Seeking a PCP (Dr) in southeastern CT

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(Bruce Pick) #1

I’ve been eating strictly keto for 6 years. I weigh 144 lb at 5’8’ height. So, not overweight.

My current PCP has been after me about my cholesterol numbers. I’m confident I’m not at risk for cardiac/arterial issues, but he will continue to push for me to use a statin.

So, can someone here recommend a PCP in SE Connecticut or nearby RI, who can help with that? I know there are more advanced lab tests that can confirm that a person is not at risk - but I think those will help only if the Dr. is on board with the Keto system.

Thanks!

(Bob M) #2

Northeast Connecticut? If you’re near RI, that is. Here’s one resource:

https://www.healthprofs.com/us/nutritionists-dietitians/connecticut?category=ketogenic-diet

I thought one of the doctors out of NYC also did telehealth into CT? I can’t remember his name though. I know I follow him on Threads, but I can’t figure out how to see who I follow.

(Bruce Pick) #3

I’m in southeast CT, which isn’t tooooo far from northeast CT.

Considering that the nearest keto-aware PCPs I’ve found are Concierge type practices near Providence, and another concierge practice near Hartford, I’m open to contacting practices as far away as Boston, Springfield MA, or further west in CT. Or tele-visits to anywhere (assuming they’re in-network for my insurance).

I visited the healthprofs.com link. The site only includes five categories of professionals, but not PCPs or MDs.

#4

Look into DO’s if they don’t have year long waiting lists, but most doc’s outside of paid membership places a going to be on you if your levels are really high. Even doc’s that are fans of keto typically don’t like really high cholesterol levels. My last doc who was all about keto and did it herself didn’t like people much above 200, and she was very aware of the metabolic differences, only ordered NMR’s etc.

How bad are yours?

(Bruce Pick) #5

lfod14, thank you for this.

Maybe you can clarify for me -
Do NMR lipids tests give LDL counts by size? My insurance company was no help and i could be stronger in life sciences. Apparently the small dense LDLs are the truly bad ones.

Chol. 238 (high borderline area)
HDL 68 (high, but HDL is the “good” cholesterol)
Triglycerides 104 (well below even borderline, so very nice)
LDL 152, borderline high

Will some cardiac MDs care about small dense LDLs vs the large ones? If the PCP is concerned about my #s maybe he could hand me off to a good cardiac doc, if I can find one.

#6

Yup, the NMR gives you everything, breakdown by type, size, everything. Although the cardiac doctors are aware of the different breakdowns, they’re still going to have a problem with the overall number. But yours are nowhere near where I’d ever consider taking a statin, unless there was actually some evidence of plaque, there’s a bunch of Cardiologists now that have some pretty cool protocols for reducing arterial plaque, it involves statins, but it’s only part of the equation, the end result (with them) is you coming off of them, not the indefinite LDL suppression without actually addressing the problem.

In keto circles, and even some mainstream ones we’re told our diets have very little effect on our serum cholesterol, but no shortage of us have proven we don’t work that way at all, mine is VERY dependent on what I eat. When I stopped forcing fat real high and not eating much protein, and switched to much higher protein and lower fat my cholesterol dropped huge.

Here’s a post I put up a couple years ago when I dropped my cholesterol huge to make my doc happy, and prove it could be done, but I have the NMR attached so you can see everything it shows.

https://www.ketogenicforums.com/t/fix-your-cholesterol-including-sdldl-fast/109381

That report shows my original test and the follow-up I think 3mo later.

(Bruce Pick) #7

lfod14, thank you for this.
Can you say something about the lower fat / higher protein macros you used? That might be my key to making this work. I’ve been happily going along (6 years) on high fat, sorta moderate protein, very low carbs. I certainly could set more precise targets for fats + protein, if that’s the key.

Over the past month or so, I’ve shifted towards more canned tuna-salmon-sardines, and for beef, I’m now draining the fat as much as possible. Making up for that fat loss with added avocado oil for the drained burger meat, and keto mayonnaise for fish, to make tuna/salmon/sardine “salad”.

Related: I just now messaged my PCP’s office, requesting that they order the NMR Lipid Profile, for my scheduled visit with him in Jan 2025. He’s been resisting ordering that for a couple years, but since my ins. says they’ll cover it, I don’t see any reason not to order it at this point.

(Bob M) #8

Here’s one:

Has virtual visits, I believe, and is an MD who lost a ton of weight using keto.

#9

Pretty much make sure I get in the old school normal 1g/lb bodyweight, I let fat come in as it does, and carbs depending on the day, I do a Targeted / Cyclical Keto so my different workout days have different amounts of carbs. On the ground beef, easier to buy lean beef, if not, you’re throwing away protein!

