Mike Nichols Quotes

Mike Nichols used to say we were two flowers, no gardener. No one was minding the relationship.

How can Martin Scorsese’s New York City be the same as Woody Allen’s New York City, which is not the same thing as Spike Lee’s New York City and Mike Nichols’s New York City? That was my introduction to perspective.

I spend my money...I don't know on what.

How beautiful black-and-white is. It's not literal. It's a metaphor automatically, already saying, this is not life, it's ABOUT life.

I never understand when people say, 'Do you do comedy or tragedy?' I don't think they're very much different. They both have to be true, and there isn't a great play in the world that doesn't have funny parts to it - as 'Salesman' does, as 'King Lear' does. The whole idea is to reflect life in some way, which means surely you have to have both.

Limitations are inspiring: they lead to thinking, so I don't mind them.

On October 23, 1963, Barefoot in the Park opened on Broadway. Just before his extremely nervous cast took the stage, Nichols gathered them for a final pep talk. “Everybody relax,” Redford says he told them. “You know your positions, you know your laughs, you know your lines, you know where the comfort zones are. So enjoy yourselves, and remember: Everything depends on tonight.

Mike [Nichols] said: Directing a movie is like sex. you never see anyone else doing it, so you're not sure you're doing it right... After the press screening of Murmurs of the Heart, Louis's mom said, "Louis, it brings back such memories!"...

But Catch’s tone of outraged bewilderment in the face of carnage and a deranged military mentality set the tone for the satires against the arms race and Vietnam. Dr. Strangelove appeared in 1964. Robert Altman’s 1970 film M*A*S*H, with its Osterizer blend of black humor and stark horror, is a direct descendant of Catch-22. Ironically, that movie appeared the same year as Mike Nichols’s film version of Catch. M*A*S*H is the better movie by far, but in a nice bit of irony, it propelled the novel—finally!—onto American bestseller

Any good movie is filled with secrets.

All the theories that acting is reacting to imaginary circumstances as though they are real, and directing is turning psychology into behavior, those are all stabs at something that can't be taught. All the great actors can't talk about what they do, and they don't want to begin to talk about it. They just do it.

It's not a film-maker's job to explain his technique, but to tell his story the best way he can.

There are absolutely almost perfect people who experience no guilt; they don't know what it is. They simply do what they need to do - or want to do - next. They see nothing wrong with it. They feel no guilt. They express no guilt. And it's not even certain what harm they do.

Thyroid. Test Thyroid Stimulating Hormone annually. The test is called TSH and could indicate thyroid problems if too high. In such cases, energy levels will be low, and exercise will have less benefit. The standard “too high” level is 4 uiu/ml (or miu/L), but the warning bells should chime at anything above 2.5. For men, a doctor should be seen if this is the case and total testosterone is below 350/dl. For women, T3 and T4 should measured, and a doctor seen if they are low. We cannot give a precise number here, because different labs use different tests for this one. So here “low” should be taken to mean low according to the lab report. The cure for a weak thyroid is levothyroxine, a very inexpensive prescription medicine.

Fasting insulin between 3 and 6 µu/dl A1C less than 5% Triglycerides below 100 mg/dl HDL greater than 65 mg/dl (male) or 75 (female) Cortisol below 12 µg/dl

For men, score an “A” if your IGF-1 is in the range 150 ng/ml ± 20 (higher is dangerous), total testosterone is above 500 ng/dl, and HDL is above 65 mg/dl. Score a “B” if your IGF-1 is above 125 ng/ml and HDL is above 45 mg/dl. Otherwise a “C.

The “normal” range for creatinine is 0.7 to 1.2 mg/dl. Actually, anything over 1.0 indicates a problem.

If ferritin is greater than 125 mg/dl, and all the other possible causes have been ruled out, consider giving blood once a year. If greater than 200, do it quarterly. (As medical procedures go, this is a very old one.)

you got a scan and measured bone density, a number greater than 135 gm/cm2 means your osteoporosis risk is low—

The way to trigger weight loss is to make dietary changes that will force your fasting insulin to a level between 3 and 6 µu/dl. This

therapeutic phlebotomy;

Usually those with triglyceride levels below 100 mg/dl will have Pattern A, and if below 75, it is almost a certainty.

