Sunday, February 7, 2010

Advanced Lipoprotein Testing and the Fallacy of "Average"

I use http://www.nutritiondata.com/ quite a bit to determined carb content of various foods now that I am tracking my blood sugar. I am prediabetic and like all good TYP'ers this is one more thing I am tracking to reduce my heart disease risk.

While at the site today I stumbled across a blog written by their so-called heart disease expert, Dr. Steve Parker, titled, "Advanced Lipoprotein Testing: Not Quite Ready for Prime Time" In it, Parker essentially said that advanced lipoprotein testing (ALT) such as that offered by NMR has, "never been shown that such testing offers any additional benefit over traditional risk factor assesement and management."

Now, I am certain that Dr. Parker is a very nice man who means well but for people like me and many others he is wrong - possibly dead wrong. It all has to do with applying common sense and the statistical fallacy of assuming what is good for the average person is good for all persons, more importantly, what is good for teh many is necessarily good for the one -YOU!

Dr. Parker starts with an argument that is perhaps the most powerful reason for using using ALT, "The Centers for Disease Control reports that half of all heart attacks occur in people with 'normal' cholesterol levels." If this is true (it is) one must come to the conclusion there must be some other factor besides standard lipid values (i.e. LDL, HDL, and Triglycerides) that can ferret out which person is likely to have a heart attack and which is not. Unfortunately, this is where Dr. Parker's deductive reasoning and intuition shut down. In fact, he contradicts himself based on an earlier blog he wrote praising ALT!

Here is the "killer" paragraph where Parker forgets all reasoning and statistical training he may have ever had.

"It's never been shown that such testing offers any additional benefit over traditional risk factor assesement and management. And all of the established clinical management guidelines utilize LDL cholesterol rather than LDL subfractions. Physicians know what to do with LDL cholesterol. We don't have evidence-based protocols that tell us what to do with these subfractions."

Let's dissect this statement to get to the truth.

1. It has never been shown that if I shoot myself out of a cannon wearing a parachute over Lake Michigan in February that I will die of exposure. What I do know is that a typical cannon with enough power to propel me from Wisconsin to Michigan (so I do not land over water) will kill me instantly and that even if shot from a lesser cannon with a parachute I will land far enough offshore that I will be unable to swim back in 36 degree water to safety. Sometimes one has to apply deductive reasoning. If I employ ALT and discover I have a dangerous lipoprotein subfraction such as Small LDL or Lipoprotein(a) (which I do) I am now in a better position to do something about it! I don't need a study to deduce this.

2. Just because "all of the established clinical management guidelines" use LDL and "Physicians know what to do with LDL cholesterol" does not mean I MUST be limited to antiquated methods applied by ignorant and behind-the-times physicians. I could go further and suggest Dr. Parker himself is ignorant. Many physicians DO know what to do with ALT and use it effectively to treat their patients using the most advanced technologies available.

3. The term "We don't have evidence-based protocols" is often shorthand for "I am too stupid or too lazy too engage in critical thinking so someone please tell me what to do." I do not need someone to do a study on taking common sense actions. I have high Lipoprotein (a) with an otherwise world-class lipid panel. My own physician (whom I fired) told me I was fine! If I had not done ALT I would not have discovered I had this independent risk factor for heart disease and would not be in a position to do something about it. I mean, c'mon, this is not rocket science!

4. The final and most crushing indictment of Dr. Parker's logic is the fallacy of extending information about statistical averages to an entire population. On average, a person with my traditional lipids (LDL, HDL, Triglycerides) would be in a low risk group - except I am among a few in this group who have high Lp(a). Yes, it might not be cost-effective to test EVERYONE for Lp(a). The cost of the test for everyone might not save enough lives to be cost-effective (this is the danger of national healthcare rules that rely on "evidence-based" medicine for the masses). BUT LET ME MAKE THIS CLEAR! I do not give a DAMN about the average guy - I care about ME! If I had followed "evidence-based" medicine and good old Dr. Parker's advice I might be dead. Instead I am proactively fighting my extraordinarily high Lp(a) - but only because I got the test and fought my insurance company to test my son (I won the battle and now my son knows 30 years before I did so he can take action even sooner).

So there it is. If you are a "good little soldier" willing to sacrifice your life for the "good of the many" and save a few bucks then great - more power to you. But, if you want to "pull out all the stops" to make certain you stay alive and your children live long lives then you will do everything possible to know your risks and take appropriate action.

No thanks Dr. Parker. I think I'll continue to track my lipoprotein sub-fractions using ALT. Just because most docs are stupid or lazy does not me I have to be. And, just because many people may not benefit from ALT does not mean ALL - specifically ME - won't benefit IMMENSELY. So, take your pick. Go with the flow or get aggressive. Practice Informed, Self-Directed Healthcare (ISH). Heck, it's your life. YOU decide!

Looking out for your heart health,


HeartHawk

14 comments:

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Ted Chapple said...

Right on. As only a high school graduate it is hard for me to sort all this stuff out so I find blogs like yours helpful. I got myself an EBT scan last July. My score was 648 and I am following Dr. Davis' protocols to the bemusements of my doctors. My cardiologist never heard of an NMR test but he did order a VAP test for me. That created confusion in the blood lab since they had to make several calls to find out what a VAP test was. I haven't gotten around to posting them on the TYP yet but I will. Anyway I noticed that Dr. Steve Parker lists as a reference at the bottom Dr. John Brunzell. I have already watched his lecture that I found on the Research Channel. Here is the link.

http://www.researchchannel.org/mov/uw_lab_liptest_1300k_qt.mov

Take a look. I'd like to hear your comments on it especially how he dismisses these new tests as just money making schemes for the inventors of these tests.

tchapple

HeartHawk said...

tchapple:

Great video! Brunzell adroitly manages to walk the tightrope between advocating for and advocating against Advanced Lipoprotein Testing(ALT). Seems he wants to have it both ways. No matter, the guy is smart and is worth the time to listen to his presentation

Let me put it this way, if you were a stockbroker and if money were no object you would buy all the information you could afford.

