13

votes

Had a heart attack - need suggestions

Answered on September 12, 2014
Created October 03, 2011 at 6:45 PM

Hi all. In August 2009 I went into the ER in the middle of the night after waking with a massive headache and what I thought was indigestion. I remember the headache because I hardly ever get headaches and actually got out of bed to take an aspirin (something else I normally never do). Anyway my troponin levels were elevated and I was told I just had a heart attack.

Hard to believe, I was 34, 5'9, 155 lbs, ate what I thought was a healthy diet (SAD), and lifted weights frequently. I looked and thought I was in peak condition. I had a heart cath and was told I had no damage and no blockage (I will upload the video if there's any interest). My total cholesterol was 115 (HDL 16, LDL 74, TG 126). I was eventually put on 20mg pravistatin.

I have since been on a mission to learn as much as I can and make whatever changes necessary. This first led me to eating a very strict low fat diet and doing an insane amount of cardio exercise. This brought my cholesterol to 138 (HDL 31, LDL 69, TG 111) on 3/21/2011. I dropped to about 145-150 lbs.

Not convinced that this was any better than before I kept searching and eventually found Marks Daily Apple. Sometime in May I started to make changes to my diet (I still lift weights and do cardio occasionally) lowering carbs and eating more eggs, red meat, and vegetables. I did another lipid panel on 7/15 and and my cholesterol was 155 (HDL 39, LDL 90, TG 130). Later that week I committed to a much more primal diet.

Since then my typical breakfast is egg casserole (local farm pastured eggs, local farm sausage, organic vegetables) with a glass of milk (full fat, organic). Throughout the morning I drink a 2 cup mug of coffee that contains half/half and a tbsp of honey. Lunch is a salad with hard boiled eggs and or avocado with olive oil. Dinner is typically either salmon or grass fed beef with veggies. I also eat a few squares of 90% coca daily.

On 8/19 I (prematurely) did another lipid panel (I'm an accountant so its all about the numbers for me) and cholesterol was 159 (HDL 34, LDL 98, TG 135). This worried me but I eventually found that this is a normal liver defatting stage. At this time I weighed 142. I also had the following tested: Glusoce 97 hsCRP 1.2 A1c 5.5

Thinking another 6 weeks should be enough time to defat my liver I got another lipid panel done Friday (9/30). I'm down to about 140lbs. Total cholesterol is now 183 (HDL 39, LDL 120, TG 120). I realize I should have had a VAP/NMR done and will do this for my next test.

My questions: Are my numbers improving yet? Should my numbers be improving yet?
Am I doing anything that is preventing my HDL from going up/TG's from going down? When should I do my NMR lipoprofile? Any other suggestions?

edit: ECG from cardiologist appointments: 4/09/10 rate 62 pr 132 qrsd 76 qt 376 qtc 382 axis p -20 qrs 85 t 24 normal ecg unconfirmed diagnosis 10/08/2010 rate 92 pr 140 qrsd 80 qt 332 atc 411 axis p 58 qrs 90 t 42 borderline right axis deviation qrs axis (90,110) otherwise normal ecg unconfirmed diagnosis 04/08/2011 rate 65 pr 128 qrsd 79 qt 360 qtc 374 axis p 12 qrs 84 t 52 normal ecg unconfirmed diagnosis.

Have another cardiologist appointment this Friday.

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on April 02, 2013
at 02:37 PM

Congrats on the zero heart scan!

A97b68379a576dfa764a4828304d2efb

(4181)

on March 31, 2013
at 06:18 PM

Did you ever see an infectious disease doctor as suggested by Paul below? What was the outcome?

7b91be6e22d4e2960f40935e306bdee5

(245)

on March 31, 2013
at 04:19 PM

I used to follow Dr Davis a lot. Blood sugar is not a problem for me. I did have a heart scan done a few months ago and my score was zero. As I stated above, I think my issue is (was) clotting but I've made some diet changes (dark chocolate and cinnamon) to take preventative measures.

7b91be6e22d4e2960f40935e306bdee5

(245)

on March 31, 2013
at 04:17 PM

Was kind of surprised to see an email that this question had new answers. Guess this would be a good time to give an update. Haven't checked cholesterol for a while. When I was testing, HDL would not go above mid/high 30's. LDL would move based on how much sat fat I was eating. I just kind of moved on. I still feel great, haven't had any reoccurring episodes. Guess I've just chalked this up to a random blood clot. I did find that I do have a clotting disorder (factor V lieden). So, cholesterol really isn't my main focus anymore.

7b91be6e22d4e2960f40935e306bdee5

(245)

on December 10, 2011
at 11:27 AM

Hi Peril. Fancy seeing you here.

2a95ea95c793d6115fe636a93b5cea2c

(0)

on December 10, 2011
at 05:01 AM

A few weeks after my NSTEMI, I also got knee swelling, joint pain and had hive like swelling around one eye and my ring finger. GP took me off lipitor and metoprolol (leaving me on aspirin and plavix) and symptoms receded. When cardio put me on crestor the knee problem returned with vengance. Took myself off crestor but pain remained until I took myself off plavix, using fish oil, red wine, cocoa and turmeric to thin blood

Medium avatar

(39821)

on October 11, 2011
at 06:28 PM

As many miles as possible at a comfortable pace. Increase volume, not intensity.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 11, 2011
at 05:38 PM

Travis or anyone else still reading, re the walking - how much walking are we talking here? And at what pace? I'm getting up a little early to get some walking in before work (and before breakfast), doing a little on my lunch hour, and some after work. But at 3mph I dont feel like I'm accomplishing much.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 10, 2011
at 02:10 PM

Comprehensive Wellness Profile. CWP: #1 ordered test - year after year! Over 50 individual laboratory tests to provide a thorough Biochemical assessment of your health, and includes the basic cardiovascular tests as well as diabetes testing: Lipid panel (cholesterol, HDL, LDL, the risk ratio, triglycerides) Complete Blood Count (CBC's) Fluids and Electrolytes Thyroid Panel w/TSH Liver Panel Kidney Panel Glucose (Diabetes) Mineral and Bone

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 02:00 PM

What's cwp? Good luck and look forward to hearing about your progress!

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 01:59 PM

Houston is paleo-friendly BTW.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 10, 2011
at 01:10 PM

Thanks grace. I'm going to add Homocysteine, CRP-hs, and CWP to my VAP order. Looking to get this done in the next few weeks. Want to get my head around all the suggestions given here to make sure I dont miss anything.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:08 AM

More: http://www.annals.org/content/101/5/629.abstract [iron depletion in those overloaded makes a big deal! Even increases Testosterone and reverses secondary hypogonadisms, e.g. makes them MEN!!! It is very OXIDATIVE and can trigger Alzheimer's, cancer, autoimmune disorders and oxidative damage to be overloaded w/any excessive metals FYI outside of physiological ranges, see my above comment to Namby]

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:06 AM

Resources for you: http://www.aafp.org/afp/2002/0301/p853.html [how to diagnosis -- great review IMHO]

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:04 AM

You need a ferritin, Tsat%, full thyroid panel, Hgb/Hct, MMA and homocysteine for a full assessment IMHO. So 3/2011 you were still non-paleo eating grains and probably experiencing gut dysbiosis which can lead to B vitamin depletion/malabsorption as well as B-vit associated anemia and/or sometimes iron/blood losses (dep on degree of intestinal permeability). Low thyroid is common w/dysbiosis as well and low thyroid independently is associated with low ferritin. If ferritin and/or Tsat% are high, then the labs may indicate iron overload now w/paleo. If normal, dep on other labs so repeat later

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 09, 2011
at 01:51 AM

Yes, white. Mostly German.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 01:00 AM

Thank your wife for getting things going...!! Pain is a good indicator. You are lucky you didn't have plaque otherwise you probably would've been stented if bad/fearful cardiologist on duty...

