Dr. Davis,

I think total cholesterol should be 290, perhaps, and not 29?

I have started using the lipoprofile in my practice.  Patients with relatively normal lipid profiles are startled with the results.  Getting them to make any changes is another thing, but I will keep trying.

Teresa

I live in the UK under the National Health Service but I also  have private medical insurance. I know that neither my private medical insurance company, nor the NHS itself, know my cholesterol numbers - they are known only to the lab, my doctors and me. How is it that patient information, which should be confidential, is given to insurance companies ? I find that a very worrisome aspect of this.

I find it kind of strange how obsessed american doctors are with cholesterol levels, in my country (Iceland) this is not such a big deal.

It's almost as if the doctors in America are going out of their way to find something wrong with their patient so that they can treat it.

For example high cholesterol, thyroid disorders. I pretty much never hear people talk about those things here.

and when she refuses to do as ordered, her insurance company will find out about that, and will then terminate her coverage. Anybody want to make a bet? So much for privilege and confidentiality in the ole US of A.

Seems very odd, I've had health insurance fornforty years, and they've never given me any advice or indication that they read my lab results.

Some insurance companies routinely require physical examinations before they will write life insurance and are happy to find any reason not to write the insurance. Could this have been a life insurance company?

What do you think is the best line of defense for the patient? My husband has similar calculated LDL - 181, the rest of numbers are excellent and he is in a very good health at 50 years old. Blood pressure is excellent(115/65), pulse is 45 at rest, fasting BS is 76. Our doctor admits it, but recommends Lipitor anyway. Our health insurance is about to be changed and it makes me worry about perspective pressure from insurance people on my husband to take that Lipitor.

How does an individual give honest answers on health questionaires when applying for new or additional life or health insurance?  If they ask my PCP they would be told that I am low risk for heart attack.   If they look at my CT scan score they would see that I am in the 90th percentile - high risk.
These are hypothetical questions at this point but my inclination would be to base my answer on my PCP's opinion rather than my calcium score, in part because medical insurance does not cover CT scans (apparently because they don't consider them to be a reliable predictor of risk) and in part because I have taken steps to significantly reduce my risk.

Let's name names!  I have coverage by United Health Care through an employer.  I have gotten several letters in the past couple of years telling me I NEED this test, or that that test, to maintain my good health!  [However, never anything about the value of lipoprofile testing!]

I consider this an abhorrent practice, an invasion of my privacy, and totally reject their "advice".  Advice should be coming from my doctor, and in fact it is.  I don't need their nurse "case manager" nor this advocacy for excessive testing.

There's nothing like a letter from an insurance company to raise blood pressure!

madcook

It is very disturbing to me that 1) her health insurance has access to her medical records and 2) that a for-profit organization is getting involved in her healthcare. Having moved from Australia about five years ago, everything about American health care disturbs me. I trust no one; they all seem to be desiring a profit and therefore paperwork is their main concern, not patient care, health, or longevity.

My last test showed calculate LDL at 208, however the one from three months ago was "directly measured lipid" and showed 263 LDL direct, so might the calculated version be wrong in either direction?  I have pattern A and am FH.

I'm for naming names too!  I have Aetna health insurance through my employer. I don't get letters from them, but I get emails. Just today, I told my email program to automatically delete any further emails from the "Simple Steps to a Healthier Life" program. Plus whenever I sign into the online portal, I get nagged to have all kinds of tests, fill out questionnaires, and join health improvement programs.  I got so tired of the demand that I "fill out a health assessment questionnaire" I finally gave in, hoping it would be removed from the page. It just opened a new can of worms: now I have a half dozen new "suggestions" on my "to do list". Bah humbug!

I'm of the "live and let live" school.  Why go looking for trouble?  As long as I'm not having symptoms, I feel no need to undergo all of these tests.

Thank God my doctor is beginning to understand that I'm not going to be taking any of those Pharma-pushed poisons just because my lab results don't meet someone's criteria. Once again, I say Bah humbug!

Thanks for catching that, Teresa.

It is indeed an eye-opener, isn't it?

Anne and Kris--

Fascinating non-American perspectives.

Insurance companies have incredible info on us. I'm always surprised more is not made of this issue.

Remember: The more they know, the better they are at denying coverage.

