Cholesterol

[Yppej]

I never paid attention to this, since it was always good, but today got borderline high on my bad cholesterol - 145 LDL with protective HDL at 71.3.

What are your numbers?

I attribute this to my new keto diet which I will be tweaking towards more olives, nuts including coconut and avocadoes and less lacto ovo. I think the 2 eggs a day and real butter on my butternut squash are probably the culprits since I don't eat meat.

[SteveinMN]

I'll find out my numbers tomorrow (first physical since going LCHF). But I'm prepared for a skirmish with my PCP, who wanted to write me an Rx for a statin three months ago.

In my research on various forums concerning diabetes and statin use, I took the following notes. They're text strings I've found on the Internet from sources I believe I can trust (IOW no interpretation on my part).


If your doctor orders a lipid profile without a type A LDL, tell him NO. Better to be considered a difficult patient than to have “hyperlipodemia ” as a permanent diagnoses on your chart. New studies show that you will live longer with high cholesterol than with low, and artificially lowered cholesterol is a free pass to living the rest of your life going to doctors. If your doctor ask what type A LDL is, or why would you want that test, you need to find a new doctor.


You should NOT put much stake in total cholesterol!

The key numbers are Cholesterol:HDL ratio (ideally below 3.5:1) and, perhaps more importantly, Triglyceride:HDL ratio (less than 2 is ideal) since this is predictive of LDL pattern subtypes. This is reflected in the current literature and isn’t at all controversial (except with doctors who don’t keep up with the literature).

In my case, the ratios were 3.3 and less than 1 on a primal diet with lots of saturated fat. Fortunately, my doctor was all on board – especially once I told him my mile time, bench and leg press weights. Then he was asking for details about the diet and training program!

If you can get a more sophisticated blood test, you’ll want to look at LDL pattern A (large, fluffy LDL) and LDL pattern B (small, dense LDL – this is the key risk for [cardiovascular disease]).

Apparently pattern A cholesterol particles are less likely to be involved in creating plaques in blood vessels. I've also read that LCHF can take up to a year before the cholesterol starts moving from pattern B particles to pattern A particles. I'll post again tomorrow once I know more.

[ApatheticNoMore]

Could be menopause etc. though certainly I would try experimenting with diet and see what effect it has, would hardly panic and wouldn't be totally blase, personally I'd try to avoid statins. I usually have good numbers due to high good cholesterol, but I don't go to the doctor every year etc. so ... I'm kind of negligent about getting tested for everything all the time.

[Yppej]

Thank you both. They are not recommending any type of medication because my HDL is at a protective level. I never never heard about types A and B. Good to know.

[JaneV2.0]

A ketogenic diet can cause a temporary uptick in Cholesterol levels. If you're concerned, or want to game the system, try the Feldman approach:
http://cholesterolcode.com/extreme-cholesterol-drop-experiment/

The last time I had my cholesterol tested (1994?), the total was 175, which I consider low (correlated as low levels are with cancer and depression)--although I'm not really concerned with the number--as I consider it mostly meaningless--I'd want my triglyceride and CRP levels as low as possible.

Keto works best with a healthy amount of saturated fat.

[Rogar]

Yppej, My "bad" cholesterol is a little better than yours, and my good, protective, is slightly worse. About 18 months ago my cholesterol was worse and my doctor was hinting at statins. I eliminated most dairy and meat from my diet and both numbers have improved about 15%. I think I technically still fall into the borderline high region, but my other major health indicators are good and the statin issue has not come up again. Do you exercise a lot?

My take is that there is mainstream cholesterol theory, but it is not quite for certain. I'd have to dig into the science more before taking a statin.

[Williamsmith]

Thanks to pharmaceutical companies advertising and drug pushing.....I have become quite cynical about the need for all these chemical “fixes”. Is here any evidence that all these pills are making us healthier?