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:58 AM

Are you white??? 1:8 have hemochromatosis by some expert estimates. It is widely underestimated and underdiagnosed until your 60s and symptomatic. Your family history -- what is it? Ancestry? Northern Euro?

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:56 AM

I consur with Quilt, you are a hypomethylator. See the 'hack jack' thread for more evolutionary thoughts on this one. Read Kruse's blog (you won't get it immediately so post more questions later *haaa!!*). Stress raises uric acid. It is profoundly common after any surgery (particularly in heart or diabetic patients) that gout is precipitated. Parvo is sometimes mild or 'asymptomatic' so the titers may give a good time frame when an infection may have occurred. You should consider the other rule out conditions listed as well; they're all autoimmune -- hemochroma, sarcoid, low thyroid...

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:51 AM

Davis expresed on his blog that E4 does best on low fat because it lowers LDL the most. Low fat (high carb) is the WORST for apo E4 by research of Dreon, Krauss et al which produced pattern B and increased small dense LDL (by proxy oxLDL and glycation) on VAP; high fat, the least amount of sdLDL: http://atvb.ahajournals.org/content/15/1/105.full

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:48 AM

Davis is great for anti-wheat propaganda but IMHO he doesn't understand the dietary implications for ApoE2, E3 or E4. His 'track record' at the cardiology website is not excellent; rarely do people achieve calcification regression (negative Agatston score): http://blog.sethroberts.net/2011/08/04/how-rare-my-heart-scan-improvement/

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 04:39 PM

Even with the heart attack symptoms that (and the previous) evening?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 03:19 PM

Would the virus most likely be something I still have? Or maybe something I *had* that went away? Only symptoms I have had are nasal congestion (pretty constant for as long as I can remember) which I just blame on seasonal allergies. B12 and local raw honey *seem* to manage it pretty well.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:51 PM

Tells me viral etiology.....get titers!

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:46 PM

Every quarter is how i do it

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:43 PM

If niacin did this you are likely a hypomethylator too....means low hdl anf high homocysteine! You better read my b vitamin blog too.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:41 PM

Great.....somebody else feels the viral angle.....hence my viral tier recs!

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:40 PM

The kitavans have zero to do with this. They have their own epigenetic biology that allows them to live as they do. Berger is as far away from as a kitavan is as a convention doc is to a shaman

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:37 PM

The more disease and destruction one acquires the the need to test. You can not manage if you cant measure.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:36 PM

Smart move berger....namby good t Houghts but his clinical path does not fit your thought process. But you are correct to test until you find gold with this situation. Most docs would not.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:32 PM

Good advice and makse sure they check for viral titers too!

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 02:15 PM

Also, the reason I checked into the ER was because I had some of the classic symptoms of a heart attack (chest discomfort, mild tingling in arm, shortness of breath). All were very mild and if it wasn't for my wife being adamant about getting it checked out I probably would have gone back to sleep. One other thing I just remembered, I felt the same discomfort the previous day and blew it off.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 02:07 PM

Just looked up parvo B19. While I dont recall having the rash associated with it, I definitely recall having joint pain and swelling AFTER the MI. My cardiologist recommended Niacin and after taking it for maybe a week I developed joint pain in my knee, ankle, neck and wrist. Researched the effects and concluded it was a gout flair up caused by the Niacin. I stopped the Niacin and the pain/swelling went away. Tried the Niacin again about 6mos-1yr ago and again the joint pain came back (stopped as soon as I noticed symptoms). Could Niacin cause this if its Parvo related?

3864f9a2af09b1b447c7963058650a34

(3703)

on October 08, 2011
at 08:03 AM

I think Sinatra is a lot like other integrative/functional doctors like Dr. Jack Kruse who is fantastic. With your family history significantly rampant for heart diseease (premature?) Namby Pamby's suggestion is prudent. Others who are great are Dr. Mark Houston MD. Resources: http://touroinstitute.com/ifm_proceedings_low.pdf#page=50 http://www.acamnet.com/houstonf2010metal.pdf http://www.guilfordmd.com/id3.html http://www.vrp.com/heart-health/ldl-oxidation-the-smoking-gun-behind-heart-disease

3864f9a2af09b1b447c7963058650a34

(3703)

on October 08, 2011
at 07:48 AM

Parvo is transmitted easily and via fomites (survival on inanimate objects). I had a friend who had this and a subsequent cath and since blockages were seen 3vessel-stents. Now he has metal in his veins forever. http://www.stanford.edu/group/virus/parvo/parvovirus.html

F1b82cc7e6d90384ad30007dd6c1b9e3

(1187)

on October 08, 2011
at 02:30 AM

i think testing every month is too often, every six months is better,

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 07, 2011
at 08:10 PM

Spoke with Dr Davis (wheat belly author and cardiologist) and he said my pattern was not characteristic of apo E4. I guess I'll know more after my VAP. Thanks for all the help here guys. This is truly a fantastic website.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 04:09 PM

so then you need to assess what is best for you.....labs or opinion? This is why I serial test....it forms the foundation of my recs. It is the rosetta stone for our epigenetic switches. Some paleo bloggers dont advocate testing. That is a decision for you to make.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 04:07 PM

For you FH may be low fat.....not for me. We have a different understanding of the condition. In fact a person at the AHS is still in contact with me about his FH. Masterjohn was asked what to do there and he qualified his response....and was low fat and non commital. I was not and spoke up about it. So did lustig.

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 05, 2011
at 02:12 PM

berger, just go to your primary care physician and ask for a referral. Just tell the infectious disease specialist, look, I had a heart attack at age 34 even though I have no sign of atherosclerosis. I have chronically low serum cholesterol. I have read that both low serum cholesterol and cardiomyopathy can be caused by protozoal infections. I want to be checked out. Let the doctors do the rest.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 05, 2011
at 12:30 PM

Is DHEAs the only additional test you would recommend with the VAP? I have the VAP ordered from here https://www.directlabs.com/OrderTests/tabid/55/language/en-US/Default.aspx and see there are packages, but I'm not sure if I need anything aside from the standard VAP. DHEAs looks like a seperate addon. I see homeosystine & hsCRP included in one of the packages, but I already had my hsCRP tested.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 05, 2011
at 12:24 PM

How on earth do I find a knowledgeable infectious disease specialist that is going to listen to a 36yo accountants ramblings about low cholesterol, heart attack and being in Jamaica. You could very well be right here, but I have no clue how to get from point A to point B on this one. If you have any recommendations, I'm all ears.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 05, 2011
at 02:08 AM

What if he's ApoE, Quilt? I mean it's like trying to treat familial hypercholesterolimia w/high fat. FH requires low fat. Unfortunately, the same applies here. Why not make him get his ApoE checked out via 23andme; I woudln't be surprised his Il6 is high. But given family history and his low TC/LDL, the most likely culprit is the genetic component: Lpa

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 01:10 AM

Imnot on board with high carb for any heart disease period. The reason for the sleep check with dhea s is because heart disease walks hand and hand with low androgens and high levels of IL6 which kills sleep. And the human heart fails with autographic failure....not apoptotic failure. Autophagy occurs with sleep. Sleep and heart disease are linked via pineal/thyroid pathways and leptin/androgen pathways

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:59 PM

Get your VAP ASAP; Lpb/a come free. Confirm the LP(a) hypothesis. Adopt Dr. Sinatra's program. Get your Cardy on board. Take fish oil and necessary supplements. Do high-carb Paleo. I would avoid SaFa, unfortunately, as much as that is believed to be innocuous. I trust Dr. Cordain on this, who's been misunderstood and misquoted so many times. Paleo is not a one size fit all. You have to tailor and finesse it to your special needs.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 07:52 PM

Should I wait a month or so for the VAP? To see if maybe I just didn't give paleo enough time to "work"? Or might that be playing with fire if I am E4?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 07:51 PM

Vap is ordered. I'm doing all tests without a Doc. My family practitioner died 10 years ago and I haven't been to the DR since probably a few years before that. I now just see the Cardiologist twice a year for a checkup.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:45 PM

And also do follow your Doc's advices (remind him of the need for a VAP)! Once you've had an attack, it's a whole new ballgame. It's not just a bunch of us farting around and doling out half-arse advices saying statins don't matter. Some of the parameters and risk factors change SIGNIFICANTLY once you're a heart attack victim.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:42 PM

Anyway, my money is on you having LP(a) >20 and having ApoE w/4 (44, 43, 34). That would explain the genetic component; those w/high Lpa have heart attacks when young and when TC and LDL numbers aren't out of the ordinary. Your HDL is low but that doesn't explain why you had an attack since your TC/LDL was also low at the time. Start Paul's safe starch program, track your Lp(a) like a time series ... unfortunately the only therapy is Niacin and that's not really proven. But I think safe starch (150-250g of carbs) is right for you, not VLC, and I would eat lean meats (i.e., avoid Sat FAt).

