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  #211   ^
Old Fri, Nov-08-19, 10:23
khrussva's Avatar
khrussva khrussva is offline
Posts: 7,763
 
Plan: My own - < 30 net carbs
Stats: 440/219/210 Male 5' 11"
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Progress: 96%
Location: Central Virginia - USA
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Quote:
Originally Posted by GRB5111
All in all, good news regarding and confirming the CAC score.

I have listed the set of recommended thyroid tests to provide a full and accurate function profile:
- TSH
- Free T3
- Reverse T3
- Free T4

- Zinc RBC
- Selenium
- Iodine (urine load test)
- Thyroid antibodies

Good luck with this. As you know, a simple TSH test requires context and additional information. Hope this helps.

Certainly, the presence of the nodule may require additional investigation.


Thanks for the info Rob. Because of that thyroid nodule and the recommendation from the CIMT technician to have my thyroid function further investigated I decided to have a full thyroid panel done. It helped that requestatest.com had a thyroid test special running last month. My results came in yesterday. I'm not sure what they all mean, but they are all well within the "normal" range. This post is a little off topic, but here are my results:

Test: Thyroid Panel with TSH

TSH ----------------------- 1.710 - Normal 0.45 - 4.50
Thyroxine (T4) -------------- 6.4 - Normal 4.5 - 12.0
T3 Uptake -------------------- 31 - Normal 24 - 39
Free Thyroxine Index -------- 2.0 - Normal 1.2 - 4.9
Thyroxine (T4) Free -------- 1.19 - Normal 0.82 - 1.77
Reverse T3, Serum ---------- 14.5 - Normal 9.2 - 24.1
Triiodothyronine (T3), Free - 2.4 - Normal 2.0 - 4.4


I added iodine to my supplement list a few months back. I'm not sure if this helped or not. This is the best TSH that I've gotten - this after nearly 6 years eating LCHF/Keto. The other numbers look good to me as well. So my thyroid function is A-OK . At this point I see no need to worry about that thyroid nodule. I'll just be sure to have it checked every few years to see if it changes.
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  #212   ^
Old Fri, Nov-08-19, 10:56
Meme#1's Avatar
Meme#1 Meme#1 is online now
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Plan: Atkins DANDR
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I'm taking iodine too since the beginning of the year. I'm up to 12.5mg x2-am and x2-pm but sometimes I forget the pm dose.
Even though I've read about it being used in France forever as an expectorant even put in nebulizers, it worked like a charm when I had some congestion after turning on our heater. An hour after taking the iodine, my lungs would clear right away.
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  #213   ^
Old Fri, Jan-17-20, 04:55
JEY100's Avatar
JEY100 JEY100 is online now
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Plan: Keto/DrWestman/IF/DrFung
Stats: 222/172/169 Female 5' 9"
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Dr Malcolm Kendrick has written an article on the CAC test that lays out the case for never doing a CAC scan! Fascinating references and conclusions, pretty much opposite of everything in this three year old thread.

As with his series on what causes heart disease, the entire post is very long, laying out all sides of the arguments. Two quotes below, much more here:

https://drmalcolmkendrick.org/2020/...cification-cac/


Things that increase calcification...

Quote:
An interesting mix, I think.

Statins increase calcification
Warfarin increases calcification
Intense exercise increases calcification
Yet, all three reduce the risk of dying of cardiovascular disease. Yes, even statins – a bit.

But, let’s turn this around for a second. If you have no calcification in your arteries, you have a greatly reduced risk of dying of cardiovascular disease. Which means that calcification can be both good, and bad? Yes, you are right, this area is not straightforward at all.

Even if you look at non-calcified atherosclerosis, or pre-calcified atherosclerosis, the picture is complex.


Quote:
Recommendations

My first recommendation is that, if you have not had a CAC scan, do not have one.

My second recommendation is that, if you have had a CAC scan, and it shows no calcification, good. Do not have another one.

If, however, you have had a CAC scan and it shows significant calcification. What then? What then indeed? You may want to read this paper: ‘Non-invasive vulnerable plaque imaging: how do we know that treatment works?’

