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Baseline labs, CAC, APOE - Could use some help

Inner Circle Member Forum >> Coronary Disease & Cholesterol Protocol >> Baseline labs, CAC, APOE - Could use some help


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Posted: 11/5/2019 2:11:46 PM
Edited: 11/5/2019 2:20:42 PM (3)
Hi folks - I’m new, be gentle.  But - you know - not too gentle, because this is serious.  

I recently learned I’m APOE 3/4, and have arterial calcification that is progressing at a rate of 25% a year, type 2 diabetes, central obesity, hypertension, lichen sclerosus (autoimmune), and hs-CRP over 7.0.  I have a very difficult time losing weight, even on a very low-carb diet, eating about 1800 calories/day.  I will get a full thyroid panel next time I test.  I’m 5’5" and 205 Lbs.  

I do not know if I have familial hypercholesterolemia, but I do have 23andme data if anyone can provide guidance on that.

I have been following a low-carbohydrate, autoimmune paleo diet for 3 months - no grains, dairy, soy, nuts, seeds, legumes, nightshades and I’m also sensitive to coconut, so that’s out too.  I eat essentially animal protein, vegetables, avocados, and fats (mostly monounsaturated), and duck eggs every few days. No seed oils.

CAC scores:

2017 total CAC score: 23
2019 total CAC score: 37 (LMA - 0; LCS - 1; RCA - 2; LAD -34) - 95th percentile for my age


Tot Chol - 276
HDL - 42
Trig - 166
LDL - 201

LDL Fractionation (everything increased after going low carb in 2019):

 Test  2018  2019
 LDL Particle Number  1945  2054
 LDL Small  498  607
 LDL Medium  331  481
 LDL Large  4695  5165

Lipoprotein Testing:

Test  Result   Range
 APO A1  141  >=125
 APO B  157  <90
 APO B/A1 Ratio  1.11  <0.63
 Lp (a)  163  <75

Blood Sugar:

A1C is 5.8
C-peptide 2.48 (ref range 0.8-3.85 ng/mL)
Comprehensive metabolic panel, CBC, and iron studies - all within range except elevated fasting blood glucose (119) and ALT (34).

My blood sugar is under pretty good control, and I expect that to continue improving.  My concern right now is my cardiac and Alzheimer’s risk.  

Current supplements:

Fish Oil (currently 2g DHA/EPA, working up to 3600)
Kelp tablets (iodine)
Vitamin D 5000 IU (working up as needed to optimize blood level at >=65)
Magnesium 400 IU/day
Vitamin K (Koncentrated K)

I take 2 prescription medications:
Hydrochlorothiazide (hypertension)
Verapamil (hypertension)

(I know Dr. Davis doesn’t like diuretics, but I’m allergic to several kids of antihypertensives and had a hard time even finding this combination.  I’d like to get off of them both.)

I also take:
selenium, zinc, and molybdenum to address copper overload, diagnosed 1/2019.
Vitamin C as an antioxidant
Antifungals, biotin, cinnamon oil, and gymnema sylvestre to address SIFO (have been taking for 2 months, about to discontinue)
L-carnitine for fat utilization (otherwise I wake up hungry in the middle of the night)
Multivitamin (no iron, no copper, bioavailable B vitamins)

I have done heavy metals hair testing and I seem to have very high lead and cadmium levels, perhaps from growing up drinking municipal water, in an old house with lead paint, and working in smoke-filled bars and restaurants for 10 years.  I’ve done some lead/cadmium chelation but had to stop because it was too stressful on my body.  I gained weight and my blood pressure rose even higher, plus the chelator I was using is known to cause SIFO - and that was my experience with it too.

My questions:

1. I should probably be on a cholesterol-lowering medication.  There are statins, Zetia, Gemfibrozil, Fenofibrate - the last 3 are not statins - anyone have an opinion on any of them?
2. What kind of exercise is best for me to be doing given my cardiac and APOE status? Cardio? HIIT? resistance training? All of the above?
3. The above labs were taken after 3 months of low carb and 1 month of pretty low saturated fat, but high mono.  I’m now considering a low-fat diet.  Maybe even plant based.  Something has to change.  Is this crazy talk?
4. What should I do about that Lp(a)? I know Dr. Davis says he doesn’t use niacin anymore.  Is the fish oil/iodine/vitD/gut health enough?

I know there are very smart, dedicated people on this board.  I’d truly appreciate any help you can offer.

Tags: , LDL-C ,calcium score,LDL-P,Lp(a),Statins

Bob Niland

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Posted: 11/5/2019 3:14:59 PM
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Posted: 11/9/2019 1:07:13 AM
Thank you, Bob!  Great feedback and information.  Much appreciated.  I’ll digest this and be back.

Dr. Davis

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Posted: 11/9/2019 3:46:54 PM
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