High cholesterol problem

[haha]

I would much rather believe what most people believe. Being a low carber can be very inconvenient.

Once gary Taubes made this very point. Someone asked him what was the most difficult aspect of low-carbing. Social conflicts he answered. Dinner parties are very trying, you make kind of a bother of yourself, and people think you are a food faddist maniac.

Also, when others order a beer at a sports bar, I am drinking whiskey.

Travel? Doable, but not easy.

Ha

 

[TromboneAl]

I agree. There is one side that understands, interprets, accepts and applies medical science. The other side does not. And it's ok - part of my job is to educate my patients too...

I'm not sure whether you are serious or not, but I remember an aha moment when I was in graduate school. At a seminar, an MD was presenting his idea for the design of an experiment. It was terrible, and the scientists tore him to shreds.

I realized then that MDs don't necessarily know anything more about science than engineers or artists. It's not surprising, because their training is quite different from that of a scientist's. They aren't necessarily trained in the scientific method, hypothesis testing, statistics, experiment design and interpretation, etc.

 

[ERD50]

See my answer to Ha. It's ok to disagree, ERD50

Are we disagreeing about anything? I didn't think so. I thought we were just discussing how anyone would know that the 'accepted protocols' actually reflect the best practices for the patient.

Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.

Mostly echoing haha again here, but it does not sound strange to me. I understand that you have a licence to protect, and as a boss of mine often said (when I was being my usual stubborn self) - '"Sometimes it's better to be wrong together, than to be right all alone" (and I bet he thought I wasn't listening!).

But it doesn't answer the question. It sounds like you are saying that I shouldn't question my Doctor on this, he/she will follow the 'party line', and I should just go along blindly. Sorry, I'm not wired that way. Personally, I think it is a little sad that someone who puts forth all the time and effort on the education it requires to become a Doctor, seems so unwilling to use that intelligence and gained knowledge to question the status quo.

I suppose this is the same as an electrician/carpenter who must follow building codes on the job, even though he may know with certainty when an alternative may be just as good/safe or even better than the published code. But somehow, I don't think of Doctors on the same level as electricians/carpenters. Maybe I should?

I guess you are saying - that is left up to the researches, and the General Practitioner just does as they are told? But this still seems odd, because not every Doctor has the same opinions on treatments.

More to the point of the OP, I guess I'm still confused as to whether Statins merely 'improve the numbers', or if there is a clear association with better outcomes for the patient.

-ERD50

 

[Mulligan]

That is exactly right. As Martha once pointed out, once someone has taken a position, arguments against it simply harden his views.

I often ask myself whether this is the case for me. However (1) I used to be very anti-low-carb pro whole grains and (2) I would much rather believe what most people believe. Being a low carber can be very inconvenient.

While I have a viewpoint and probably wont move too far from it at this point, that doesnt mean I am not opposed to listening and learning info about various others such as low carb. Presonally, I am not at the point of being proved right or wrong yet concerning diet. I know at this point in time of my life, I am unwilling to change. I enjoy carbs and will continue to eat them, but I have modified the intake of them. Food is still an enjoyable hobby to me. As long as I am in good health, I will continue to tweek around the edges. I was hoping for a transition in old age from " eating, then seek entertainment" to "eating for entertainment", but it probably isnt going to happen if I want a lengthy, healthy retirement.

 

[audreyh1]

Sometimes you frighten me.

I also found it somewhat disturbing. I will definitely keep looking out for myself!

It sounds like you are saying that I shouldn't question my Doctor on this, he/she will follow the 'party line', and I should just go along blindly. Sorry, I'm not wired that way. Personally, I think it is a little sad that someone who puts forth all the time and effort on the education it requires to become a Doctor, seems so unwilling to use that intelligence and gained knowledge to question the status quo.

Agreed.

 

[Major Tom]

I don't think we're being fair to ob. His role is to practice and administer the current form of medicine as accepted and approved by his profession. At some point, the understanding regarding cholesterol and it's relation to health will improve and recommendations given by doctors will change accordingly.

No science is ever perfect. Instead, it advances by observation and the development of models that more and more closely describe those observations.

