Saturday, September 20, 2008

More bad news on the medical front

After getting the news I did on Tuesday about my eyesight, I decided I should share the worst of my blood work numbers with my primary care physician (PCP) at Kaiser. Funny: in the midst of a brief back-and-forth with my PCP, I received another letter from Dr. Leonardi.

First, my correspondence with my PCP.

Dr C______:

I went "out of plan" to get some very detailed analytic work done by Dr. David Leonardi of the "Leonardi Executive Health Institute."

I thought you should see at least some of the results (most particularly, those that are "out of range" or near out-of-range). So here are what I sense are the more salient numbers from a 6/18/08 blood draw after a 12-hour fast with [testing norms] and, where available or different, [/optimal numbers]:

Glucose - 97 [65-95/<90]

Hemoglobin A1C - 5.4 [3.5-5.1]

Insulin - 6 [1-5]

Cholesterol - 209 [0-200]

Triglycerides - 153 [0-100]

Cholesterol, HDL - 44 [50-200]

Cholesterol, LDL, calculated - 134 [0-100/<70]

Coronary Risk Ratio - 4.8 [1-3.5/<3.0]

Cholesterol, VLDL - 31 [4-40]

WBC w/ Differential & Platelet - MCH - 33.2 [27-33]

Testosterone, Total - 441 [750-1100]

Testosterone, Free - 54.6 [90-130]

Estradiol, High-Sensitivity - <2 [10-40]

DHEA Sulfate - 143 [350-500]

Cortisol, AM - 6.8 [8-18]

IGF-BP3 - 5.8 [2-4]

TSH - 0.08 [0.3-2.0; T-3 & T-4 were normal]

Results from 8/6/08 blood draw after 12-hour fast:

LDL Particle # - 1942 [<1000]

LDL Particle Size - 20.0 [>20.5]

Small LDL Particle # - 1581 [<600]

Large HDL Particle # - 6.6 [>6.6]

Vitamin D - 25.0 [>50]

His response:
Well, they look okay. . . . [T]hey all look pretty good.

On our scale, your testosterone of 441 would be normal.

The particle sizes I don't know what to do with. That's not normally a test I run.

You have quite a bit of hormone deficiency but as they stand I'm not sure of the significance.

We could refer you to an endocrinologist and they could address all of those issues if you like.

The A1C is a tad high but that is not a good screening test and anything less than 6 is still normal.

The cholesterol is borderline high but I still wouldn't treat it with medications.

We could get you some testosterone injections and see what happens. It might fix a few of the other hormonal abnormalities.

Let me know what you want to do.

On the one side, I was astonished he was willing--and, apparently, Kaiser-Permanente would be willing--to even consider dealing with the testosterone issue. But to compare his comments to Dr. Leonardi's is . . . almost . . . distressing.

When we met three and a half weeks ago, Dr. Leonardi made a big deal about what he called "glycation"--a process by which sugar molecules become bonded to proteins in the body and create AGEs--Advanced Glycation End-products--the cause of many age-related chronic diseases, specifically type II diabetes, cardiovascular disease, Alzheimer's disease, cancer, peripheral neuropathy, deafness, blindness . . . and more.

As he put it,

No one dies of old age. Aging is the development of degenerative disease (heart disease, cancer, dementia (Alzheimer's and vascular), stroke, Parkinson's disease, diabetes, osteoporosis, and osteoarthritis, in particular).

And we now know what causes these things. The disease biochemical pathways have been mapped. We now have biomarkers that measure the disease pathways and to demonstrate the effect of our diet and activities on them. Put another way, we know what accelerates and retards--or even reverses--our progress down the path of degenerative diseases.

Much of what promotes disease, we do to ourselves.