De267f213b375efca5da07890e5efc25

(3747)

on October 04, 2011
at 07:32 PM

You still may not show symptoms. Mention it to your PCP - I'm sure he would agree that this avenue needs to be explored.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:14 PM

For now, I'd give the same advice high-carb Paleoers would give: add some safe starch (white rice, yams, sweet potatoes). By extension, that would reduce your consumption of fat, esp. saturated fat by the crowding out effect. Don't be afraid of safe starch and you're not overweight to begin with.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:11 PM

If you have 4 in 1 or more of your APoE alleles, high fat could increase LDL. I think you're part of the 35% of the general population w/a 4 allele. Look back at your history: you started Paleoing in 5/2011, and it's low-carb Paleo (you mention no starch and very lil sugar). Your LDL increased 75% from your 3/2011 number, while your HDL & Trigs are up marginally. But the key is your Trigs should plummet while low-carbing; you ain't.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 06:33 PM

One place I'm confused re ApoE4. Doesn't ApoE4 usually mean high cholesterol? If anything I would think E2 given my low cholesterol levels. Unless I'm missing something? And one other place I'm confused - since my MI, my cholesterol levels look MUCH better (+59% overall, +62% LDL (could be good or bad), +144% HDL, and -5% TG). Is it possible I'm responding to the whole foods diet, just at a slow pace?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 06:04 PM

I seem to sleep fine. Wake up very refreshed, usually before my alarm clock. No headaches except for the one mentioned the night of my MI.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:13 PM

Check out this link regarding genetic testing: http://paleohacks.com/questions/57164/the-wheres-and-hows-of-getting-tested-apoe-cortisol-genome-o6o3-ratio-mine#axzz1ZplFKRB4

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:12 PM

That's a genetic test you can get from 23andme and other such sites. Doctors may not be open to this.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:09 PM

There you go: you need a VAP test not for the particle size but for the genetic components (Lpa). That is a huge risk component that's hard to measure w/simple infl markers. It's unfortunate. People on this board might disagree, but you might have to be open to the possibility that Paleoing (high fat) might not work for you. Some of us are not genetically ideal for high fat.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 05:04 PM

I do not smoke, have slightly elevated BP (130/85 ish), lots of heart attacks in family history (both sides), not diabetic or have any autoimmune diseases that I know of. I agree with you on the VAP, most likely type B (have not tested this yet).

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 05:00 PM

I know he is. Which is what pisses me off. He can look at me and see that I'm young, in great physical condition, have no blockage, perform the stress test without breaking a sweat, and generally do not fit the profile for a heart attack, yet still treat me like I'm 85 or 350 lbs.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 04:43 PM

That's why u need to look at other risk factors: (1) u smoke: (2) howse your BP; (3) family history of CVD; (4) diabetes, (5) autoimmunity, etc. U need a VAP test but I can tell based on your Trigs that your LDL is the small ones. ANA needs to be tested for autoimmunity and a whole host of inflammation markers (fibrinogen, Homycysteine, IL-6, ESR, Ferritin, LP(a) from VAP, TNF). Rule out hypothyroidism w/a panel. Also, look at Paul's suggestions for dyslipidemia: http://perfecthealthdiet.com/?cat=115

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 04:36 PM

Your doctor is going straight from the book: low-dose aspirin therapy and statins are de riguer in mainstream medicine for someone who's had a heart attack. You can't really argue against the statin since Pravistain is less virulent than Crestor/Lipitor and statin therapy somewhat reduces risk (vs. someone w/no heart attack) if you've ahd one. For the time being, I would follow those suggestions. You are a classic case of someone who's TC and LDL do not fit a heart attack candidate; but then 50% of those who suffer heart attacks are like u.

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 04, 2011
at 03:53 PM

berger, I would ask for a referral to an infectious disease specialist and get checked out. Be sure to tell them of the low serum cholesterol and its relation to protozoal infections. Jack, CMV is always a possible contributing factor but usually doesn't cause acute disease by itself, and doesn't lower serum cholesterol. Trypanosoma cruzi is found in the US. He was also in Jamaica. These conditions may not be common in the US but are probably not uncommon among people who have heart attacks at age 34. I think he needs a knowledgeable specialist to do a workup and diagnosis.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 02:02 PM

Cardiologist recommended low dose (80mg?) aspirin I believe due to its ability to "prevent heart attacks" lol. Also taking 20mg pravistatin.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 01:55 PM

Why daily NSAID? Prescription or OTC? What dose and what type of NSAID is it? What inflammation condition do you have that is being treated by NSAID? That will cause leaky gut in a jiffy. Also, what statin and how much dose of stain ru taking?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 01:17 PM

I'm having trouble finding the Apoe4 test. What is it called? FWIW I'm using directlabs.com. Re poor sleep - I'm sleeping great! And waking feeling very refreshed.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:17 PM

Liver enzymes were within range (18/24 I think). I do not have the tests in front of me. No know issues.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:03 PM

True, I was referring to the signs (#5) on the leptin prescription page. The labs tell a different story.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:00 PM

Male. I'm not taking calcium supps but I have been taking a multivitamin and daily nsaid since the incident. I recently (maybe a month ago) started taking 4000 iu D3, and 3 1000mg fish oil daily. I also take B12 for allergies (been taking this for 5+ years). And of course the statin.

3a567c1637db69f1455ce35e78201a2c

(1054)

on October 04, 2011
at 03:07 AM

But your labs do not reflect that you are even close to Leptin sensitivity. Your are still in a very vunerable place with your labs.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 01:35 AM

It was classified as a NSTEMI. Why should I stop testing? I want to find out what is going on with me and there have been many good test suggestions here that may help figure this out.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 01:04 AM

Have not had vitamin D tested, just started supplementing about a month ago. I take 4000 iu once a day.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:52 AM

If youre thinking infection and im not CMV makes more sense.....and you could easily test for it.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:50 AM

I dont think this fits either. Usually seen in post menopuasal women and most have heart disease history

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:43 AM

To me this is not chagas. History does not fit and neither does blood work. At 34 your exposure could have been as a teenager but given your geography and history only way to get it would be a blood transfusion that was infected with it. The cardiac manifestations also are not ischemic but usually of pump failure due to the amastigotes love of the neural plexi. Moreover, the admission labs would have shown some abnormalities in lymphocytes fractions. And if this was chronic chagas with cardiac issues.....other organs and symptoms of mega organogenesis would be present.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on October 04, 2011
at 12:41 AM

lol...."good thing they started a statin".