‘Atherosclerosis is an inflammatory disorder that can evolve into an acute clinical event by plaque development, rupture, and thrombosis. Plaque vulnerability represents the susceptibility of a plaque to rupture and to result in an acute cardiovascular event. Nevertheless, plaque vulnerability is not an established medical diagnosis, but rather an evolving concept that has gained attention to improve risk prediction. The availability of high-resolution imaging modalities has significantly facilitated the possibility of performing in vivo regression studies and documenting serial changes in plaque stability. This review summarizes the currently available non-invasive methods to identify vulnerable plaques and to evaluate the effects of the current cardiovascular treatments on plaque evolution.’ 8

It will, at least, give you some idea of the other forms of investigation that are available.

Or, you might want to read this one: ‘New methods to image unstable atherosclerotic plaques.’

‘Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity.

Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too.

In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.’ 9

The key words in that abstract are ‘hold promise.’

My final recommendation is that we should NOT be doing CAC scans, until it can be proved in a well conducted clinical trial, that we can do something positive and beneficial about the findings.

Yes, a ‘negative’ CAC is reassuring. This, however, must be set aside against the psychological damage caused by a ‘positive’ CAC scan. At present we are playing a form of psychological Russian Roulette. Half the population walks away reassured, half the population reels away, scared witless.

Also, often puzzled and disappointed. I have lost count of the number of people who have written to me saying that they: don’t smoke, exercise regularly, are not overweight, have low cholesterol levels, do not have high blood pressure, do not have high blood sugar levels, etc. etc. yet they have a terrifyingly high CAC score. What should they do?

Well, what can they do?

I don’t know. Because I don’t know what the test means. Not for sure. Not enough to provide any advice that I can be certain is right. Some boxes are better left unopened, however tempting it may be to peek inside.

Just because you can do something does not mean that you should.
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  #214   ^
Old Fri, Jan-17-20, 08:09
bkloots's Avatar
bkloots bkloots is offline
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Plan: Atkins/LCHF/Keto
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Thank you, Janet, as always for the information in a readable excerpt.
Quote:
Yes, a ‘negative’ CAC is reassuring. This, however, must be set aside against the psychological damage caused by a ‘positive’ CAC scan. At present we are playing a form of psychological Russian Roulette. Half the population walks away reassured, half the population reels away, scared witless.
This matches up with my feeling about a lot of diagnostic testing. This is on my mind today because my sister is having a follow-up ultrasound to investigate a bump in her abdomen that didn't give any information via the CT she already had. The investigating physician is a surgeon with a big practice in laparoscopic surgeries. I suggested "Don't let him cut anything out without getting a second and maybe a third opinion." A surgeon gotta cut, right? Pays for the machines and the building. And maybe the swimming pool.

A few years ago, my PCP insisted I have a CAC. The hospital was having a fifty-dollar special, so, okay. My result was ZERO. But that seems like a lucky break in the light of this article. I never planned to have another one.

I wonder what else they could find NOT WRONG with me that needs to be fixed??
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  #215   ^
Old Fri, Jan-17-20, 12:01
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thud123 thud123 is online now
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Plan: M-W-F ADF (2020 Q2)
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Quote:
...if you have not had a CAC scan, do not have one.

I can follow this advise
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  #216   ^
Old Fri, Jan-17-20, 12:31
cotonpal's Avatar
cotonpal cotonpal is online now
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Plan: very low carb real food
Stats: 245/128/135 Female 62
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Quote:
Originally Posted by thud123
I can follow this advise


I can too. Some advice is so easy to follow.
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  #217   ^
Old Sun, Feb-09-20, 15:22
SabreCat50 SabreCat50 is offline
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Has Ivor Cummins made a response to this?
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  #218   ^
Old Sun, Feb-09-20, 21:16
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GRB5111 GRB5111 is online now
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Plan: Ketogenic (LCHFKD)
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Yep, in the comments following Kendrick's article:
https://drmalcolmkendrick.org/2020/...cification-cac/

Quote:
TheFatEmperor
January 20, 2020 at 3:37 pm

Hey Malcolm I emailed you about having a Podcast to debate this one – should be good!

In the meantime for everyone here I’ve jotted down initial thoughts on the matter – following PDF has my replies to your main points, then further down a reply I sent to William Davis MD’s “Cureality” website, in response to much discussion there on your provocative blogpost:

https://drive.google.com/open?id=1N...NCX8-LVYyglvMXY

Looking forward to the debate – it should really help clarify CAC in people’s minds 🙂

Best

Ivor
Reply ↓

Dr. Malcolm Kendrick Post author
January 20, 2020 at 7:49 pm

Good idea, it would be good to have a discussion, absolutely.