A good doctor should welcome questioning by his patients, and I imagine that most doctors present their recommendations as just that - recommendations, that the patient is free to follow or disregard as they wish.

 

[REWahoo]

I don't think we're being fair to ob. His role is to practice and administer the current form of medicine as accepted and approved by his profession. At some point, the understanding regarding cholesterol and it's relation to health will improve and recommendations given by doctors will change accordingly.

I'm not sure Obgyn is a doctor. I've never seen him use that term, always choosing to describe himself as a 'clinician' which is defined as:

A health professional, such as a physician, psychiatrist, psychologist, or nurse, involved in clinical practice, as distinguished from one specializing in research.

Now, let the dead horse beating continue...

 

[Major Tom]

I'm not sure Obgyn is a doctor. I've never seen him use that term, always choosing to describe himself as a 'clinician' which is defined as:

Now, let the dead horse beating continue...

Aaah, there I go making assumptions again, though my POV applies even more if he is a clinician.

Agreed about the dead horse beating. I'm rather hoping this thread comes to an end fairly soon.

 

[ERD50]

I don't think we're being fair to ob. His role is to practice and administer the current form of medicine as accepted and approved by his profession. At some point, the understanding regarding cholesterol and it's relation to health will improve and recommendations given by doctors will change accordingly.

No science is ever perfect. Instead, it advances by observation and the development of models that more and more closely describe those observations.

JMO, but I don't think this is about being fair/unfair to anyone. I think some of us are just trying to learn/decode the info out there, and part of that is understanding where our Doctors are 'coming from'.

I'm rather hoping this thread comes to an end fairly soon.

I'm hoping to learn far more before that happens. Why end the thread for others - when you can put it on ignore if you feel that way?

-ERD50

 

[Major Tom]

Good points ERD50. I thought that a few of the posts were a bit hostile towards obgyn65 but accept that my interpretation could be at fault.

Hehehe - I don't think I'm about to end the thread for others am I? I don't have that power, and wouldn't want to end it anyway. I have never put a thread or a person on ignore on any forum, but simply pay less attention to the things (and people) that interest me less. If I were to put this thread on ignore, it's pretty much guaranteed that Al will post about a tasty and healthful food that he's just discovered; I wouldn't want to miss out on something like that.

 

[obgyn65]

You are joking, right ? If you google "defensive medicine" you will find hundreds of thousands of hits. A vast majority of my peers practice the same. I am sorry this concept is new to you.

Sometimes you frighten me.

 

[obgyn65]

When I joined I asked a couple of mods for advice. It was suggested I do not use absolute values (numbers), do not mention where I live, or my exact profession. As a consequence, since I provide obgyn services, I refer to myself as a clinician. There are only four titles that allow to do so : MD, DO, PA, and NP (take your pick). And yes, I do have the "doctor" title which I rarely use.

I'm not sure Obgyn is a doctor. I've never seen him use that term, always choosing to describe himself as a 'clinician' which is defined as:

Now, let the dead horse beating continue...

 

[obgyn65]

It seems I get in trouble every time I discuss anything related to healthcare ! Sorry, guys, maybe it's been a long day, but I do not think that my responses above have been treated fairly. So please feel free to eat and drink whatever you want to, feel free to read about clinical best practices or guidelines or not, at the of the day it's your choice - not mine. I only meant to help. This is my last posting under this thread. Take care.

I'm hoping to learn far more before that happens. Why end the thread for others - when you can put it on ignore if you feel that way?

-ERD50

 

[RAE]

I agree. There is one side that understands, interprets, accepts and applies medical science. The other side does not. And it's ok - part of my job is to educate my patients too...

With all due respect, obgyn, I find this comment from you to be overly sarcastic and condescending. There are many highly educated medical professionals and diet/nutrition researchers who do not agree at all with the traditional advice from doctors regarding cholesterol and the effect of diet on heart health, as Trombone Al and others have pointed out. It's okay to say that you have to provide the "traditional" advice in order to protect yourself from malpractice lawsuits; it is another thing to ridicule those that have a different viewpoint than yours, and imply that they do not understand how to apply good science. I could cite many researchers who understand the scientific method very well, and have studied all the literature on this subject, and have a very different opinion about diet and heart health than you do, but Chris Kresser is a good one to start with:

Chris Kresser

RAE

 

[toofrugalformycat]

Sounds good. Also avoid tobacco, drugs, alcohol (the usual culprits). What you write in your post is a good start. Keep us informed and good luck.