0dbd7154d909b97fe774d1655754f195

(16131)

on October 03, 2011
at 11:54 PM

I am sorry if I am missing this but what is your vitamin D level? Do you supplement D3?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 09:49 PM

04/08/2011 rate 65 pr 128 qrsd 79 qt 360 qtc 374 axis p 12 qrs 84 t 52 normal ecg unconfirmed diagnosis.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 09:44 PM

ECG from cardiologist appointments: 4/09/10 rate 62 pr 132 qrsd 76 qt 376 qtc 382 axis p -20 qrs 85 t 24 normal ecg unconfirmed diagnosis 10/08/2010 rate 92 pr 140 qrsd 80 qt 332 atc 411 axis p 58 qrs 90 t 42 borderline right axis deviation qrs axis (90,110) otherwise normal ecg unconfirmed diagnosis

77877f762c40637911396daa19b53094

(78467)

on October 03, 2011
at 09:28 PM

One thing is certain, Coenzime Q10 100-200 mg per day is probably going to help. Look for the best quality.

Bece6312a7d51fc6a98a49bd62cf3152

(85)

on October 03, 2011
at 09:24 PM

Troponins rise because the ballooning is damaging to the heart. Your cholesterol level was normal and your coronaries were clean...its a good thing they started a statin.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:58 PM

I cannot recall any stressful events at that time. But it was classified as a NSTEMI. I do have the EKG papers at home and will post any notes from the when I get home.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:46 PM

I do not think I have any of the other symptoms associated with this above infection. I really dont think I have any other symptoms period. I do have "allergies" which result in itchy eyes and problematic sinuses. Other than that, I *think* I'm as healthy as can be. Aside from the heart attack.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:26 PM

I have not. I'm from Ohio. I have been (south) to Southern Cal about 13 yrs ago, Fla various times ago, Jamacia 11 yrs ago. I think thats it.

Medium avatar

(39821)

on October 03, 2011
at 08:20 PM

Wow, that's interesting; have you traveled to Central or South America, berger?

Medium avatar

(39821)

on October 03, 2011
at 08:13 PM

Wow, that's interesting; have you traveled to Central or South America or Mexico, berger?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:01 PM

I have though, always suspected that I did NOT actually have a heart attack, I just couldnt find any reason for the troponin to be elevated. Are you thinking I still have the infection (low HDL)? If so I could go have my troponin retested (without heart attack symptoms).

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 03, 2011
at 08:00 PM

Try reading the Wikipedia page on Trypanosoma cruzi: http://en.wikipedia.org/wiki/Trypanosoma_cruzi. Human American trypanosomiasis, or Chagas disease, has two forms, a trypomastigote found in human blood and an amastigote found in tissues. The acute form usually goes unnoticed and may present as a localized swelling at the site of entry. The chronic form may develop 10 to 20 years after infection. This form affects internal organs (e.g., the heart, the esophagus, the colon, and the peripheral nervous system). Affected people may die from heart failure.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:58 PM

Thanks Paul. Are there any other symptoms that would support this? I almost never get headaches. That incident was probably the last time I took medication for a headache. Thanks.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:46 PM

I appreciate that Nance. Its hard not to get caught up in what people say. Heck according to my cardiologist I'm fine (so then why did this happen to me?). For my family's sake I just want to make sure of that.

Medium avatar

(39821)

on October 03, 2011
at 07:44 PM

That would be fine. You lunch is so low in carbohydrates that it wouldn't have much of an effect at all, especially after 5 hours. Just try to log as many miles per day as is practical. The weight lifting seems like it wouldn't help much and possibly be dangerous until things are better under control.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:43 PM

Dare I say I have already started to experience Leptin Sensitivity without ever reading that before.

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on October 03, 2011
at 07:29 PM

I admit it makes me nervous to offer advice because you're dealing with significant medical issues. I was going to say, "Read what the masters (Sissons, Cordain, Eades, Kruse, etc.) say" but I see below that someone else already made at least one such reference. I'll change mine to "Don't act on comments by amateur hackers."

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:29 PM

Thanks Travis. How long fasted would be optimal? Would just before dinner work (about 5 hours after lunch)?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:24 PM

Added Glucose, hsCRP and A1C levels

0bc6cbb653cdc5e82400f6da920f11eb

(19245)

on October 03, 2011
at 07:02 PM

Can you add how tall you are?

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15 Answers

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4
3c6b4eed18dc57f746755b698426e7c8

on October 04, 2011
at 06:15 AM

Actually, most mainstream cardiologists in the know would say that your low HDL is immaterial because your total cholesterol and LDL are also low. Remember, the Kitavans have very low HDLs but they are not known to suffer heart attacks. The Tarahumaras of Mexico, who live on three sisters (squash, beans, and corn) are known to have HDLs in the teens (and TC under 100). They also don't have heart problems. At least, that's the vegan-Castelli-Framingham argument: if your TC or LDL is low (~100; , you don't need a busy working crew of Roto Rooter (HDL). At least that was so until recently, when your TC went up and your HDL has been stagnant.

Your Trigs are high and remain elevated even on a whole foods diet. Your CRP is also high for someone eating whole foods. Your A1c isn't too good for a nondiabetic and you're insulin resistant. How are your liver enzymes? Do you have some underlying issues like autoimmune diseases? I think you would need a whole host of inflammation markers (homocysteine, etc.) to be tested. Your numbers don't seem to be improving, despite eating healthy. They're actually getting worse, except for some HDL increase but that's negated by TC going up.

The issue is largely suggested by your elevated Trigs, in relation to HDL, and despite your avoidance of processed carbs. Something is preventing your Trigs to drop and your LDL is going up: it might indeed be ApoEE. If you're taking calcium supplements, I would stop. Consider taking fish oil.

Are you male or female? If female, the most important marker is your LP(a), which could be elevated, as it is genetically determined. Forget LDL/HDL/Trigs, if that's the case.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 04:36 PM

Your doctor is going straight from the book: low-dose aspirin therapy and statins are de riguer in mainstream medicine for someone who's had a heart attack. You can't really argue against the statin since Pravistain is less virulent than Crestor/Lipitor and statin therapy somewhat reduces risk (vs. someone w/no heart attack) if you've ahd one. For the time being, I would follow those suggestions. You are a classic case of someone who's TC and LDL do not fit a heart attack candidate; but then 50% of those who suffer heart attacks are like u.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 05:00 PM

I know he is. Which is what pisses me off. He can look at me and see that I'm young, in great physical condition, have no blockage, perform the stress test without breaking a sweat, and generally do not fit the profile for a heart attack, yet still treat me like I'm 85 or 350 lbs.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 05:04 PM

I do not smoke, have slightly elevated BP (130/85 ish), lots of heart attacks in family history (both sides), not diabetic or have any autoimmune diseases that I know of. I agree with you on the VAP, most likely type B (have not tested this yet).

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:17 PM

Liver enzymes were within range (18/24 I think). I do not have the tests in front of me. No know issues.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:09 PM

There you go: you need a VAP test not for the particle size but for the genetic components (Lpa). That is a huge risk component that's hard to measure w/simple infl markers. It's unfortunate. People on this board might disagree, but you might have to be open to the possibility that Paleoing (high fat) might not work for you. Some of us are not genetically ideal for high fat.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 02:02 PM

Cardiologist recommended low dose (80mg?) aspirin I believe due to its ability to "prevent heart attacks" lol. Also taking 20mg pravistatin.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:00 PM

Male. I'm not taking calcium supps but I have been taking a multivitamin and daily nsaid since the incident. I recently (maybe a month ago) started taking 4000 iu D3, and 3 1000mg fish oil daily. I also take B12 for allergies (been taking this for 5+ years). And of course the statin.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 04:43 PM

That's why u need to look at other risk factors: (1) u smoke: (2) howse your BP; (3) family history of CVD; (4) diabetes, (5) autoimmunity, etc. U need a VAP test but I can tell based on your Trigs that your LDL is the small ones. ANA needs to be tested for autoimmunity and a whole host of inflammation markers (fibrinogen, Homycysteine, IL-6, ESR, Ferritin, LP(a) from VAP, TNF). Rule out hypothyroidism w/a panel. Also, look at Paul's suggestions for dyslipidemia: http://perfecthealthdiet.com/?cat=115

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 01:55 PM

Why daily NSAID? Prescription or OTC? What dose and what type of NSAID is it? What inflammation condition do you have that is being treated by NSAID? That will cause leaky gut in a jiffy. Also, what statin and how much dose of stain ru taking?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:40 PM

The kitavans have zero to do with this. They have their own epigenetic biology that allows them to live as they do. Berger is as far away from as a kitavan is as a convention doc is to a shaman

21
9e20abb05f3f6e3cc4bb107f8980aecd

on October 03, 2011
at 07:46 PM

I would suspect a parasitic infection, perhaps trypanosomes.