By seventy, other things being equal, the density will have sagged to around 105, with is the “fracture threshold.

These fully grown particles are the “really good” cholesterol we mentioned earlier, and are also known as HDL2b, mature cholesterol, or very large HDL particles.

The cause of these tiny LDL particles is high triglycerides. High triglycerides and tiny particle size are in lockstep. This is solidly established.

Lp(a). People with high concentrations of Lp(a), an LDL variant, are at increased risk of heart problem and should focus on heart-healthy practices (exercise, low carbs). APO-E4. Apolipoproteins are a family of proteins that coat LDL, HDL, and chylomicron particles in order to make them water soluble. The APO-E4 subtype is a strong risk factor for Alzheimer’s and heart disease. Again, the best way to fight it, indeed, the only way, is through heart-healthy practices. Celiac Disease. This is caused by a reaction to gluten, which is found primarily in wheat. It can be quite serious if undiagnosed. Some cannot digest wheat. The solution is simple, though: no wheat or other glutens. LDL particle size. A predominance of small LDL particles causes heart disease. The size is determined by diet and exercise, but also genetically. Again heart-healthy practices can counteract this. Homeostatic weight. If you are on a low-carb diet and exercise, your body will regulate to the weight that your hypothalamus thinks is your healthiest. Further weight loss is difficult. The specific level is largely genetic. MTHFR. A deficiency of this could result in high homocysteine. Homocysteine is a toxic breakdown product of the essential amino acid methionine. Stress

Before diving in, consult QuantitativeMedicine.net for the latest list (and pricing). Enter “Blood Test Panels” in the search box. The availability and usefulness of the various tests are moving targets. Several important tests are no longer available. The reasons for this are unknown, but almost surely financial. We hope they return, along with some useful new ones. Good

Lp(a). Already mentioned, Lp(a) is a lipoprotein (cholesterol) variant that increases heart risk. About 10% of the population is at risk. See the “Is Your Lp(a) High?” section in chapter 9 for details. APO-E4. Apolipoproteins are a family of proteins that coat LDL, HDL, and chylomicron particles in order to make them water soluble. The APO-E4 subtype is a strong risk factor for Alzheimer’s. See “Do You Have the APO-E4 Variant?” in chapter 9 for details. Again, the best way to fight it, indeed, the only way, is through heart-healthy practices, and knowledge of its presence provides strong motivation. Normally this test is ordered after it is too late. Caught early, the risk can be substantially reduced. TTG and Gliadin Antibodies - Gluten Intolerance. Gluten intolerance is a severe reaction to gluten, found primarily in wheat. In the extreme, it is called celiac disease. Some cannot digest wheat at all. The solution is simple though: cut out wheat and other glutens. See “Are You Gluten Intolerant?” in chapter 9 for details.

Tests Done Once and in Response to a Specific Symptom Some tests should be done once and also if a problem is suspected: MTHFR. A persistently high level of homocysteine, a frequently measured blood marker, could indicate an MTHFR deficiency. See “Do You Have MTHFR Deficiency?” in chapter 8 for details. H. pylori is a stomach bacteria and a nasty one. It causes stomach cancer, ulcers, and other serious problems. It is fairly common in the west, but endemic in much of the developing world. It should be treated with antibiotics. It is a tough bacteria, and several courses of antibiotics could be needed. Normal practice is to treat it when a symptom develops. It’s better to be preemptive. H. pylori should be tested once, and retested again after any trips to countries having a strong prevalence. Re-test for this if living in Asia, visiting, or experiencing chronic stomach distress.

