Tom: As you rightfully ask us beneficiaries of your communications , it was my pleasure to contribute $ 100 to the foundation Just before going back to France for the summer tomorrow, I just wanted to give you an update on my case # 211 At that time I was 330 lbs and you rightfully so referred to "morbid obesity" , metabolic syndrome , insulin resistance ....... those for sure got my attention !I am happy to let you know I am now at 250 lbs on my way to 220 target by year end ,most importantly not through a temporary one time diet, but rather a lifestyle change , going from.... " a bear preparing for the winter ...but never hibernating " to take control of my metabolism , with1.) controlled and dramatically reduced carbohydrates intake .2.) frequency of healthy* small meals /snacks, rarely exceeding 4-5 hrs without feeding, attempting to eat what I burn in a day with the appropriate balance of Carbo / protein /fat for healthy muscle tone . (* building on mediteranean diet )3.) overall reduced food quantities, yet never discontinued my wine societies social activities with great meals and great wines in moderation.4.) lot of exercise having resumed biking in 2009 after 25 years interruption and since October 28th 2010 going to serious biking with a carbon fiber speed bike .......2338 miles ....average speed of 17.3 mph......on my 60th birthday February 24th I did bike 100 miles , a symbolic 160 km in just a little over 6 hrs (pictures included )5.) Medications: on metformin 2 x 500 since April 2009.......reduced Crestor from 40 to 20, 10 and since 4/26th 5 mgr ! , reduced Zetia from 10 to 5 mgr ,Altace 5mgr, Aspirin, Levothyroxin 50 , discontinued Toprol 50 after an episode of very low resting HR in march (43) and near perfect blood pressure of 117/70 after 35 miles biking full speed by 85*F . (In 2008 I tried Niacin , but had to discontinue due to severe hotflush /dizziness after 2 months while traveling to India - jet leg ? )6) continued supplements from Omega 3, OQ10enzymes ,to multivitamins , D3, B complex, Mg/K for cramps moderation , Glucosamine/Chondroitine for joints health.The way I feel and medical results speak by themselves ( e.g.small LDL-P from 1247 to 442!....HDL-C exceeding LDL-C , TG at 34, HA1c 5.8% ) Take a look at the enclosed table summarizing the data for the last 6 years ........almost all green, except that at 250 lbs I got to keep loosing more weight and belt size (adipokines control !)......biking in hilly areas should help further !My doctors, Cardiologist, Internist and Endocrinologist are all delighted and are encouraging me to continue this regiment including training for and realizing my plan to bike this coming September from Malmedy, Belgium (Battle of the Bulge area) where I grew up to my current vacation home in Provence, a 900 miles trip over 2 weeks going through the Alpes (if you are interested /curious.
Needless to say I have myself gained a totally different prospective on life as our common friend Dr X who I met in March in Naples would certainly confirm.I want to thank you for having been part of this transformation through the publishing of case #211 and your highly didactic monthly case studies, looking forward to continue to learn more overtimeFeel free to use the enclosed medical data for further research/studies/publishing, case update ?, and let me know if I can be of further help .Jean M. Heuschen
Please visit current issue of JCI http://www.jci.org/articles/view/41651/pdf
Free for downloading is
Always suspected what niacin does to lipids is only a part (likely modest) part of its MOA
TD
Keywords: niacin
Head over to the Lancet and check out the just published HPS data in Lancet: C-reactive protein concentration and the vascular benefi ts of statin therapy: an analysis of 20 536 patients in the Heart Protection Study:
Interpretation Evidence from this large-scale randomised trial does not lend support to the hypothesis that baseline CRP concentration modifi es the vascular benefi ts of statin therapy materially.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62174-5/abstract
Also see editorial by JP Despres
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62316-1/fulltext#article_upsell
Sooner or later they will all figure out that it is apoB and LDL-P that predicts what statins will or will not do. Why does no one, other than Alan Sniderman and his many followers (including me) ever mention the pretty ugly apoB data in JUPITER in all those folks with normal LDL-C. We need to see the NMR data from HPS that Dr Virgil Brown tlaked about in the IAS meeting in Boston two years ago. One day we will hopefully also have the JUPITER NMR data. Then we can all move on.
The following article written by myself and Tara Dall is available for free and can be downloaded. It is called: "MOVING beyond LDL-C incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes"
http://www.dovepress.com/article_5601.t2554196
Abstract: Lipoproteins are complex protein-enwrapped particles which traffic hydrophobic lipids and other molecules between tissues in plasma. Under a variety of pathological states, specific lipoproteins trafficking sterols, phospholipids, and fatty acids enter arterial walls enhancing a maladaptive inflammatory response resulting in atherogenesis. Several lipoprotein particle geometric parameters are now readily available from the laboratory. Such measurements beyond standard lipid concentrations can be used to better understand both the link between atherogenesis and the trafficking patterns of lipoproteins. Often, the various laboratory indices, especially standard particle lipid concentrations versus lipoprotein particle parameters, seem to conflict or exhibit discordance and thus confuse the patient and the provider. By using readily available (but often misunderstood) particle geometric parameters from two patients, we have attempted to illustrate that by properly utilizing the newer assays, very discordant standard lipid concentrations and lipoprotein laboratory parameters can be present in two specific patients and demonstrate how the newer parameters can aid the clinicians in performing better risk assessment and treatment decisions.
Dr. John West of just outside Atlanta GA, is a good friend and fellow certified lipidologist who has put together a nice exercise program - very simple for patients to understand. He like many of us is on a mission to wipe out cardiovascular risk and understands there is more toi this task than writing drug prescriptions.
Check out: http://www.thewestwayfitness.com/
John describes his regimen as not a diet plan. He teaches 2 simple lifestyle rules for everyone to follow to reduce their calories without dieting. In addition, he has devised an aerobic resistance training exercise routine called The Ultimate Workout. The routine is a 21 exercise workout done in a circuit training fashion that takes only 25 minutes to complete right in your own home. No special equipment, no gym, no travel, no personal trainer.
John can be contacted via his website, the NLA website or at jwmd85@aol.com
Keywords: exercise
All lipidologists treating or advising women need to read this superb document regarding the use of all hormonal therapies: estrogen, progetogens, SERMS, tibilone.
The entire statement can be found at http://www.endo-society.org/journals/ScientificStatements/upload/jc-2009-2509v1.pdf
Friends and Lipidaholics: I have made three postings today - Go over to Lipidaholics Group to see Case #261 and decide if your very high risk patient had an LDL-C < 40 mg/dL if you would reduce the potent statin dose. At the Lipid Geeks Group there is a cute little diissertation on fatty acids and my comments on the newest statin: pitavastatin (Livalo).
I'd love comments on all!
Happy Lipiding, Tom D
