The Good, the Bad, & the Ugly (my doctor visit)

[Josselyn]

* The GOOD news is:

I have a perfectly functional pair of kidneys.
MD was thrilled that I'd lost 17 pound in the 3 mos. since I'd seen her.
She was very pleased that my A1c went from 6.6 to 6.1 (I was somewhat less pleased; wanted to be in the 5s, but I've posted that already). At my request, she's put me on the metformin XR to see if I can't control the sleeping BG numbers better.


* The BAD news is that my cholesterol total increased (although some of it was ok):

Chol (range 0-200) 267 (from 213 four mos. ago/different lab, though)
Trig (range 0-150) 148
HDL (range >40) 67
LDL-CALC (range 0-100) 171
TC:HDLC (range 0-4.4) 4.0


My doc's a maverick, God bless her, and so is considering my weight loss, my lower carb diet, my D, and so forth as affecting those numbers in a temporary sense...and we are waiting for the next tests in three months before seriously discussing cholesterol meds (thank goodness).

She's telling me where to cut out the fat from my diet, but that so gets in the way of my low carbing.
There won't be much left to eat soon.
Gonna have to give up coffee if I can't have cream or half & half in it (sigh).
Evidently, I've eaten quite enough in my life...:(

* The UGLY news involved the C-Reactive Protein test results that someone here suggested I request (thank you!).

For those of you who don't know, this measures the level of cardiac and vascular inflammation, and is a dependable predictor of relative risk of a stroke or heart attack.

CRP Reference range:

Low risk: <1.0 mg/L
Average risk: 1.0-3.0 mg/L
High risk: >3.0 mg/L



My risk results???? 6.6 mg/L :eek: :eek: :eek:
WTF am I gonna do about THAT????? Buy life insurance?

Input would be welcome here, friends.

[foxl]

There IS evidence in the literature that lipids get poorer before they improve on the lower-carb diet!

Hang in there and keep up the great work!

[jps]

Josselyn

I can only speak from my personal experience. There was a point, about two months after I started low carbing, where my lipids got worse. Then within the next two months, they dropped down beautifully. I can't explain why. Some suggest that it may be the inital transition of fat loss. I really don't know why but it corrected itself, coincidentally, as my glucose control improved. I can't guarantee the same will happen with you, but I'm hopeful. My doctor also wanted to discuss statins at one time. I told him no, I wanted to wait and see what I could correct through low carbing. Obviously, it's a non-issue right now.

As for the CRP, please understand that while it is a predictor of cardiac risk, there are alot of things that can elevate it. It's very non-specific. You can almost think of it as having an elevated temperature. It basically tells you that something is awry, but not exactly what is wrong. Could be a virus, could be a bacterial infection, etc.

It's not all that rare that diabetics will have elevated CRP's. Another one, as in my case, was ferritin. Used primarily for iron studies, it's an acute phase protein, as CRP is, that is very non-specific. Just tells you that something is going on, but not what.

As my glucose control improved through low carbing, my CRP and ferritin returned to normal, as did my entire lipid profile.

Let me ask you this. Are you happy with your glucoses? Do you feel better physically? Let how you feel and let your meter dictate your course of action and see where it leads you. This isn't a sprint. It took us quite some time to get to the point of poor health. It's going to take awhile for our bodies to heal the damage. Be patient, be vigilant and good luck.

[dbaratta]

* The BAD news is that my cholesterol total increased (although some of it was ok):

Chol (range 0-200) 267 (from 213 four mos. ago/different lab, though)
Trig (range 0-150) 148
HDL (range >40) 67
LDL-CALC (range 0-100) 171
TC:HDLC (range 0-4.4) 4.0



Input would be welcome here, friends.[/COLOR]

I had high cholesteral, I am now on crestor once a day and my numbers are normal. Dropped 60 points. You might give it a try if you are not on something already.

You need the fat in your diet...... (my opinion):confused:

[NewdestinyX]

Let how you feel and let your meter dictate your course of action and see where it leads you. This isn't a sprint. It took us quite some time to get to the point of poor health. It's going to take awhile for our bodies to heal the damage.This is such SAGE advice, JPS. It's totally what keeps me going daily. I took a LONG time to get to this place - will take a long time to get back to healthy.

