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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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lipid..HDL..fasting and the t3 level decreased by amount of 60..LDL

Resolved Question:

Hi,I am from Iraq,my wife is suffering from high lipid profile as shown:

VLDL 61 H
CHOLLESTROL 171
TG 303
HDL 64
DL 46

She did these tests after she felt a pain in the heart[one month ago] and after that she did the fasting and the TG level decreased by amount of 60 ,then she went to the doctor and he advice her to take [lopid 600 /gemfibrozil 600mg ] with the fasting and she did the same tests yesterday they were as shown

VLDL 100 H
CHOLESTROL 189
TG 499 H
HDL 55
LDL 34

At the first 2 weaks the dose was one tab and the last 2 weaks the doctor adviced her to increase the dose to 2 tab per day . So I think the treatment was not good to her so I need your advice if you can help me ,by the way she did the liver test and all were normal
Submitted: 2 years ago.
Category: Health
Expert:  A. Schuyler, NP replied 2 years ago.

Hello,

Welcome to Just Answer and thanks for your question. How long did she take the medication before the last tests were done yesterday? Are both the results you have listed fasting results?

 

 

 

Customer: replied 2 years ago.
She took the medication for whole 2 weeks and the 2 results were fasting results but not hard fasting .
Expert:  A. Schuyler, NP replied 2 years ago.

Sorry, but there is no such thing as "soft" fasting. Either one abstains from all food and drink (other than water) for 8-12 hours before the test or one doesn't. Even small amounts of food and drink (other than water) an affect the results.

 

The normal dosage of Lopid is 600 mg twice a day. You generally start with one 600 mg tablet per day and after a week or two add the second tablet. It can take 2-3 months to see how much the medication will ultimately affect the lipid profile. To expect any change within just two weeks (especially without compete fasting) isn't realistic. She is on typical therapy, and should show much better numbers when she is retested in August.

 

 

Customer: replied 2 years ago.
I am sory there was a misunderstanding the interval of fasting was 12 hours before the test , on my explanations I ment with the word fasting was diet not fasting but before the tests she did the real fasting even from water ,but my question is why when she get the mediction the levels increased but when she did the diet the levels decreased?
Expert:  A. Schuyler, NP replied 2 years ago.

Levels will vary some just from day to day - even fasting ones. Dieting alone can help some people, but many people have to take medication as well as following a diet to get their lipid profiles in order. Do not be alarmed at the seeming increase after such a short time. It isn't anything to be concerned about. You will be able to tell a lot more in a couple of months when she is retested. That will give the medication a chance to work. Even then, Lopid may not be enough and she may need a second medication as well to get to normal range. Cholesterol/lipid numbers always take time to correct. It will always be a matter of months rather than days or weeks to see any significant change.

 

Customer: replied 2 years ago.
what is 2nd medication you advice ,which one of these is safe with the lopid is it statins or niacin or resins or fibrates?
Expert:  A. Schuyler, NP replied 2 years ago.

Lopid is a fibrate. I don't recommend any drug to a patient that I haven't seen and examined and whose complete history I don't know. That would be unethical and very unfair to the patient. The Lopid may be enough once she has been on it long enough to see.

 

Customer: replied 2 years ago.
yesterday she went to another doctor and he advice her to replace lopid with fenofibrate or to take Avas 40 and Esetimibe with lopid is it safe?
Customer: replied 2 years ago.
Relist: Incomplete answer.
I need a qualified doctor and specialist
Expert:  Julia Kizhner replied 2 years ago.

Hello and thank you for your question,

 

I agree with Ms. Schuyler that retesting cholesterol in 2 weeks was rather soon and the numbers will not reflect much of a change. The fact that they went up is not unusual either because they do tend to fluctuate depending on the diet for 3 days prior to the blood test. To take a true cholesterol reading it is actually recommended to abstain from red meat for 3 days and to have a very light dinner before the blood test.

 

Gemfibrozil and Fenofibrate are both used to reduce the level of triglycerides (TG) on the cholesterol panel. I, personally, prefer to use Fenofibrate. It has less interaction with other medications and it is only once a day dosing. So I think that will be a good switch.

 

In terms of Avas and Ezitimibe. Avas, which is branded in United States as Atorvastatin (Lipitor), is a good medication. It lowers overall cholesterol and "Bad" (LDL) cholesterol. It also has properties of preventing heart attacks and strokes. Ezitimibe, although not harmful and is safe to take with other cholesterol lowering medications, has not shown any health benefit in many research studies.

 

So my suggestion would be to switch to Fenofibrate and add small dose of Avas and wait for at least 6-8 weeks before rechecking the cholesterol. For 3 days prior to recheck, your wife should avoid red meat and have a very light dinner the night before the blood test.

 

I hope you find this information helpful. Please feel free to follow-up with any other questions you may have.

If you are satisfied with the answer, please do click 'Accept' button so that I may get credit for my work.

 

Best wishes and good luck,

Julia

Customer: replied 2 years ago.

Till now I am very satisfied,all your talks about the 3 days before the recheck and the night before recheck is true ,becuase my wifes commitment with the diet for the last 5 days was not enough and her dinner was not light and the amount of red meat was not small,so I need your advice about the type of the food ,what she can get or not ,i.e a good diet system. By the way the first doctor advice my wife to take OMEGA 3 with the treatment,is it useful? .Another question is TG=499 is dangeruos?

I would like to thank you and Schuyler, your informations were very helpful

Expert:  Julia Kizhner replied 2 years ago.

Hello again,

 

In order to get the most accurate cholesterol reading, it is best to avoid red meat all together for 3 days prior to the blood work and to have a smaller dinner the night before.

 

Your wife's cholesterol is actually pretty good, total cholesterol of 189 is considered normal. Her only issue are the high triglycerides. Normally there is no immediate danger with having high triglycerides of 499 but over a long period of time having high triglycerides can cause cholesterol plaque formation in the arteries. Triglycerides is a measurement of fats in the blood, so the higher the number of the triglycerides, the more fat is floating in the blood stream.

 

The diet which is recommended to lower triglycerides should consist of having more white meat and fish rather than red meat. All fried foods need to be avoid. Dairy should be low fat. She should use olive oil or canola oil for cooking. Butter needs to be avoided all together. She needs to eat more fruits and vegetables. That's the general diet which we recommend for lowering triglycerides.

 

Again, besides triglycerides, your wife's cholesterol is rather normal. I think only a very small dose of Avas should be used (no more then 10 mg).

 

Omega-3 Fish oil is very helpful in reducing triglycerides. So if your wife does not or cannot eat at least 3 servings of fish weekly, she should start taking Fish oil. It will help over a period of time.

 

Once your wife switches to Fenofibrate and Avas, please allow about 6-8 weeks before rechecking her cholesterol to get the most accurate results.

 

I hope this information helps and is not too confusing. Please let me know if you have any other questions.

If I answered your questions, please do click 'Accept' button so that I may get credit for my work.

 

Julia

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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