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  • Necessary Diagnostics and Supplementation

    Hi Docs, happy Sunday!

    I've heard in past content/podcasts that you two are pretty selective in terms of what screenings to do, based on the evidence around efficacy/outcomes and chance for harm. I wanted to dig into this a bit when it comes to cardio vascular health and get your advice.

    I have a PCP/MD and also have been maintaining a relationship with an ND for several years prior. The ND was regularly (around 2x a year) ordering and trending my results with full lipid panels and more specialized work like the Boston Heart Diagnostics more "in-depth" and novel methods for CV health. We would review the results together that were more detailed than just traditional Total Cholesterol, HDL, LDL, HDL/LDL ratio, etc. My PCP/MD is not familiar with Boston Heart and is just fine to do the normal lipid panel and more "traditional"/top-line information. May I ask your take on this, please?

    Also, just to add in --- my paternal grandfather died of a heart attack around 60 years of age and my father had a massive heart attack and triple-/quadruple-bypass surgery immediately after at age 57. He had another heart attack in the past 10 years and is currently 91.

    I believe I know how you view NDs and their focus around supplementation and such. Unless your views have changed, I believe I've heard you generally not think that supplementation is really warranted in most cases normally for people. My ND did have a handful of supplements that she recommended, including daily Vitamin D (including regular screening for D that I heard you in the past say in unreliable/not useful, still true?) and most specifically the concept of daily 1-2 fish oil supplementation due to CV health markers and family history. Any changes recently with respect what I've heard you say in the past and what I've written here that you would recommend?

    I've been a "fan" of supplementation for a long time in terms of the narratives resonating with me that modern food supply/soils/etc. do not provide the same level of nutrition that they previously did, that my lifestyle may not be providing enough of the micro-nutrients that I need, and that it was a safe/though likely unnecessary investment in assuring that my "bases were covered". However, I'm starting to reexamine things in terms of the cost and being unnecessary (and perhaps even non-zero harm) and wanted to get your latest thoughts on this area (or please refer me to latest articles/podcast). This would also entail dropping my engagement with my ND and just sticking with my PCP/MD going forward and simplifying (and lessening the cost of) my life.

    I stay fairly up to date with your materials, but get busy from time to time. So, apologies if I missed recent content/updates on this front. I know there has been talk of a nutrition book (?) for a while and not sure if I missed that.

    Thanks again for your advice & thoughts.

    Shawn

  • #2
    Shawn,

    Thanks for the post. For your questions:

    1) Boston Heart Diagnostics is a company, not a specific set of labs or tests. Hard to comment on their utility without knowing the labs and why these are being trended twice a year. The frequency is suspect unless actively monitoring something that may require an intervention or change, which your ND would not be aware of or trained to do.

    2) We would not recommend supplementing vitamin D or screening for it in most people. Fish oil supplementation is not indicated either and does not seem to improve CV-related outcomes outside of lowered triglycerides in individuals who are unable to take more effective medications.

    I think our multivitamin and vitamin D podcasts would be useful

    -Jordan
    Barbell Medicine "With you from bench to bedside"
    ///Website /// Instagram /// Periā„¢ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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    • #3
      Our recommendations for your general health are best outlined here:

      https://www.barbellmedicine.com/blog...ove-my-health/ (pairs with podcast episode 98)

      For cholesterol/blood lipids, see here:

      https://www.barbellmedicine.com/blog...sterol-part-i/

      https://www.barbellmedicine.com/blog...terol-part-ii/

      Regarding your cardiovascular risk, checking a blood lipid panel, apolipoprotein B level, and a one-time check for Lipoprotein(a) would be wise, then combining this with other information like your blood pressure, blood sugar, and other factors to estimate/project your long-term cardiovascular risk. This helps to guide treatment decisions beyond lifestyle measures alone, all of which are discussed in the cholesterol articles linked above.
      IG / YT

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      • #4
        Originally posted by Jordan Feigenbaum View Post
        Shawn,

        Thanks for the post. For your questions:

        1) Boston Heart Diagnostics is a company, not a specific set of labs or tests. Hard to comment on their utility without knowing the labs and why these are being trended twice a year. The frequency is suspect unless actively monitoring something that may require an intervention or change, which your ND would not be aware of or trained to do.

        2) We would not recommend supplementing vitamin D or screening for it in most people. Fish oil supplementation is not indicated either and does not seem to improve CV-related outcomes outside of lowered triglycerides in individuals who are unable to take more effective medications.

        I think our multivitamin and vitamin D podcasts would be useful

        -Jordan
        Here is a view of the output received from the specific Boston Heart Diagnostics lab ordered and results:
        Click image for larger version

Name:	image.png
Views:	103
Size:	258.6 KB
ID:	77693I'm assuming you would say these are surrounded by much data/evidence to be useful.

        Thank you for your insights on this.
        Shawn

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        • #5
          Originally posted by Austin Baraki View Post
          Our recommendations for your general health are best outlined here:

          https://www.barbellmedicine.com/blog...ove-my-health/ (pairs with podcast episode 98)

          For cholesterol/blood lipids, see here:

          https://www.barbellmedicine.com/blog...sterol-part-i/

          https://www.barbellmedicine.com/blog...terol-part-ii/

          Regarding your cardiovascular risk, checking a blood lipid panel, apolipoprotein B level, and a one-time check for Lipoprotein(a) would be wise, then combining this with other information like your blood pressure, blood sugar, and other factors to estimate/project your long-term cardiovascular risk. This helps to guide treatment decisions beyond lifestyle measures alone, all of which are discussed in the cholesterol articles linked above.
          Thanks a lot, Austin. Brilliant articles, I read them, including part III. I am schedule for a CAC screening next Tuesday, based on my doctor's recommendation. Generally, my HDL is around 50, my LDL is around 100, my TC is around 160 and Triglycerides are under 40. These are long-term trends. I guess my wild cards are my paternal/genetic risk factor and also I have had (for around 15+ years) this angina discomfort/pain in left chest/left shoulder area when I start intense activity (running, swimming) at the outset. This usually subsides in minutes. I've had stress tests/etc. in the past with no conclusive findings. It was best chalked up to "exercise induced asthma".

          Amusingly, my ND has been working with me for a couple of years on "improving" my HDL scores. I've seen some limited influence on my ability on HDL, but pretty much more accurately described as an inability. I better understand now from the articles that I should really focus on much more fiber, whole grains, and other recommendations to get TC and overall cholesterol in my body as low as possible as the lower the better seems to be the mantra. Thanks for the education and also the clarity in which you convey all this. It is highly appreciated by me.

          Shawn

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