First, your serum cholesterol is way too low and the most likely cause is a parasitic - protozoal - infection. You might read the various posts in this series, especially the ones about hunter-gatherer serum cholesterol levels: http://perfecthealthdiet.com/?cat=140.

Second, indigestion and headache may be more consistent with a parasitic infection than a heart attack.

Third, parasitic infections can cause cardiac damage and high cardiac troponin levels. For trypanosomes doing this see http://www.ncbi.nlm.nih.gov/pubmed/21283741, http://www.ncbi.nlm.nih.gov/pubmed/16075261. Some parasites also produce proteins that closely resemble troponin, eg http://www.ncbi.nlm.nih.gov/pubmed/19090648.

There's no obvious reason for a young, healthy, atherosclerosis-free person to have heart damage apart from an infection, so I would look carefully into this. The low cholesterol is a great clue that your infection is protozoal.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 09:44 PM

ECG from cardiologist appointments: 4/09/10 rate 62 pr 132 qrsd 76 qt 376 qtc 382 axis p -20 qrs 85 t 24 normal ecg unconfirmed diagnosis 10/08/2010 rate 92 pr 140 qrsd 80 qt 332 atc 411 axis p 58 qrs 90 t 42 borderline right axis deviation qrs axis (90,110) otherwise normal ecg unconfirmed diagnosis

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:46 PM

I do not think I have any of the other symptoms associated with this above infection. I really dont think I have any other symptoms period. I do have "allergies" which result in itchy eyes and problematic sinuses. Other than that, I *think* I'm as healthy as can be. Aside from the heart attack.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:26 PM

I have not. I'm from Ohio. I have been (south) to Southern Cal about 13 yrs ago, Fla various times ago, Jamacia 11 yrs ago. I think thats it.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 05, 2011
at 12:24 PM

How on earth do I find a knowledgeable infectious disease specialist that is going to listen to a 36yo accountants ramblings about low cholesterol, heart attack and being in Jamaica. You could very well be right here, but I have no clue how to get from point A to point B on this one. If you have any recommendations, I'm all ears.

Medium avatar

(39821)

on October 03, 2011
at 08:13 PM

Wow, that's interesting; have you traveled to Central or South America or Mexico, berger?

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 05, 2011
at 02:12 PM

berger, just go to your primary care physician and ask for a referral. Just tell the infectious disease specialist, look, I had a heart attack at age 34 even though I have no sign of atherosclerosis. I have chronically low serum cholesterol. I have read that both low serum cholesterol and cardiomyopathy can be caused by protozoal infections. I want to be checked out. Let the doctors do the rest.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:58 PM

Thanks Paul. Are there any other symptoms that would support this? I almost never get headaches. That incident was probably the last time I took medication for a headache. Thanks.

Medium avatar

(39821)

on October 03, 2011
at 08:20 PM

Wow, that's interesting; have you traveled to Central or South America, berger?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:43 AM

To me this is not chagas. History does not fit and neither does blood work. At 34 your exposure could have been as a teenager but given your geography and history only way to get it would be a blood transfusion that was infected with it. The cardiac manifestations also are not ischemic but usually of pump failure due to the amastigotes love of the neural plexi. Moreover, the admission labs would have shown some abnormalities in lymphocytes fractions. And if this was chronic chagas with cardiac issues.....other organs and symptoms of mega organogenesis would be present.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:52 AM

If youre thinking infection and im not CMV makes more sense.....and you could easily test for it.

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 03, 2011
at 08:00 PM

Try reading the Wikipedia page on Trypanosoma cruzi: http://en.wikipedia.org/wiki/Trypanosoma_cruzi. Human American trypanosomiasis, or Chagas disease, has two forms, a trypomastigote found in human blood and an amastigote found in tissues. The acute form usually goes unnoticed and may present as a localized swelling at the site of entry. The chronic form may develop 10 to 20 years after infection. This form affects internal organs (e.g., the heart, the esophagus, the colon, and the peripheral nervous system). Affected people may die from heart failure.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 09:49 PM

04/08/2011 rate 65 pr 128 qrsd 79 qt 360 qtc 374 axis p 12 qrs 84 t 52 normal ecg unconfirmed diagnosis.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:01 PM

I have though, always suspected that I did NOT actually have a heart attack, I just couldnt find any reason for the troponin to be elevated. Are you thinking I still have the infection (low HDL)? If so I could go have my troponin retested (without heart attack symptoms).

9e20abb05f3f6e3cc4bb107f8980aecd

(5939)

on October 04, 2011
at 03:53 PM

berger, I would ask for a referral to an infectious disease specialist and get checked out. Be sure to tell them of the low serum cholesterol and its relation to protozoal infections. Jack, CMV is always a possible contributing factor but usually doesn't cause acute disease by itself, and doesn't lower serum cholesterol. Trypanosoma cruzi is found in the US. He was also in Jamaica. These conditions may not be common in the US but are probably not uncommon among people who have heart attacks at age 34. I think he needs a knowledgeable specialist to do a workup and diagnosis.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:32 PM

Good advice and makse sure they check for viral titers too!

5
Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:59 AM

My bet is you have a very leaky gut that needs a good hack and few other things to think about.....apoE4 allele is in play, low vitamin D levels, suboptimal free and total testosterone, low thyroid function, low dhea-s, low pregnenolone levels, and poor sleep.

Get those labs and i bet some trends appear. Your low HDL is a major clue.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:13 PM

Check out this link regarding genetic testing: http://paleohacks.com/questions/57164/the-wheres-and-hows-of-getting-tested-apoe-cortisol-genome-o6o3-ratio-mine#axzz1ZplFKRB4

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:11 PM

If you have 4 in 1 or more of your APoE alleles, high fat could increase LDL. I think you're part of the 35% of the general population w/a 4 allele. Look back at your history: you started Paleoing in 5/2011, and it's low-carb Paleo (you mention no starch and very lil sugar). Your LDL increased 75% from your 3/2011 number, while your HDL & Trigs are up marginally. But the key is your Trigs should plummet while low-carbing; you ain't.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:59 PM

Get your VAP ASAP; Lpb/a come free. Confirm the LP(a) hypothesis. Adopt Dr. Sinatra's program. Get your Cardy on board. Take fish oil and necessary supplements. Do high-carb Paleo. I would avoid SaFa, unfortunately, as much as that is believed to be innocuous. I trust Dr. Cordain on this, who's been misunderstood and misquoted so many times. Paleo is not a one size fit all. You have to tailor and finesse it to your special needs.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 05:12 PM

That's a genetic test you can get from 23andme and other such sites. Doctors may not be open to this.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 01:17 PM

I'm having trouble finding the Apoe4 test. What is it called? FWIW I'm using directlabs.com. Re poor sleep - I'm sleeping great! And waking feeling very refreshed.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 01:10 AM

Imnot on board with high carb for any heart disease period. The reason for the sleep check with dhea s is because heart disease walks hand and hand with low androgens and high levels of IL6 which kills sleep. And the human heart fails with autographic failure....not apoptotic failure. Autophagy occurs with sleep. Sleep and heart disease are linked via pineal/thyroid pathways and leptin/androgen pathways

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:42 PM

Anyway, my money is on you having LP(a) >20 and having ApoE w/4 (44, 43, 34). That would explain the genetic component; those w/high Lpa have heart attacks when young and when TC and LDL numbers aren't out of the ordinary. Your HDL is low but that doesn't explain why you had an attack since your TC/LDL was also low at the time. Start Paul's safe starch program, track your Lp(a) like a time series ... unfortunately the only therapy is Niacin and that's not really proven. But I think safe starch (150-250g of carbs) is right for you, not VLC, and I would eat lean meats (i.e., avoid Sat FAt).

