LDL too low???

I am a 62 yr. old T2 diabetic controlled w/1000 mg. lipitor bid. I'm also on a beta blocker w/HCTZ and atorvastatin (Lipitor 10 mg). My latest serum tests came in at:

TC 126
TG 167
HDL 50
LDL 42 vLDL 33

What are the consequences of such a low TC and LDL? Should I consider coming off the statin and go on a fibrate like gemfibrozil to better target my trigs (which sometimes go up to 350-400 w/my metabolic syndrome)

but not a guarantee.

Selenium reduces toxicity of mercury, because selenium forms tight compound with mercury, which inactivates it. Many fish have high selenium content, which reduces the toxicity of mercury in them. Still, if one eats a lot of fish, it might be beneficial to take selenium supplements for precaution.

Seychelles' fish consumption is among the largest in the world. They consume a lot of large predatory fish which typically have rather high mercury content. Still, this has not had negative effect on the cognitive development of the children there as has been shown in the long term
Seychelles Child Development Study, see
http://groups.google.com/groups? selm=iufd6t03mi92uc6pql9esu2lvrpkhqc9bb%404ax.com (http://tinyurl.com/t1lp)

References about the protective effects of selenium against mercury toxicity:

1: Frisk P, Wester K, Yaqob A, Lindh U. Selenium protection against mercury-induced apoptosis and growth inhibition in cultured K-562 cells.
Biol Trace Elem Res. 2003 May;92(2):105-14.
PMID: 12746570 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=12746570& dopt=Abstract

2: Hol PJ, Vamnes JS, Gjerdet NR, Eide R, Isrenn R. Dental amalgam and selenium in blood.
Environ Res. 2001 Dec;87(3):141-6.
PMID: 11771928 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11771928& dopt=Abstract

3: Wang A, Barber D, Pfeiffer CJ. Protective effects of selenium against mercury toxicity in cultured
Atlantic spotted dolphin (Stenella plagiodon) renal cells.
Arch Environ Contam Toxicol. 2001 Nov;41(4):403-9.
PMID: 11598777 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11598777& dopt=Abstract

4: Frisk P, Yaqob A, Nilsson K, Lindh U. Selenite or selenomethionine interaction with methylmercury on uptake and toxicity showing a weak selenite protection: studies on cultured K-562 cells.
Biol Trace Elem Res. 2001 Jun;80(3):251-68.
PMID: 11508630 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11508630& dopt=Abstract

5: Watanabe C. [Selenium deficiency and brain functions: the significance for methylmercury toxicity]
Nippon Eiseigaku Zasshi. 2001 Jan;55(4):581-9. Review. Japanese.
PMID: 11265129 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11265129& dopt=Abstract

6: Drasch G, Mail der S, Schlosser C, Roider G. Content of non-mercury-associated selenium in human tissues.
Biol Trace Elem Res. 2000 Dec;77(3):219-30.
PMID: 11204464 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11204464& dopt=Abstract

7: Dietz R, Riget F, Born EW. An assessment of selenium to mercury in Greenland marine animals.
Sci Total Environ. 2000 Jan 17;245(1-3):15-24.
PMID: 10682353 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10682353& dopt=Abstract

8: Seppanen K, Laatikainen R, Salonen JT, Kantola M, Lotjonen S, Harri M,
Nurminen L, Kaikkonen J, Nyyssonen K. Mercury-binding capacity of organic and inorganic selenium in rat blood and liver.
Biol Trace Elem Res. 1998 Dec;65(3):197-210.
PMID: 9892493 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=9892493& dopt=Abstract

9: Schuurs AH, Groten J, van Dokkum W, van den Heuvel J. [Selenium and mercury. (Un)healthy antagonism?]
Ned Tijdschr Tandheelkd. 1996 Mar;103(3):88-91. Review. Dutch.
PMID: 11921953 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11921953& dopt=Abstract

10: Molin M, Bergman B, Marklund SL, Schutz A, Skerfving S. Mercury, selenium, and glutathione peroxidase before and after amalgam removal in man.
Acta Odontol Scand. 1990 Jun;48(3):189-202.
PMID: 2368614 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=2368614& dopt=Abstract

11: Das SK, Giri AK, Sharma A, Talukder G. Effects of mercury-selenium antagonism on mammalian cell division.
Cytobios. 1985;42(169S):271-8.
PMID: 4028833 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=4028833& dopt=Abstract

12: Mochizuki Y, Kobayashi T, Doi R. Comparison of cytotoxicity of mercury-selenium and mercury compounds on cultured cells.
Toxicol Lett. 1984 Jul;22(1):47-51.
PMID: 6235624 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=6235624& dopt=Abstract

13: Mochizuki Y, Kobayashi T, Doi R. In vitro effects of mercury-selenium compounds on enzymes.
Toxicol Lett. 1982 Dec;14(3-4):201-6.
PMID: 7167980 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7167980& dopt=Abstract

14: Hansen JC, Kristensen P, Al-Masri SN. Mercury/selenium interaction. A comparative study on pigs.
Nord Vet Med. 1981 Feb;33(2):57-64.
PMID: 7232147 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7232147& dopt=Abstract

15: Paulsson K, Lundbergh K. The selenium method for treatment of lakes for elevated levels of mercury in fish.
Sci Total Environ. 1989 Nov;87-88:495-507.
PMID: 2558416 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=2558416& dopt=Abstract

"... The treatment of lakes with selenium has been found to be one of the few known methods of lowering the mercury content of fish quickly and easily."