Test Tumor Markers Twice a Year There are many tests available that could indicate cancer, and indicate it at a stage early enough for effective treatment. These are PSA, for the prostate, and CA-125 for ovarian cancer. If CA-125 is above 20 u/ml, see your gynecologist. For PSA, trend is important, meaning more than one measurement is needed. If PSA rises more than 0.6 ng/ml in a 12 month period or less, see a urologist. If PSA is over 3, a urologist should also be consulted.

Three other tests are out there which will perform a Pattern A/Pattern B analysis: Ion Mobility, NMR, and VAP. We prefer them in that order. If your triglycerides are below 100 mg/dl, you are highly likely to be Pattern A, and it is a near certainty if triglycerides are below 75. High Lipoprotein(a), also designated

The cause of these tiny LDL particles is high triglycerides. High triglycerides and tiny particle size are in lockstep. This is solidly established. Now here’s the

Test Annually TSH - indicator of thyroid function Test Every Six Months PSA (men) - indicator for prostate cancer CA-125 (women) - indicator for ovarian cancer

The Sugar Management Group This includes fasting glucose, A1C (average glucose), and insulin. These

Lipids (fats) of interest here are HDL, triglycerides, and Lp(a). Lp(a) need be measured only once. HDL and triglycerides are measured quarterly.

Ideally, triglycerides should be below 100. In Dr. Mike's cohort, 292

LDL particle size varies. A predominance of larger ones is called Pattern A, and is a major key to heart health. Pattern B means that primarily smaller LDL particles are present, and this is undesirable.

Almost everyone will flip to Pattern A if they can reduce and maintain their triglycerides to a level lower than 100 mg/dl.

reason not to aim for a lower number, 100 say, or even 75.

Three other tests are out there which will perform a Pattern A/Pattern B analysis: Ion Mobility, NMR, and VAP. We prefer them in that order. If your triglycerides are below 100 mg/dl, you are highly likely to be Pattern A, and it is a near certainty if triglycerides are below 75. High Lipoprotein(a), also

Specifically, it accelerates cell turnover and growth. Its normal level in childhood is around 100 ng/ml. With the onset of puberty it soars to 1000 or more, attesting to its potency. Most readers will have had some experience with this. IGF-1 then drops to around 200 in adulthood, gradually declining to maybe 100 in old age. If you are exercising, your body will raise your IGF-1 level. This signals cells to repair, grow, and divide. This is anabolism, the building of new body parts.

IGF-1 and testosterone should be measured quarterly.

Microvascular health would not show up on a scan, but there is an interesting blood number we can use: creatinine. Creatinine is naturally produced bodily junk and one of the kidney’s tasks is to get rid of it.

Now the microvascular health of the kidneys is going to be very similar to the microvascular health everywhere else. So this one measurement is going to give us the big picture—microvascularly speaking. A creatinine level at or above about 1.2 mg/dl is bad.

Anything over 1.0 is a red flag. However, high creatinine levels are reversible. With appropriate exercise, the level can be moved from the danger zone, 1.2, to a very healthy level, 0.9 or even lower. Measure creatinine quarterly.

The liver numbers are AST, ALT, bilirubin, and GGT. They should be within the normal ranges, which

There are several sorts of scans, but the one of interest here is the CT (Computed Tomography) or “cat” scan. The CT with the lowest exposure is called EBT (Electron Beam Tomography). The exposure is very moderate and will not likely be a problem. All these machine work by rapidly spinning an x-ray around you. The EBT accomplishes this by moving the x-ray beam electronically, which is inherently much faster than moving it mechanically, as is done in a normal “cat” scan.

Try to find an EBT machine or one of the newer 256 or 320 slice machines.

We recommend a full-body scan with a virtual colonoscopy, even if you are under 50.

The full-body scan will reveal these: Amount of heart calcium—the best non-invasive measurement of atherosclerosis. Bone density—how far are you from osteoporosis? 
 Colon problems—any early signs of colon cancer. Thoracic or abdominal aneurisms—these can be fatal and ~4% of people over 65 have one. Cancers or pre-cancerous condition in various organs—includes lungs, liver, gall bladder, spleen, kidneys, adrenal glands, etc.

