Why is my lipid metabolism messed up?
8
Ṁ520Ṁ617resolved Sep 1
80%11%
Nothing more specific than "developing metabolic syndrome"
12%6%
Fluoxetine hepatotoxicity
8%1.4%
Familial hypercholesterolemia
2%Other
78%
ANTE
0.0%
Didn’t fast appropriately before blood test
0.3%
Recent alcohol use
I will resolve according to subjective probabilities at time of close, determined by whatever tests or information I be have at that time.
No catch-alls, like "you are unwell". Har har.
On my last blood test, I had pretty bad lipid levels. I am obese (BMI 35) and they aren't the healthiest anyway, but they shot up very markedly since my last blood draw. My last blood draw was 5 months ago. Since then, I've switched antidepressants from Escitalopram to Fluoxetine.
Glucose and A1c are fine. AST 26 IU/L, ALT 48 IU/L. Total cholesterol ~2x of top of normal range, same with triglycerides and calculated VLDL. Calculated LDL ~3x of normal range. 5 months ago, total cholesterol ~1.3x normal range, triglycerides ~3x normal range.
Since the timing fits, I hope it's hepatotoxicity from the Fluoxetine and that it'll get better with dosing/medication change. Could also be familial hypercholesterolemia but no xanthelasma plus rapid recent change plus no early heart problems in family.
Might add more relevant details later.
May 30, 3:03am: Point against Fluoxetine hepatotoxicity is that it seems relatively rare. My current hypotheses include: Fluoxetine hepatotoxicity, some sort of cascade in metabolic syndrome over last couple months, familial hypercholesterolemia.
May 30, 9:00am: The recent blood test was taken before eating anything that day.
May 30, 9:51am: See also: https://manifold.markets/agentydragon/which-measures-will-be-taken-to-get
May 30, 10:52am: Not a regular drinker, last drink before the test was ~1-2 days ago, ~2 standard drinks. Drink <5 standard drinks per month.
May 30, 10:58am: Also non-smoker, using cannabis, average <once/month. Last use of cannabis ~1 month ago. No other illegal drugs. Of non-prescribed drugs, had some NSAIDs for headache recently, but in what should be safe doses (not exceeding 1000 mg Paracetamol per dose & 4000 mg per day).
May 30, 11:07am: see also: https://manifold.markets/agentydragon/if-i-lower-my-dose-of-fluoxetine-or
Jun 14, 3:01pm: saw doctor. thinks of prescribing statins, will redo labs. didn't seem super convinced of SSRI hepatotoxicity hypothesis. got referral to psychiatrist, seeing an endocrinologist later.
Jun 22, 11:36am: re-test yesterday. total cholesterol 362 mg/dL, triglycerides 445 mg/dL, HDL 45 mg/dL, VLDL 97 mg/dL, LDL 220 mg/dL. negative on hep A, B, C. hepatic function (all within reference range): total protein 7.7 g/dL, albumin 4.9 g/dL, bilirubin total <0.2 mg/dL direct <0.1 mg/dL, alkaline phosphatase 77 IU/L, aspartate aminotransferase 25 IU/L, alanine aminotransferase 31 IU/L.
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@Angela yes. i have been taking escitalopram for several years and switched because it seemed that it was no longer working 100%, and was already on max dose.
@agentydragon What are the normal lipid ranges in the country you live in? You mentioned a previous blood draw – when was that? What was your BMI at the previous blood draw?
@S I just moved from Switzerland to USA. previous blood draw was December 1, 2021. BMI at previous blood draw was basically same (34.5 - 36 or so) - could look up the exact number if you think it matters.