Also -- a CRP is different than a C-Peptide.. right?

[jps]

Yes, the two are totally different. CRP stands for C-reactive protein.

I agree, it can get confusing. Alot of acronyms and literally thousands of tests that most people can't pronounce.

[Granny Shanny]

(((Josselyn)))

You've done great! Of course there's still work to do - there always IS - but your progress is wonderful. I'm so happy you have a doc who'll work with you. We need more mavericks in this world!

JPS, great post . . . a good reminder for all of us.

[ShottleBop]

Check out the UCSD Statin Effects Study. There is still no evidence that statins reduce total mortality in women of any age. Read Uffe Ravnskov's book, Fat and Cholesterol Are Good For Your, or Miles Kendrick's The Great Cholesterol Con. Your HDL is getting up there--over 60 is considered protective. Work on getting your triglycerides down--there is research (fgummett has the link handy) showing that, once your triglycerides are below 70, it's virtually certain that your LDL will be the light, fluffy kind.

I am somewhat in your boat, as well (as I've posted elsewhere)--my LDL is higher now than it was at diagnosis (219, directly measured, vs. 194). Given my near-doubled HDL (79, from 40) and very low triglyceride (41) levels, however--and that my ratios of HDL to LDL and to total cholesterol place me in the "average risk" categories, she has asked me simply to try to get my LDL down to under 190.

[NewdestinyX]

Check out the UCSD Statin Effects Study. There is still no evidence that statins reduce total mortality in women of any age. Read Uffe Ravnskov's book, Fat and Cholesterol Are Good For Your, or Miles Kendrick's The Great Cholesterol Con.
I am somewhat in your boat, as well (as I've posted elsewhere)--my LDL is higher now than it was at diagnosis (219, directly measured, vs. 194). Given my near-doubled HDL (79, from 40) and very low triglyceride (41) levels, however--and that my ratios of HDL to LDL and to total cholesterol place me in the "average risk" categories, she has asked me simply to try to get my LDL down to under 190.Though I'm also of the mind that the general medical community is 'not being straight' with us about cholesterol -- and that there's never been a proven link between "dietary" cholesterol and heart disease -- I think more on this forum (me included) should at least 'warn' people that lo carb will mean 'higher fat' and 'cholesterol' (even if only while obesity is still present, as JPS points out) such that their doctors will notice these higher numbers as a direct result of eating more fat and cholesterol. Even though those studies and books you cite will make the case that 'that's okay!' - fat and cholesterol get a bad rap. I still think newly dx'ed T2Ds would want to know that one downside to eating lo carb being 'higher fat and cholesterol'. Oh yeah -- then there's the 'majorly diminished food choice' -- but we've explored that topic ad nauseum already.;)

[fgummett]

Oh yeah -- then there's the 'majorly diminished food choice' -- but we've explored that topic ad nauseum already.Are you trying to present a reasonable counterpoint or start another flame-wars :confused:

Here is the PDF on the relationship between LDL particle size and Triglycerides mentioned above The Role of LDL Particle Size Assessment... (http://www.centerforpreventivemedicine.com/04114med_messenger.pdf)

[Larry H.]

Josselyn

I can feel your pain.. I too had major cholesterol problems when I got here. So for me this thing about increasing my fat intake was a non starter. I had cholesterol of 257 when I had my bypasses six years ago now.

This last November (a year ago), I had a blood test that was overall the best I had had. It showed:

Chol. 143. ( That was up 20 points from the previous test due to influence here that more fat was good).

Triglycerides. 37. that is down from readings in the 300 range at one time!

HDL 68
LdL 67

Cholesterol Heart Ratio 2.1 (lowest I ever saw).

I interpret these figures to be the results of my two years of daily half hour walking and eating to fairly low carb and keeping fat to reasonable levels also. Which for me would me I do not use creams, whole milks, high fat cheeses, and stay to small cuts of lower fat meats.

It can be done, maybe as some say it takes time to reverse it. But I wouldn't put much faith in eating more fats as a strategy to stay healthy. For some of us its possibly deadly.

[musique913]

You know, something that struck me when I went to the diabetic educator was that they didn't suggest as many "Good" fats to me as much as they did the mediocre or bad fats.

