As promised I’m posting results of the n=1 experiment wrt. lipid medication. No changes in diet or exercise or other lifestyle factors, sleep, level of stress insofar as I can tell (low), supplements. One change in medication: went from empagliflozin 12.5mg/day to 25mg/day and an additional change - sirolimus: same dose 6mg/1-week, but this time it was only 3 weeks of the Zydus brand vs 11+ weeks of the Eris brand, and the Zydus came after a 7 week break from rapa.
Pitavastatin 4mg/day alone vs pitavastatin 4mg/day + bempedoic acid 180mg/day.
Pita alone - 5 months; Pita + BA - 39 days.
Legend: Pita alone - PA; Pita + BA - P+BA.
Total Cholesterol: PA - 228 mg/dL ; P+BA - 208 mg/dL
LDL-C Calc: PA - 123 ; P+BA 110
Trig: PA - 93 mg/dL ; P+BA - 62 mg/dL
HDL: PA - 89 ; P+BA - 87
However, several biomarkers went in the wrong direction, some to a worrying degree (worst I ever had!), and a couple went in a better direction. Short of it: better direction - glucose and insulin (I didn’t do HbA1c because it had not been 3 months since my last test). Worse direction: hsCRP, homocystein, RDW, neutrophils, lymphs, sodium, chloride, and so on. Current is P+BA and previous is PA.
hsCRP: PA - 0.25 mg/L ; P+BA - 0.57 mg/L
homocysteine: PA - 7 umol/L ; P+BA - 10.8 umol/L
uric acid: PA - 3.0 mg/dL ; P+BA - 3.4 mg/dL
insulin: PA - 14.2 uIU/mL ; P+BA 8.6 uIU/mL
sirolimus: PA - 5.6 ng/mL ; P+BA - 4.4 ng/mL [note: both tests were performed 49-51 hours after last dose of rapamycin, taken on an empty stomach, same protocol]
So I don’t know what to make of this. Lipids in general seem to be going in a better direction, but not by a ton on the addition of BA, liver enzymes also largely better, and the uric acid went up by 0.4 from 3.0 to 3.4. So the liver, uric acid seem to be OK with BA. Meanwhile why has my hsCRP rocketed from 0.25 to 0.57 - the highest I’ve ever had my hsCRP measured was 0.4 - so 0.57 is shocking, but BA is supposed to lower the hsCRP, so who knows. My RDW went from a nice 11.8 to a catastrophic 13.4 - insane, I’ve never had it so high, ever, worst was like 12.x something. The glucose I also don’t know what to make of, because the only change was going from 12.5mg/day to 25mg/day of empagliflozin which seems a rather dramatic change for such an insignificant factor as a doubling of empagliflozin, which is not a result I’d expect based on the empagliflozin literature; also, the 12.5mg/day dose was measured in the PA test after 4 months, whereas the BA test with the 25mg/day was after 39 days on that dose. Plus the insulin went way lower, and empagliflozin is not an insulin sensitizer. The sodium and chloride is worrisome, but perhaps I was somewhat dehydrated as I had no food or liquids for 18 hours, but my blood tests are all taken at least 14 hours of fasting with no liquids - FWIW, I don’t add salt to my food, don’t eat much in the way of processed food, and empagliflozin is not supposed to retain sodium if anything the opposite. So who knows.
The sirolimus is interesting insofar as there are two factors here. No change in the dosing protocol, but first, the PA test was with Eris BioCon, whereas the P+BA was with the Zydus brand; second, the Eris was after 11 weeks, wheras the Zydus was after a 7 week break from rapamycin (due to surgery) and after 3 weeks of taking Zydus. Also a rather dramatic difference, going from 5.6 to 4.4. Possibly, rapamycin accumulates with time for me, or perhaps some other reason. I am going back to the Eris/BioCon brand at the same dose protocol and will retest the sirolimus, though not the next test as I wan to first test my sirolimus level on the last day before the next dose, to see what my lowest level is before the next dose 24 hours later. But then in the test after that test, I’ll go back to testing the 50 hour level, at which point it should again be 11 weeks of the Eris/BioCon brand so we’ll see if it’s something random in my body or a consistent effect.
The bottom line in all of this, is that you should test often - because your test results might be a one off, and you don’t want to make big interventions based on unreliable one off results. This is why I’m testing repeatedly, even though it’s $500+ every time with so many tests. I figure after 8-10 of these, I’ll have more reliable results… although if spread over a year, I must account for the effect of becoming increasingly older 
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Next test will be pitavastatin 4mg/day + ezetimibe 10mg/day. This time I’ll be on the ezetimibe for 50 days, so a little longer, to give my body a chance to wash out the BA. I’ll post the results again - I’ll be testing in early August.
