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    lipids and weight loss question
    mad_mike posted:
    i've worked my tail off, literally... i've slowly taken off 76 lbs over the past year and few months... this past week, i had blood work done and when the report came today, i was very disappointed that my HDL/LDL ration had barely budged...

    both are at the opposite borderlines... HDL is 39 and LDL is 118...

    i was proud of the triglycerides though, they came down nearly 50 points.

    total cholesterol was 184...

    question... i've been told over and over and over that losing weight would improve these... i've done that, and even with walking between 2 and 3 miles a day, i'm just about where i was last year...

    i'm proud of the work i've done, but i'm so very disappointed by the report...

    any suggestions?
    Pamela Peeke, MD, MPH, FACP responded:
    Hi Mike and thanks for your posting. First, kudos to you for your wonderful weight reduction. Well done! What was your total cholesterol, HDL and LDL to start with? Currently your ratio (total cholesterol/HDL) is 4.7. The goal is 4.0 or less as an indicator of cardiac risk, While your total cholesterol is excellent, your HDL is lower than normal. HDL is the key here. Regular exercise with intensity intervals really helps to boost HDL. Keeping your fat intake to no more than 25% or so helps as well. Very important is genetics. Look at your family line for lipid issues and cardiac disease. I would also recommend that you ask your doctor to order a VAP (vertical auto profile) blood test and it is a much more comprehensive bvreakdown of HDL and LDL pinpointing more precisely where your problems lie.

    Your terrific weight loss resulted in a great reduction in your triglyercides, which, by the way, decreased your risk for diabetes substantially. Weight reduction results in a shift in cholesterol with reductions in cholesterol, LDL as well as HDL as it's all proportional. As you reduce your weight, fat cells are releasing their contents, which include free fatty acids. There is a shift in lipids in your body, especially with such a good loss of body fat. If you have reached your goal, then typically medical folks will help you refine your diet and exercise further to see if you can boost your HDL. If, despite an excellent effort on your part with healthy lifestyle habits, you still cannot increase your HDL, then other therapies are explored.

    Shoot me your initial numbers and let's see what your ratio was to start with. As well, unless you already have, do the tweaks in diet and exercise I mentioned. Bump up the intensity in your workouts, and watch your fat intake as well.

    Good Luck

    Dr. Peeke
    mad_mike replied to Pamela Peeke, MD, MPH, FACP's response:
    many thanks!!!

    this years results...

    triglycerides = 136
    hdl = 39
    ldl = 118
    vldl = 27

    Last test, a year ago...

    triglycerides = 182
    hdl = 39
    ldl = 115
    vldl = 36

    year before...

    triglycerides = 305
    hdl = 36
    ldl = 97
    vldl = 61

    i don't have records prior to these... i changed doctors and didn't get them like i asked...

    i do recall though that the triglycerides were extraordinarily high!!! way back when, i had one doctor tell me they were the highest he'd ever seen!

    there were a few members of my mother's family with heart disease... none in my father's... my immediate family has no symtoms.

    i've kept pretty much to a 1500 cal per day diet and walk between 2.5 to 3 miles a day. i'm willing to go some more with the exercise... i'm considering weights... if i can find the room in the house...

    i'm going for 100 lbs! even though the goal the doctor from the university hospital is only 5 lbs away. he measured my bones and stuff and gave me a goal for my structure.

    i think i could go ahead and lose more though... i still have pockets of fat i want to get rid of...

    i will admit that many times my diet would not measure up healthwise to weightwatchers etc... i'm kinda doing my own thing based upon suggestions the doctor i mentioned earlier gave me.

    i wasn't always that heavy... 10 years ago, i began medicating for arthritis, depression, mild hypertension, and possible fibromyalgia...

    i began gaining weight like crazy!!! i kept telling the doctors to find the problem, but noone would admit that anything i was taking would cause it.

    after 8 years of struggling with this, i've actually been on a diet all this time... i accidentally found which one it was... since then, its been simple, because i've been dieting for so long, its second nature...

    i'm wearing my old clothes from 10 years ago now... they're rather out of style but they fit!!! and some are too large!
    Pamela Peeke, MD, MPH, FACP replied to mad_mike's response:
    Hey there. Wow, thanks for the terrific feedback. OK, first up wearing old SMALLER clothes makes them VERY fashionable. LOL
    Next, please quit saying you're "dieting". That's so last year. Instead say "I'm eating healthier foods" and can the "diet speak".
    Now to your numbers. It doesn't appear your HDL has seen north of 39. Ideally you want it to be at least in the low 40's and closer to 50. I'll bet there's a genetic element to this. Since you cannot change your genes, you can raise HDL by keeping saturated (animal) fats low along with trans fats and the "partially hydrogenated" fats in so many processed foods. I mentioned increasing the frequency and intensity of your physical activity, specifically cardio, to increase HDL as well. You can actually decrease the time you exercise if you increase the intensity. Aim to burn 400 cals every time you do your cardio. Weight lifting is great to help sustain your wonderful success and it also helps to augment the cardio effect on increasing HDL.
    I would really be strict about doing all of this for about 90 days. Then, whip into your doc's office and get a full VAP profile as I described in my first posting to you. I'd love to know the results when you do.

    You're on the right track. That next blood test will help determine next steps to optimize your lipid profile.

    Keep it up. You're doing a terrific job.

    Dr. Peeke
    mad_mike replied to Pamela Peeke, MD, MPH, FACP's response:
    ok, a dr. visit with discussion...

    i have added a hit of niacin/aspirin
    a metamucil cocktail as a mid afternoon snack
    a session on an elliptical after lunch - did 45 minutes yesterday.
    apples with lunch
    tuna fish or other fish with lunch

    is this really going to help? hope so... last time i took cholesterol medication, my liver went into seizures... a doctor called me personally and ordered me to stop taking it at once... how many times does anyone get a personal call from the doctor?

    i'm still looking at the naproxen thing... i had to take it because of an arthritis flareup in my foot/ankle and gained 5 lbs last week. doc says its fluid retention... perhaps so, this time... but 70 to 80 lbs of fluid? i'd be drowning!

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