We will hear more soon.
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  #219   ^
Old Mon, Feb-10-20, 08:01
SabreCat50 SabreCat50 is offline
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Plan: modified Atkins
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Quote:
Originally Posted by GRB5111
Yep, in the comments following Kendrick's article:
https://drmalcolmkendrick.org/2020/...cification-cac/


We will hear more soon.

I look forward to hearing the debate and I will give Ivor's pdf a read.

Thanks.
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  #220   ^
Old Mon, Feb-10-20, 10:50
khrussva's Avatar
khrussva khrussva is offline
Posts: 7,763
 
Plan: My own - < 30 net carbs
Stats: 440/219/210 Male 5' 11"
BF:Energy Unleashed
Progress: 96%
Location: Central Virginia - USA
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Shortly after that Kendrick article came out a member of the CholesterolCode.com FB forum posted this twitter link from Ivor Cummings...

Quote:
Ivor Cummins
~FatEmperor
Ok guys I'm considering not responding to any questions on #CAC, unless the questioner has watched this talk first - and understood it. The #PowerOfZero guys. Get with the program... #statin #pharma #OverTreatment #Engineering #Science

https://www.youtube.com/watch?v=32aBLRDIW-g


I watch the hour+ long video that Ivor linked to. It was quite interesting to hear the history and debate about the use and usefulness of having a Coronary Calcium Score done. The two significant takeaways from this talk as I see it...

1) A zero CAC score can and should end the debate that a patient may be having with their doctor who is pushing statins to resolve a high LDL-C score. This is more true today due to the popularity of keto and the fact that it is becoming popular with lean, active people for health and performance reasons. These non-metabolically ill keto people seem to have a higher rate of getting 'doctor freaking' high LDL from their keto/carnivore lifestyle. Doctors are prescribing statins to treat these people even though it is now known that there is no benefit from statins when the patient has a zero CAC score and no other risk factors other than high LDL-C. Having a CAC done that results in a zero score should put an end to treating patients with statins who don't really have a CVD problem.

2) If your CAC scan results in a positive score -- especially 100 or more -- there is only one course of action: AGGRESSIVE STATIN TREATMENT. PERIOD. This was the troubling takeaway for me since I have a CAC score > 100. What bothered me most was that there was no talk of root causes, diet or lifestyle changes. The consensus in the room, for the speaker, and even from Dr. Agatston himself (from another video I saw on Fat Emporer) is that the first course of treatment for a high CAC is and should always be statin therapy. They see it as cheap, safe, and effective - with minimal side effects. Statin prescriptions are automatic, practically mandatory. I don't see it that way. I'm choosing to stick with a healthy diet & lifestyle in the hope that I have addressed the root causes of my disease. From what I have learned I believe that statin benefits are overrated and the side effects more serious than what is portrayed.

Here are the links to Ivor's two part interview with Dr. Agatston...

https://www.youtube.com/watch?v=oQmRBjhBqrs

https://www.youtube.com/watch?v=DBwch25cw6o

In that interview doctor Agatston - the author of the CAC scoring method and the South Beach Diet - said that in all his years of doing CAC scans he has not seen calcium score regression. Slowing or achieving lack of progression is the goal and this is done with statins, diet and lifestyle changes. Since statins are known to increase calcification, I'm wondering if the reason he has never seen regression is the fact that statins are his first course of treatment. I want to believe that if the root causes have been addressed, then there is no benefit from a statin -- just like those who have a zero CAC score. I'm definitely going against the grain on this, but I make my own choices and I must live with the results.

