thinking of the future: when gene therapy becomes available and safe for apoe, wouldn't it be healthier to "simply" become 3/3?
Yeah, maybe one day. But for now I think that dietary modulation can do a lot to help overcome the downsides of this particular allele.
Elus, things actually look pretty good in your blood tests, all things considered. The small dense LDL is probably the most worrisome, while the LDL really isn't that bad. The changes in your diet (reducing fat, alcohol, etc) will probably clean this up a lot. I'd stay with the fish oil, since it looks like s.d. ldl is more of an issue that total LDL. I like the iodine idea, along with the GTE. Both of those had positive effects on my mood and motivation, FWIW. You could knock your high iron down some by donating blood.
After a few months of the new regimen, you could repeat the tests that were abnormal. I'd be surprised if your doctor/insurer wouldn't go for that. I think you are going to be in great shape. You are super lucky to have figured this out at such a young age.
Thanks, niner. Yes, I plan on repeating the tests for sure in the coming months. I will post an updated bloodwork here when I do. I could reduce iron by reducing meat intake as well, because I'm a little squeemish when it comes to needles and my arm
. But yeah, if push comes to shove I could do that as well. I'll stick with fish oil for now but I'll see what the studies say when it comes to total LDL...
I believe your HDL and LDL levels are definitely cause for concern.
The latest guidelines discussed by multiple researchers at the Lipid Summit last year (12/3/2011) were:
- LDL < 70
- HDL around 60
Increased LDL is is closely associated with atherosclerosis and increased risk, increased HDL is loosely associated with decreased risk. So getting the LDL down is probably more important than getting the HDL up.
For HDL, the story is a bit more confused: there seems to be a decreased risk around 60, then risk goes up again after that. However, the effectiveness of HDL depends on the person's genotype, so for some individuals very high HDL is protective, for others it's an indication of something going wrong.
A patient with levels like yours was discussed in one lecture as someone who appeared to be fine and was doing all the right things, but still got a heart attack at the age of 38.
From what I've read I'd suggest that you try niacin. It decreases LDL and raises HDL. 500mg to start once a day. Do not use time released niacin because it can cause liver damage.
Vitamin K2 will help keep the calcium out of your blood vessels.
Avoid wheat in particular and carbs in general.
Intense exercise 4x a week is also a must.
Thanks for the niacin tip. I'll definitely look into that. Could you possibly link the lecture with the 38 year old heart attack victim? I'd love to compare my stats to his just for kicks (Though differing genetics would make such a comparison questionable).
Is my calcium high in my blood, do you think?
Also, I plan to up my exercise, but I will keep it fairly mild (Some biking, jogging, lifting probably). I'm a very skinny guy (as you can probably surmise from my posted BMI).
Vitamin D: suggest targeting more like 30-40 ng/dL 25(OH)D3.
The iron: you will want to get this down, surely. I might suggest cutting down on the meat, in favor of vegetable protein if you want to keep your pro up: a better path on multiple fronts than (more than normal) blood donation.
This is an idea that has some support in case-control studies, and has become widely believed because it has been advanced vigorously by paleo and strong low-carb advocates (esp when it touches on sat fat concerns), but there is little support for the idea in prospective studies, and the overall evidence doesn't support it.((1) -- and see more recently (2), published after this meta-analysis. And (3), again more recent, finds it in women but not men). Certainly your (Elus') levels are remarkably high. It looks to me like it's a surrogate marker for insulin resistance and central obesity, with no independent predictive power or etiological significance. No glycemia aside from fasting glucose, Elus ...?
IAC, it's total and LDL cholesterol that has been thus linked to risk of AD per se (rather than CVD) which is surely Elus' concern: I know of no studies looking specifically at small, dense LDL as a risk factor in AD.
Genotyping: an overall review finds the evidence on this lacking,(4,5) tho' this can't be considerede definitive as there are so few studies and no proper meta-analysis.
1: Ip S, Lichtenstein AH, Chung M, Lau J, Balk EM. Systematic review: association
of low-density lipoprotein subfractions with cardiovascular outcomes. Ann Intern
Med. 2009 Apr 7;150(7):474-84. Review. PubMed PMID: 19349632.
(AHRQ version here)
2: Toft-Petersen AP, Tilsted HH, Aarøe J, Rasmussen K, Christensen T, Griffin BA,
Aardestrup IV, Andreasen A, Schmidt EB. Small dense LDL particles--a predictor of
coronary artery disease evaluated by invasive and CT-based techniques: a
case-control study. Lipids Health Dis. 2011 Jan 25;10:21. PubMed PMID: 21262005;
PubMed Central PMCID: PMC3038964.
3: Ai M, Otokozawa S, Asztalos BF, Ito Y, Nakajima K, White CC, Cupples LA,
Wilson PW, Schaefer EJ. Small dense LDL cholesterol and coronary heart disease:
results from the Framingham Offspring Study. Clin Chem. 2010 Jun;56(6):967-76.
Epub 2010 Apr 29. PubMed PMID: 20431054.
4: Masson LF, McNeill G. The effect of genetic variation on the lipid response to
dietary change: recent findings. Curr Opin Lipidol. 2005 Feb;16(1):61-7. Review.
PubMed PMID: 15650565.
5: Masson LF, McNeill G, Avenell A. Genetic variation and the lipid response to
dietary intervention: a systematic review. Am J Clin Nutr. 2003
May;77(5):1098-111. Review. PubMed PMID: 12716659.
Hey Michael, I definitely am planning to get my iron down (as it promotes oxidation, right). As for my primary concern, I don't want either CVD or AD, obviously, so I want to minimize my risk of both (23andme says I have a lowered risk of CVD, but I haven't actually read the studies that these claims are founded on, so I can't be sure).
No one in my family has had diabetes, and the blood glucose level you see in my tests is fasting glucose (didn't eat anything 12 hours prior to the test). I haven't measured my non-fasting blood glucose.... should I?
EDIT: Thank you for those studies! Will definitely read up...
Edited by Elus, 08 January 2012 - 07:58 PM.