Interesting that we just need to refine the notion of "good and bad cholesterol," and it seems to be about particle size, not density. Are lp(a) small? Is there a treatment that converts small LDL to benign LDL but doesn't raise HDL?

Keith.

Lp(a) particle size tracks LDL particle size. Small, dense LDL therefore occurs with small, dense Lp(a) (referring to the LDL part of Lp(a), not the apo(a) portion).

Small LDL responds to the same treatments that raise HDL. I do not know of any treatments that diverge on this point with the exception of alcohol, which principally raises HDL.

That's an eye opener. In England all we get is LDL, HDL and trigylceride reports, and even then the decision to put someone on statins varies between doctors and deviates from guidelines. It's all messed up.

Just to deliver some more from Trevor Marshall (against vit D), what's your opinion of this article? It's a lengthy one. http://bacteriality.com/2008/01/26/cad/
I'm guessing the reason this has shown effect is not really the reduction of vitamin D but antibiotics that mimic it's effects. Do note that the author of that author is biased because she follows Marshall.

Every so often, a kooky idea comes along that seizes the attentions of the fringes. Linus Pauling and high-dose vitamin C to cure heart disease, cancer, and most human illnesses was this way. Nanobacteria did this. Chelation is another.

From what I've read of the so-called Marshall Protocol, I would lump this with the above.

The focus of this blog and the www.trackyourplaque.com website is reduction of coronary calcium scores and regression of coronary plaque. I do not think that we need to invoke these sorts of ideas and reinvent the wheel to accommodate the rants of people like this.

By the way, the article states that the causes of heart disease are not often revealed by conventional cholesterol values. I heartily agree with this. The answers will be found in lipoprotein analysis and associated laboratory and lifestyle examination. It is not in antibiotics.

I did find a web site that outlined the risks for someone that follows the Marshall Protocol. I should point too that Dr. Marshall is not a MD.

http://lassesen.com/cfids/MarshallProtocolRisks.htm

    *  Major risk of Addison Syndrome (5%-25% of CFS that complete the protocol)
    * Increased risk (100 300%) of Heart Attack
    * Increased risk (100+%) of Cancer (Breast, Colon and Prostate are well documented)
    * Increased risk (67+%) of Multiple Sclerosis
    * Increased risk (400+%) of Diabetes
    * Increased risk of Depression
    * Increased risk (500+%) of Osteoarthritis and Osteoporosis
    * Increased risk of nephrotic syndrome, schizophrenia and severe bipolar disorder.
    * Increased risk of Hyperparathyroidism
    * Increased risk of Crohn Disease and Sjogren's syndrome
    * Increased risk of Rheumatoid Arthritis
    * Increased risk of Systemic Lupus Erythematosus
    * May cause fetal and neonatal morbidity and death
    * Risk of Angioedema

Another from the UK!  I've often wondered how cholesterol is measured in a standard lab (as described my moblogs)   If cholesterol is contained within or is a part of a lipoprotein, how on earth do they separate out the different contents of the lipoproeins and then measure them with any precision?

Of course, LDL is NOT measured.

The other cholesterol fractions are measured enzymatically and separated by density.

I looked at the article linked by mobloogs.  At first I was surprised it didn't list his background like it did the others it mentioned, until I looked around the site and realized the whole site is just a PR piece for Marshall.  The site states Trevor Marshall, Ph.D., is a biomedical researcher.
His site http://trevormarshall.com/ says "Prof. Marshall is currently a Director of the Autoimmunity Research Foundation, an Adjunct Professor of the School of Biological Sciences and Biotechnology, Murdoch University (Western Australia)"
Wikipedia lists him as "Trevor Marshall received his PhD in Electrical Engineering from the University of Western Australia in 1984 [3]. He also possesses an undergraduate and a masters (1978) degree in Electrical Engineering.[4]"
Murdoch dosn't show him on their research page
http://www.bsb.murdoch.edu.au/research/interests/

Thanks Dr Davis  (anon from the UK)

Dr. Davis - I have been a faithful reader of your blog for about a year and try to follow your protocol for plaque reduction even though I have not been able to afford a CT Heart Scan.   I did have a lipoprotein breakdown and believed that Vitamin D, Fish Oil, and Vitamin K are very important.   My Vit D level was 36 while taking 2,000IU of Carlson's capsules.  I doubled it to 4,000IU and my blood level went to 48.   I then decided to try to get it closer to 60, so I started taking 6,000IU back in Sept.  I have a lot of cancer in my family history, have already been diagnosed with borderline osteopenia (-2.0) and fear heart disease, so Vitamin D seemed the logical thing to supplement up to a blood level of 60-70.   Then...