Dr. Davis,

I didn't want to put this here (not sure if I could post it elsewhere) , but I thought you would find this interesting if you haven't seen it yet.

http://www.psychologytoday.com/blog/p-nu/201103/cardio-may-cause-heart-disease-part-i

RyanH

Anonymous1 said:
"I have coverage by United Health Care through an employer"
Ah, United. I have Oxford/United. '
Several years ago, when everyone at Oxford (and patients) worked toward a noble goal of "salary" for their CEO of 1.6 Billion a year, they sent me several letters suggesting that I have basic check up. I followed their suggestion. Then, I started to receive letters ... refusing to pay - 100% refusal. Each time, I had to call and ask nicely and politely: "Are you nuts?" They paid.

Though I am not in the habit of defending health insurers, I have found that they tend to provide a benign "you should speak to your doctor about . . ." kind of approach.

I often wonder, however, if at some point they start to be more coercive. Something like: "You should strongly consider a cholesterol-reducing drug. We anticipate that your premiums may be higher if you do not."

That would be scary.

Ah, I should have continued.
In a way, Oxford achieved their goal. What they paid was minimal, but they avoided bigger cost at that time.
They scared me to death - if they don't pay for what they send to ( with letters firmly printed) which is basic, stated officially in some book as my right, they probably won't pay for anything else. I neglected all symptoms and asked for medical attention when I really didn't have any choice (and in a slightly new climate)
I was diagnosed with two quite serious conditions - neither curable, but one was preventable and the other was at this time preventable to a degree. I mean the condition would be one only (the result of "bad" accumulation +genes?), less serious and correctable.

An insurance company has a tremendous incentive to reduce its costs and hence a great incentive to find out the truth. If they are not, it means that something is fishy. Why are insurers not commissioning their own studies? Are they not allowed to? Is it the regulators who are holding them back? Or are they actually stupid?

I have not had any insurers say they know what a patient's lipid numbers are, but they can pretty well tell from claims data what tests have been done, and what medications are prescribed.

We get faxes all the time recommending that meds be changed or weaned or made as needed rather than routine.  Yes, I know Mrs. Jones has been on an ulcer medicine for 6 months, and we should try to wean it.  What they don't know is that she won't change her diet and lose some weight, so maybe her symptoms would stop, and her symptoms get horribly worse without her ulcer medication.

Teresa

Dr. Davis,

Based on Claudia's numbers, I guess I should expect a letter from my insurance company and a prescription from my doc for a statin. I won't fill the scrip.

I'm 65, slim, eat VLC, and haven't been afraid of  saturated fat. But I just got my labs and TC was 476, HDL 146, Triglycerides 79 (I'd had wine with dinner--they're usually in the 30s), and LDL 314!!!

How worried should I be about these numbers?

Hey Dr. Davis,

At my last visit, my doctor mentioned my lipid numbers; but even he had to admit that my LDL (157) and TC (234) had improved (from 177 and 255), and the rest of my labs were all WNL. I generally eat low carb -- other than my recent indulgence in mini PB cups -- so I suspect that, as you indicated, the actual numbers are better than the official calculated numbers.

My doc didn’t try to prescribe any meds this time. But at other visits he’s tried to guilt me into following the accepted guidelines by telling me his “performance score” is determined by how well he adheres to those guidelines, including prescribing all the meds and tests recommended by the so-called experts for a patient of my age with my lab results.

I also fear that things are changing in this regard – and not for the better. Our government has now decided that we all must have insurance or pay a fine. If I refuse to follow the recommended guidelines, either my insurance company or my doctor, or both, may “fire” me. The truth is, I really don’t give a fig which entity it is (doctor, insurance company, or government panel) that tries to hector me into following guidelines promulgated by “experts” who believe in the lipid hypothesis. I simply choose to believe that I’m in charge of my body and that I get to determine whether to take a recommended med or have a recommended test.

As for insurance companies getting lab results, I don’t know whether the doctor’s office or Quest Labs has been feeding my results to my insurance company, but when I look at my online health info on the insurance company’s web site, all my lab results are listed. And I’m sure the company is basing at least some of its many recommendations on those results.

I must admit, having the results online makes it easy for me to keep track of them; but given the ease with which records can be hacked, I fear for my health privacy. And I resent the big brother attitude of the insurance company. I'm a well-informed, healthy adult. Treat me like one.

Just this past week, my insurance company (Aetna), which has paying for my test strips for the past year and a half, sent me a letter suggesting that I might have diabetes, and should talk to my doctor.

Hi Dr. Davis,

I spent the weekend reading your older posts about LDL. I guess I need to get a test done to determine my LDL particle number before my doc and I have a discussion. Thanks for posting that info in such detail on your blog.

Regarding the hamburgers: Was the blood sugar increase due to some sort of recipe used or did you purchase the ground beef not knowing bread was added to it? A strange place to find it I'd say! I'll probably switch to grinding my own now.