[JaneV2.0]

Thanks to pharmaceutical companies advertising and drug pushing.....I have become quite cynical about the need for all these chemical “fixes”. Is here any evidence that all these pills are making us healthier?

I've read that statins might buy you a week or two--probably a week with dementia, rhabdomyolysis, diabetes, depression...
Oops--overly optimistic: https://drmalcolmkendrick.org/2015/10/27/how-much-longer-will-you-live-if-you-take-a-statin/

[Teacher Terry]

i will never take a statin.

[catherine]

Thanks to pharmaceutical companies advertising and drug pushing.....I have become quite cynical about the need for all these chemical “fixes”. Is here any evidence that all these pills are making us healthier?

I have been to presentations where doctors have touted statins as a wonder drug, with benefits that go beyond cholesterol-lowering. That was back when Lipitor first came out. My doctor swears by them, and says he tells his parents to take them. I've got really high HDL and borderline LDL, so the HDL pushes my cholesterol up, but most of it is HDL, so I'm not that concerned. He hasn't convinced me to get on the statin bandwagon yet.

[rosarugosa]

My total cholesterol is high at 222, but all the underlying numbers are good, so I'm, not worried and my MD says he isn't either. This doesn't really make any sense to me, but as a famous philosopher said "What Me Worry?"
Total - 222
LDL - 123
Triglycerides - 65
HDL - 86
Ratio - 2.6

[Yppej]

Do you exercise a lot?

I walk 20 minutes several times per week and do yardwork.

My mother was on Lipitor but able to get off it by modifying her diet.

Today I didn't have any coffee at work as that tempts me to have half and half.

I am not worried about gaming tests. It's a free country and no one can force me to take a medicine I don't want to.

[frugal-one]

Thanks to pharmaceutical companies advertising and drug pushing.....I have become quite cynical about the need for all these chemical “fixes”. Is here any evidence that all these pills are making us healthier?

I was told by my doctor that I needed to take statins to lower my cholesterol. I asked this same question. What percentage of people are actually helped by statins. She sent me to the pharmacy and it was researched. I was told one study was found that 20% of people were helped and not had an "incident" and one study was found where 10% less people died. Not sure if I am wording this correctly. I did post this elsewhere on this forum but cannot locate the post now. It should be noted that the main problem with statins is that they deteriorate the muscles in your legs, some of the other side effects cancer, diabetes and cataracts. Other places I have checked say less than 1% of people are helped by statins. Either way .. the risk outweighs the reward IMO.

[Tammy]

It's a risk benefit analysis that has to be individualized to each person. My husband's cholesterol was over 400, so obviously the benefit is greater than the risk in his case .

[Rogar]

The first time my cholesterol was reported as borderline high, the office just called with the results and said, the doctor says to go on a low cholesterol diet. Now that some of diet science says dietary cholesterol doesn't necessarily translate to blood cholesterol levels I got a variety of answers from what ever reliable sources I could find. Then there's beneficial omega 3's, oatmeal, and my favorite, 1-2 alcoholic beverages per day. I know a guy who read a book that claimed high cholesterol was not even that big a health indicator. Personal opinion is that I think there is that medicine seems to rely mostly on diet and not enough on exercise and maintaining a proper weight. And some is just unavoidable genetics.

I guess my point is that it's not an exact science.

[Tybee]

The first time my cholesterol was reported as borderline high, the office just called with the results and said, the doctor says to go on a low cholesterol diet. Now that some of diet science says dietary cholesterol doesn't necessarily translate to blood cholesterol levels I got a variety of answers from what ever reliable sources I could find. Then there's beneficial omega 3's, oatmeal, and my favorite, 1-2 alcoholic beverages per day. I know a guy who read a book that claimed high cholesterol was not even that big a health indicator. Personal opinion is that I think there is that medicine seems to rely mostly on diet and not enough on exercise and maintaining a proper weight. And some is just unavoidable genetics.

I guess my point is that it's not an exact science.

