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Cardiovascular Risk and the Apo B test

Uncategorized Jan 29, 2024
 

I received an article just recently written by Dr. Ron Grisanti and he is with Functional Medicine University. That's one of the places where I trained. So I get their articles from time to time. They are usually pretty good. They're very concise. So I want to share this one with you. This one's about a lab test called APO B or Apolipoprotein B. Now we're all used to doctors using a standard cholesterol panel or lipid panel to kind of judge the risk of cardiovascular disease. Well, if you've been seeing me for any length of time, you know that I kind of disagree with the utility of a basic lipid panel for that. I think you can learn some things from the triglycerides. There are a couple of ratios you can run, but it's limited in what it can give you. So one of the tests that's becoming more popular now, and we do it on our annual physical panel is called Apolipoprotein B, and it's proven to be more predictive of who's likely to have cardiovascular disease or plaque in the arteries...

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Why won't your MD run my lab panels?

 
Patrick Krupka, DC, CFMP:

So a question I get regularly from patients is, can they get their family practice doctor, or gynecologist, or endocrinologist, whomever, to run our lab panels instead of us running them? Which I don't mind. I tell the patients regularly, I don't care who orders it. As long as it's got the components that I need, it'll work for us. So that comes up regularly.

Well, there are several reasons why we've had very little success getting other doctors to run our lab panels. So I just want to run through this real quickly. It's, again, something I answer pretty regularly during an average week at the office.

So number one, understand that I do functional medicine, and the lab panels that we've put together are specifically geared toward finding underlying mechanisms. Looking for problems before they are so far down the road that they're diagnosable. Looking for indications that there's dysfunction even if there's not disease at this point.

That's, to a large...

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Foundational 5 Magnesium

 
Speaker 1 (00:01):

Magnesium deficiency is probably the second most common nutritional deficiency in the industrialized world, right? Definitely in the us. Um, it, it kind of goes back and forth with vitamin D depending on who you talk to, but that's how it made its way onto our foundational five. We find magnesium deficiency in, I probably, I would say 50 or 60% of the patients in which we test magnesium. If they're not already supplementing with it, they end up being deficient in it. Um, vitamin D is probably a little bit higher than that. Um, and, and I don't know if that's just because more people are supplementing with magnesium, but it's an issue. So real quick testing for magnesium, uh, very specific test. You will get a magnesium test a lot of times in your regular lab work, but it is a serum magnesium test. The normal range will be somewhere between probably one and three, something like that.

(00:57)
Um, and, and that's not an appropriate test for magnesium. It's accurate...

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Foundational 5 Vitamin D

 
Speaker 1 (00:01):

Next on our list of the foundational five is vitamin D. I've done videos on vitamin D in the past. Please go find them. Um, they're gonna have more information than I can put in this video here, but I'm gonna give you kind of a, a, a rapid overview on vitamin D. So, vitamin D, anti-inflammatory, anti autoimmune, immune regulating, anti-cancer, um, not directly, but helps our body do all these things, right? It supports our body's natural mechanisms for doing all these things. Um, so very important to have. It's generally considered the most, if not in the top two. Uh, magnesium being the other, uh, nutritional deficiencies in our bodies. Uh, we make vitamin D from the sun. Sun has to hit our skin, not really showing your skin there and interact with cholesterol. And that makes the first conversion that it has to go to the liver, get converted to the kidneys, get converted, then you finally get active vitamin D.

(00:58)
So it's a multi-step process. Um, and...

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Foundational 5 Probiotics

 
Speaker 1 (00:01):

So next on our list of the foundational five, we've already talked about multivitamins, we've talked about fish oil. This video, we're gonna talk about probiotics. And the next couple of videos we'll handle vitamin D and magnesium. So probiotics, those are the good bacteria that are supposed to be in our gut. Now, a couple of misconceptions about probiotics. Many people feel that when you take a probiotic, you are trying to colonize the gut with what you're taking. I mean, it wouldn't be bad if that happened. I think probably a little bit of that happens. But by and large, the reason you take a probiotic is that on its way through your system, while it's temporarily in there, it changes the environment somewhat. Those bacteria that you put in there, and sometimes nutritional yeast that you put in there, they ferment your food on their way through, and the byproducts of that fermentation set up an environment that's advantageous for your normal flora to kind of...

