42 replies to this topic

[message]

Been lurking for a while and decided to join.  First off, thanks for all the great discussion and all the great info!

 

Asking in regards to my dad - he is early 60s, mildly obese, htn well controlled on atacand, sleep apnea but does not use CPAP, wegner's in remission (used to be on methotrexate and prednisone).  Eats okay, not great, but not bad.  Has been worked up and does not have coronary or carotid disesase.  Lipids are borderline.  

 

Besides exercising, eating well and getting enough sleep, what kind of supps should he be taking?

 

Currently prescribed candesartan 32mg and 1mg folic acid (which he takes here and there).

 

What I have been giving him:

 

asa 81mg daily

green pasture cod liver plus butter oil tabs 3-4 daily

AOR ortho core or some other multi 1 tab daily

takes ginger and turmeric tabs occasionally (his own choice)

 

 

1. For his overall well being and longevity, what else do you guys recommend?  Additions or removal of things from regimen would be greatly appreciated.

 

2. Should he cont the folic acid?  I believe that was prescribed to counter the methotrexate.  Is there harm from taking it?

 

Thanks again.

Edited by message, 03 November 2014 - 08:05 PM.

[Dolph]

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

2. Stop this butter oil WPF bullshit!!!

3. If he is no longer on MTX I don't see a reason to continue taking the folic acid, especially not at that dose.

4. If his lipids are borderline this would be the most logical vector to improve longevity, aka to implement primary prevention of CVD. If for whatever reason he doesn't want to take a statin for that or isn't able to control it effectively by diet alone, niacin could be an option to some degree. But that is nothing just to "give him" for obvious reasons. 

[niner]

At his age, he'd probably benefit from an increase in his carnitine pool.  I'd look at a gram a day of ALCAR as one way to do that.   If he's not getting 150 mcg/d iodine from the multi, I'd add it.  I like NOW's potassium iodide that supplies 225 mcg iodine per tab.  Some sort of magnesium supplement is usually worthwhile.  Normally I'd recommend c60-olive oil for anyone over young-middle age, but his Wegener's worries me a little,  C60 might make things better there, or might make things worse.  Fullerenes have shown efficacy in treating some of the conditions that Methotrexate is used for, but tinkering with the immune system in this case scares me a little.  MitoQ might represent a far more expensive partial alternative to C60-oo, without the immunomodulatory concern. 

[message]

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

 

I read here that ASA also has other unique properties, such as cancer prevention?.  My rationale was that athero disease cannot be ruled out fully unless one gets a coronary or carotid cath.  Is that a reasonable argument for continuing ASA? 

 

 

 

2. Stop this butter oil WPF bullshit!!!

 

LOL - I came across the butter oil plus cod oil blend and read that it provides optimal balanced  omega levels.  I may be wrong. Product is this: http://www.greenpast...Blend/index.cfm

 

Should I stop using?  If so, what product is recommended?

 

 

3. If he is no longer on MTX I don't see a reason to continue taking the folic acid, especially not at that dose.

 

Agreed.

 

4. If his lipids are borderline this would be the most logical vector to improve longevity, aka to implement primary prevention of CVD. If for whatever reason he doesn't want to take a statin for that or isn't able to control it effectively by diet alone, niacin could be an option to some degree. But that is nothing just to "give him" for obvious reasons. 

 

Well statins were mentioned by his PCP.  I read on here that statins do more harm than good.  He would not have any qualms with taking statins.  I just wasn't sure that I should give the 100% backing of statins as I read on here about the host of other issues they can cause...

 

 

 

 

Thanks for chiming in.  

Have replied one by one.  Let me know your thoughts.  Also, besides these, is there anything else he should be taking...

[message]

At his age, he'd probably benefit from an increase in his carnitine pool.  I'd look at a gram a day of ALCAR as one way to do that.   If he's not getting 150 mcg/d iodine from the multi, I'd add it.  I like NOW's potassium iodide that supplies 225 mcg iodine per tab.  Some sort of magnesium supplement is usually worthwhile.  Normally I'd recommend c60-olive oil for anyone over young-middle age, but his Wegener's worries me a little,  C60 might make things better there, or might make things worse.  Fullerenes have shown efficacy in treating some of the conditions that Methotrexate is used for, but tinkering with the immune system in this case scares me a little.  MitoQ might represent a far more expensive partial alternative to C60-oo, without the immunomodulatory concern. 