A typical 40-year-old will have a bone density of 175 mg/cc. These are strong bones, hard to break and quick to heal if they do. With age, there is about a 2% loss per year. This adds up. By seventy, other things being equal, the density will have sagged to around 105, with is the “fracture threshold.

Adult onset diabetes will be reversed and cured. Alzheimer’s will be slowed, and in the early stages even partially reversed. Atherosclerosis will be halted, and slowly reversed. Cancer in principle will be slowed, but if a tumor has resulted, it must be treated. Future cancer risk and risk of recurrence of a treated cancer will both be reduced. Osteoporosis can be stopped and reversed. Loss of stature will, in some cases, reverse also. Osteoarthritis can be reversed in some cases. Aging will noticeably slow.

Here is the standard replacement schedule: Cell Type Turnover Time Small and Large Intestine 4 days Skin 2-3 weeks Mitochondria 3 weeks Red Blood Cells 4 months Stomach 7 days Pancreas 40 days Bone 3 years Fat Cells 8 years Heart Muscle 50 years Lens Never Neurons Never Tattoos Never

These are known as white blood cells or leukocytes, and come in over a dozen different types. They are all daughters or granddaughters of a single stem cell type: Hematopoietic Stem Cell, or HSC.

Engulfers are called phagocytes (cell eaters). There are three subtypes here. A large one that can engulf a lot of bacteria (macrophage), a smaller, very mobile one (neutrophil) that tends to be a first responder, and finally, in mammals, a marker one (dendritic cell) that identifies the pathogen. The poisoners are called basophils and eosinophils. Basophils are responsible for allergic reactions. Eosinophils specialize in bacteria, and carry toxins that will destroy them.

As you can easily imagine, out-of-control immune cells could be highly dangerous. For this reason, there is a coordinated chemical communication system. These chemicals, which are secreted and detected, are called interleukins, so named because the white cells themselves are called leukocytes. There are a couple of dozen interleukins with a variety of functions: some are generated by cells needing help, and others are generated by the white blood cells themselves.

The types and levels of the circulating interleukins provide a good overview of any infectious battles that may be going on.

Mitochondrial degradation and damage to stem cells probably account for 95% of degenerative disease.

This happened about 500 million years ago. In due course, hagfish became fish, and the rest, as they say, is history.

The spleen appears to be a warehouse for immune system cells, and the thymus actively generates a type of adaptive immune system cells and gives them their name: T-cells.

HUNTER-GATHERER BLOOD TEST NUMBERS There is some such data available today for the few remaining tribes. How the data was obtained would be an interesting story in and of itself. In any case, the numbers are almost always pristine even if the specific lifestyles are varied and rugged. Here are some various measurements obtained from a variety of tribes. Measurement Ideal value Americans aged 55 Typical hunter-gatherer value Blood pressure 110/70 145/85 110/70 Total cholesterol 150 215 125-158 mg/dl Triglycerides 70 110 73 mg/dl Glucose 75 103 72 mg/dl

Likewise, a high level of C-reactive protein could be the result of atherosclerosis or due to other factors.

Reversing Atherosclerosis - Exercise, HDL, and HDL2b The other side of the equation consists of increasing the amount of HDL and maximizing the percentage of “mature” cholesterol, also called HDL2b.

Exercise should have these attributes to be effective: Varying the heart rate up to its (safe) maximum and back. Explosive, a sudden burst of activity. Concentric, meaning muscle should be shortening.

Overall HDL level is controlled by the hypothalamus, and if the exercise is concentric and explosive, the HDL level will be increased, along with numerous other healing and repair functions.

predominance of large LDL particles will reduce cardiac events two to threefold. But how can LDL size be controlled? This is quite easy, but the reason it works is rather counterintuitive. LDL particle size tracks inversely with triglycerides. High triglycerides (circulating fat) means small particles and vice versa. This is an important relationship. More in a bit.

Predominance of the larger size is called Pattern A. The necessary triglyceride reduction needed to achieve this pattern varies, but the threshold tends to be somewhere near 100 mg/dl.

