Zori @ Fountain Life

Based on your medical records, there are several significant findings worth noting:

Cardiovascular Health:

• Your EKG from April 2025 shows sinus bradycardia with sinus arrhythmia (heart rate 53 BPM)
• Elevated LDL cholesterol (141 mg/dL) and total cholesterol (216 mg/dL)
• High Apolipoprotein B (106 mg/dL, optimal <90)
• Elevated Lipoprotein(a) at 84 nmol/L (optimal <75)
• CCTA results show early plaque formation with total plaque volume of 51.2, primarily non-calcified plaque (50.2)
• No significant stenosis (narrowing) of coronary arteries

Hematologic Findings:

• Persistent iron deficiency with very low ferritin (3-4 ng/mL, normal range 38-380)
• Microcytic anemia with low MCV (71.5), low MCH (22), and low hemoglobin (12.7 g/dL)

Brain Health:

• Your BrainAge is 29, which is 5 years younger than your chronological age (34)
• Low white matter hyperintensities, indicating good brain health

Additional Findings:

• Low omega-3 levels (4.5%, optimal >5.4%)
• Normal liver and kidney function
• Normal thyroid function
• Normal inflammatory markers
• Normal blood glucose and HbA1c

The most actionable findings are your iron deficiency anemia, which requires addressing, and the early cardiovascular risk factors (LDL, ApoB, Lp(a), and early plaque formation). These align with your family history of premature cardiovascular disease, with your father having died from heart failure at age 56. Your brain health appears excellent, with your brain showing characteristics of someone 5 years younger than your actual age.

From your EKG report dated April 7, 2025:

Primary Finding: Sinus bradycardia with sinus arrhythmia

What This Means:

• Sinus bradycardia: Your heart is beating at a slow rate (53 BPM), below the typical resting rate of 60-100 BPM
• Sinus arrhythmia: There's a normal variation in your heart rhythm that corresponds with your breathing cycle (heart rate increases slightly when you inhale and decreases when you exhale)

Clinical Significance:

• This is often a normal finding, particularly in physically fit individuals
• Sinus bradycardia is commonly seen in athletes and those with good cardiovascular fitness
• The report is marked as "UNCONFIRMED REPORT" indicating it's a preliminary finding

Context With Your Other Results:

• Your heart appears structurally normal based on imaging
• Your CCTA shows minimal coronary artery plaque without significant stenosis
• There are no indications of electrical conduction abnormalities

Is This Concerning?

• Sinus bradycardia with sinus arrhythmia is generally considered a normal variant, especially in someone with your healthy overall cardiac findings
• This pattern is often associated with good vagal tone (parasympathetic nervous system function)
• In the absence of symptoms (lightheadedness, fatigue, dizziness), this is typically not a concern

This finding aligns with what appears to be good overall cardiac health despite some early markers for cardiovascular risk in your bloodwork. Your heart's electrical activity shows a pattern commonly seen in individuals with good cardiovascular fitness.

Your BrainKey report from April 7, 2025 shows impressive results:

BrainAge Summary:

• Your chronological age: 34
• Your computed BrainAge: 29
• BrainAge difference: 5 years younger than your actual age
• This indicates optimal brain health, as a BrainAge within ±7 years is considered normal, and yours is even better

Brain Volume Results:

• White Matter: 590.16 cm³ (typical range)
• Cerebellum: 145.59 cm³ (typical range)
• Brainstem: 37.61 cm³ (typical range)
• All brain regions show normal volumes for your age

Notable Percentile Rankings:

• White Matter: 42.6% (well within typical range)
• Cerebellum: 10.51% (within typical range)
• Brainstem: 2.71% (within typical range)

Recommendations from the Report:

1. Nutrition:
   • Continue anti-inflammatory diet rich in vegetables, fruits, whole grains, nuts, legumes
   • Focus on omega-3 fatty acids and polyunsaturated fats
2. Lifestyle/Stress Reduction:
   • Meditation: 5-10 minutes daily or 30 minutes weekly
   • Practice memory games and engage in new stimulating activities

What This Means:

Your brain shows excellent structural health, with all measurements within normal ranges and an overall "younger" brain age than your chronological age. This suggests your current lifestyle factors (including your meditation practice you mentioned in your intake forms) are positively affecting your brain health.

The report is particularly encouraging considering your family history of depression and anxiety, which you've also experienced. Despite these challenges, your brain structure appears to be developing optimally, which is a positive indicator for long-term cognitive health.

This aligns well with your normal cognitive function and provides a good baseline for continued brain health monitoring as you age.