In December I came down with a c-diff infection out the blue, my immune system now seems to be in really bad shape which is a complete shock to me, a self-proclaimed health nut who strives to eat right, exercise and take multiple supplements.  I am really devastated to think I might have done this to myself.

A few weeks ago I ran across this new study indicating that high Vitamin D doses could harm the immune system.

http://www.sciencedaily.com/releases/2008/01/080125223302.htm

Please comment on this study to ease my mind....I dropped back to 2,000IU a day of the D supplement as I'm scared to death!
Thanks,
Noreen

I've commented on this bit of nonsense several times, both here and in the Track Your Plaque forum. It is patent nonsense based on the rants of a single man. Yes, there is a sliver  of science in his comments, but nothing more. Vit D has nothing to do with catching an infectious bacterial disease in the gastrointestinal tract.

Thank you Dr. Davis -- I felt like you would have an unbiased opinion on this.  Its just scarey to read about immunosuppression, especially when you seem to be suffering from it!   I've also had a flu-like episode and a cold since the first of Dec!  

I feel like I am literally starving myself on (ugh) white bread, white potatoes and white rice, but thats all I can eat at this time.   Things I haven't eaten in over 5 years!

Thanks for clarifying the Vitamin D issue.  I'll go back to my 6,000IU dose.

Noreen (who is healing slowly)

Knowing that Pam has Lp(a) can point us in an entirely different direction than just LDL cholesterol. It might mean high-dose fish oil, a more serious approach to niacin, hormonal treatments like DHEA or testosterone. It might mean more attention to warning your children about the possibility that they, too, might share this genetic trait.

What's your beef with wheat?

I married a depressive. Passion generated seritonin, so she was fine. She went off her pills.

Then, she was prescribed a statin.

The normal physiological process in "falling in love" moves from seritonin to frendship chemicals and then nothing at which point you have hopefully bound yourselves up in obligations, respect, and friendship.

Well, statins decrease testosterone in women, which supports the seritonin production, so if that women is a depressive, the passion is terminated and you never get to friendship.

No woman should ever be prescribed a statin. Sure they might have better cardiac health, but their quality of life will sink--if they survive the depression and suicides.

Not fun.

Never sign an ARM. Never take a statin.

Please see my numerous prior posts on this question. Wheat products are among the most heart disease and diabetes causing foods I  know.

Here's an even better idea, combine both tratments and lower your risk even further !!! In MOST people statins are very and VERY helpful.

There are times when the Lipitor becomes superfluous.

Hi Dr. Davis,

Because I know my risk is high due to previous cardiac events, I didn't stop taking Lipitor 80 and Zetia 10 before getting a Berkeley Heart Lab (BHL) blood draw earlier in the week.

My thought was that I could assess my BHL numbers, begin ramping up on the TYP program recommendations this week and next, and then draw down my Lipitor dose sometime later over time (perhaps never to 0) as I feel more confident that I'm not putting myself at increased risk in doing so.

Does that make sense as a general strategy for transitioning to TYP?  Any other general thoughts about this?

I've come to think of wheat as a "sugar equivalent"  and it makes no difference if it's whole wheat or not.

Yes, absolutely. A stepwise approach to converting to a program with the least amount of drugs but maximum benefit is usually best.

Actually I would think the best combination would be Zocor and Slo niacin. According to the Hats Trial this combination reduced the risk of heart attack by 90% versus placebo. In this case the niacin would probably be the best thing for the small LDL particuls. Add your vitamin D and an aspirin a day and you have virtually no chance of heart disease if you eat well and excercise.

Dr. Davis,

Could the short term memory problems associated with a statin be mistaken for the beginnings of memory problems associated with aging.  My grandmother is 84, has taken a statin for years, but in the last few has been having problems with her short term memory.  

I asked her internist about it, but his comment was that the research was controversial and had her keeping taking the lipitor.

She also is slipping toward hypothyroidism which may have to be treated soon.

Thanks!

Hi, Michelle--

To my knowledge, the only way to connect Lipitor with memory deficits is to stop the drug for about 4 weeks. It takes that long to see the effects recede if it is indeed due to the drug. However, you will need to discuss this with your grandmother's doctor first.

"muscle aches (inevitable in my experience)"

I took statins for about 20 years until a couple of weeks ago when I decided to stop.  I didn't experience muscle aches.

--Lub Dub (my TYP membership name)