Doctors are taught to tell their patients to avoid alcohol, because of the incipient alcoholics out there (they take one drink, they're an alcoholic). Overconsumption of alcohol is more dangerous to your health than heart disease.
However, if you know you are NOT an alcoholic, the truth is that moderate alcohol use is so powerful at raising HDL, that in studies they have to control for its use. Moderate seems to mean 2 glasses of wine a day for a man, one for a woman. With the link between alcohol and breast cancer, I limit myself to half a glass a day.
Don't believe me, the scientific references are copious, just google.
It worked for me, YMMV.

 

[Moscyn]

Getting my cholesterol level down appears more and more challenging. Of all the things I read in this thread which I find the hardest to do is to consume less carbohydrate and no alcohol. I think I'll just do my best and everything in moderation. But I know one thing I can't do is avoid alcohol - I'm not an alcoholic but I do enjoy a glass of good wine with my dinner. You see, I don't just drink wine, I appreciate wine a lot - I like to evaluate the taste and changes as I drink it with different food. I'll just have to drink less. What is easy for me to do in the entire list of my To Do list is the increase of exercise and more cardiovascular activities. In fact, I enjoy that very much.

 

[braumeister]

It seems I get in trouble every time I discuss anything related to healthcare ! Sorry, guys, maybe it's been a long day, but I do not think that my responses above have been treated fairly. So please feel free to eat and drink whatever you want to, feel free to read about clinical best practices or guidelines or not, at the of the day it's your choice - not mine. I only meant to help. This is my last posting under this thread. Take care.

A bit of medical advice. Probably applicable to many of us:

Thin skin? Added protection helps - MayoClinic.com

 

[Mulligan]

Getting my cholesterol level down appears more and more challenging. Of all the things I read in this thread which I find the hardest to do is to consume less carbohydrate and no alcohol. I think I'll just do my best and everything in moderation. But I know one thing I can't do is avoid alcohol - I'm not an alcoholic but I do enjoy a glass of good wine with my dinner. You see, I don't just drink wine, I appreciate wine a lot - I like to evaluate the taste and changes as I drink it with different food. I'll just have to drink less. What is easy for me to do in the entire list of my To Do list is the increase of exercise and more cardiovascular activities. In fact, I enjoy that very much.

I guess Im not very sophisticated wine drinker, I only evaluate the buzz it gives me I have a bottle every two weeks or so, but consumed in one evening. If I had a health issue, I would just quit, as I prefer drinking water and ice tea. I am like you, eliminating carbs would be very difficult. I am thankful I have no reason to, for now anyways.

 

[Moemg]

I just read this thread . Some of you are brutal . Have you noticed that rarely do medical people get in these discussions . Its because they are beaten up and spit out . If you really want opinions from the front line not just articles with a bias treat the medical people with the respect they deserve .

 

[ERD50]

I just read this thread . Some of you are brutal . Have you noticed that rarely do medical people get in these discussions . Its because they are beaten up and spit out . If you really want opinions from the front line not just articles with a bias treat the medical people with the respect they deserve .

I guess people read the same things and see them differently. I honestly don't see were any 'beating up and spitting out' was going on, nor anything brutal.

To the layperson, there seems to be a lot of contradictory information, or information pertaining to 'numbers' with little/no back up to real-life results. We are confused, and looking for some pointing in the right direction.

Here's an example of a comment/response that throws me:

Comment: I guess I need to heed the doctor's advice to limit the high cholesterol food I take.

Response from a(n assumed) Medical Professional: Sounds good

Now wait a minute - I thought it was learned long ago that the amount of cholesterol in the foods a person eats has little/no bearing on the cholesterol levels in a persons blood. Am I misinformed on that?

And I just added 'assumed' up there, as this is the internet and we can't know for sure. But I have no reason to doubt the poster, just trying to be clear, nothing more.

-ERD50

 

[Mulligan]

I guess people read the same things and see them differently. I honestly don't see were any 'beating up and spitting out' was going on, nor anything brutal.