Unless otherwise advised by a doctor, this is all-out effort. The 20 to 30-second surge should be repeated 5 times, with perhaps a 10 or 15-second rest in between.

The best non-invasive measurement is the cardiac calcium scoring done in a full-body scan. This measures the amount of calcified material, which in turn gives an accurate assessment of the underlying atherosclerotic load. A measurement of the calcified area is computed. It is known as the Agatston score. A score of 0 means no calcium, and therefore a light atherosclerotic load. A typical 60-year-old man or 70-year-old woman might have a score of 30, which is not a particularly high value, though it could be quite a lot higher. In the absence of exercise and dietary control, the Agatston score will double every two or three years, indicating significant buildup. The score is soon into the hundreds and can go on up into the thousands.

If your fasting insulin level is below 3, and you are not hypoglycemic, your Personal Sugar Rule is “Eat More Fruit and Starch.” Low insulin prevents the building of new muscle and bone. However, avoid junk. Eat healthy sugar and starch, such as northern fruits (berries, apples, etc.) and potatoes. A daily amount that seems reasonable should be chosen, and glucose and insulin re-measured after a month or so. If you got an “A” in Sugar (insulin is between 3 and 6 µu/dl and fasting glucose below 80 mg/dl), then it is OK to continue eating the amount of sugar, starch, and fruit currently being consumed. The Personal Sugar Rule is “Hold the Line.” However, low quality food, like cereal, should be swapped out for food richer in micronutrients, like northern fruits or potatoes. Breakfast cereals have little in the way of micronutrients beyond what the manufacturer added for “fortification.” If you got a “B” (insulin is between 6 and 12, and fasting glucose below 90) , then a reduction in sugar, starch, and fruit is called for. The Personal Sugar Rule here is “Reduce the Fruit, Sugar, and Starch.” If you got a “C” (insulin is over 12 or fasting glucose is over 90, all sugar, starch, and fruit should be cut. The Personal Sugar Rule is “Fruit, Sugar, and Starch Are Forbidden.” This is a pre-diabetic condition, or worse. If these have already been cut and the numbers are still high, then more meat should be added and vegetables cut further. Dietary fat, including saturated fat, is ad libitum—all you want.

JACKIE ONASSIS HAD a dinner party to welcome Jane and me to New York. Guests included William Styron and his wife, Rose—they were Martha’s Vineyard regulars with Jackie; Pete Hamill, the Daily News columnist; and Annabel and Mike Nichols.

And then Dustin Hoffman just blasted open the door for actors. Dustin was a student of Lee Strasberg’s at the Actors Studio when I started to hear about him. You would pick up on other students discussing him with a strange reverence, like he was a ghost or a wanted criminal. There was such energy around his name you had to see him for yourself, to see if he lived up to his formidable reputation. And then Mike Nichols got hold of him, all of him, for The Graduate. The Graduate was contemporary and of the moment, a commentary on the world we were living in, and it fit him perfectly. It came along at the right time, right when we were ready for it. And its success made Dustin a movie star supreme. I was working up in Boston when The Graduate opened, and I said, this is it, man—it’s over. He’s broken the sound barrier. The excitement for me was in seeing an artist doing something so well, something original, that you recognized had never been done before.

MIKE NICHOLS: There are many funny stories about making The Day of the Dolphin. And I won’t tell any of them.

Did he or did he not feel that he burned something out when he wrote it? I think whoever wrote Salesman something would’ve burned out because its so close to the target, its so… alive.

The story of an alienated young man cosseted by privilege, smothered by the comforts that surround him, and determined to listen to himself had come to feel personal in a way he had never imagined.

Well you improvise with some people better than with others… [Mike Nicholls and I] had the same kind of playfulness. We enjoy the same kind of pretend. As kids do. You know. If he had come and said: ‘I’m a doctor, are you sick?’ I would have said, if I was kid: ‘I don’t feel good’. Because I wouldn’t have said: ‘Whaddya mean?’ I would have known what he was doing. We were very childish for our age.