16: Yoshida M, Abe M, Fukunaga K, Kikuchi K. Bioavailability of selenium in the defatted dark muscle of tuna.
Food Addit Contam. 2002 Oct;19(10):990-5.
PMID: 12443562 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=12443562& dopt=Abstract

"... The results indicate that the defatted DMT contains high levels of Se in a nutritionally available form."

17: Cappon CJ, Smith JC. Chemical form and distribution of mercury and selenium in canned tuna.
J Appl Toxicol. 1982 Aug;2(4):181-9.
PMID: 7185899 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=7185899& dopt=Abstract

18: Boyer CI Jr, Andrews EJ, deLahunta A, Bache CA, Gutenman WH, Lisk DJ. Accumulation of mercury and selenium in tissues of kittens fed commercial cat food.
Cornell Vet. 1978 Jul;68(3):365-74.
PMID: 668395 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=668395& dopt=Abstract

I did not know that mercury is found only in the fish muscle, thank you for clarifying this for me. I did find a remote study, but it certainly does not sound worrisome. 'normal use' is not a specific term and means different things for different people.

Clin Toxicol. 1978;12(5):579-81. Mercury and selenium in cod-liver oil.

van de Ven WS.

Cod-liver oil preparations were analyzed for mercury and selenium. The conclusion can be drawn that the intake of mercury and selenium in the normal use of these preparations will be very low.

measurable amounts is your key word. this does not mean 'zero'.

It wasn't too expensive. No, insurance did not cover it.

unfortunately, these sites also sell fish oil, and remind me of phamaceutical reps for prescription drugs.

www.pubmed.gov and let me know what you find.

Ok, the purpose was to find some clarification for the concept.

I don't know the field well enough to make any suggestions. What do you think?

FMI, was it expensive and did insurance cover your procedure?

Well, I've stopped my statin (5 mg Crestor) - it was Dr. Mirkin's comment that statins delay recovery from exercise. That may be why for years I haven't gained strength at the gym. If I did have at least one risk factor for heart disease, besides age, I would keep on statins. My diet and exercise and moderated drinking have boosted my
HDL from 35 to 69 - and I estimate my total chol will be 200 without
Crestor - giving me a good ratio. If not, I can always go back on
Crestor.

Re BP and Hba1c: super numbers for you! I agree with you, 9 fish oil capsules would be unpleasant. Personally I eat either salmon or canned herring every day. Moderate drinking (up to 2 drinks a day) may increase HDL and (I believe) low BG, at least temporarily. Of course,

taking my statin (Crestor 5 mg).

this profile is at goal.

you might consider hs.CRP and homocystiene levels.

if you are concerned about too much fish oil, then consider a mercury level, as it can be a contaminant and some studies suggest it to be a risk factor for promoting atherosclerosis.

Sorry for the delayed response. My HbA1c is 5.5 and BP is 100/60.
Boy, that's a LOT of fish oil I'll smell like a dead grouper

I'm under impression that the best quality _concentrated_ fish oil products don't contain measurable amounts of mercury or other pollutants, because these have been removed in the molecular distillation process.

Jim has a nice point.

Your diabetes dramatically increases your chd risk. A low ldl is good prevention. You might look into niaspan (increase HDL).

Impurities in Fish Oil http://www.iherb.com/mercury.html

"... Molecular distillation is the only method (currently) that can remove metals, pcbs and other toxins to below detectable levels for human consumption. ..."
http://www.iherb.com/dha.html

"Purified by Molecular Distillation-"

Fish Oil Comparison http://www.dr-sears-fishoil.com/compare.asp

"True molecular distillation process removes all man made pollutants such as PCB's, dioxins and mercury."

Found with Google:
http://www.onelook.com/?w=molecular+distillation
http://www.infoplease.com/ipd/A0541577.html

"a vacuum distillation in which the molecules of the distillate reach the condenser before colliding with one another."
http://www.books.md/M/dic/moleculardistillation.php
http://plastics.about.com/library/glossary/m/bldef- m3492.htm

"Definition: A process for the separation of polymers into fractions of different molecular weight at the lowest possible temperature to avoid damage."
http://www.theglassplant.com/asahi/english/products/ vacuum/
http://www.popeinc.com/pope/wiped_film.htm
http://www.chelationtherapyonline.com/GarryGordon/ KarlLorenResearch/p20.html

"Molecular distillation is the only method (currently) that can remove metals, pcbs and other toxins to below detectable levels for human consumption. Most processing keeps the oils at up to 250 degrees C for up to 6 hours under vacuum. We use a molecular distillation process that takes only 45 seconds at 250 degrees C under high vacuum. This shortening of the "sit" or "residence" time for the process greatly improves the quality because it guarantees that no trans fats are created. Other molecular distillation processes and steam distillation have the potential to create trans fats because of the length of time the oil sits at high temperature.