Last edited by khrussva : Mon, Feb-10-20 at 16:19.
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  #221   ^
Old Mon, Feb-10-20, 12:50
GRB5111's Avatar
GRB5111 GRB5111 is online now
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Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
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Location: Herndon, VA
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Quote:
Originally Posted by khrussva

2) If your CAC scan results in a positive score -- especially 100 or more -- there is only one course of action: AGGRESSIVE STATIN TREATMENT. PERIOD. This was the troubling takeaway for me since I have a CAC score > 100. What bothered me most was that there was no talk of root causes, diet or lifestyle changes. The consensus in the room, for the speaker, and even from Dr. Agatston himself (from another video I saw on Fat Emporer) is that the first course of treatment for a high CAC is and should always be statin therapy. They see it as cheap, safe, and effective - with minimal side effects. Statin prescriptions are automatic, practically mandatory. I don't see it that way. I'm choosing to stick with a healthy diet & lifestyle in the hope that I have addressed the root causes of my disease. From what I have learned I believe that statin benefits are overrated and the side effects more serious than what is portrayed.

In that interview doctor Agatston - the author of the CAC scoring method and the South Beach Diet - said that in all his years of doing CAC scans he has not seen calcium score regression. Slowing or achieving lack of progression is the goal and this is done with statins, diet and lifestyle changes. Since statins are known to increase calcification, I'm wonder if the reason he has never seen regression is the fact that statins are his first course of treatment. I want to believe that if the root causes have been addressed, then there is no benefit from a statin -- just like those who have a zero CAC score. I'm definitely going against the grain on this, but I make my own choices and I must live with the results.

I put the last couple sentences in bold to emphasize this important point that Agatston may have overlooked due to him being convinced that the CAC score cannot be reversed. Also, in addition to statins, blood thinners like warfarin and some of the newer ones can increase calcium deposits in arteries. There are other medications, supplements, and poor eating habits that can do this as well.

Ken makes an excellent point, and this is where I've arrived: If you make the correct lifestyle changes to slow or even reverse atherosclerosis along with experiencing other health improvements, why add a medication (statin)? The unkown, despite claims to the contrary, is how much additional damage results in following a protocol for which the overall health impact is not entirely consensus driven despite its popularity. The primary issue is that statins are used to lower harmful blood lipids (cholesterol, LDL), and these very lipids are now suspected of not even being valid CVD/CHD health markers. Those who follow very low carb and keto have a very different lipid profile. So, no, I don't think it's going against the grain; rather, I think it's a very informed, rational approach after weighing all of the known findings, variables, and possible choices.

I look forward to further Kendrick/ Cummins discussions to further illuminate this important topic.
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  #222   ^
Old Mon, Feb-10-20, 12:56
cotonpal's Avatar
cotonpal cotonpal is online now
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I too place my bets on lifestyle change. I can see no downside to the way I eat and have only experienced numerous health improvements while eating this way. It seems a much safer bet than taking medications who value may be overestimated and whose risk underestimated.
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  #223   ^
Old Mon, Feb-10-20, 13:54
JEY100's Avatar
JEY100 JEY100 is online now
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Plan: Keto/DrWestman/IF/DrFung
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Progress: 94%
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This debate should be fun, and I am VERY interested in what they both have to say. Usually nice guys, with I think, even tempers...so let the discussion begin.

"To CAC or not to CAC" - the debate.
With none other than Dr. Malcolm Kendrick, and uber-Cardiologist Dr. Scott Murray. Releasing this Thursday 13th on The Fat Emperor Podcast - don't miss it (it's a biggie!)
😀 #CAC #Prevention #Cardiology https://thefatemperor.com/to-cac-or...r-scott-murray/
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  #224   ^
Old Thu, Feb-13-20, 13:04
SabreCat50 SabreCat50 is offline
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Plan: modified Atkins
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Quote:
Originally Posted by SabreCat50
I look forward to hearing the debate and I will give Ivor's pdf a read.

Thanks.

The first and second parts of the debate are available on youtube between Kendrick and Dr. Scott Murray with Ivor as ??? I haven't had a chance to watch/listen to it yet but will soon.

The first part is at: https://youtu.be/FjpDAkU4u9Q

Last edited by SabreCat50 : Thu, Feb-13-20 at 16:53.
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  #225   ^
Old Thu, Feb-13-20, 13:56
JEY100's Avatar
JEY100 JEY100 is online now
To Good Health!
Posts: 11,375
 
Plan: Keto/DrWestman/IF/DrFung
Stats: 222/172/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 94%
Location: NC
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Also on Ivor's podacast. I've heard parts of both as I drive around...this may need a bit more concentration than I have the time to give it. But as I expected, a gentlemanly debate with 3 smart men approaching it from different angles.
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