A Place in the Sun

A typical 40-year-old will have a bone density of 175 mg/cc.

The Anabolic Group Score For men, score an “A” if your IGF-1 is in the range 150 ng/ml ± 20 (higher is dangerous), total testosterone is above 500 ng/dl, and HDL is above 65 mg/dl. Score a “B” if your IGF-1 is above 125 ng/ml and HDL is above 45 mg/dl. Otherwise a “C.

Did you get a VO2Max? They are a bit hard to come by, but tend to cost under $100. They can also be estimated using your two-kilometer rowing time on a Concept 2 rower. Though not as good, these machines are at least widely available, being found in most gyms. VO2Max measures your ability to huff and puff. It’s the maximum rate you can use oxygen. The higher the healthier, and it is a great exercise marker because many things must be operating well to get a good score. If your exercise is effective, your VO2Max will climb. This is a good way to monitor your overall progress.

The quarterly blood panel measures ALT, AST, bilirubin, and GGT. All of these should be in their proper ranges.

Bones If you got a scan and measured bone density, a number greater than 135 gm/cm2 means your osteoporosis risk is low—for now. Other things being equal, you will lose bone density at 2% per year. A person with a density of 135 gm/cm2 will be at the “fracture threshold” in about 15 years. This is where bones start to crush in, height is lost, and the back may start to hunch over. Calcium supplementation may slow this, but increase the risk of heart attack, so this is not recommended. However, safe prevention is quite simple. Proper load-bearing exercises, such as squats and deadlifts, will not only stem the loss of bone but will reverse it. New bone will be built. These lifting sorts of exercises are described in the EXERCISE section coming up.

The way to trigger weight loss is to make dietary changes that will force your fasting insulin to a level between 3 and 6 µu/dl.

Getting triglycerides below 75 will almost always increase the size of the LDL particles to Pattern A, and thus

Pattern A and B are called lipid subfractions. Unfortunately, this test isn’t standardized and there are three competing methods: Ion Mobility (IM), Nuclear Magnetic Resonance (NMR), and Vertical Auto Profile (VAP). We prefer them in that order. They don’t yield identical results, but are close.

The lipid group works somewhat differently. Triglycerides, as we just saw, move rather quickly. The HDL and LDL numbers depend on both diet and exercise, and take longer to change, perhaps six months, but possibly as little as three. The anabolic group is mainly responsive to exercise and should show a lot of improvement within six months.

HDL is amazing. If you do whatever it takes to get your HDL level up and functional (no drugs allowed here), you probably won’t get sick. It is about as close as the body comes to having a molecular fairy godmother that can fix everything. It alone is that powerful. HDL is built

The preferred method is to find a facility that directly measures VO2Max. They are a bit rare, but some are not too pricey, maybe around $150. Usually EKG and blood pressure are simultaneously measured. The test is normally done on a treadmill. This measurement represents extreme conditions, and a medical consultation beforehand is recommended.

program doesn’t seem to be working, see a specialist, or visit the website (QuantitativeMedicine.net) and see if there is additional information there. Most barriers can be overcome.

Let’s Get Started The knees are usually everyone’s weak link, so start by seeing how far you can squat. Ideally you can get your fanny almost all the way to the floor with no pain, like our young lady here (actually, she’s 95). If you can squat this deeply and come back up with no pain, you can probably skip the rest of this section. Just remember to frequently run your joint under full range of motion, while employing some mild weight or resistance.

Squats. Squats are an ideal whole-body exercise. Go down slowly into the squat, and then explosively push up hard with your legs. The upward movement is concentric because muscles are shortening while working, the exercise is multi-planar, involving a complex series of motions, and is closed-chain, due to the sequence of neural-muscular activity and balance required. The explosive start and the whole body involvement are crucial elements. Form is important.