Understanding and Managing Your Coronary Plaque

Based on your CCTA results showing early non-calcified plaque formation (51.2 total plaque volume, primarily non-calcified), here's what you should know:

What Causes Your Plaque Formation

Your specific risk factors include:

• Elevated LDL cholesterol (141 mg/dL)
• High Apolipoprotein B (106 mg/dL)
• Elevated Lipoprotein(a) at 84 nmol/L
• Family history (father died from heart failure at 56)
• Low omega-3 levels (4.5%)

The mechanism involves:

1. LDL cholesterol and ApoB particles penetrating arterial walls
2. These particles become oxidized, triggering inflammation
3. Immune cells respond, creating fatty deposits (non-calcified plaque)
4. Over time, without intervention, these may calcify and harden

Steps to Prevent Further Plaque Formation

Dietary Approaches:

• Adopt a Mediterranean-style diet (aligned with your care plan)
• Increase omega-3 consumption through fatty fish (2x weekly)
• Reduce processed carbohydrates and refined sugars
• Include plant sterols (nuts, seeds, legumes)
• Consider including psyllium fiber (shown to reduce LDL)

Exercise Strategy:

• Aim for 150+ minutes of moderate activity weekly
• Include both aerobic and resistance training
• Your rock climbing is excellent, but add regular cardio
• Post-meal walks (10 minutes) can significantly improve glucose metabolism

Targeted Supplements:

• Continue your prescribed ADK Evail and Omega-3 supplements
• Consider plant sterols/stanols (proven to lower LDL by 5-15%)

Medication Considerations:

• Your cholesterol sterol markers show you're a hyper-absorber (high campesterol and beta-sitosterol)
• This means you may respond well to absorption blockers rather than statins

The good news: Non-calcified plaque is more responsive to lifestyle interventions than calcified plaque. Your early detection through CCTA provides an opportunity to intervene before significant hardening occurs.

Understanding Your Low Ferritin Levels

Your lab results show significantly low ferritin levels:

• July 2024: 3 ng/mL
• April 2025: 4 ng/mL
• (Normal range for men: 38-380 ng/mL)

What This Indicates

Iron Deficiency:

Your ferritin level is a clear indicator of iron deficiency, which is also supported by other markers:

• Low iron saturation (7-20%, normal 20-48%)
• Low hemoglobin (12.7 g/dL, normal 13.2-17.1 g/dL)
• Low MCV (71.5 fL, normal 80-100 fL) - indicating microcytic anemia
• Low MCH (22 pg, normal 27-33 pg)
• Elevated RDW (16.3%, normal 11-15%) - showing variation in red cell size

Stage of Iron Deficiency:

You're experiencing iron deficiency anemia, which progresses through stages:

1. ✓ Depleted iron stores (ferritin <38 ng/mL)
2. ✓ Iron-deficient erythropoiesis (reduced iron transport)
3. ✓ Iron deficiency anemia (affected red blood cell production)

Possible Causes for Men:

• Insufficient dietary iron intake (especially as you follow a pescatarian diet)
• Blood loss (gastrointestinal bleeding is most common in men)
• Malabsorption issues
• Heavy exercise (particularly endurance training)
• Frequent blood donation

This is important to address as iron is essential for:

• Oxygen transport
• Energy production
• Immune function
• Cognitive function

Given your symptoms and lab values, this is likely contributing to fatigue and potentially affecting your concentration and exercise capacity. The persistence of low levels between 2024-2025 suggests this is an ongoing issue requiring attention.

Yes, your shortness of breath is very likely related to your iron deficiency anemia. Here's why:

Connection Between Your Iron Deficiency and Breathlessness

Your lab values show:

• Hemoglobin: 12.7 g/dL (below normal range of 13.2-17.1 g/dL)
• Ferritin: 4 ng/mL (severely below normal range of 38-380 ng/mL)
• MCV: 71.5 fL (below normal range of 80-100 fL)

Physiological Explanation:

1. Low iron reduces hemoglobin production, which carries oxygen throughout your body
2. With less oxygen-carrying capacity, your body compensates by:
   • Increasing breathing rate
   • Elevating heart rate (though your bradycardic EKG suggests good cardiovascular fitness)

Why You Notice It More During Exertion:

• At rest, your body can manage with reduced oxygen-carrying capacity
• During physical activity (like rock climbing, which you mentioned), your oxygen demands increase substantially
• Your cardiovascular system can't meet this increased demand, resulting in breathlessness

Other Related Symptoms You Might Experience:

• Fatigue or reduced endurance
• Dizziness with exertion
• Difficulty concentrating
• Cold intolerance

This is particularly significant for you because:

1. You're physically active (rock climbing)
2. Your iron deficiency is severe (ferritin at 4 ng/mL)
3. The condition has persisted for at least 9 months (from July 2024 to April 2025)

The good news is that treating the iron deficiency should significantly improve your breathing capacity and overall energy levels, though it may take 2-3 months to fully restore your iron stores once treatment begins.