Doctor Davis... YOU ROCK!!

I'm a T1.5... who lost 78lbs, I have normal blood sugar ...for non-diabetics.

NO meds, NO insulin... Keep Spreading the word... to ALL.

Love your blog ...

Steve

I can pretty much count on higher BG readings when I eat at group meal gatherings away from home, unless I bring and eat only my own food.  I don't normally eat much processed convenience food, so I forget that boxed heat & serve breakfast sausage links can be full of sugar.  I also now know to steer clear of table grapes and fruit trays (I used to make sure to have fruit with the bacon or sausage and eggs for breakfast to deflect the comments from others, but now I don't bother with the fruit  because it's always too high-sugar.  

At restaurants I ask for dressing on the side if I use dressing at all.  I dip my fork in the dressing before spearing a bite - that provides enough flavor without all the dressing.  Most of the time I avoid the dressings because they are made with soybean or canola oil anyway.  I ask for Olive Oil and Vinegar - not vinaigrette, which is often sweetened.  

At home I always make salad dressing or simply toss with EVOO and a good vinegar, freshly ground SS & BP.  It's been years since I bought salad dressing.  Homemade is a breeze to make (even Ranch style) and economical, too.

Frozen yogurt is far worse than full fat high quality ice cream.  Frozen yogurt almost always has more sugar and no fat or eggs to slow the absorption of the sugar.  Homemade ice cream is the best because you can control the sweetness level and use more cream and egg yolks (commercial is too sweet-tasting for me anymore, BG notwithstanding).  

OJ - like a glass of pure sugar - absorbs into the blood stream nearly instantly.  I have a valencia orange tree in my garden but I don't dare drink the juice straight.  I put a tiny splash of freshly squeezed OJ or drop a squeezed orange wedge in a tall glass of Gerolsteiner sparkling mineral water (good source of magnesium).

BBQ sauce & catsup - loaded with sugars - watch out for honey mustard sauce, too.

Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.

http://www.reuters.com/article/idUSTRE6205AQ20100301

Michael

I looked at the back of my vinegar and it has 5 grams of carbs per tablespoon, 2 of which are sugars. But the only ingredients listed are red wine vinegar and grape musts.

Michael,

That article isn't talking about a new study per se, but rather a review of several select studies. In other words, it's not really providing any new information. It's a (biased) interpretation of a sampling of the existing data.

I found this quote from the article to be pretty funny:

"Now, if there are specific instances of vitamin D or calcium deficiency, then that's a separate issue that should be discussed with a personal physician."

Uh, except it's hardly a separate issue since nearly everyone is deficient in vitamin D.

David

grape musts? That should have given you a clue. Grapes are very high in sugar. It always comes down to the same thing: Always read the labels. Carefully. Never trust anything that is processed. Not even if you buy it in Health Food shops.

You don't need to test your blood sugar.  You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most.  

Mostly this is because you ingest those in greater quantities since you like them, but partly because you choose those because the blood sugar rushes feel good.

"You don't need to test your blood sugar. You can figure whatever your favorite carbs are, those are the ones that are spiking your blood sugar the most."

No. This is not a reliable way to go about things, as it isn't always true. It's never good to simply trust your feelings. Being objective with a glucometer isn't difficult or expensive. There's nothing to lose.

re hamburgers, also watch out for worcestershire sauce! Just discovered (much to my dismay) that the brand I had been using contains molasses and high fructose corn syrup. Yech!

Michael said...
"Here is a link to a recent study that says vitamin D has no real link to heart health. Perhaps you can comment on this.
Calcium, vitamin D pills don't help heart: study"
The RDA for Vitamin D is set for bone health. Therefore, an RDA dose of Vitamin D makes no difference to anything except bone health. It takes a dose about ten times the RDA to be effective elsewhere.

If you give people one tenth the correct dose of a medication, would you be surprised that the medication is ineffective?

Nige.

so easy to make homemade tomato soup, still a little high in carb's but nowhere near store boguht, handy if you absolutely must have a bowl of tomato soup.  Use tomato paste, water and some heavy cream and salt to taste.  you don't need the cream, but it tastes better.  One of the fastest "homemade' soups.  Keep in mind that tomatoes do have carbs, about 4 per 2 tbsp of paste.  You can add splenda to sweeten a little

It's infuriating that sugar and starch show up in places you would least expect them.  You have to read labels very carefully.  I've been burned by failing to read labels.  Even better, eat real food prepared from scratch.