George, exactly!! I discussed him with the top lipidologist this morning. He thinks its most likely multifactorial but primarily insulin resistance and excess dietary sugars/fructose driven. He doesn't think checking apoe2 will add any value: even if he is apoe2 it won't change the following:
2 weeks zero sugar, I've even banned fruit for 2 weeks (lol the start of a lifetime of zero added sugar), zero starchy carbs, moderate lean protein, predominantly non starchy veggies. Zero alcohol.
Then we'll see what he can go down to. Sadly he may need metformin for his insulin resistance and possibly a statin cos this is nasty nasty. But I'll be cautious and see what he can do with lifestyle.
Thanks for the electrolyte tip. I'll call him now, he's gonna have some massive shifts.
Btw Julie our practice's record for TGs is 85. Thats about 80 thousand in your units. Insulin resistance, obese, sedentary 40yr old woman on an atypical anti psychotic.