I have high cholesterol after menopause--was nice and low before and if I started drinking 1-2 alcoholic drinks a day I would be an alcoholic really quickly. So that would present other, more challenging health problems.
Have not agreed to take statins either.
My mom has had high cholesterol since menopause and is now 91, so screw it, is my attitude.

[Williamsmith]

Just saw the doctor yesterday. Not worried about my cholesterol levels. The side effects of statins are muscle pain, increase risk of type 2 diabetes, neurological and liver complications. I hope I don’t ever have to make that decision. I’m thinking hell no.

[Teacher Terry]

My friend's grandma had cholesterol of 350 most of her adult life and was fine until she died around 90. They also have a serious impact on your memory. Statins are just a money maker for RX companies. Too bad many doctors have bought into this. If they were ever prescribed I would not fill them.

[JaneV2.0]

I've done my research, and I think they're snake oil. I'm amazed and appalled at how over-medicated people are. Good old capitalism, I guess. Advertising and coercion. We're not as free as we'd like to think.

[SteveinMN]

Back from seeing the doctor on Wednesday. I don't have cholesterol test results yet, but nothing else seemed amiss and my A1c came in at 5.8. :cool: No discussion of statins or metformin.

I did tell the doctor that my low-carb/high fat way of eating included a fair amount of saturated fat (though not as much as I'm "supposed" to be eating; I've lost 10 pounds since June). So I was a little concerned that the standard lipid panel might come back high; if it does, we've agreed to do a "pattern A/pattern B" test. I'll update this thread once I see the cholesterol test results.

[Williamsmith]

Don’t get me wrong, I think modern medicine in it’s most basic form and most researched treatments are wonderful. It’s saved my mother’s life several times over. But I see most of this work done by specialists. The general practitioner seems to have gone through a metamorphosis over my life time. And I think that change has been largely brought on by the drug industry. So when I hear accounts of older people having repeated testing to screen for this deficiency or that condition with an eye toward establishing a regular prescription to bring the number to an “acceptable” level, I get cautious. That caution is born out of the over prescription of practically every drug available. Now if I could look around and see that all this ingestion of chemicals has made our population healthier than other developed countries....I’d think, wow the marvel of the pill bottle. But I don’t see it. In fact, what I see is that the same business models that sell us processed foods to make us sick also sell us medicine to make us well again. Does that seem irrational?

[Rogar]

I suppose most people these days follow up their doctors recommendations with some sort of internet research. My go to site for what I consider mainstream medicine is the Mayo Clinic site. They have a fairly practical evaluation of statin risks and benefits. They claim that not everyone has the side effects and those that do can try alternates. It's sometimes a choice people have to make and I wouldn't totally discount what mainstream medicine has to say just because the pharmaceutical companies are pushing their products. I'd make every reasonable effort to avoid statins, though.

[SteveinMN]

In fact, what I see is that the same business models that sell us processed foods to make us sick also sell us medicine to make us well again. Does that seem irrational?
What's irrational? The business model? Or your perception of its existence? If it's the latter, I'd say no, it isn't irrational.

In general I am not a conspiracy theorist. But I see (time and again) evidence that the American model of medicine is not serving anyone except insurance companies and the makers of pharmaceuticals and related items. For example, the American Diabetes Association's guidelines for "blood sugar control" is a reading of 180 mg/dL two hours after eating -- even though pretty much any endocrinologist not associated with the ADA would say that a reading above 140 mg/dL by then would cause damage to the body. Yes, the entire home blood-glucose measuring process introduces some error. But you'd think then the ADA would be aiming for control levels even below 140 mg/dL to address that measurement error. After all, that's the same "concern" for a safety margin that had my PCP recommending that I take a statin for cholesterol numbers that (it turns out) were only borderline (under) for health issues (it's "protocol").

Both recommendations turn into long-term and (frequently) expensive courses of treatment and are ridden with side effects which require further spending. The cynic in me says it keeps the economy going. And that the ever-increasing profit motive is a huge obstacle to ever reforming the American health care system into one where outcomes align with what we spend for them.

