The question I have - what happens if you eliminate wheat, add the fish oil, and niacin, normalize vitamin D and still don't hit the TYP target of 60-60-60? What's the thought process for deciding to take a statin???

Dr. Davis,

Have you checked this out yet. It looks like something worth considering. I've heard some very interesting things lately about new microbes being found in association with diseases not considered infectious until now. The association of enterovirus with Type 1 and Type 2 diabetes also points to the inflammation potentially being nonautoimmune in nature and raises the question of whether Vitamin D is downregulated as part of the body's attempt to fight invasion.

Since the studies I've found show raising Vitamin D does NOT have a positive impact on diabetes, though Vitamin D is low in diabetes, this is a serious concern.

If we are eliminating inflammation but not organisms causing inflammation, long term the results may not be so good.

A total cholesterol of 132 can be quite unhealthy considering that all cause mortality in the lowest quartile of total cholesterol is twice the death rate in the upper quartile of total cholesterol.  A paleo diet would produce more optimum cholesterol numbers (no grains, etc, as recommend here) but that diet varies by latitude with more carbs the closer to the equator one lives with total cholesterol varying accordingly.

Additionally, dig a little deeper and Sam likely has a much better LP(a) value than John.  He's probably sick fewer times during the year, and he's risk of getting cancer is half that of John's.

Oh, and Sam probably has less bodyfat as a nice healthy side effect of wheat reduction.

My HDL was suck at 38 since 2002. I went to 40mgs crestor mid 2008. I put myself on 2 grms of niacin, this fixed the perpetually high trigs, and the 40gms crestor crushed the LDL

Then I found this blog and went on vitamin D.  I already had followed fish oil but not consistently so I fixed that.  After 4 months on Vitamin D, my HDL was up to 50
oh...and my LDL dropped too.

My Dr. told me I was a poster child for Crestor treatment but she allow the change back to 20mgs anyhow.  I did take a month off from crestor to get rid of the muscle/bone aches and pains and have now restarted 20mgs with no problems.

I am going to spend a few months on 20mg and check the lipid profile, if good, next step is statin free for me.

I eliminated wheat - and all grains - from my diet nearly three years ago (I eat low carb Paleo). My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John's or Sam's:

LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl

My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.

I have read too that too low a cholesterol level is just as bad and, maybe worse, than too high !

Anne

Hi, Jenny--

Excellent point. Perhaps a topic for a future discussion.

However, we do witness positive effects on various phenomena associated with diabetes when vitamin D is normalized: reduction in CRP, dramatic increase in HDL, modest reduction in triglycerides and small LDL, and reduction in blood sugar if insulin resistance is present.

Will vitamin D replacement impact on cardiovascular mortality in diabetics? Uncertain, though I predict it does to a substantial degree.

Plus John will likely experience some nasty side effects from the statin that Sam will not!

Jenny, love your blog, your spirit,and your free questing mind.

My take on Vitamin D and Diabetes:

In general, Vitamin D does better at preventing disease than ameliorating it once it exists.  There is soom good Finnish epidemiological evidence that supplementing Vitamin D to levels in the 50's can decrease the incidence of Type 1 diabetes in children.
Proposed mechanism has to do with the leaky gut hypothesis.  D deficiency leads to impaired intercellular signalling through degredation of tight junctions between cells.  Adjacent intestinal lining cells can't effectively talk to each other. Bacteria, viruses etc "leak" through, The immune system gets overwhelmed, then the immune system notices that pancreatic islet cells look a whole lot like a portion of a proteus or klebsiella bacteria and whammo, you have type 1 diabetes, rheumatoid arthritis, etc.  

Type 2 diabetes seems to be another story.  Since Vitamin D is often sequestered in fat, lowering serum 25-OH Vitamin D levels, and type 2 diabetics tend to be obese, therein may be part of the association.  

But no one essentially dies of a Hgb A1c of, say, 6.7.  As you know, it's the sequelae -  the heart attacks, strokes, CHF.  I do recall one recent study on MI, diabetes, and Vitamin D levels.  It may be that D can help prevent the adverse sequelae of type 2 dm with no direct effect on A1c.

Dr. Davis,

I just saw your reply to my earlier question.  The one decent study I've found suggests that dramatically raising Vitamin D has no significant effect on blood sugar.

My concern is this: when we lower inflammation by raising Vitamin D are we putting out the fire or turning off the smoke alarm.

Though inflammation clearly raises heart attack risk and lowering it does prevent heart attack, there are many other forms of inflammation that are important because it's a sign we are fighting off invaders that need to be fought off. So if we turn down inflammation we may be promoting microbe-stimulated cancers five years later.

And if as some evidence suggests, cardiac inflammation stems from bacteria originally associated with gum disease, raising the Vitamin D might lower the inflammation but not bacterial infestation which over time cannot be good for us.

Is there any evidence that Vitamin D does more than improve the markers like CRP (the smoke alarm) and actually eliminates the disease state?

So far I am not seeing that in Diabetes.

I know some ladies at my barber shop that will enjoy reading this article.  2 hair cuts ago I mentioned the TYP program to my barber.  To my surprise when i came in for my last cut 5 hair cutting ladies began questioning me about heart health, and wanted my opinion on the up coming Presidential elections and what it means for the health care industry.  One lady asked questions about where can one of her customers be tested for lipoprotien A.  I was impressed.  

I recently mentioned to my father what happened so he decided to try the same with his Florida hair cutter.  Same interest from all the barbers in the shop happened to him  he told me last night.

You can add GREED to the list.

I have thought for some time that the medical services industry resembles a 3 headed dog (providers, pharma and insurance companies): all 3 heads snapping away for their piece of the poor consumer....
Many changes need to be made but there is so much pressure (money) to maintain the status quo that I don't think it will ever happen.
What would shake up the industry would be for more people to take responsibility for their own health and not put so much trust in the system!

Isn't it strange how our government supports expensive treatments and drugs needed AFTER one gets ill?  Once we are in trouble, we are generously allowed to claim tax deductions or pay for drugs and treatment out of tax free Flexible Spending Accounts.

It would make more sense to allow us to use those tax free Flexible Spending Accounts to help pay for the supplements and life style choices required to PREVENT getting ill in the first place.  --- Too bad:  supporting prevention does not generate useful cash flows for the health care industry, it does not generate incomes for lobbyists, and it does not generate campaign funds and votes for politicians.

I have thought for some time that the medical services industry resembles kamagra and cheap kamagra(providers, pharma and medicine ):