I added olives, use exclusively olive oil, eat almonds with snacks sometimes, and my triglycerides are really good. I think it's entirely possible to eat low carb and low fat, just make sure you choose the right fats. Believe it or not the good fats actually satisfy you almost as much as the carbs do comfort wise, at least in my experience.:)

It's so tough, best of luck to you Josselyn.:)

Angela

[Josselyn]

There IS evidence in the literature that lipids get poorer before they improve on the lower-carb diet!

Hang in there and keep up the great work!

I've heard that AND have experienced it...but there wasn't so much hanging in the balance then. I was young and "immortal" then. Thank you for the encouragement, Linda.

Josselyn

I can only speak from my personal experience. There was a point, about two months after I started low carbing, where my lipids got worse. Then within the next two months, they dropped down beautifully. I can't explain why. Some suggest that it may be the inital transition of fat loss. I really don't know why but it corrected itself, coincidentally, as my glucose control improved. I can't guarantee the same will happen with you, but I'm hopeful...

...It's not all that rare that diabetics will have elevated CRP's. Another one, as in my case, was ferritin. Used primarily for iron studies, it's an acute phase protein, as CRP is, that is very non-specific. Just tells you that something is going on, but not what.

As my glucose control improved through low carbing, my CRP and ferritin returned to normal, as did my entire lipid profile.

Let me ask you this. Are you happy with your glucoses? Do you feel better physically? Let how you feel and let your meter dictate your course of action and see where it leads you. This isn't a sprint. It took us quite some time to get to the point of poor health. It's going to take awhile for our bodies to heal the damage. Be patient, be vigilant and good luck.
I feel better than I have in a few years, JPS. My BG is a work in progress, as is my weight, but I seem to have generally good control. I'd like to get my numbers down by another 10-15 points, but I've made great strides. That's part of what freaks me out about the CRP results...I feel well and strong. Maybe it's residual inflammation from the year-in-h e l l-with gallbladder. I was dx-ed three months after its removal, and there's no evidence to indicate I was D beforehand. I aspire to be where you are in the process, and make efforts to move in that direction. Thank you very much for your input, support and example.

I had high cholesteral, I am now on crestor once a day and my numbers are normal. Dropped 60 points. You might give it a try if you are not on something already.

You need the fat in your diet...... (my opinion):confused:

I agree that some fat is needed for me to be healthy. I don't eat much red meat, but I do like my dairy products and eggs. I'm not on anything like a statin...I know little about them, so the idea makes me nervous. I hate taking meds. I'm hoping these readings are transitional things as my body adapts to its healthier lifestyle. This is gonna take a while. It certainly took years to get here...
Thank you for your input. It's appreciated.


(((Josselyn)))

You've done great! Of course there's still work to do - there always IS - but your progress is wonderful. I'm so happy you have a doc who'll work with you. We need more mavericks in this world!

JPS, great post . . . a good reminder for all of us.

I agree with you about maverick doctors and JPS. :D Thank you for your nurturing kindness...and the hug. You're a sweetie.

Check out the UCSD Statin Effects Study. There is still no evidence that statins reduce total mortality in women of any age. Read Uffe Ravnskov's book, Fat and Cholesterol Are Good For Your, or Miles Kendrick's The Great Cholesterol Con. Your HDL is getting up there--over 60 is considered protective. Work on getting your triglycerides down--there is research (fgummett has the link handy) showing that, once your triglycerides are below 70, it's virtually certain that your LDL will be the light, fluffy kind.

I am somewhat in your boat, as well (as I've posted elsewhere)--my LDL is higher now than it was at diagnosis (219, directly measured, vs. 194). Given my near-doubled HDL (79, from 40) and very low triglyceride (41) levels, however--and that my ratios of HDL to LDL and to total cholesterol place me in the "average risk" categories, she has asked me simply to try to get my LDL down to under 190.