[Williamsmith]

What's irrational? The business model? Or your perception of its existence? If it's the latter, I'd say no, it isn't irrational.

In general I am not a conspiracy theorist. But I see (time and again) evidence that the American model of medicine is not serving anyone except insurance companies and the makers of pharmaceuticals and related items. For example, the American Diabetes Association's guidelines for "blood sugar control" is a reading of 180 mg/dL two hours after eating -- even though pretty much any endocrinologist not associated with the ADA would say that a reading above 140 mg/dL by then would cause damage to the body. Yes, the entire home blood-glucose measuring process introduces some error. But you'd think then the ADA would be aiming for control levels even below 140 mg/dL to address that measurement error. After all, that's the same "concern" for a safety margin that had my PCP recommending that I take a statin for cholesterol numbers that (it turns out) were only borderline (under) for health issues (it's "protocol").

Both recommendations turn into long-term and (frequently) expensive courses of treatment and are ridden with side effects which require further spending. The cynic in me says it keeps the economy going. And that the ever-increasing profit motive is a huge obstacle to ever reforming the American health care system into one where outcomes align with what we spend for them.

It makes me think of the economy as some meat grinder and I see these cut out representations of people being stuffed into the feed bin of the grinder. You know in a Monty Python cartoonish kinda way.

[Suzanne]

This may be of interest: https://www.marksdailyapple.com/why-did-my-cholesterol-go-up-after-going-primal/

[Suzanne]

My own numbers:
Total cholesterol: 217mg/dL
Triglycerides: 51mg/dL
HDL: 71 mg/dL
LDL: 136 mg/dL

All my ratios are excellent, whether TC:HDL, LDL:HDL, or Triglycerides:HDL.

The LDL:HDL ratio is apparently considered the best predictor of heart disease. The higher the ratio, the higher the risk. A ratio of 2.5 LDL:1HDL is regarded as excellent. As my ratio is 136/71 = 1.9:1, I'm not worried by my LDL reading being over the ideal of 100. I don't particularly believe in this ideal anyway!

I have low blood pressure, good fasting glucose, and excellent bone density. My waist:height and waist:hip ratios are good. I think the whole picture is more important than any single part.

Edited to add: I do low-carb, high-fat, about 80% of the time.

[Yppej]

My ratio is 2.03.

Trump's is 1.49 but he is on statins.

[Ultralight]

Is cholesterol good or bad at the moment?

[pinkytoe]

I had a free health screening at work right before I retired two years ago:
Total Chol: 221
LDL: 124
HDL: 72
Triglycerides: 123 mg
Blood pressure was 122/65 which they marked as pre-hypertensive.
I don't worry too much about numbers. My goal is to not take pharmaceuticals of any kind. (Ironic as my mother was a pharmacist; I think she hastened her own death by taking Premarin for years back in the day. It was touted as a miracle too much like statins are now).

[sweetana3]

I think I mentioned this before but my doctor tried to use her fancy computer program to "show" me I was hastening my death by not using statins. I have always had high cholesterol and NOW borderline high blood pressure but 20 points lower than when I was working. Well, her fancy program showed I have a normal less than 5% chance of death in the next 10 years and since I am 64, not unexpected. Popped her bubble.

I also pointed out that my heart scan ($49 at local hospital) showed ZERO plaque built up. I am with pinkytoe and am very resistant to any pharma (except for my amazing asthma medication which I need for breathing).

[rosarugosa]

Sweetana: Can I ask what your asthma medicine is? My mom has asthma and she takes Brio with good results.

[JaneV2.0]

...
I guess my point is that it's not an exact science.

I don't think it's science at all; it's about strong-arm marketing. Aside from the side effects mentioned above, it's my opinion that statin (and other Pharma drug) use is what's filling up dialysis centers. Kidney failure is a known side effect.