In my "other" life I develop analysis systems for companies. They pay me and pay me for what what are often extreme amounts of analysis. Why? Because what they pay me is dwarfed by the cost of not knowing the most arcane data.

You need to answer one question when determining how much time and money and to spend collecting data about your health - what is your life worth to you?

It really is THAT simple!

Being a conservative I err on the side of collecting as much data as possible! My life is worth that much to me. I'll take all the ALT I can get my hands on!

Looking out for your heart health,

HeartHawk

Gene Kalmens said...

Totally agree. I am looking for a place to take my blood for NMR ALP testing, but haven't found anything. Could you advise how it can be done? How can I fight the insurance company, if the doctor wouldn't support me? I am prepared to pay out of pocket, but looks like it costs $399. Can it be done for less?

HeartHawk said...

Gene:

I think it is time to do some doctor shopping! It was the samrtest thing I ever did. You need a second, third, and fourth opinion if need be. Any doc can order the test and submit it to insurance. They may not pay it but at least you will get the test.

If you have no luck with docs I believe you can still independently order the NMR online at http://www.privatemdlabs.com/lp/nmr.php

If you live close enough to one of their blood-draw sites (quite a few) you can handle it yourself (I believe price is under $100).

HeartHawk

Anna said...

It is sick. He also has a page out there that targets preachers to sell it to their congregants. I believe in chelation and the good it does because I have done it and the results were great and life changing, but I don't agree with a company just trying to rip off its customers by misleading them. They don't even have a specific ingredients page, a picture of the product or directions on how to use it.

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Hel said...

HeartHawk -- I came across your blog while doing research on omega3/omega6 for a molecular biology project -- was wondering if you had any personal statements regarding heart health/cardiovascular health and whether or not you actually take supplements (like fish oil) or if you have increased your fish in diet? would much appreciate response and I can further explain --

Thanks so much!
Helen Hale
hale-h001@mymail.mssu.edu

Anna said...

These days because of very less care of our own self which might be because of lack of time as a result of busy work schedule and because of carelessness people tend to be caught to many heart diseases which may result in very adverse effects if not taken timely care.Thus this advanced lipoprotien may really be helpful in various ways.

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Ed Terry said...

Just came across your blog and your comments on ALT. I've paid out of pocket using privatemdlabs site for NMR tests, and I've adjusted my diet to see what effect it has on my lipoprotein profile.

In my late 30's and early 40's. my HDL consistently hovered around 25, which explains whay all the men in my family tree experience heart attacks or strokes before they turn 50. I've managed to raise my HDL to the 70 to 76 range by doing my own research. I have never found any study showing raising HDL by 300% has any effect on heart disease progression.

That being said, I'm betting that doing that will reduce my chances of experiencing a heart attack or stroke. I will not be part of the grand experiment that tries to prove that lowering LDL is "the way" to prevent heart disease. So far the experiment has failed.

I'm also a numbers geek, although not of your level. I do obtain frequent blood chemistry measurements by whatever means available (e.g. blood donations, free screenings, doctors) instead of trusting conventional wisdom.

I had an EBCT a couple of years ago, and I had a total Ca score of 80. My cardiologist tried to bully me into taking statins and I pointed out to him that there's never been a single valid study showing lowering LDL reduces heart disease. He was still adamant that I take one because my LDL was elevated at 80! I told him I'd stick with niacin because it has shown to reduce mortality.

I don't really care what's good for the masses. I care what's good for me.

HeartHawk said...

Ed:

Bingo! Just like me as I started at an HDL of 29 and are now consistently in the 50's.

I also agree on statins although I have experimented with them and believe they can be useful if properly prescribed. The key seems to be reducing Small LDL and statins will reduce all LDL big and small. This is what may account for the fact that statins work for some (where it preferentially reduces Small LDL) and not for others and why the average total LDL for persons with and without heart attacks is statistically identical.

Frankly, I have expereinced PROFOUND results with diet (low carb), exercise (30 minutes 5 times per week minimum), niacin (2g), Vitamin D (enough to maintain a blood level of 60ng/dL, 6000-8000IU), and fish oil (on the high side at 5g EPA/DHA). But even I takes drugs for hypothyroidism and at the dose I take niacin is a drug.

Finally, I continue to unabashedly and shamelessly shill for Doc Davis. He is like the Nostradamus of heart disease and is consistently 1 to 5 years ahead of everyone with a virtually 100% "on the moeny" track record with his heart disease prevention observations. Yeah, his Track Your Plaque website has a paid membership (a whopping $6.65 per month, lol) but there is also a ton of free stuff there and his Heart Scan Blog loaded with good advice and is completely free.

Regards,


HeartHawk

lipsy discount code said...

As per my knowledge, Like many of us in healthcare know, since sterols are insoluble in the blood, need to be driven by the body in lipoproteins. These include HDL-P, P-VLDL, LDL and P, among others. Keep useful as a great post

Sustanon said...

Lipoprotein subfraction testing is not routinely ordered, but its use is growing. You post such a nice detail about this testing i am not aware this much about it.

Dental Acrylics said...

Lipoprotein testing is new method for the determine health and fitness. Your article gives amazing informations about the health care and fitness.

www.españa-3d.com said...

So, I don't really believe it may have success.

 
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