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 07:52 PM

Should I wait a month or so for the VAP? To see if maybe I just didn't give paleo enough time to "work"? Or might that be playing with fire if I am E4?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 06:33 PM

One place I'm confused re ApoE4. Doesn't ApoE4 usually mean high cholesterol? If anything I would think E2 given my low cholesterol levels. Unless I'm missing something? And one other place I'm confused - since my MI, my cholesterol levels look MUCH better (+59% overall, +62% LDL (could be good or bad), +144% HDL, and -5% TG). Is it possible I'm responding to the whole foods diet, just at a slow pace?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 05, 2011
at 12:30 PM

Is DHEAs the only additional test you would recommend with the VAP? I have the VAP ordered from here https://www.directlabs.com/OrderTests/tabid/55/language/en-US/Default.aspx and see there are packages, but I'm not sure if I need anything aside from the standard VAP. DHEAs looks like a seperate addon. I see homeosystine & hsCRP included in one of the packages, but I already had my hsCRP tested.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:14 PM

For now, I'd give the same advice high-carb Paleoers would give: add some safe starch (white rice, yams, sweet potatoes). By extension, that would reduce your consumption of fat, esp. saturated fat by the crowding out effect. Don't be afraid of safe starch and you're not overweight to begin with.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 04, 2011
at 07:45 PM

And also do follow your Doc's advices (remind him of the need for a VAP)! Once you've had an attack, it's a whole new ballgame. It's not just a bunch of us farting around and doling out half-arse advices saying statins don't matter. Some of the parameters and risk factors change SIGNIFICANTLY once you're a heart attack victim.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 07:51 PM

Vap is ordered. I'm doing all tests without a Doc. My family practitioner died 10 years ago and I haven't been to the DR since probably a few years before that. I now just see the Cardiologist twice a year for a checkup.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 05, 2011
at 02:08 AM

What if he's ApoE, Quilt? I mean it's like trying to treat familial hypercholesterolimia w/high fat. FH requires low fat. Unfortunately, the same applies here. Why not make him get his ApoE checked out via 23andme; I woudln't be surprised his Il6 is high. But given family history and his low TC/LDL, the most likely culprit is the genetic component: Lpa

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 04:07 PM

For you FH may be low fat.....not for me. We have a different understanding of the condition. In fact a person at the AHS is still in contact with me about his FH. Masterjohn was asked what to do there and he qualified his response....and was low fat and non commital. I was not and spoke up about it. So did lustig.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:48 AM

Davis is great for anti-wheat propaganda but IMHO he doesn't understand the dietary implications for ApoE2, E3 or E4. His 'track record' at the cardiology website is not excellent; rarely do people achieve calcification regression (negative Agatston score): http://blog.sethroberts.net/2011/08/04/how-rare-my-heart-scan-improvement/

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:51 AM

Davis expresed on his blog that E4 does best on low fat because it lowers LDL the most. Low fat (high carb) is the WORST for apo E4 by research of Dreon, Krauss et al which produced pattern B and increased small dense LDL (by proxy oxLDL and glycation) on VAP; high fat, the least amount of sdLDL: http://atvb.ahajournals.org/content/15/1/105.full

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 07, 2011
at 08:10 PM

Spoke with Dr Davis (wheat belly author and cardiologist) and he said my pattern was not characteristic of apo E4. I guess I'll know more after my VAP. Thanks for all the help here guys. This is truly a fantastic website.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:36 PM

Smart move berger....namby good t Houghts but his clinical path does not fit your thought process. But you are correct to test until you find gold with this situation. Most docs would not.

5
77877f762c40637911396daa19b53094

(78467)

on October 03, 2011
at 09:37 PM

I would go for the something that can only help and almost certanly not hurt. Since you had heart attack, lets boost the heart first:

  • Coenzime Q10, 200-300mg, highest quolity [has potential to rise HDL too, deals with statin induced deficiency]
  • L-Carnitine, few grams [don't know exact values for MI]
  • Vitamin B5, 100mg
  • Vitamin C, 4-12g [has potential to lower LDL too and recover adrenals if it was stress]
  • Good multivitamin, just to make sure everything important is there.
  • Fish oil and Mg might not be bad idea too

3
3864f9a2af09b1b447c7963058650a34

(3703)

on October 08, 2011
at 04:13 AM

berger6696,

You mentioned a prodromal viral-like syndrome in the days prior leading to the ACS?

Have you considered being tested for Parvo B19 antibodies?

The inflammatory damage simulate coronary spasm/damage and NSTEMI 'infarctions'. http://content.onlinejacc.org/cgi/content/full/52/7/523

Avoiding saturated fats, eating high refined carbs (high glycemic index, gluten-related gut dysbiosis, vast omega-3 deficiencies, excessive canola/corn oils products, blah blah blah) put you in a good spot for a viral syndrome and hugely impaired immunity to tackle a virus.

HDL of 16 OMG WTF???! You are lucky you discovered resources on the net and now on a more decent diet and lifestyles.

Personally I have a lot of anti-statin material I am too lazy to post here but consider the value of ignoring the LDL count but consider the quality (buoyancy) and other biomarkers of health (gut testing, get digestion perked up, optimal/perfect hormones, CoQ10, etc)

Good luck and please keep us posted on your continued progress and learning!

G

ADDITION:

Did you see THIS or the NACB diagnostic guidelines?

Table 6-1 Elevations of Cardiac Troponins without Overt Ischemic Heart Disease

??? Trauma (including contusion, ablation, pacing, ICD firings including atrial defibrillators, cardioversion, endomyocardial biopsy, cardiac surgery, after interventional closure of ASDs)

??? Congestive heart failure???acute and chronic

??? Aortic valve disease and HOCM with significant LVH

??? Hypertension

??? Hypotension, often with arrhythmias

??? Postoperative noncardiac surgery patients who seem to do well

??? Renal failure

??? Critically ill patients, especially with diabetes, respiratory failure, gastrointestinal bleeding, sepsis

??? Drug toxicity, e.g., adriamycin, 5-fluorouracil, herceptin, snake venoms, carbon monoxide poisoning

??? Hypothyroidism

??? Abnormalities in coronary vasomotion, including coronary vasospasm

??? Apical ballooning syndrome

??? Inflammatory diseases e.g., myocarditis, eg. parvovirus B19, Kawasaki disease, sarcoid, smallpox vaccination, or myocardial extension of BE

??? Post PCI patients who appear to be uncomplicated

??? Pulmonary embolism, severe pulmonary hypertension

??? Sepsis

??? Burns, especially if total surface burn area (TBSA) 30%

??? Infiltrative diseases including amyloidosis, hemachromatosis, sarcoidosis and scleroderma

??? Acute neurological disease, including cerebrovascular accident, subarchnoid bleeds

??? Rhabdomyolysis with cardiac injury

??? Transplant vasculopathy

??? Vital Exhaustion

1Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ 2005;173:1191???202.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:41 PM

Great.....somebody else feels the viral angle.....hence my viral tier recs!

3864f9a2af09b1b447c7963058650a34

(3703)

on October 08, 2011
at 07:48 AM

Parvo is transmitted easily and via fomites (survival on inanimate objects). I had a friend who had this and a subsequent cath and since blockages were seen 3vessel-stents. Now he has metal in his veins forever. http://www.stanford.edu/group/virus/parvo/parvovirus.html

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:56 AM

I consur with Quilt, you are a hypomethylator. See the 'hack jack' thread for more evolutionary thoughts on this one. Read Kruse's blog (you won't get it immediately so post more questions later *haaa!!*). Stress raises uric acid. It is profoundly common after any surgery (particularly in heart or diabetic patients) that gout is precipitated. Parvo is sometimes mild or 'asymptomatic' so the titers may give a good time frame when an infection may have occurred. You should consider the other rule out conditions listed as well; they're all autoimmune -- hemochroma, sarcoid, low thyroid...