Vitamin B6, folic acid, magnesium, and zinc increased mortality 3-6%

Your Anabolic Score Score 2 points if your IGF-1 is in the range 130 to 170 ng/ml (higher is dangerous) or else score 1 if in the range 100 to 130. If your total testosterone in ng/dl is greater than 500 (men) or 20 (women), score a point. If your HDL is greater than 65 mg/dl for males, or 75 mg/dl for females, score 2 points, and score 1 point if HDL is below that, but above 55 mg/dl for males or 65 mg/dl for females. A total of 3 is good. 4 is superb, and 5 is Olympic material. These are exercise numbers. If you want to improve them, consider increasing the intensity of your exercise rather than the duration. Keeping the score high will promote cellular health, retard aging, and stave off degenerative disease.

Score 1 for each one of these you meet. The top score, 5, is great, and 4 is good too. A score of 0, 1, or 2 indicates a need for improvement. Add your two scores together. You could be a perfect 10—perfectly aligned and anabolic. For most people this is achievable, though it would take some dedication and discipline. The reward for doing so is a long disease-free life. Most sensible and active 25-year-olds and most hunter-gatherers of any age would score a 9 or a 10. Any combined score below 5 should sound an alarm. Above 6 is quite good. An average 55-year-old American would probably come in between 4 and 6. Someone with adult onset diabetes would likely score below 3. Suppose the homeostatic score is good,

Niacin raises HDL—the famous “good” cholesterol—and lowers triglycerides as well. However, niacin doesn’t reduce all-cause mortality. In fact, it increases it. This is certainly an unwelcome surprise.

THE SUGAR MANAGEMENT GROUP SUMMARY SUGAR MANAGEMENT GROUP MEASURES Ability of body to metabolize sugars and starches SCORING Special Case 1 - Insulin less than 3 µu/dl - See “Hypoglycemia” Special Case 2 - Insulin less than 3 µu/dl- See “Are You Too Thin?” “A” - Fasting glucose below 80 mg/dl, A1C below 5%, Insulin between 3 and 6 µu/dl “B” - Fasting glucose below 90 mg/dl, A1C below 5.5%, insulin below 12 µu/dl “C” - Anything else RISKS “A” - Healthy “B” - Slight insulin resistance - early warning for adult onset diabetes “C” - Insulin resistant - significant risk of adult onset diabetes. REMEDIES “A” - No changes needed “B” - Cut some sugar and starch “C” - Cut all sugar and starch, or as much as you can tolerate. TIMING Results should be apparent in 3 months, retest at that time.

How is your sugar management? You get an “A” if fasting glucose is below 80 mg/dl, A1C is less than 5%, and insulin is between 3 and 6 µu/dl. Fasting means 12 to 14 hours after your last meal.

THE LIPID MANAGEMENT GROUP SUMMARY LIPID MANAGEMENT GROUP MEASURES How the body is dealing with fat and cholesterol SCORING Special case - Lp(a) greater than 30 mg/dl - see “Is Your Lp(a) High?” “A” - Triglycerides below 100 mg/dl and HDL above 65 (men)/ 75(women) “B” - Triglycerides below 150 mg/dl and HDL above 55 (men)/ 65(women) “C” - Anything else RISKS “A” - Healthy “B” - Atherosclerosis is developing “C” - Significant heart disease risk. Rapid plaque development. REMEDIES “A” - No changes needed “B” or “C” - High triglycerides indicates a need to cut starches and sugars. HDL should respond to higher intensity exercise. TIMING Result should be apparent in 3 to 6 months, retest at those times.

Lipoproteins come in five species: VLDL, ILDL, LDL, HDL, and chylomicrons. The first four, from large to small, stand for Very Low, Intermediate, Low, and High Density Lipoprotein. All these originate in the liver. The odd one, the chylomicron, is constructed by the intestines while digesting a meal, and released directly into the bloodstream. As blood tests are performed after a 12 to 14-hour fast, almost all the chylomicrons are gone. Its life story is much like VLDL, but without the cholesterol.

They circulate around the body, pick up all sorts of junk, and swell up into “mature” HDL particles (also termed HDL2b), at which point the liver takes them out of service and recycles them.