But will it be mine or my doctors?
He will be doing this because, based on the New Zealand Primary Care Handbook 2012 - Cardiovascular Disease Risk Assessment (Updated 2013), I will be at a "'high' (15-20%) risk level, 5-year cardiovascular disease (CVD) risk (fatal and non-fatal)". He will have looked at the systolic blood pressure he measured on Monday (160) - which alarmed him at the time - (he didn't pay attention to me when I said that it was unusually high when I got up that morning but was fine the previous morning). He immediately scheduled a lipid panel and a follow-up appointment for 2 weeks.
Well, what is going to arouse him about my latest tests? I'll tell you. First off the total cholesterol is 7.5, the triglycerides are 2.8 and the LDL is 5.1. This makes the TC/HDL ratio 6.7. By all the standards that conventional medicine practitioners in New Zealand follow these are HIGH. These are what will have him reaching for his 'prescription pad'.
Now, the last time I had this panel performed we did so on the understanding that we would ask for a screening of apolipoprotein A1 and apolipoprotein B, the test that shows the predominance of the 'good' and 'bad' particles of that notorious LDL that everyone has been fixated about for the last 20-30 years. Well it turns out that the 'lab technician' (loosely called the Chemical Pathologist) at Waikato Hospital, vetoed this screening:
"Comment: Apolipoprotein A1 & Apolipoprotein B has not been performed as the results usually provide very little additional information and are not performed routinely in Waikato Hospital Laboratory. Dr Stephen Du Toit , Chemical Pathologist"
Well, what a fine fettle. I agreed to do the blood tests because we were going to do some additional screening that would cast some nuances and perhaps tell us something useful and now they dismiss that out of hand. (SMH).
Fortunately, Phinney and Volek to the rescue. Recent research shows that we can work out the predominance of Apo A or Apo B by doing a calculation of triglyceride/HDL-C. Any result over 3.5 indicates a higher proportion of the Apo B (the ones that you don't want). I have performed this calculation myself - because they likely don't understand the importance of it in our NZ hospitals - and my doctor will not be up-to-date in these matters. I've put all my results up and will provide a link at the end of this post, but the story goes as follows:
My first ever lipid panel was done in 2010 when I was 56 years old, 87kg and on the standard New Zealand diet of grains and all that rubbish. Ignoring all the other results for now the TG/HDL ratio was 2.8. By the beginning of 2013 I had climbed to 90kg and was getting concerned for my weight, starting to research what to do about it. I settled on a low-carb, high-fat way of eating as the most logical (from my research) step and commenced preparing all the meals for my wife and I based on this system - starting around April that year. Within a couple of months, we had both shed about 10kg, with no real effort (as LCHF allows you to eat as much as you like).
A lipid panel done about 6 months into the LCHF revealed high trigs (probably a result of greater mobilisation of fatty acids while I was losing weight). But the TG/HDL ratio at that point was 4.0, indicating a predominance of the B pattern. The following year (13 months into LCHF) the ratio was back down to 3.1.
Now, the current results (4 months into a new experiment of Zero Carb (food from the animal kingdom only - no plants) show that the ratio has gone to 2.5 - lower than it had been 5 years ago.
I had another lipid panel done 14 July 2016 and the results are:
The chart below was more to demonstrate what effect my life-style changes have had on uric acid but also shows the result on the lipids.