[sweetana3]

I take Advair daily and Alburterol for rescue needs. Tried to wean off and impossible. Probably have some serious allergies involved.

[rosarugosa]

Thanks, Sweetana. DH has untreated COPD and just uses a rescue inhaler. I'm pretty sure we need to get him on something else.

[frugal-one]

See that now the blood pressure numbers have been lowered so that more people will show high blood pressure, and therefore, HAVE to take more drugs. I agree. Marketing!

[sweetana3]

Rosa, the rescue inhaler puffs for me only last 2 hours exactly. The Advair is a 12 hour drug and for me it is a 24 hour drug (although when I told the MD she thought I was crazy). The only time I take it twice a day is when i have a cold or other illness. It is expensive!!! I have good insurance. I have very sensitive bronchial tubes or the little hairs inside as I describe them.

[Williamsmith]

Rosa, the rescue inhaler puffs for me only last 2 hours exactly. The Advair is a 12 hour drug and for me it is a 24 hour drug (although when I told the MD she thought I was crazy). The only time I take it twice a day is when i have a cold or other illness. It is expensive!!! I have good insurance. I have very sensitive bronchial tubes or the little hairs inside as I describe them.

Im afraid my old school doctor is very near retirement. I went through this before. Do you know how hard it is to track down a doctor who: 1. Actually does an examination and doesn’t send a Physicians Assistant to do the work? 2. Doesn’t carry a laptop into the exam room but instead writes illegible scribble into a yellow folder ( I prefer the scribble to be illegible ) and 3. Actually says I don’t think we need to do that test.

[Teacher Terry]

Sweetana, I do the same thing as you. I only use it once a day unless sick. I tried to go without but it did not work well for me.

[Tammy]

Seeetana - after 15 yeas on advair I saw an asthma allergy specialist and started getting allergy shots. It took three years or more, but I eventually was able to stop using all my asthma medication, except for when I get an upper respiratory infection. It's miraculous.

[SteveinMN]

Im afraid my old school doctor is very near retirement. I went through this before. Do you know how hard it is to track down a doctor who: 1. Actually does an examination and doesn’t send a Physicians Assistant to do the work? 2. Doesn’t carry a laptop into the exam room but instead writes illegible scribble into a yellow folder ( I prefer the scribble to be illegible ) and 3. Actually says I don’t think we need to do that test.
It probably is hard to find a doctor who can tick all three boxes. #2 is going to be the hardest because, like every other employed person, the doctor is being leaned on by his/her superiors to improve efficiency and by the clinic's legal staff to document the bejabbers out of everything. Medical transcriptionists cost money, so doctors enter their own records now, electronically. If you find someone old-school enough to scribble, they're likely taking their own free time to transcribe.

I've actually listed a PA as my "doctor" more than someone with an MD or DO after his/her name. The PA sees far more of me (literally!) than the doctor ever does, has more time to answer my questions, and (OK, luck of the draw here) has been far more approachable as far as letting self-management address health conditions and in going after tests I request. I get better care from a PA so I'm fine with 'em at my clinic.

[jp1]

I'm with Steve regarding PA's. Until last year I had not seen a doc since we moved to San Francisco in 2009, other than a specific non-life-threatening situation that obviously required a day surgery procedure during our first year here. A couple of issues prompted me to finally go for a physical 6 months ago. The PA spent a full hour with me taking a full medical history and discussing at length various concerns and potential issues that an old man of 50 should be thinking about. The blood work showed higher than ideal cholesterol and in our followup conversation he basically left it up to me to determine if/how I wanted to proceed on that front. Reading Steve's post about the ratios confirmed my thoughts on the subject at the time (no statins unless absolutely necessary) and I will be rejecting any efforts to put me on statins, but may ask for more tests next time of my pattern A and pattern B LDL. After that conversation I came to realize that that one issue (statins) was one of the main things that kept me out of doctors' offices for 8 years.