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 02:07 PM

Just looked up parvo B19. While I dont recall having the rash associated with it, I definitely recall having joint pain and swelling AFTER the MI. My cardiologist recommended Niacin and after taking it for maybe a week I developed joint pain in my knee, ankle, neck and wrist. Researched the effects and concluded it was a gout flair up caused by the Niacin. I stopped the Niacin and the pain/swelling went away. Tried the Niacin again about 6mos-1yr ago and again the joint pain came back (stopped as soon as I noticed symptoms). Could Niacin cause this if its Parvo related?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 09, 2011
at 01:51 AM

Yes, white. Mostly German.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 03:19 PM

Would the virus most likely be something I still have? Or maybe something I *had* that went away? Only symptoms I have had are nasal congestion (pretty constant for as long as I can remember) which I just blame on seasonal allergies. B12 and local raw honey *seem* to manage it pretty well.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 02:15 PM

Also, the reason I checked into the ER was because I had some of the classic symptoms of a heart attack (chest discomfort, mild tingling in arm, shortness of breath). All were very mild and if it wasn't for my wife being adamant about getting it checked out I probably would have gone back to sleep. One other thing I just remembered, I felt the same discomfort the previous day and blew it off.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 01:00 AM

Thank your wife for getting things going...!! Pain is a good indicator. You are lucky you didn't have plaque otherwise you probably would've been stented if bad/fearful cardiologist on duty...

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:43 PM

If niacin did this you are likely a hypomethylator too....means low hdl anf high homocysteine! You better read my b vitamin blog too.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 09, 2011
at 12:58 AM

Are you white??? 1:8 have hemochromatosis by some expert estimates. It is widely underestimated and underdiagnosed until your 60s and symptomatic. Your family history -- what is it? Ancestry? Northern Euro?

2a95ea95c793d6115fe636a93b5cea2c

(0)

on December 10, 2011
at 05:01 AM

A few weeks after my NSTEMI, I also got knee swelling, joint pain and had hive like swelling around one eye and my ring finger. GP took me off lipitor and metoprolol (leaving me on aspirin and plavix) and symptoms receded. When cardio put me on crestor the knee problem returned with vengance. Took myself off crestor but pain remained until I took myself off plavix, using fish oil, red wine, cocoa and turmeric to thin blood

7b91be6e22d4e2960f40935e306bdee5

(245)

on December 10, 2011
at 11:27 AM

Hi Peril. Fancy seeing you here.

3
Medium avatar

on October 03, 2011
at 07:11 PM

I think you need to work on increasing HDL and decreasing TG via a high volume of low intensity exercise and cutting out all fructose from your diet. It's the oxidation of VLDL (the transporter of endogenous TGs) or LDL that likely played a role in your heart attack. So long as you have elevated TGs, you likely have a Pattern B particle size since the synthesis of VLDL in the liver soaks up cholesterol and results in LDLs that contain less cholesterol and are thus smaller in size. These smaller lipoproteins can much more easily become trapped in the arterial linings.

You should also make sure that you're taking vitamin K2 in order to pull any calcium that may be in your arteries out and deposit it in bone. Additionally, you probably should not consume dairy until you do this, as more dietary calcium is working against you. That may have been a factor in your heart attack. As far as the rest of your diet goes, I would increase fat from grass-fed red meat and shoot for a total cholesterol of 200-240.

Good luck.

Edit: That walking would be far more advantageous if it were in the fasted state.

Medium avatar

(39821)

on October 03, 2011
at 07:44 PM

That would be fine. You lunch is so low in carbohydrates that it wouldn't have much of an effect at all, especially after 5 hours. Just try to log as many miles per day as is practical. The weight lifting seems like it wouldn't help much and possibly be dangerous until things are better under control.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:29 PM

Thanks Travis. How long fasted would be optimal? Would just before dinner work (about 5 hours after lunch)?

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 11, 2011
at 05:38 PM

Travis or anyone else still reading, re the walking - how much walking are we talking here? And at what pace? I'm getting up a little early to get some walking in before work (and before breakfast), doing a little on my lunch hour, and some after work. But at 3mph I dont feel like I'm accomplishing much.

Medium avatar

(39821)

on October 11, 2011
at 06:28 PM

As many miles as possible at a comfortable pace. Increase volume, not intensity.

2
Bece6312a7d51fc6a98a49bd62cf3152

on October 03, 2011
at 08:53 PM

Takotsubo cardiomyopathy --> google it

The condition is transient and presents as a NSTEMI (Non-ST elevation myocardial infarction) heart attack with typical heart attack physical symptoms and a small rise in troponins. Coronaries are usually 100% clean.

Slang name is "Broken Heart Syndrome" because it is sometimes brought on by stress. It causes a ballooning of the apical region of the heart due to a weakening in the muscle of that area of the heart.

More common in women.

Any recent stressful events in your life?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 04, 2011
at 12:50 AM

I dont think this fits either. Usually seen in post menopuasal women and most have heart disease history

Bece6312a7d51fc6a98a49bd62cf3152

(85)

on October 03, 2011
at 09:24 PM

Troponins rise because the ballooning is damaging to the heart. Your cholesterol level was normal and your coronaries were clean...its a good thing they started a statin.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on October 04, 2011
at 12:41 AM

lol...."good thing they started a statin".

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 08:58 PM

I cannot recall any stressful events at that time. But it was classified as a NSTEMI. I do have the EKG papers at home and will post any notes from the when I get home.

2
3a567c1637db69f1455ce35e78201a2c

(1054)

on October 03, 2011
at 07:16 PM

Your HDL is very low, your triglyderides are way too high. Low HDL is indicative of Leaky Gut Syndrome. The following from Dr. Kruse, The Quilt.

[quote]It appears when your plasma HDL is low, so is your level of paraoxonase. So HDL is a type of a clinical marker for paraoxanase (and perhaps Vitamin K2 levels by extrapolation). This should explain to you why I use HDL as a measure of how leaky our gut is (and why your Vitamin K2 is likely low too) to endotoxins that then are able to oxidize our LDL molecules. The absolute level of LDL is of little consequence to me in clinical evaluation. The level of oxidation of the plasma, however, is hugely important. So when one has a low HDL, high HS-CRP and a high ferritin level you have the ???trifecta of a highly inflammatory serum plasma??? and one that causes all kinds of neolithic diseases. This was explained in detail in my VAP and leaky gut posts here.[/quote]

http://jackkruse.com/how-to-find-your-inner-masterpiece/

You need to be on Dr. kruse's Leptin Reset Protocol to get you back to a healthy state. Many are now reaping the benefits of his protocol. Look for it Leptin Prescription. You can prevent another heart attack but you must change your lifestyle in what you eat and how you think.

3a567c1637db69f1455ce35e78201a2c

(1054)

on October 04, 2011
at 03:07 AM

But your labs do not reflect that you are even close to Leptin sensitivity. Your are still in a very vunerable place with your labs.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 12:03 PM

True, I was referring to the signs (#5) on the leptin prescription page. The labs tell a different story.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 03, 2011
at 07:43 PM

Dare I say I have already started to experience Leptin Sensitivity without ever reading that before.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 05, 2011
at 04:09 PM

so then you need to assess what is best for you.....labs or opinion? This is why I serial test....it forms the foundation of my recs. It is the rosetta stone for our epigenetic switches. Some paleo bloggers dont advocate testing. That is a decision for you to make.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:37 PM

The more disease and destruction one acquires the the need to test. You can not manage if you cant measure.