 

Thanks for replying niner.

 

What brand ALCAR product do you recommend?

 

I will check his multi and see if iodide is in it.  I think he is taking ALIVE brand now.  

As far as the multi goes, do you think he needs one?  He used to be on AOR ortho core - 1 tab and now he in on this one. 

 

 

I agree about the c60-oo.  I am a little hesitant to start him on that as it is too unpredictable. 

[Dolph]

 

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

 

I read here that ASA also has other unique properties, such as cancer prevention?.  My rationale was that athero disease cannot be ruled out fully unless one gets a coronary or carotid cath.  Is that a reasonable argument for continuing ASA? 

 

The effect size of the anti-cancer effects of ASA may be a nice extra if you take it for secondary prevention but the increased bleeding risk sets it off otherwise. The letter is basically true also for primary prevention of CVD. Even with a ten year risk of 20% excess bleeding risk and preventing events levels eachother off! If calculated risk is even larger and/or if there is evidence for subclinical atherosclerotic disease or an equivalent (diabetes!) ASA may be worth it.

 

 

 

2. Stop this butter oil WPF bullshit!!!

 

LOL - I came across the butter oil plus cod oil blend and read that it provides optimal balanced  omega levels.  I may be wrong. Product is this: http://www.greenpast...Blend/index.cfm

 

Should I stop using?  If so, what product is recommended?

 

I can't judge your dad's diet. If it is lacking longchain Omega 3 PUFA and IF he won't change it think about adding ordinary fish oil. 

Avoid anything like the plague if it is pushed by the crackpot-orginazation the WPF is. Really... An atherogenic diet combined with atherogenic supplements and magic (AKA homeopathy) won't help your dad or yourself live longer to say the least!

 

 

 

 

4. If his lipids are borderline this would be the most logical vector to improve longevity, aka to implement primary prevention of CVD. If for whatever reason he doesn't want to take a statin for that or isn't able to control it effectively by diet alone, niacin could be an option to some degree. But that is nothing just to "give him" for obvious reasons. 

 

Well statins were mentioned by his PCP.  I read on here that statins do more harm than good.  He would not have any qualms with taking statins.  I just wasn't sure that I should give the 100% backing of statins as I read on here about the host of other issues they can cause...

 

*sigh* I really have to take a deep breath being confronted with these "specialists" again. Yes, there are a few very vocal self-proclaimed "statin-victims" on this board, and no, it's all bullshit, of course! The chance of suffering a meaningful side effect from a statin, let alone a really relevant one are about as low as being hit by a piano falling down some apartment buildings front. And yes, the net benefit is absolutely without any question if said piano didn't hit your head sometime before.

 

 

 

 

[message]

 

 

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

 

I read here that ASA also has other unique properties, such as cancer prevention?.  My rationale was that athero disease cannot be ruled out fully unless one gets a coronary or carotid cath.  Is that a reasonable argument for continuing ASA? 

 

The effect size of the anti-cancer effects of ASA may be a nice extra if you take it for secondary prevention but the increased bleeding risk sets it off otherwise. The letter is basically true also for primary prevention of CVD. Even with a ten year risk of 20% excess bleeding risk and preventing events levels eachother off! If calculated risk is even larger and/or if there is evidence for subclinical atherosclerotic disease or an equivalent (diabetes!) ASA may be worth it.

 

Noted.  I will have him stop.

 

2. Stop this butter oil WPF bullshit!!!

 

LOL - I came across the butter oil plus cod oil blend and read that it provides optimal balanced  omega levels.  I may be wrong. Product is this: http://www.greenpast...Blend/index.cfm

 

Should I stop using?  If so, what product is recommended?

 

I can't judge your dad's diet. If it is lacking longchain Omega 3 PUFA and IF he won't change it think about adding ordinary fish oil. 

Avoid anything like the plague if it is pushed by the crackpot-orginazation the WPF is. Really... An atherogenic diet combined with atherogenic supplements and magic (AKA homeopathy) won't help your dad or yourself live longer to say the least!