To the layperson, there seems to be a lot of contradictory information, or information pertaining to 'numbers' with little/no back up to real-life results. We are confused, and looking for some pointing in the right direction.

Here's an example of a comment/response that throws me:

Comment: I guess I need to heed the doctor's advice to limit the high cholesterol food I take.

Response from a(n assumed) Medical Professional: Sounds good

Now wait a minute - I thought it was learned long ago that the amount of cholesterol in the foods a person eats has little/no bearing on the cholesterol levels in a persons blood. Am I misinformed on that?

And I just added 'assumed' up there, as this is the internet and we can't know for sure. But I have no reason to doubt the poster, just trying to be clear, nothing more.

-ERD50

From what Ive read, about 75% of your cholesterol is body produced, so that leaves about a quarter. I think that is why my doctor was insistent on the fact that dietary food changes wont drastically change your levels, thus his advocating Lipitor pretty freely.

 

[obgyn65]

Although I said I was not going to post under this thread again, I realize some people reading it may get conflicting information. My top priority is to protect patients. Therefore, I am pasting below AAFP info on ATP III guidelines as well as dietary / lifestyle changes.

Nutrient Composition of the Therapeutic Lifestyle Changes Diet
-----------------------------------------------------------------------

Nutrient Recommended intake
Saturated fat*
<7 percent of total calories

Polyunsaturated fat
Up to 10 percent of total calories

Monounsaturated fat
Up to 20 percent of total calories

Total fat
25 to 35 percent of total calories

Carbohydrates†
50 to 60 percent of total calories

Fiber
20 to 30 g per day

Protein
Approximately 15 percent of total calories

Cholesterol
<200 mg per day

Total calories‡
Balance energy intake and expenditure to maintain desirable body weight

From Cholesterol Treatment Guidelines Update - March 1, 2002 - American Family Physician (Tx guidelines). Please read these guidelines.

Take care everyone and keep safe.

ob

 

[TromboneAl]

Here's an example of an experiment that was well done at Stanford. Essentially, they put 300 women on different diet plans. One of the plans was Atkins. If eating more saturated fat and cholesterol negatively affects one's cholesterol numbers, you'd expect the women doing Atkins would have shown a worsening of the numbers.

Jump to 23:00 for the results (and he talks more about this at 25:30).

And note that the scientist, Chistopher Gardner, was a vegetarian (funny part at 53:00).

If eating fat hurts your cholesterol numbers, then it's hard to account for those results.

 

[ERD50]

Here's an example of an experiment that was well done at Stanford. Essentially, they put 300 women on different diet plans. One of the plans was Atkins. If eating more saturated fat and cholesterol negatively affects one's cholesterol numbers, you'd expect the women doing Atkins would have shown a worsening of the numbers.

Jump to 23:00 for the results (and he talks more about this at 25:30).

....

If eating fat hurts your cholesterol numbers, then it's hard to account for those results.

Thanks for that (and the time references, I never would have watched the whole thing right off).

Question: Relevant to the info that obgyn65 provided, recc Cholesterol <200 mg per day, do they cover in that talk (or do you know from other studies) how much dietary chol the Atkins group was consuming? For ref, a single egg yolk is ~ 190mg chol. I'm guessing that they would exceed 200mg/day, and their chol went down - this is the kind of things that seem conflicting to me. And then there is the issue of whether the numbers correlate with quality of life. It's tough for the layperson to slough through all this, but if the recc info seems off, what to think?

-ERD50

 

[Katsmeow]

Here's an example of an experiment that was well done at Stanford. Essentially, they put 300 women on different diet plans. One of the plans was Atkins. If eating more saturated fat and cholesterol negatively affects one's cholesterol numbers, you'd expect the women doing Atkins would have shown a worsening of the numbers.

Jump to 23:00 for the results (and he talks more about this at 25:30).

That is a great video which I have seen before. Of course, in my own case I had the experience of testing my cholesterol numbers shortly before starting low carb eating and then after 6 months of low carb eating. For me, my total cholesterol and LDL went up (especially LDL), HDL is basically unchanged and triglycerides went down. I felt those results were mixed. That said, my fasting glucose went down markedly which I felt was very positive.