The issue which ultimately pushed me to see the PA was tinnitus. He didn't deal with that in any substantive way beyond explaining what does/doesn't cause it (allaying my fears that I had some underlying serious issue) and then gave me a referral to a specialist to look into it in more depth.

[Teacher Terry]

-Tammy, I tried allergy shots and not only did they not help but they almost killed me. Now I am taking allergy drops that my insurance will not pay for. No one has ever died from these. They help but still need asthma meds.

[Williamsmith]

-Tammy, I tried allergy shots and not only did they not help but they almost killed me. Now I am taking allergy drops that my insurance will not pay for. No one has ever died from these. They help but still need asthma meds.

I am very interested in this. My wife gets a weekly allergy shot. I’m not sure what they do for her.

[mamalatte]

sweetana - do you mind if I ask, what type of scan did you have that shows there is no plaque? I thought that the only way to find this out was the stress/treadmill test followed by some sort of angiogram procedure if "stress test" results not good, but perhaps I am way outdated??

[Williamsmith]

My experience has taught me not to fret about the details. Death is death. It comes by way of heart disease and it comes by way of an ice dam breaking loose from a roof at the worst time. One should not mock it but I think we Americans are preoccupied with our “privilege” to live long fulfilled lives. Amen.

[sweetana3]

mamalatte: A local hospital (to use equipment and personnel that are not 100% used by patients) has $49 heart scans on the CT machines to detect hardened plaque build up in the various arteries. The results are immediately read by a professional and provided in writing. Quick and cheap way to learn something about the heart. I had zero calcium build up but husband found he had 50%+ build up and made an appointment with a cardiologist (not a part of this hospital) for a longer workup.

[catherine]

Thanks to pharmaceutical companies advertising and drug pushing.....I have become quite cynical about the need for all these chemical “fixes”. Is here any evidence that all these pills are making us healthier?

I always hate to be an apologist for the pharma companies, but I found it very interesting that over the 20 years I have
asked doctors the same question: "What has changed over the past decade?" Primary care physicians over the past 10 years inevitably said "well, I no longer have to run to the ER for patients who have had heart attacks."

I'm just as skeptical of Big Pharma as anyone else but I do believe that antihypertensives have helped a lot. Sorry. I'm the one that has probably asked a few hundred doctors the same question and I get the same answer.

At the same time, are we overprescribed medications and are our healthcare choices driven by profit? Absolutely. But I give credit where credit is due.

You have to take the good with the bad I guess.

[JaneV2.0]

Or it could be because smoking rates are way down...

[Williamsmith]

Or it could be because smoking rates are way down...

You have to admit.....she’s got a point. I mean, in the medical field don’t they always refer to double blind research? Or something like that?

[catherine]

You have to admit.....she’s got a point. I mean, in the medical field don’t they always refer to double blind research? Or something like that?

Check out the Framingham study if you want to look at double-blind studies. https://www.framinghamheartstudy.org/about-fhs/history.php

Smoking is definitely a risk factor for heart disease, but high blood pressure trumps that. And antihypertensives do lower high blood pressure.

[Yppej]

I wish my blood pressure were a little higher so I wouldn't feel dizzy when I stand up suddenly.

[catherine]

My numbers:

Total: 211
HDL: 78
LDL 115
LDL/HDL Ratio: 1.47
Cholesterol/HDL Ratio: 2.7

I'm 65, take no meds.
I eat everything in moderation. I'm not on any special dietary bandwagon, although I eat very little meat.
Thank you, Puritan ancestors, for the good Yankee stock genes.

[SteveinMN]

I wish my blood pressure were a little higher so I wouldn't feel dizzy when I stand up suddenly.
I have (controlled) high blood pressure and I often feel dizzy when I stand up (or bend down and then back up again) quickly. My doctor (welll, PA) says it's a matter of hydraulics related to age. "Just get up more slowly." Can't fault her for the Occam's Razor approach....