 

Noted.  I am certain he will benefit from Omega 3.  What daily dose and brand of product do you recommend?

 

 

 

 

4. If his lipids are borderline this would be the most logical vector to improve longevity, aka to implement primary prevention of CVD. If for whatever reason he doesn't want to take a statin for that or isn't able to control it effectively by diet alone, niacin could be an option to some degree. But that is nothing just to "give him" for obvious reasons. 

 

Well statins were mentioned by his PCP.  I read on here that statins do more harm than good.  He would not have any qualms with taking statins.  I just wasn't sure that I should give the 100% backing of statins as I read on here about the host of other issues they can cause...

 

*sigh* I really have to take a deep breath being confronted with these "specialists" again. Yes, there are a few very vocal self-proclaimed "statin-victims" on this board, and no, it's all bullshit, of course! The chance of suffering a meaningful side effect from a statin, let alone a really relevant one are about as low as being hit by a piano falling down some apartment buildings front. And yes, the net benefit is absolutely without any question if said piano didn't hit your head sometime before.

 

Good analogy.  I will reach out to PCP to start statin.  Is any one statin recommended over the other?  Should he supplement with anything in particular while he is on the statin?

 

 

 

 

 Thanks again.  Appreciate your help. 

[Dolph]

 

 

 

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

 

I read here that ASA also has other unique properties, such as cancer prevention?.  My rationale was that athero disease cannot be ruled out fully unless one gets a coronary or carotid cath.  Is that a reasonable argument for continuing ASA? 

 

The effect size of the anti-cancer effects of ASA may be a nice extra if you take it for secondary prevention but the increased bleeding risk sets it off otherwise. The letter is basically true also for primary prevention of CVD. Even with a ten year risk of 20% excess bleeding risk and preventing events levels eachother off! If calculated risk is even larger and/or if there is evidence for subclinical atherosclerotic disease or an equivalent (diabetes!) ASA may be worth it.

 

Noted.  I will have him stop.

 

2. Stop this butter oil WPF bullshit!!!

 

LOL - I came across the butter oil plus cod oil blend and read that it provides optimal balanced  omega levels.  I may be wrong. Product is this: http://www.greenpast...Blend/index.cfm

 

Should I stop using?  If so, what product is recommended?

 

I can't judge your dad's diet. If it is lacking longchain Omega 3 PUFA and IF he won't change it think about adding ordinary fish oil. 

Avoid anything like the plague if it is pushed by the crackpot-orginazation the WPF is. Really... An atherogenic diet combined with atherogenic supplements and magic (AKA homeopathy) won't help your dad or yourself live longer to say the least!

 

Noted.  I am certain he will benefit from Omega 3.  What daily dose and brand of product do you recommend?

 

There is no universal agreement about dosages. For general supplementation, if increased triglycerides are not an issue, I would aim for something between 0.6 and 1.2 g of EPA+DHA daily. With most products that equals 2-4 g of fish oil.

I have absolutely no overwiev over the huge US supplement markets. But AFAIK despite what some manufacturers claim differences between fish oil products are miniscule.

 

 

 

4. If his lipids are borderline this would be the most logical vector to improve longevity, aka to implement primary prevention of CVD. If for whatever reason he doesn't want to take a statin for that or isn't able to control it effectively by diet alone, niacin could be an option to some degree. But that is nothing just to "give him" for obvious reasons. 

 

Well statins were mentioned by his PCP.  I read on here that statins do more harm than good.  He would not have any qualms with taking statins.  I just wasn't sure that I should give the 100% backing of statins as I read on here about the host of other issues they can cause...

 

*sigh* I really have to take a deep breath being confronted with these "specialists" again. Yes, there are a few very vocal self-proclaimed "statin-victims" on this board, and no, it's all bullshit, of course! The chance of suffering a meaningful side effect from a statin, let alone a really relevant one are about as low as being hit by a piano falling down some apartment buildings front. And yes, the net benefit is absolutely without any question if said piano didn't hit your head sometime before.

 

Good analogy.  I will reach out to PCP to start statin.  Is any one statin recommended over the other?  Should he supplement with anything in particular while he is on the statin?

 

In general the difference between statins most important are the differences in pharmacokinetics. So depending on comedication some have less potential for trouble then others. I would suggest 

leaving the decision on what specific statin to use to his practitioner. 