Molecular distillation is also used to concentrate and increase the levels of EPA and DHA well above the standard 18% EPA and 12% DHA.
Molecular distillation must occur before concentration begins! If the fish oil is concentrated prior to distillation it will also concentrate the PCBS's, metals and other toxins significantly increasing their levels. Therefore it is essential that fish oil be molecularly distilled prior to concentration.

Please note: The fish oils processed with this technology have very low levels of impurities between, below 0.005ppm are very safe for human consumption and are below California's Proposition 65 requirements. It is virtually impossible to remove 100% of all impurities but we can get them to below detectable levels.

Very low levels of PCB's and Heavy metals, PV (peroxide value) and Anisidines are the indicators that tell about the purity and quality of fish oils. High quality oils will have PV's from 1-3.5meq/kg and Anisidines of 13.5meq/kg or lower. Anisidines are just one aspect of the oxidative indications and are not as significant as PV.
Anisidines of between 18 or below are also acceptable."

First a couple of references about fish oil and cod liver oil. According to them mercury levels in these oils seem to be negligible:

Koller H, Luley C, Klein B, Baum H, Biesalski HK. [Contaminating substances in 22 over-the-counter fish oil and cod liver oil preparations: cholesterol, heavy metals and vitamin A]
Z Ernahrungswiss. 1989 Mar;28(1):76-83. German.
PMID: 2718527 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=2718527&amp; dopt=Abstract>

"Fish oil capsules are increasingly used by self-medicating patients. We studied 22 commercial fish oil and menhaden oil preparations in respect to accompanying substances that could be harmful. The substances measured were: cholesterol as determined by gas liquid chromatography, heavy metals measured by atomic absorption, and vitamin A as determined by high-performance liquid chromatography (HPLC). The contents of cholesterol and heavy metals were in ranges which can be regarded as negligible; the content of vitamin A in menhaden oils, however, was found in amounts which warrant that pregnant women do not exceed the dosage as recommended by the manufacturers."

van de Ven WS. Mercury and selenium in cod-liver oil.
Clin Toxicol. 1978;12(5):579-81.
PMID: 679643 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&amp;db=PubMed&amp;list_uids=679643&amp; dopt=Abstract>

"Cod-liver oil preparations were analyzed for mercury and selenium.
The conclusion can be drawn that the intake of mercury and selenium in the normal use of these preparations will be very low."

Secondly, from the same issue of NEJM a couple of studies which give contradictory results about the association of mercury and coronary heart disease:

Yoshizawa K, Rimm EB, Morris JS, Spate VL, Hsieh CC, Spiegelman D, Stampfer
MJ, Willett WC. Mercury and the risk of coronary heart disease in men.
N Engl J Med. 2002 Nov 28;347(22):1755-60.
PMID: 12456851 [PubMed - indexed for MEDLINE] http://content.nejm.org/cgi/content/full/347/22/1755

"... Conclusions Our findings do not support an association between total mercury exposure and the risk of coronary heart disease, but a weak relation cannot be ruled out."

Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, Aro A, Gomez-Aracena J,
Kark JD, Riemersma RA, Martin-Moreno JM, Kok FJ; Heavy Metals and Myocardial
Infarction Study Group.
Mercury, fish oils, and the risk of myocardial infarction.
N Engl J Med. 2002 Nov 28;347(22):1747-54.
PMID: 12456850 [PubMed - indexed for MEDLINE] http://content.nejm.org/cgi/content/full/347/22/1747

"... Conclusions The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake."

These studies have been reported and commented in the article:

Mercury Intake and Adverse Heart Events. Journal Watch Cardiology 2003: 3-3 http://cardiology.jwatch.org/cgi/content/full/2003/207/ 3

"... Comment: Although U.S. researchers found no link between mercury and CHD risk, international researchers found one between mercury and risk for first MI. The international study's findings suggest that the benefits of omega-3 fatty-acid intake via fish may be nullified by mercury intake. Much remains unclear in this area of research; strong recommendations cannot be made at this time. ..."

69 - moderate drinking, eating oily fish every day,over 1

hour aerobic exercise daily, and eating moderate amounts of "good" fats (olive oil, nuts). Two key numbers for diabetics -

Hba1c and blood pressure. How do you rate on those? Did you see the
AHA article on fish oil capsules and/or oily fish - to

combat high trig you may consume up to 9 capsules a day?