insurance charging thing like why first blood work you go straight to the expensive particle test?
The LDL particles test is more expensive than the useless old test. However, $1,000 for that test is ridiculous, though it all depends on your health insurance. That said, you are paying for health insurance, and it should cover that test. If they don't want to cover it, they are ripping you off. It is your body and your health.
Just posted numbers. lots of room for improvement
Yes. Please God, let them have insurance
Find a new doctor and start a low carb diet