Studies trying to reduce the incidence of myalgia by Coenzyme Q10 supplementation have general been failures so this most certainly is not well spent money. Some argue that a healthy vitamin d level is useful to reduce the incidence of myalgia but it's also rather anecdotal. I wouldn't worry much about it as long as it doesn't happen. Myalgia is fully reversible and IF it should happen cofactors can still be investigated. A healthy vitamin d level isn't wrong in any case.

 

 

 Thanks again.  Appreciate your help. 

 

 

[niner]

 

1. Never(!) use ASA for primary prevention! Especially not without any hint of subclinical atherosclerotic disease.

 

I read here that ASA also has other unique properties, such as cancer prevention?.  My rationale was that athero disease cannot be ruled out fully unless one gets a coronary or carotid cath.  Is that a reasonable argument for continuing ASA? 

 

The effect size of the anti-cancer effects of ASA may be a nice extra if you take it for secondary prevention but the increased bleeding risk sets it off otherwise. The letter is basically true also for primary prevention of CVD. Even with a ten year risk of 20% excess bleeding risk and preventing events levels eachother off! If calculated risk is even larger and/or if there is evidence for subclinical atherosclerotic disease or an equivalent (diabetes!) ASA may be worth it.

 

Dolph, has the bleeding risk been quantified at this level?  There are millions of people taking 81mg Aspirin, including me.  The thing that I would worry about would be a cranial bleed, but I suspect that GI bleeds are the more likely (by far(?)) risk.  I'm working under the assumption that a GI bleed would be noticeable before it became life threatening.

[blood]

From a health perspective, wouldn't/shouldn't weight loss be an urgent priority for someone who is "mildly obese"?

It's difficult to know how to help normal people (non-health fanatics) with weight issues, though.

Edited by blood, 05 November 2014 - 07:15 AM.

[Dolph]

 I'm working under the assumption that a GI bleed would be noticeable before it became life threatening.

 

 

What I can tell for certain is that this assumption is unfortunately wrong. Most massive bleeding incidences with ASA do come pretty much out of the blue. 

 

As for the discussion about the relation between MI risk reduction and bleeding risk increase: http://www.bmj.com/c...t/340/bmj.c1805

 

Also consider that the FDA has recently changed their view regarding primary prevention with ASA: http://www.fda.gov/D...s/ucm390574.htm

[message]

From a health perspective, wouldn't/shouldn't weight loss be an urgent priority for someone who is "mildly obese"?

It's difficult to know how to help normal people (non-health fanatics) with weight issues, though.

 

Well he is working on it....

 

any tips about what to supplement would be good.  thanks.

any consensus on the ASA 81mg for primary prevention?  

 

Studies do show it is not advised, but the longecity community has many advocates for this practice.

[message]

So from what I read about helping Dad:

 

1. Start ALCAR 1gram daily

2. Check to see if multi with iodide.  If not, add NOW's potassium iodide that supplies 225 mcg iodine 1 tab daily.

3. Stop folic acid

4. Take one tab multi daily - either LEF 2/day or AOR Basics 3/orthocore

5. Touch base with PCP regards to starting a statin

6. One WPF butter/cod shit is done, switch to regular fish oil, preferably Carlsons

7. Add a Magensium tablet at night - have to find one, dose, etc....

 

Still up in the air about stopping ASA....

 

Loose weight.

 

Anything else recommended for overall well being?  Nothing for the brain or some other supps for something, etc. etc. ?  ? 

 

Thanks again everyone. 

[niner]

 

 I'm working under the assumption that a GI bleed would be noticeable before it became life threatening.

 

What I can tell for certain is that this assumption is unfortunately wrong. Most massive bleeding incidences with ASA do come pretty much out of the blue. 