What accelerates aging? According to Leonardi,
  • Oxidative stress

  • Glycation

  • Inflammation

  • Declining levels of vital hormones

  • Dyslipoproteinemia (unhealthy patterns of serum proteins carrying fats & cholesterol)

  • Acidic nutrition [Not necessarily referring to foods that are acidic within themselves--for example, oranges. Rather, acidic nutrition refers to foods that cause the body to produce acids so that its own pH balance moves to the acidic side].
Leonardi showed me how each and every one of these six factors interacts with the others to accelerate degeneration. And then he discussed how, by taking specific actions against these factors, one can retard and potentially, even, reverse their effects.

Though I found "new revelations" in each of these areas, for me, the biggest revelations had to do with glycation and hormones . . . with particular emphasis on glycation . . . because I can so readily affect it by what I eat.

Glycation occurs when "extra" sugar molecules randomly bump into proteins and form AGEs. --That's what an AGE is: a mass of proteins gunked up/stuck together by sugars. . . . High blood sugar levels (caused by intake of high-sugar--or, more accurately, high glycemic index/glycemic load--foods . . . from soda pop to cakes, mashed potatoes to bread, chips to cereals, and rice, corn, peas, bananas and grapes!) increase the probability that sugar molecules will bump into proteins and cause AGEs. So the thing I need to do, said Leonardi, is to maintain a low blood sugar level.

Hemoglobin A1C (HbA1C), said Dr. Leonardi, is the best way to measure average blood sugar levels over a long period (the past 60 days). It is, he said, a "direct measure of AGE formation."

The "normal" HbA1C level is 4.3 to 5.9 but our goal should be 4.3 to 5.0 because, said Leonardi, levels above 5.0 correlate with carotid plaque, colorectal cancer, and all-cause mortality (Dr. Leonardi referenced the original report).

Oh. Guess what my mother died of . . . at age 55? Yep, colorectal cancer!

And yet, with all these studies, and with my mother's history, my PCP says, "HbA1C is not a good screening test."

And though, as I pointed out back on August 29th, that Dr. Leonardi says LDL and HDL, on their own, are not good markers or predictors for heart attack but/and the number of LDL cholesterol particles per unit of blood is the #1 risk marker for heart attack (and my number is almost double the highest range of "normal"), and while, even on the basis of my LDL/HDL ratio my risk of having a coronary event appears high, my primary care physician not only doesn't know what to do with the particle number, but wouldn't treat my cholesterol with medication.

And this is the day after the Kaiser-Permanente ophthalmologist noted in my records, for my PCP to read, that I had just suffered serious (negative) results from non-arteritic anterior ischemic optic neuropathy.


Meanwhile, the same day that I am engaging in this correspondence with my doctor, as I said above, I received a letter from Dr. Leonardi with the results of my "Carotid Intima-media Thickness Test (CIMT)"--An ultrasound measurement of the thickness of the artery walls in my neck--"the part of the wall of the carotid arteries that is affected by atherosclerosis."

The part of the wall measured is composed of the intima (a single layer of endothelial cells) and media (muscle layer adjacent to the intima).

Atherosclerosis (plaque formation) occurs between these two layers, increasing the thickness as plaque accumulates. Normative ranges have been determined for our population and are stratified by age and gender. Knowing how you stand relative to your peers and what "relative age" your CIMT represents gives us an impression of your relative risk of both stroke and heart attack.

A number of studies have validated CIMT as a good indicator of the risk of cardiovascular "event."

Dr. Leonardi explains that, after the tests are done,
Your results are then compared to a "normative" population so we can score your artery with the age that corresponds to the wall thickness. . . . Our goal [is] to track a reduction in your artery age every one to two years.
So what did the test show for me? Chronologically, I'm 52--just shy of 53--years old. Compared with the "normative" (i.e., average) population, my CIMT shows me to have the carotid arteries of an average 64-year-old!


I have radically altered my diet over the last four weeks since I visited Dr. Leonardi; my "discovery" Tuesday has motivated me even more.


I'll try to address the issue of hormones, and especially testosterone, in a future post.

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