@Ioanna Polymenea , thank you for posting this because your numbers are a very good example of why **high ApoB is not always the same metabolic pattern**. A few things stand out immediately. Your **ApoB of 301 mg/dL** and **LDL-C of 659 mg/dL** are extremely high, and given that you already know you have **familial hypercholesterolemia**, genetics are very likely a major upstream driver here. In FH, the issue is often not simply that the liver is “making too much cholesterol.” A major problem is that **LDL particles are not being cleared efficiently from the blood**, usually because LDL-receptor function is impaired genetically. That matters because your other markers did **not** look like the classic insulin-resistant pattern. Your triglycerides were 80, HDL 73, fasting insulin 5.2, glucose 91, and HbA1c 5.2. So I would not look at those numbers and say, “This is mainly insulin resistance driving ApoB.” Your pattern is much more consistent with: **strong genetic LDL-clearance impairment + diet response + active fat loss possibly amplifying the numbers.** The carnivore / very-low-carb context may also have pushed LDL and ApoB even higher, especially if saturated-fat intake was high and you were in a calorie deficit. Some lean people can see dramatic LDL rises in that setting, but in someone with established familial hypercholesterolemia, I would be especially cautious because the baseline clearance problem is already there. Your thyroid numbers are also interesting. TSH 2.11 and free T4 of 1.0 do not immediately scream overt hypothyroidism, but your **free T3 at 1.93 pg/mL is on the low side in many laboratory ranges**. During calorie restriction and weight loss, T3 can fall as part of an adaptive response. That does not automatically mean primary thyroid disease, but it is another reason I would not interpret your lipid panel without considering the context of active dieting. The most important change you shared is this: **ApoB fell from 301 to 121 after lowering fat intake and starting ezetimibe.**

@Leilani Tedeski The most important point is this: if she has an active Klebsiella urinary infection and kidney stones, the urologist needs to know the current infection status before stone treatment. Current urology guidelines specifically recommend checking urine for infection before stone removal, treating a UTI first, and delaying definitive stone treatment if there is an infected obstructed kidney until the infection is controlled. Uncontrolled UTI is also listed as a contraindication to shock-wave lithotripsy. So I would not rely on the Google/AI answer that says, essentially, “the procedure will force Klebsiella into the bloodstream and she may die.” That is too absolute and frightening. But the underlying concern is real: stone manipulation in the setting of an active infection can increase the risk of bacteremia and sepsis, which is why urine culture, antibiotic sensitivity, obstruction status, and appropriate antibiotic coverage matter so much. Because her procedure is tomorrow, what I would want her to do today is call the urologist’s office and ask very directly: - Was a recent urine culture done? - Is Klebsiella still present? - What is the antibiotic sensitivity pattern? - Is she currently on an antibiotic that the organism is actually sensitive to? - Is there any obstruction or hydronephrosis? - What type, size, and location are the stones? - Does the urologist suspect an infection stone such as struvite? - Given the infection history, do they still feel shock-wave lithotripsy is the safest procedure tomorrow? That is a much better use of the next 24 hours than trying to rapidly change her diet. On the question of whether she can simply change her diet now and pass or dissolve the stones naturally, the answer is: we cannot assume that at all. It depends completely on the stone composition, size, location, and whether there is obstruction. Most calcium stones do not dissolve with dietary changes. Small stones may pass on their own, but larger stones or stones causing obstruction often require intervention.

@Leilani Tedeski , thank you for the update. The **7 mm size and the history of recurrent Klebsiella infection are very important pieces of information**, and I want to clarify one point because it changes how I would think about this. A **uric-acid stone and a struvite stone are two different stone types**. They can occasionally occur as mixed stones, but I would not treat “uric acid/struvite” as one category. Her history of **gout** does make uric-acid stones plausible. Uric-acid stones usually develop when the urine stays too acidic, and they are unusual because they can sometimes be **dissolved medically by raising the urine pH**, generally with something such as potassium citrate under medical supervision. Struvite stones are different. They are **infection-related stones** associated with urease-producing bacteria. Klebsiella can be one of those organisms. If this is predominantly a struvite/infection stone, simply changing her food is generally **not enough to dissolve the stone or remove the bacterial reservoir**. Complete stone clearance and treatment of the infection become much more important. Her doctor is correct that the **most definitive way to know the composition is stone analysis after a fragment is retrieved or passed**. Imaging can give us clues, though. CT density in Hounsfield units, urine pH, appearance of the stone, infection history and her metabolic history can all help estimate what type is more likely, but they do not replace actual stone analysis. The other important issue is the **7 mm size**. A 7 mm stone is not automatically impossible to pass, particularly if it is already in the ureter and relatively close to the bladder, but the likelihood depends heavily on **where it is located**. Current stone guidelines allow observation for some ureteral stones under 10 mm, and medications such as an alpha-blocker may sometimes be used to assist passage, particularly for distal ureteral stones. But that recommendation applies to **uncomplicated stones**—meaning pain is controlled and there is no concerning infection or high-grade obstruction.