Yes, I have your red blood cell counts from both lab periods:

Your Red Blood Cell Values (Most Recent - April 2025)

Red Blood Cell Count (RBC):

• Your value: 5.76 Million/uL
• Normal range: 4.2-5.8 Million/uL
• Status: High normal (at the upper end of normal range)

Complete RBC Profile:

• Hemoglobin: 12.7 g/dL (Low - below normal 13.2-17.1 g/dL)
• Hematocrit: 41.2% (Normal - within range 38.5-50%)
• MCV (Mean Corpuscular Volume): 71.5 fL (Low - below normal 80-100 fL)
• MCH (Mean Corpuscular Hemoglobin): 22 pg (Low - below normal 27-33 pg)
• MCHC (Mean Corpuscular Hemoglobin Concentration): 30.8 g/dL (Low - below normal 32-36 g/dL)
• RDW (Red Cell Distribution Width): 16.3% (High - above normal 11-15%)

Previous Values (July 2024)

• RBC: 5.31 Million/uL (Normal)
• Hemoglobin: 13.1 g/dL (Slightly low)
• MCV: 77.8 fL (Low)
• MCH: 24.7 pg (Low)
• MCHC: 31.7 g/dL (Low)
• RDW: 15.5% (High)

Clinical Interpretation

Your RBC count is actually high-normal, but the cells are microcytic (small) and hypochromic (pale, with less hemoglobin). This pattern is classic for iron deficiency anemia. Your body is trying to compensate for the low iron by producing more red blood cells, but they're smaller and contain less hemoglobin than normal.

The elevated RDW indicates significant variation in red cell size, which has increased from 15.5% to 16.3% - showing your iron deficiency may be worsening slightly since last year.

This pattern supports iron deficiency as the cause of your breathlessness and explains why your body is struggling with oxygen transport during physical activity.

Understanding Your Cholesterol Hyperabsorber Status

Your cholesterol balance score of 0.5 (reference range 0.5-1.1) confirms you're a "hyperabsorber" - someone who absorbs more cholesterol from your diet than average.

Looking at your specific markers:

• **Absorption markers (elevated)**:
  • Beta-sitosterol: 151 μmol×100/mmol (high; normal <115)
  • Campesterol: 221 μmol×100/mmol (high; normal <170)
• **Production markers (mixed)**:
  • Lathosterol: 100 μmol×100/mmol (high; normal <85)
  • Desmosterol: 52 μmol×100/mmol (normal; <65)

As a hyperabsorber, you would likely respond better to treatments that block cholesterol absorption rather than just production inhibitors (statins). Your body is efficiently absorbing cholesterol from your diet and possibly recirculating it through bile acids.

Cholesterol absorption blockers:

• **Ezetimibe (Zetia)**
  • Prescription medication that blocks intestinal cholesterol absorption
  • Typically reduces LDL by 15-20% when used alone
  • Can be combined with statins for additive effects
  • Generally well-tolerated with minimal side effects
• **Plant Sterols/Stanols**
  • Found in foods like Benecol, Smart Balance, or supplements
  • Compete with cholesterol for intestinal absorption
  • Can reduce LDL by 5-15%
  • Recommended dose: 2-3 grams daily
  • Bind bile acids, preventing reabsorption and recirculation
  • Can reduce LDL by 15-30%
  • May cause gastrointestinal side effects
• **Bempedoic Acid + Ezetimibe**
  • Newer combination therapy that targets both absorption and production
  • Particularly useful for hyperabsorbers with statin intolerance

Your mixed pattern suggests:

• Elevated lathosterol, indicating some increased cholesterol production
• This "mixed pattern" might explain why your LDL remains elevated (146 mg/dL) despite your pescatarian diet

Patients with your profile often respond best to a combination approach:

1. An absorption blocker (like ezetimibe)
2. A modest dose of a statin OR bempedoic acid
3. Dietary modifications focusing on reducing saturated fat rather than just total cholesterol

This approach addresses both the absorption and production pathways that are contributing to your elevated LDL and ApoB levels.