 

As for the discussion about the relation between MI risk reduction and bleeding risk increase: http://www.bmj.com/c...t/340/bmj.c1805

 

Also consider that the FDA has recently changed their view regarding primary prevention with ASA: http://www.fda.gov/D...s/ucm390574.htm

 

Thanks Dolph.  One of the refs in the bmj paper showed that the risk of a GI bleed from low dose aspirin is somewhat lower than from high dose aspirin, but not as much lower as one might hope.    I have a family history of stroke / TIAs, probably due to familial high lp(a) which I am currently treating with niacin and monitoring.  (Also some carotid plaque.)  Colorectal cancer chemoprevention is also an item on the positive side of the ledger as I evaluate the risk/benefit.  In the absence of the lp(a) issue, I'd find it a lot easier to quit low dose aspirin, but instead it's a more difficult decision.  

 

Message, as far as your dad's use of ASA, I'd probably stop, in the absence of major risk factors. 

Edited by niner, 07 November 2014 - 01:02 AM.

[Dolph]

Well, if I had any amount of carotid plaque AND a family history of stroke and/or TIA AND lp(a) I definetely wouldn't stop the ASA personally(!) either, even if there was no solid evidence. This is just a gut feeling but I absolutely understand your point. Especially the carotid plaque can be seen as proof of subclinical atherosclerosis and as I understand it this justifies the use of ASA even in view of the new guidelines.

 

Edited by Dolph, 07 November 2014 - 08:17 AM.

[message]

His last cholestrol was around 215 mg/dl.  PCP gave him the option of whether to start a statin or holf off.  He opted to not start.  Is this a value that merits starting a statin?

 

 

 

niner - I agree.  I will have him stop the ASA.  In addition, I am going to start AOR multibasics and this already has iodine.

 

 

 

 

[Dolph]

The total cholesterol is not very informative. But with a TC of 215 he most certainly doesn't need aggressive treatment which will further reduce the already low risk of side effects.

It needs to be stressed again that the relative risk reduction achieved by a certain degree of LDL-lowering under statin therapy is always the same, no matter what the starting cholesterol was! 

Edited by Dolph, 07 November 2014 - 03:12 PM.

[message]

The total cholesterol is not very informative. But with a TC of 215 he most certainly doesn't need aggressive treatment which will further reduce the already low risk of side effects.

It needs to be stressed again that the relative risk reduction achieved by a certain degree of LDL-lowering under statin therapy is always the same, no matter what the starting cholesterol was! 

 

Cholesterol, Total   186   100-199 mg/dL

 

Triglycerides   102   0-149 mg/dL

 

HDL Cholesterol   60   >39 mg/dL

 

VLDL Cholesterol Cal   20   5-40 mg/dL

 

LDL Cholesterol Calc   106   0-99 mg/dL

 

LDL/HDL Ratio   1.8

 

 

Does this help in regards to starting therapy?

 

 

Some other labs:

 

 ESR, westergren was 17  (ref is 0-20mm/hr)

HEMOGLOBIN   13.0   13.2-17.1 g/dL HEMATOCRIT   39.7   38.5-50.0 %

 

Edited by message, 07 November 2014 - 03:56 PM.

[Dolph]

Well, to be honest, if these are HIS results I wouldn't worry too much and probably wouldn't opt for a statin but rather minor dietary adjustments to get the LDL a little bit lower. That doesn't mean he wouldnt benefit at all, but his TC/HDL is 3,1 which is really nice. Also probably no lipid triad, as HDL and Trigs look good/OK.

Edited by Dolph, 07 November 2014 - 03:57 PM.

[message]

Yes dolph. those are his. I also added ESR and the H/H.

 

Since I am logged in, will add COMP panel as well.

 

GLUCOSE   92   65-139 mg/dL

SODIUM   139   135-146 mmol/L

POTASSIUM   4.6   3.5-5.3 mmol/L

CHLORIDE   101   98-110 mmol/L

CARBON DIOXIDE   27   19-30 mmol/L

UREA NITROGEN   15   7-25 mg/dL

CREATININE   0.84   0.70-1.33 mg/dL

BUN/CREATININE RATIO   NOTE   6-22

CALCIUM   10.0   8.6-10.3 mg/dL PROTEIN,

TOTAL, SERUM   7.5   6.1-8.1 g/dL

ALBUMIN   4.5   3.6-5.1 g/dL

GLOBULIN,CALCULATED   3.0   1.9-3.7 g/dL

A/G RATIO   1.5   1.0-2.5

BILIRUBIN,TOTAL   0.8   0.2-1.2 mg/dL

ALKALINE PHOSPHATASE   67   40-115 U/L

AST   21   10-35 U/L

ALT   22   9-46 U/L

EGFR NON AFR AMERICAN   98   >=60 mL/min/1.73m2

EGFR AFRICAN AMERICAN   113   >=60 mL/min/1.73m2

 

Last Hgb1ac from Jan was 5.2

 

Last Test level in Jan was 

153   348-1197 ng/dL

 

Edited by message, 07 November 2014 - 04:01 PM.

