I???m hoping for some reassurance that my recent lipid panel numbers are explainable and not reason for panic, and not as my doc suggests, cause for Crestor & niacin. This is going to be long, but I don???t know how to do justice to the question without giving background & test results.
Background: 53 year old female, 5???6???, 115-120 lb, recreational cyclist who races 3-4 times/month June-December. Am post-menopausal since complete hysterectomy in 1993. Immediately upon loss of ovaries, started taking ???Estratest???, an oral combo of synthetic estrogen & testosterone. Continued taking it until February 2011 when I decided it was time to stop (basically afraid of cancer risk from synthetic hormones & liver toxicity).
Almost immediately, I started experiencing hot flashes, which were especially disruptive at night. By mid-summer, I was waking 5-6 times each night, only sleeping for 1 to 1-1/2 hours at a time and consequently feeling dog tired all the time.
I finally got desperate and visited a traditional doctor in early fall who prescribed a synthetic hormone (Climara Pro, combo of estrogen & progesterone, transdermal patch) which I began using October 10, 2011.
By late November, hot flashes were gone but I was still waking 3-4 times a night. I was still tired during the day but felt noticeably better. I decided to see an anti-aging practice (doctor and RN) to switch to bioidentical hormones.
On November 29, they ran a full blood panel including lipid VAP and did a 24-hour urine collection for hormone levels. I got the results recently and am in shock. I expected low hormones but the lipid panel has the doc concerned. See below for results.
One additional piece of information: I pulled a hamstring 10 days before the tests and slightly re-injured it 3 days before.
Diet & supplements: Have been paleo since December 2009 but prior to that, I was a long-time abuser of carbs, including lots of ???whole-grain??? cereal, bread, rice, pasta, not to mention cake, muffins & the like on a regular basis. I follow paleo pretty strictly other 1-2 cheats per month (gluten-free pizza, pancakes), starches like sweet potatoes, white potatoes, & white rice when I increase my training, and 3-4 NorCal margartas per week.
I do have a couple of bad habits, which I just recently ditched. I was eating a lot of 85% dark chocolate (up to 3 ounces a day) and 1-2 tablespoons of almond butter. Sigh, I know, very bad. No other nuts in the diet. Combination grass-fed and traditional meat & poultry, combo of regular & pastured eggs, fish (mostly wild caught) 1-2 times per week. Lots of veggies and a fair amount of fruit (1 apple, 1 banana, a few strawberries & blueberries, small box of raisins) every day. Butter, ghee and some olive oil (1 tablespoon per day) and 1/4 avocado per day. Until last week, I was erratic about taking 1 tablespoon Carlson???s fish oil per day but now am regular with that. Take D3 1000 IU, 450 mg CoQ (for migraines), glucosamine supplement.
Other issues: I???ve had migraines since I was a teenager which are much better since going paleo. I also have osteoarthritis in both hands.
All vitamins good, including D3 & K2
Amino acids good, except Asparagine 38, low, Reference Range (RR) > 39
All minerals good, except Calcium 37, low, RR > 38
Glucose-insulin interaction 60, RR > 38
Fructose sensitivity 48, RR > 34
hsCRP 4.4, high, RR < 3.0
Total cholesterol 219, borderline high, RR < 200
LDL 119, borderline high, RR 40-130
HDL 78, RR > 40
Triglycerides 75, RR 30-150
Non-HDL cholesterol 141, borderline high, RR < 160
VLDL particles 43, RR < 85
Total LDL particles 1008, high, RR < 900
Non-HDL particles 1051, high, RR < 1000
RLP (remnant lipoprotein) 142, RR < 150
Small Dense LDL III 253, RR < 300
Small Dense LDL IV 145, high RR < 100
Total HDL 9191, RR > 7000
Large Buoyant HDL2b 3595, RR > 1500
Hormone levels (I won???t include them all as it is extensive):
DHEA, no detectable levels, RR 0.20-0.90
Testosterone, no detectable levels, RR 0.16-0.65
Aldosterone, no detectable levels, RR 6.0-44.0
Cortisol 99, high, R 20-90
THE 21.70, high, RR 3.80-11.20
Alpha-THF 2.90, RR 0.70-4.90
THF 5.70, RR 2.40-7.10
11-beta-HSD index 0.40, RR .59-1.42, ???indicates poor cortisol activation???
Estrogens ??? E1 5.3, low normal, RR 3.0-52.0
E2 2.3, low normal, RR 1.0-17.0
E3 3.2, low, RR 9.0-60.0
4-OHE1 8.8, very high, RR <=5.3
Anabolic/Catabolic balance 0.2, RR 1.0-3.9
Pregnanediol 0.64, low normal, RR 0.30-4.20
Pregnanetriol 0.71, low normal, RR 0.60-2.50
Questions to you all: How alarming are these test results? My doc is worried about the hsCRP, non-HDL particles, and small dense LDL IV particles and wants to start me on low-dose Crestor (5 mg 3x weekly) and niacin to get those numbers down. I think the HDL numbers look good, but are they good enough to counterbalance the LDL values? How reliable is a VAP test, anyway? It was done through SpectraCell (and hormones through Genova Diagnostics).
The real question for me is what is the underlying cause of the hsCRP being high. Is it apt to be low hormone levels along with poor sleep and the recent injury? Perhaps a high omega 6:3 ratio? Would that also account for LDL IV & non-HDL particles being high?
I don???t want to treat symptoms, I want to find and fix the cause. My thinking right now is to start on the recommended hormones and supplements but not take Crestor or niacin. Then in a couple of months, re-test lipids to see what happens with hsCRP, LDL IV & non-HDL particles.
Besides the Crestor & niacin, they recommended bioidentical hormones (progesterone, testosterone, estrogen), 7-keto DHEA, some methylation products, DIM, calcium, digestive enzymes (protease for low asparagine) and some anti-inflammatory herbals.
Thanks for any & all assistance!
asked byLyndra (40)
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on January 12, 2012
at 03:21 PM
Niaciamide and progesterone(the estrogen and testosterone are not good) are probably beneficial to take in your situation regardless of what your numbers are. The fish oil is garbage.
on January 12, 2012
at 02:49 PM
Lyndra - first, let me congratulate you on awesome lipid #'s. Yes, thats right, they are awesome. Your Dr' has spent too many 'lunches' with the drug reps. IMO, you should NOT take 'crestor'+niacin for your 'high ldl' because, its not high, at all. And your HDL is fantastic. Statins are bad for you and will cause more harm than good.
If you want to adjust your hormone levels find a doc that prescribes bio-identical hormones and have at it.
on January 12, 2012
at 12:02 PM
I'm far from an expert, but you might review Masterjohn's take on lipoprotein levels, he thinks it has a lot to do with thyroid function. Moderately high levels of small LDL could be caused by sub-clinical hypothyroidism. It would also be related to low energy and low levels of sex hormones.
on January 12, 2012
at 05:38 AM
I would very much encourage you to do LOTS of deep research about crestor and niacin in combination. My dad took some drug (I'm sorry, I don't know which one) for cholesterol plus niacin and it created lymphoma for him.
It might comfort you to do some research on how they 'invented' the number ranges. Me, I wouldn't get excited about those numbers, especially as you've said, you're also dealing with hormones, and you're likely still gut healing. I've read that triglycerides are more worrisome than other things, and yours are fine.
Your fat intake sounds low to me. Especially since you're an athlete. I eat way more healthy fats, and I'm sedentary (I have a genetic condition that interferes with my ability to exercise) and my numbers are in range.
I'm not any kind of expert in anything, just an over-educated patient. ymmv.