Thanks for the advice, ShottleBop. Thankfully, my doctor seems informed and, so far, not alarmed about my results. I'm going to re-address what I'm eating and see if I can whittle at the fat content a bit while stepping up the activity level. We retest in three months, and I pray there's an improvement...in both the CRP and cholesterol results. I really want to avoid statins if I can. I hate taking meds, and wish to keep them at a minimum. The scary CRP results just plain freak me out. :eek:

Though I'm also of the mind that the general medical community is 'not being straight' with us about cholesterol -- and that there's never been a proven link between "dietary" cholesterol and heart disease -- I think more on this forum (me included) should at least 'warn' people that lo carb will mean 'higher fat' and 'cholesterol' (even if only while obesity is still present, as JPS points out) such that their doctors will notice these higher numbers as a direct result of eating more fat and cholesterol. Even though those studies and books you cite will make the case that 'that's okay!' - fat and cholesterol get a bad rap. I still think newly dx'ed T2Ds would want to know that one downside to eating lo carb being 'higher fat and cholesterol'. Oh yeah -- then there's the 'majorly diminished food choice' -- but we've explored that topic ad nauseum already.;)

I agree that the jury is out on the dietary fat/cholesterol issue...and luckily my doctor approaches that skeptically. But I'd rather not use my situation here as a BoogeyMan to people who wish to control their BG with a low(er) carb diet and exercise before considering serious meds. I will always extoll the merits of a low(er) carb diet to anyone willing to listen. If one is eating healthy food, then I suppose the quantity of choices is naturally somewhat limited...but it's real food...healthy food that doesn't produce belly fat by its very nature. What's "diminished" by choosing that eating method, and I mean no disrespect, are most of the processed food options that cause health and BG problems in the first place.

As for me, I've had some pretty unique things happen systemically this past year, and my body seems to be on the rebound. My MD believes I'm in a state of flux and is taking a wait-and-see attitude. She did not tell me to stop low carbing, interestingly enough...just to weed out any excess fats I might be eating. Irrespective of our differing dietary approaches, I appreciate your interest and input into this thread, Grant.

Josselyn

I can feel your pain.. I too had major cholesterol problems when I got here. So for me this thing about increasing my fat intake was a non starter. I had cholesterol of 257 when I had my bypasses six years ago now...

This last November (a year ago), I had a blood test that was overall the best I had had. It showed:

Chol. 143. ( That was up 20 points from the previous test due to influence here that more fat was good).

Triglycerides. 37. that is down from readings in the 300 range at one time!

HDL 68
LdL 67

Cholesterol Heart Ratio 2.1 (lowest I ever saw).

I interpret these figures to be the results of my two years of daily half hour walking and eating to fairly low carb and keeping fat to reasonable levels also. Which for me would me I do not use creams, whole milks, high fat cheeses, and stay to small cuts of lower fat meats.

It can be done, maybe as some say it takes time to reverse it. But I wouldn't put much faith in eating more fats as a strategy to stay healthy. For some of us its possibly deadly.

Thanks for sharing your thoughts about this, Larry. It's just possible that, like you, I might have to tough out a lower carb diet that limits a lot of the "extras" like cheeses and cream. It's also becoming obvious that my previously sedentary lifestyle is coming back to bite me in the backside.

With Atkins, in the past, I did learn that one really can eat a lot of fat and protein with no cholesterol issues...but one cannot...ever...eat grainy and starchy carbs while doing so. Else, one is getting the worst of both worlds.

...I added olives, use exclusively olive oil, eat almonds with snacks sometimes, and my triglycerides are really good. I think it's entirely possible to eat low carb and low fat, just make sure you choose the right fats. Believe it or not the good fats actually satisfy you almost as much as the carbs do comfort wise, at least in my experience.:)

It's so tough, best of luck to you Josselyn.:)

Angela

The foods you mention provide delicious, healthy fats, and I agree that they are, indeed, satisfying. I use them, too. Thank you, Angela, for offering your support.

Oh, and Frank, thank you for the LDL link. :)

[flowerbabe68]

Just saw my cardiologist last week and asked for a CRP. She barked back," CRP's show inflammation,that's true,but many things can interfere with the results like arthritis, any inflammation you have on your body(I assumed she meant zits,cuts,uti,etc) Dr said she doesn't put much faith in the test. See what your next one is before buying a big insurance policy. Just when I think I have a good routine, something goes out of whack. Keep at it.:flowers:

[Moonglo]

My doctor only checks my cholesterol, lipids, triglycerides and such every six months... perhaps because it can get worse before getting better? Interesting, though, as I had never thought of this before.

Either way, Josselyn, you've done a great job. Keep it up! :)