@Rachel Rose thank you — this gives me a much clearer picture, and the photos of the products are helpful. The first thing I want to correct is the idea that because you have not been eating nose to tail, you must automatically be nutrient deficient. You may have a deficiency, but we need the bloodwork to tell us which one. Your symptoms are enough for me to investigate nutrients, but I do not want you replacing one large supplement stack with another one before we know what is actually low. A few things stand out from what you're currently taking. The “Zero In” product is the first thing I would stop for now. It is not simply a cognitive supplement. Each capsule contains 100 mg of caffeine, plus a 575 mg proprietary blend containing N acetyl L tyrosine, L theanine, mucuna pruriens, pine bark and turmeric. So if you take 2 capsules, that is already 200 mg caffeine, in addition to unknown amounts of tyrosine and mucuna. Mucuna naturally contains L DOPA, so this is a fairly stimulatory dopaminergic formula, not something I want muddying the picture while you are dealing with severe sleep disruption, shakiness, weakness and tingling. It could potentially make some of those symptoms harder to interpret. It also contains 25 mcg vitamin D per capsule, so 2 capsules gives you another 50 mcg, or about 2,000 IU, of vitamin D without us intentionally choosing that dose. Your “Lion's Mane” formula is also not actually just lion's mane. At the 2 capsule serving it contains 266 mg each of lion's mane, cordyceps, reishi and shiitake, plus a proprietary blend of several additional mushrooms including maitake, turkey tail, chaga, agaricus, white button and black fungus. I don't necessarily see something alarming there, but right now I would rather simplify than have 8 or 9 mushroom extracts in the background while we're trying to understand neurological and sleep symptoms. If you want to use lion's mane later, I would prefer a simple lion's mane product with a clearly stated dose rather than a large mushroom blend.

@Rachel Rose Rachel, thank you — these photos help a lot because now I can actually calculate what you were taking rather than guessing. A few things stand out. Your **Super B-Complex** at the full 2-tablet dose was giving you **10 mg of vitamin B6, 48 mg niacinamide, 900 mcg B12, 400 mcg methylfolate, 20 mg B1 and 14 mg B2** each day. That is not an extreme B6 dose by itself, but because you were taking it daily and you have tingling/neurological-type symptoms, I still think it was appropriate to stop it while we wait for the bloodwork. I would still like a B6 level if your GP will order it, because susceptibility varies and we also need to know whether there were other B6-containing products in the background. Your **zinc carnosine** gives **16 mg elemental zinc per 2 capsules**. You were taking 2 capsules morning and 2 capsules evening, so that was approximately **32 mg supplemental zinc per day**, before counting zinc from food. That is much more relevant than I initially realized. It is still below the U.S. adult upper limit of 40 mg/day from all sources, but long-term use at that level can put pressure on **copper status**, especially if your diet is also high in zinc. I would leave that out for now too. When the bloodwork comes back, I would like to see copper and ceruloplasmin if they are available, particularly if you have been taking this dose for a long time. The biggest thing I noticed is the **trace mineral product**. The label says **20 drops provides 102 mg magnesium**. You previously told me you were taking about **120 drops per day**. If that is still correct, that works out to roughly: - **612 mg magnesium/day** - **2,010 mg chloride/day** - **234 mg sodium/day** - **270 mg potassium/day** from the drops alone. That is actually a fairly substantial supplemental magnesium intake, especially if you were also using magnesium citrate separately. It may not be dangerous in someone with healthy kidneys, but it is enough to cause GI symptoms in some people and it absolutely can muddy the picture when we are trying to understand reflux, weakness, shaking or bowel changes.

@Leilani Tedeski @Mariam Als. @Divina McGuirk , thank you so much for such a kind message. That truly means a lot to me. I’m very grateful for this community and for the trust you all place in me. And yes, Duke and Kash definitely seem to have become part of the class too. 😂 Wishing you and your family a very Happy Thanksgiving as well. May God continue to bless you with health, peace, strength, and many good years ahead. 🙏❤️