My adult VCFS son has Crohn's and started flaring in October 2012 and didn't stop flaring until 1 mth ago after his 3rd Remicade infusion. SCD was not enough to halt flaring. He was on Prednisone since then, always between 40-60mg but had not gained weight.
He weighed 205 pre Crohn's 6 yrs ago and went down to 165 lbs when we went Paleo the last 3 yrs. He plummeted to 149 with his recent flare/hospitalizations. Then he shot up to 185 lbs (on Prednisone) eating mostly high carb SCD and now Paleo (mod carb).
He just had a physical and his doc sent him his results asking him to reduced his saturated fat and cholesterol intake and retest in 4 wks.
I've read all of Dr. Kresser's chol articles and Chris Masterjohn's stuff over time. I'm not sure if I should be concerned here since triglycerides are high. If there's nothing to worry about how do I counter his internist with anything other than we're Paleo and I'm not worried? I want to understand so I can have whatever discussion I need to have with the doc.
Could his numbers be off because he's tapering off Prednisone and his body is trying to remember how to make these hormones again? And since Remicade is helping, he's been able to stop having high carb SCD and has returned to Paleo (2 eggs daily, grass fed butter, whole cream in coffee, one banana/day, low starch/carb). No ketones were found in his urinalysis if that helps. I saw a Quilt post that discussed hormones, losing weight, etc. that says he's not concerned with chol numbers other than triglycerides until a patient is one year into losing weight and hormones are stablized (or something to that effect).
What do you see in his lab numbers?:
Triglycerides *232; Normals 44-150
Cholesterol *299; Normals 130-200
HDL *88; Normals 40-65
Ratio Chol/HDL 3.4 Normals 2.0-5.0
Non-HDL *211 Normals <190 (in high risk primary prevention category)
LDL *165 Normals <130
VLDL 46 ------
Apparently, I can't comment from any position. Let me try here:
Thanks. He's been on LDN since April and has achieved a medically induced state of remission (along with the Prednisone and Remicade). At some point, if imaging comes back negative for active Crohn's, we'll be considering coming off Remicade. He'll be done Prednisone in 3 weeks if continued tapering goes well.
His caloric intake is not obscene considering he's on Prednisone, but his high SCD carb intake is going down now that he's in remission and can tolerate a low residue diet. He was on clear liquids & IV saline solutions for months...
Thanks for the info. I need to decide whether to broach the converstation with his doc, in a letter no less.
asked bySandra_Brigham (573)
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on August 20, 2013
at 01:44 AM
The only number that could be significatly off is his trigs. And it's not due to Prednisone but because he/you neglected to fast before testing. Those trig #s are pretty much meaningless. I would, however, take solace in high HDL and a very good Tc/Hdl ratio. LDL is also meaningless at that level, unless he has LDL-P or ApoB numbers. However, if he has sub-100 trigs, and I think he might at 165, then the good TC/HDL ratio ensures that his LDL-P or ApoB will not be very high.
If I had Crohn's, I would not be concerned with those levels of cholesterol. I would be concerned about avoiding my next flare and pushing my disease into remission. I would eat egg yolks but not egg whites. Get on autoimmune Paleo. I would also not do dairy, SCD or no SCD. If I had to, I would combine the gluten/dairy free recommendations of Paleo with SCD.
As far as low-carbing to lower his trigs: I used to think only low-carbing would lower trigs. Actually trigs reflect caloric intake, not just carb intake. Low-carbing and VLCing are very good at lowering trigs, certainly. But having optimal trigs does not require you to low-carb, especially when you have inflammation and autoimmune attacks raging through your body. Going on a ketosis is the last thing I would do if I had an autoimmune condition. That would put additional stress on his immune system and metabolism.
If going on a strict autoimmune Paleo diet doesn't work, I would consider low-dose naltrexone (LDN). Penn State recently did a clinical trial where 70% of Corhn's sufferers experienced remission of symptoms. There is really nothing more effective than LDN right now. When combined with Paleo, LDN is effective for most people and side effects do exist but are very mild compared to corticosteroids.
on August 20, 2013
at 01:16 AM
Triglycerides will drop when he brings his carbs under better control. Triglycerides are a direct reflection of carb intake.
Don't let the doctors convince him that he needs to avoid fat, for goodness sake. Fat will help his gut heal. He needs dietary fat, good saturated fat, Omega 3's especially. And he should particularly avoid inflammatory Omega 6's right now!!!
I note that his labs aren't fasted, so they can't really tell you much of anything as far as cardiac risk. Even then I wouldn't worry about his cholesterol right now. The steroids mess with the adrenals and by extension the thyroid. Until he's stable from the celiac, it's all useless information.
on August 19, 2013
at 11:08 PM
My triglycerides dropped more than 40% in one year thanks to using coconut oil daily (when frying foods). Maybe your son will have similar success?
Best of luck. I suffered with IBS for years and can only imagine how life is with Crohns. Thankfully SCD and killing off an H. Pylori infection saved me from a life os misery.