1
51047b6885c2155ea2ed9f40670a806e

on March 30, 2013
at 01:18 PM

This is serious stuff. I dont think this is time to go To Paleo diet websites, Have you seen their lipid numbers? Some double yours and more. Hunter-gatherers had low Total cholesterol, low ldl, probably thanks to parasites and infections, since we can't reproduce their lipid numbers today with similar diets.

I would try A diet like that of Furhman for a while until you lowered your numbers. Yes thats a vegetarian protocol, still you can have eggs or fish or bone broth once a week, if you feel the need, because he preaches 90% compliance %10 leeway. He has proven to reduce ldl 33%, without affecting HDL or triglicerides in weeks. WEEKS. Though Id go hard core for a whole, specially after such a scare.

Heres teh link to the study:

http://www.ncbi.nlm.nih.gov/pubmed/11288049

Hope you get better, my best wishes.

7b91be6e22d4e2960f40935e306bdee5

(245)

on March 31, 2013
at 04:17 PM

Was kind of surprised to see an email that this question had new answers. Guess this would be a good time to give an update. Haven't checked cholesterol for a while. When I was testing, HDL would not go above mid/high 30's. LDL would move based on how much sat fat I was eating. I just kind of moved on. I still feel great, haven't had any reoccurring episodes. Guess I've just chalked this up to a random blood clot. I did find that I do have a clotting disorder (factor V lieden). So, cholesterol really isn't my main focus anymore.

1
De267f213b375efca5da07890e5efc25

(3747)

on October 04, 2011
at 05:36 PM

Have you been tested for obstructive sleep apnea (OSA)? It is a common cause of unexplained heart attacks and affecting roughly 1/4 of men it is not rare. You aren't overweight but that's only a risk factor - visit the OSA forums and you'll find plenty of otherwise healthy sufferers, myself included. Some people get daytime tiredness but not all, I think less so at your age. My AHI was 50 and I only discovered that I had it because I was chasing down a mildly elevated serum CO2, which was probably unrelated. My father in law is the same but only discovered it after a heart attack like you, though he's older. Nighttime and morning headaches are one of the hallmark symptoms of sleep apnea. Hyopia leads to CO2 retention, which may not last to the day when your doctor checks it, which causes the headaches. To diagnose it you just get a sleep study, which isn't too bad.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 06:04 PM

I seem to sleep fine. Wake up very refreshed, usually before my alarm clock. No headaches except for the one mentioned the night of my MI.

De267f213b375efca5da07890e5efc25

(3747)

on October 04, 2011
at 07:32 PM

You still may not show symptoms. Mention it to your PCP - I'm sure he would agree that this avenue needs to be explored.

1
7b91be6e22d4e2960f40935e306bdee5

on October 03, 2011
at 09:00 PM

I do recall that I was nearly "couch ridden" for the few days leading up to the event. I am normally energetic but those days I would go home and lay on the couch until bedtime.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 08, 2011
at 04:39 PM

Even with the heart attack symptoms that (and the previous) evening?

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:51 PM

Tells me viral etiology.....get titers!

0
13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on March 31, 2013
at 01:47 PM

There's a book "Don't Die Early" that may interest you. Have you had a heart scan? You may want to take a look at the Track Your plaque forum too (fee based), but read the book first.

If blood sugar is part of the problem, the bernstein diabetes forum is a good resource. Hve you made an post meal blood sugar checks?

7b91be6e22d4e2960f40935e306bdee5

(245)

on March 31, 2013
at 04:19 PM

I used to follow Dr Davis a lot. Blood sugar is not a problem for me. I did have a heart scan done a few months ago and my score was zero. As I stated above, I think my issue is (was) clotting but I've made some diet changes (dark chocolate and cinnamon) to take preventative measures.

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on April 02, 2013
at 02:37 PM

Congrats on the zero heart scan!

0
7b91be6e22d4e2960f40935e306bdee5

on October 09, 2011
at 01:54 AM

Apologies in advance for omitting this if its relevant (which I think it may be). On the 3/21/11 lab test I'm showing an Iron reading of 43. This was before I started eating Paleo, so it may have changed by now. Does this help/confirm/change anything???

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 02:00 PM

What's cwp? Good luck and look forward to hearing about your progress!

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:04 AM

You need a ferritin, Tsat%, full thyroid panel, Hgb/Hct, MMA and homocysteine for a full assessment IMHO. So 3/2011 you were still non-paleo eating grains and probably experiencing gut dysbiosis which can lead to B vitamin depletion/malabsorption as well as B-vit associated anemia and/or sometimes iron/blood losses (dep on degree of intestinal permeability). Low thyroid is common w/dysbiosis as well and low thyroid independently is associated with low ferritin. If ferritin and/or Tsat% are high, then the labs may indicate iron overload now w/paleo. If normal, dep on other labs so repeat later

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:08 AM

More: http://www.annals.org/content/101/5/629.abstract [iron depletion in those overloaded makes a big deal! Even increases Testosterone and reverses secondary hypogonadisms, e.g. makes them MEN!!! It is very OXIDATIVE and can trigger Alzheimer's, cancer, autoimmune disorders and oxidative damage to be overloaded w/any excessive metals FYI outside of physiological ranges, see my above comment to Namby]

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 09:06 AM

Resources for you: http://www.aafp.org/afp/2002/0301/p853.html [how to diagnosis -- great review IMHO]

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 10, 2011
at 02:10 PM

Comprehensive Wellness Profile. CWP: #1 ordered test - year after year! Over 50 individual laboratory tests to provide a thorough Biochemical assessment of your health, and includes the basic cardiovascular tests as well as diabetes testing: Lipid panel (cholesterol, HDL, LDL, the risk ratio, triglycerides) Complete Blood Count (CBC's) Fluids and Electrolytes Thyroid Panel w/TSH Liver Panel Kidney Panel Glucose (Diabetes) Mineral and Bone

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 10, 2011
at 01:10 PM

Thanks grace. I'm going to add Homocysteine, CRP-hs, and CWP to my VAP order. Looking to get this done in the next few weeks. Want to get my head around all the suggestions given here to make sure I dont miss anything.

0
3c6b4eed18dc57f746755b698426e7c8

on October 04, 2011
at 07:51 PM

This may be a bit forward-looking, but I think your problem is in your family history, not in traditional risk factors. I recommend Dr. Sinatra, who is somewhat Paleo-friendly:

http://www.drsinatra.com/lower-lpa-with-5-nutrients

3864f9a2af09b1b447c7963058650a34

(3703)

on October 08, 2011
at 08:03 AM

I think Sinatra is a lot like other integrative/functional doctors like Dr. Jack Kruse who is fantastic. With your family history significantly rampant for heart diseease (premature?) Namby Pamby's suggestion is prudent. Others who are great are Dr. Mark Houston MD. Resources: http://touroinstitute.com/ifm_proceedings_low.pdf#page=50 http://www.acamnet.com/houstonf2010metal.pdf http://www.guilfordmd.com/id3.html http://www.vrp.com/heart-health/ldl-oxidation-the-smoking-gun-behind-heart-disease

3864f9a2af09b1b447c7963058650a34

(3703)

on October 10, 2011
at 01:59 PM

Houston is paleo-friendly BTW.

0
F1b82cc7e6d90384ad30007dd6c1b9e3

(1187)

on October 04, 2011
at 12:32 AM

no damage and no blockage? was it a heart spasm not heart attack? due to low minerals? give the paleo a year, stop checking so often. all good advice above, just stop the testing for a while.

7b91be6e22d4e2960f40935e306bdee5

(245)

on October 04, 2011
at 01:35 AM

It was classified as a NSTEMI. Why should I stop testing? I want to find out what is going on with me and there have been many good test suggestions here that may help figure this out.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 08, 2011
at 02:46 PM

Every quarter is how i do it

F1b82cc7e6d90384ad30007dd6c1b9e3

(1187)

on October 08, 2011
at 02:30 AM

i think testing every month is too often, every six months is better,

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