Superior Index Go to the next: Chapter 7
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These are the six tests you need to evaluate cardiovascular risk:
The tests I recommend in this book are not exotic or unusual. They can be done by any qualified medical laboratory.
If your insurance doesn't cover testing and you are paying out of pocket, use DirectLabs for all testing. Direct Labs offers the highest quality testing at a reasonable price. To order the six tests I recommend, click on the Tim Smith, MD Panel. Current price is $189. (You may want to consider adding the Special Thyroid Panel, Iron Panel, and Testosterone Free and Total.)
If you do have insurance coverage, but with a high deductible, use DirectLabs.
If your insurance does cover testing, take the list of six tests (lipid panel, C-reactive protein, homocysteine, fibrinogen, fasting glucose, and LDL particle size profile) to your doctor and ask him or her to order them for you. Expect some resistance. Most doctors are not up to date on the latest cardiovascular research findings. Chances are they won't appreciate the importance of these tests. They may even have a bit of an attitude about it. You may be told that these newer tests are still "experimental," or "unproven," or "unnecessary," and "all you really need is a lipid panel".
If your doctor does agree to order these tests, it is unlikely that (other than cholesterol) he or she will know how to interpret and/or treat abnormal results. Though many hardheaded physicians believe they learned everything they need to know in medical school, there are some flexible souls out there who truly want to learn and grow and apply the latest research findings. If your doctor is one of these, it might help to provide them with a copy of this book.
If you need help with any aspect of testing or interpretation, including finding a local physician who understands the principles outlined here, contact me at drsmith@renewalresearch.com.
If you are a physician who supports an enlightened approach to cardiovascular disease, please contact me at drsmith@renewalresearch.com. There are patients out there who need you!
If you have PPO (Preferred Provider Organization) health care insurance, chances are excellent that all the tests will be covered.
Because deductibles can be high and other labs charge much higher rates than DirectLabs, using your insurance - even with coverage - may not be the most cost-effective option. Compare prices!
If you have an HMO, expect a hassle from your "gatekeeper" doctor. Insurance company HMOs don't like their doctors to order too many tests, so they penalize the ones who do. HMOs are not into prevention; they are more concerned about cutting short-term costs. It won't hurt to ask, but you will almost certainly be told that these tests aren't covered. If this is the case, go to DirectLabs or contact me at drsmith@renewalresearch.com for more information.
Medicare covers all the tests I recommend - so long as you haven't signed your wonderful "original Medicare" coverage over to an HMO. (Don't do that!)
For each abnormal (out-of-range) results, read the corresponding chapter in Part II of this book. For example, if your CRP and fibrinogen are elevated, read Chapter 8 about CRP and Chapter 10 about fibrinogen. Of course, I'd be honored if you read all the chapters, but you really only need to read the ones that pertain to your abnormal test results.
Important note: The normal ranges listed on your lab test printout are often inaccurate (that is to say, not consistent with the latest research literature). Do not use them! Follow the normal ranges provided below and in this book.
Allow me to provide a couple of examples. A typical lab printout will give the normal range for homocysteine as "0-13.0 μmol/L". The research literature tells us, however, that heart attack risk starts at a homocysteine of 5, and has doubled in those with a level of 10. At 13 the probability of a coronary event is 250% of baseline! Obviously, an individual with a homocysteine of 13 is at high risk.
Another example: Recently one of my patients received a lab printout that gave the normal range for fibrinogen as "208-423 mg/dL". Her level looked normal at 352. However, the research literature shows that cardiovascular event risk begins at 250, and is 2-3 times higher by the time you get to 352.
The two situations where the labs and I agree are cholesterol (including the entire lipid panel) and LDL Particle Size. Lab normals for the other four markers - C-Reactive Protein, Homocysteine, Fibrinogen, and Fasting Glucose - are usually at variance with the current literature.
Normal ranges for all markers are provided in the bulleted list below and in the respective chapters:
Remember, each abnormal result tells you atherosclerotic disease is developing in your arteries right now. Reversing that abnormal result will reverse the disease process.
For each of your markers that is outside the normal range: 1.) read the relevant chapter (see list below), and 2.) follow the recommended program:
Using the information provided in the appropriate chapters, design your own personal program. To make this process easier, I've provided numerous dietary, lifestyle, and nutritional medicine options that work to normalize each marker. These are not casual or random recommendations; every item I've listed has been proven effective in peer-reviewed published research studies. The nutritional medicines I recommend are widely used by today's alternative and integrative physicians. The more of these recommendations you can follow, the better your outcome will be.
Repeat testing at regular intervals is the only way you will know whether your program is working. Here is the schedule I recommend:
Once you have chosen the elements of your program, follow it consistently. Take your supplements twice a day, every day. Follow your diet every day. Exercise for a full hour every day, if you possibly can. Then, after two to three months, it's time to retest. You only need to retest the markers that had been abnormal on initial testing.
These results are your guide to adjusting your program. Don't be disappointed if your markers have not yet become normal. The purpose of testing at this point is simply to make sure that you don't continue too long on a program that is not working. Your program will take from 6-12 months or more to have its full effect, so the results you get on the first follow-up test are unlikely to be ideal. We are simply looking to make sure that you are moving in the right direction.
If your numbers indicate improvement - even if it is modest - continue on your program. If you have followed your program carefully and the number for any given marker hasn't budged (or is higher), then you do need to try different options. Otherwise, stay the course, while reminding yourself that this is a gradual process.
We are all metabolically and biochemically different. Therefore, some nutritional medicines will work for you that might not work for others, and vice versa. That's why I have listed many different options (all supported by the research literature) for treating each marker. If your initial program does not seem to be working, don't give up, just switch to other options. Although I expect the top-ranked options to work for more people more of the time, only trial and error coupled with repeat testing will determine the program that works best for you. Again, for each marker that is moving (however gradually) in the right direction, just keep doing what you have been doing. If any marker is not moving toward normal, study the list of recommendations for that marker and change your program.
Continue testing each abnormal marker every three months until it becomes normal.
To make sure your program is working, it is necessary to retest at three-month intervals until you find the combination of supplements that works best for you. Continue to adjust your program and retest until your abnormal markers are all consistently moving toward the normal range.
After all of your elevated risk factors have moved into the normal range, retest all the markers (not just the ones that have been abnormal) every six months to make sure they stay there.
The importance of avoiding low quality nutritional supplement products cannot be overemphasized. These products can make you sick because they contain inferior and/or toxic source material. Supplements from any national drugstore and supermarket chain, or any big box store (even the ones we have come to trust for quality in other areas, such as food, pharmaceuticals, or other consumer products), virtually always contain low quality, often toxic source material, and unwanted additives. Companies whose products I do recommend include Renewal Research (disclaimer: the author is founder and part owner of this company), ProThera, Thorne Research, Allergy Research Group/Nutricology, Ecological Formulas/Cardiovascular Research, Solgar, Phytopharmica, Intensive Nutrition, and Pure Encapsulations.
In Part Two, I will discuss the personality of each heart marker, how it participates in the atherosclerotic disease process, and what you need to do if yours comes back abnormal ...