If your doc doesn’t want to order the test, do it yourself. I do a lot of testing, but stopped relying on Docs a long time ago, especially with the weird things I test, at least as far as the mainstream is a concern.

You buy your test online at a pretty significant discount, and you have the lab req in your email usually within the hour! Think they’re doing 25% off right now for the holiday still. If you like I can also give you a referral code which (i think) gets you $10-$20 off, not sure, but it’s money off either way. Then you just go to the lab when it works for you, get your draw done it’s results are emailed to you and also on the Quest or LabCorp page as well.

(Bruce Pick) #10

ifod14, Thank you.

(Bruce Pick) #11

Update: Today my PCP ordered a NMR Lipoprotein test.
I like that. I’ve been asking him to order that for a couple years now.
There’s plenty material out there on interpreting it, so even if he’s still old school in that regard, I have hope he will see things our way before very long.

(Bruce Pick) #12

This took a little while, but I have a lab result from the Lipoprotein NMR lab work. I expected to see more values in the result than what I received. Below is a paste of the complete output that I received.

[We’ve been a bit busy here with pre-holiday responsibilities, but the lab caused the majority of the delay by ordering a Lipoprotein-A test instead of the NMR, from their first draw, so I needed to have a second draw done.]

I expected to see data on the sizes and densities of LDL particles. Is that data here, and I’m simply not recognizing it? Or did they merely use NMR technology to find the same LDL and HDL count data that simple Lipoprotein tests provide?

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(Robin) #13

Oy, my test had so many factors and info that I had to have help just to understand what was what.
This is ridiculous.
I hope you didn’t pay much for it.

(Bob M) #14

You should get something like this:

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#15

You don’t have it all, I’d go into your doc’s portal and see if you can pull the lab there. Since it specially says it was an NMR it’s all there somewhere. You may also be able to go to the labs page directly and pull it. When mine are done the one I get from my docs portal doesn’t look to different than what you’re showing visually, but when I pull if from LabCorp directly it has all the nice graphs and ref ranges etc.

This is the last one I could find for an idea

NMR_noname.pdf (246.1 KB)

(Bruce Pick) #16

Robin,
Thanks. Fortunately this had no cost to me. My insurance paid for it. Free, and worth every penny!

Thank you. I messaged my PCP who ordered that NMR lab - his result data is the same as mine. He offered to send me to a lipoprotein specialist. Before doing that, I will review my options for order-your-own NMR lab work. I don’t want to go down a black hole of being compliant on this.

(Bob M) #17

Where do you live? In the US, you can get something like this:

On that website, there are a few options for NMR.

Personally, I’m not convinced any of this matters. Since I believe LDL does not cause heart disease, then sizes of LDL don’t matter. To the extent that sizes of LDL do matter, I think they are just markers of what you’re eating and your metabolic system, as trigs/HDL is. It’s not the “small dense LDL” that’s dangerous, it’s the diet and metabolic system that causes there to be more small dense LDL.

(Bruce Pick) #18

Bob,

Thank you.
I’m in southeastern Connecticut, in the US.
I found this source for an NMR Lipids panel (below).
For $45.95 (US), it has all the items in the ‘Your Own Labs’ test, but without the Insulin Resistance score. No docs have ever been concerned about my insulin or sugar levels, even before Keto.
I think I’ll go with that lab, unless anyone here has a reason not to.
Ulta Lab Tests: Lipoprotein Fractionation, NMR

(Bruce Pick) #19

I have the NMR results from Ulta Labs, in pic further below. Blood draw was Dec 26, 2024.
I’ll appreciate any notes from those who know more about this than I. For me, this has been learning curve all the way. Short version: LDL size is very nice, HDL count is high = nice, and TriG:HDL ratio is only 1.1, very nice.

I doubt my pcp will be able to interpret these results; he recently offered to send me to a lipo specialist to follow up on my cholesterol numbers.

(I ate strictly keto on 12-25, virtually zero carbs, and I had a 12+ hour fast before the draw.)
The lab’s total turnaround time for the NMR was only 4 days; I got the results email on Dec. 30.

First, the basic cholesterol numbers from Dec. 4:
Cholesterol: 237
HDL:80
Triglycerides: 88
LDL Calculated:142
And, the TG:HDL ratio was 88/80 = 1.1; quite low. Nice!

Now, the NMR data from the 12-26-24 blood draw:

LDL P: 1679 (nmol/L
Small LDL P:605 (nmol/L)
LDL Size: 21.3 (nm)
HDL P: 35.3 (umol/L)
Large HDLP: 7.4 (umol/L)
HDL size: 9.1 (nm)
Large VLDL P: <1.5 (nmol/L)
VLDL size: 44.9 (nm)

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(Bob M) #20

Those are great numbers, particularly the HDL and trigs.