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Foundational 5 Fish Oil Supplementation

 
Speaker 1 (00:01):

Continuing the foundational five series. The last video I did was on multivitamins. If you didn't catch it, look around wherever you're seeing this video and you'll find it. Today. I'm talking about the second component of the foundational five, and that's ul. So it as a recap, the foundational five generally supplements that I think everybody would benefit from. Same disclaimers I did on the last video. I'm not giving you medical advice. Take notes on what I'm telling you. If some of this is of interest or you think you want to take one of these, if there's any question about whether it's relevant for you or not, or safe for you or not, speak to your functional medicine practitioner, um, your nutritionist, somebody that understands supplementation. Alright? If you ask your regular family doctor about supplements, they may or may not have any knowledge at all about supplements in the information yet may be less relevant than what you're getting here, even though...

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Five Supplements Everyone needs! Foundational 5

 
Speaker 1 (00:02):

To me, there are five main supplements that, that I kind of call my foundational five that almost everybody would benefit from taking. Now I say almost everybody, so understand real quick disclaimer, I'm not giving you medical advice. I don't know your specific situation, so take notes on what I'm gonna say and know that these are generally good for everybody, but there may be some special circumstances for you. So discuss that with your functional medicine doctor or your clinician practitioner who's knowledgeable about nutrition and supplementation. Your regular family practice doctor might not know much of anything about supplementation and they're not always the best, um, resource for whether or not you should or can be taking something, find someone knowledgeable about supplementation. So that being said, the foundational five for me, uh, it's gonna consist of number one, a multivitamin of some sort, fish oil, probiotics, vitamin D, and magnesium.

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Are all low carb diets the same?

 
Patrick Krupka, DC, CFMP:

So you can't really go anywhere without hearing somebody talking about a low carbohydrate diet. There's whole 30, keto, low-carb paleo, diets that prioritize protein, fasting mimicking diets, fasting, intermittent fasting, keto, carnivore. We could go on all day with different diets that accentuate protein, or in the case of keto, protein and fat, at the expense of carbohydrate. I don't have a big issue with that. I think in many people, that's beneficial. But I want you to understand that whichever one of those you choose or whichever one of those is recommended to you or whatever, they all share a very common goal, a very similar goal. They go about it a little bit differently, but the goal is to expose you to a lot less insulin than you've been doing already. So I'm going to talk you through real briefly two or three different things to explain what insulin does and how it becomes a problem because we need it.

Why would you want less of it? So we're...

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Stop fasting for your labwork? Maybe...

 
Patrick Krupka, DC, CFMP:

So I was listening to another clinician talk recently about getting lab work done in a non-fasted state. And you guys know, things like cholesterol and blood sugar and things like that, when we send you to the lab for those, we generally want you to be fasting when you go into the lab. 6, 8, 10 hours without eating, you can certainly have water, but we want a decent amount of time without food consumption before you go into the lab and have those drawn. So there's a little bit of a push now to say, look, why don't we just do labs in the condition in which people live? Most people don't spend most of their time in the fasted state. Yes, you wake up that way, but then you eat, and then later you eat, and then later you eat again, and you snack a little bit, and then you exercise, and then you eat again, and then you go back to bed.

So most of your time is not spent in the fasting state, most of your time is spent in some version of what we loosely call the...

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A1c standards are wrong, IMO

 
Patrick Krupka, DC, CFMP:

I want to talk for a minute about hemoglobin A1c. It's a kind of three month average test for, or how frequently and how high you would spike your blood sugar. We'll talk more about that in a minute. So I was dealing with a patient recently who brought lab work in from her other practitioner and said, "Oh, doc, I think it's really good news. Doctor, my other doctor said my hemoglobin A1c," or she just called it, "My A1C, came back great, he said. So I think what we're doing is working. I'm doing better." Or her hemoglobin A1c had come down from, I think it was eight something, down to 7.2, 7.1, something like that, still abnormal.

And her other doctor said, "We're doing great. We're right on target. This is where we want you to be. Don't change anything. This is perfect." Well, I had to kind of explain to her that it's not perfect at all. It's what's considered good management of a type 2 diabetic to be kind of in the upper sixes. Some doctors are okay...

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