[Dolph]

Did he ever smoke? Blood pressure is OK, too?

 

You know, I'm rather aggressive with my own risk factor management, but this isn't the classical statin candidat for sure. At least not now.

Edited by Dolph, 07 November 2014 - 04:00 PM.

[message]

Never smoked.

 

BP is excellent with the atacand 32 mg.

 

The testosterone level is a bit low - thoughts on supplementing test?

 

A1c borderline....

[Dolph]

No, test is not a good idea. http://www.medscape....warticle/813833

 

A1c borderline could make him as well a statin candidate but also one for metformine. 

[message]

Hmm thanks.

 

Should the A1c be rechecked again before starting therapy?

 

Also, which is a lesser evil of the two: statin or metformin?

[Dolph]

They both are NOT evil at all and are actually the closest to antiaging drugs currently available. If it was me, my own health and my own risk, I would probably opt to take both without a moment of hesitation.

The question what would yield more benefit at the moment is hard to answer. He isn't really prediabetic (yet) and his cholesterol is not so bad. So in my view it's pretty hard to make a mistake whatever you decide to do.

Edited by Dolph, 07 November 2014 - 05:06 PM.

[message]

They both are NOT evil at all and are actually the closest to antiaging drugs currently available. If it was me, my own health and my own risk, I would probably opt to take both without a moment of hesitation.

The question what would yield more benefit at the moment is hard to answer. He isn't really prediabetic (yet) and his cholesterol is not so bad. So in my view it's pretty hard to make a mistake whatever you decide to do.

 

Ya? you take em now?

 

So, if I understand correctly, you suggest he start both.

 

 Lipitor 10 mg daily and Metformin SR 500mg daily. 

[Dolph]

I wrote that if THAT PERSON DESCRIBED WAS ME and my own health situation I would opt do just that. But that's just me!

I don't take metformine as my A1c is great as approved just two days ago and I took simvastatin before without problems, now controlling my cholesterol with niacin and diet. 

 

Even if your father and his gp decided to put him on said drugs for obvios reasons I couldn't comment much on the doses suggested, although generally speaking both seem to be not completely unreasonable.

Edited by Dolph, 07 November 2014 - 05:54 PM.

[niner]

Never smoked.

 

BP is excellent with the atacand 32 mg.

 

The testosterone level is a bit low - thoughts on supplementing test?

 

A1c borderline....

 

 

Most doctors would consider an A1c of 5.2 to be fine.   Anti-aging enthusiasts would like to see it in the 4's, but I haven't managed to pull off that trick just yet...   I don't think I'd mess with T if he's not having problems.  With his lipid numbers, I'd skip the statins.  If you want to get a better picture of what's going on lipid-wise, you could get a VAP analysis from Atherotech, or a similar one from Berkeley.  I think everyone should do that, at least once.  They aren't particularly expensive.    It would be good to know his ApoE genotype.  The cheapest way to get that is through a 23andMe genome scan.   That gets you a lot of other data at the same time.  I like to know ApoE because it's actionable-- your genotype tells you which diet and medication strategies will help or harm you.

[sthira]

Would your father be willing to go the vegetarian or pescararian route for a bit? Combine that with regular walking, maybe some light yoga, and try a meditation practice? Learning how to breathe more deeply and consciously really isn't as woo as many think. Proper breathing -- even using a device like the Resperate -- has some outside the box medical use. My dad is about the same age as yours, and thinks the Resperate (expensive but worth it) has really helped him maintain a closer awareness of his overall health, fwiw.

[krillin]

Never smoked.

 

BP is excellent with the atacand 32 mg.

 

The testosterone level is a bit low - thoughts on supplementing test?

 

A1c borderline....

 

You could try tribulus. 1 g/day increases my testosterone 160 points from 400 to 560.