LDL-C, LDL particle count, diet, and statins

[haha]

Since Al left I hesitate to start a health thread, as he did it so well and presented his data very clearly. But I think this could be helpful to others, as it seems to show that blood chemostry may well respond to diet and lifestyle changes.

Some here might remember that I have been following a very low carb diet for 10+ years. For many people this improves cholesterol profile. All my numbers got better, except for that pesky LDL. Over the past 3 years my LDL-C has increased, to where my Doc was pretty strongly recommending that I start a statin. This was not something I was eager to do, so we came up with a plan for a diet and exercise trial. First I got a nuclear-magnetic resonance particle count test, which showed many good effects of my low carb diet, but also more LDL-particles than is considered healthy.

At this point we agreed that I might try some diet and exercise changes to see if I can bring down that total LDL-particle count. Staying with a very low carb approach, I just switched from butter to olive oil for cooking, and ate more fish. In 6 months my particle count is now normal, and I have almost 0 small particles.

About a month ago I met a guy who told me that at age 66 he had a total cholesterol of 330, and his brother had just had a heart attack. So he immediately quit eating red meat, and switched to mostly chicken and fish and within 6 months on no meds dropped his TC to 170.

If I can get more skilled at preparing chicken, I will move toward largely replacing red meat with chicken and fish and see if my particle counts drop even further. I already eat all the fish I can afford, and I cook it well.

I also think that my almost daily rowing is helping a lot too.

Ha

 

[donheff]

Thanks for the info Ha. I like red meat so I don't like your results. But the numbers seem to tell a story. DW has much higher cholesterol than I do and is being pressured the same way you were. We already do fish and chicken, maybe I need to cut the red meat back - at least on her plate.

 

[haha]

Thanks for the info Ha. I like red meat so I don't like your results. But the numbers seem to tell a story. DW has much higher cholesterol than I do and is being pressured the same way you were. We already do fish and chicken, maybe I need to cut the red meat back - at least on her plate.

Yes Don, it is really hard to stop eating something you love.The Doc also says that in most people moderate dose statins are harmless and do the job very well. His general advice is first eat low carb/ low glycemic load to deal with any carbohydrate metabolism issues. Often this will also decrease LDL, and it almost always increases HDL and decreases trigycerides. If on the other hand, it increases LDL, get a particle test from Liposcience. If LDL particles are too high, then he suggests statins, as his experience is that most people will not be radical enough to make big changes in LDL with diet alone.

This Doc is a cardiologist

I tend to be a little negative about meds so I am willing to try some changes, and I feel good that they seem to be working.

Ha

 

[Alan]

Thanks for the info Ha, very interesting. Many years ago (~1998) DW had similar results. It was part of a health program where she worked. Each year they would have a physical and score points for attaining certain targets. That score translated to annual bonus up to $500. After her first year she switched our diet to be much less red meat plus she started an exercise regime and the following year her cholesterol numbers had changed quite dramatically for the good.

What did the NMR test consist of? I always thought NMR was the same as MRI, with the name changed to avoid the negative reaction to the words "Nuclear Magnetic Radiation".

Did the test involve a blood sample undergoing an NMR/MRI scan?

 

[haha]

Thanks for the info Ha, very interesting. Many years ago (~1998) DW had similar results. It was part of a health program where she worked. Each year they would have a physical and score points for attaining certain targets. That score translated to annual bonus up to $500. After her first year she switched our diet to be much less red meat plus she started an exercise regime and the following year her cholesterol numbers had changed quite dramatically for the good.

What did the NMR test consist of? I always thought NMR was the same as MRI, with the name changed to avoid the negative reaction to the words "Nuclear Magnetic Radiation".

Did the test involve a blood sample undergoing an NMR/MRI scan?

Glad to hear of her good results. I think MRI stands for magnetic resonance imaging, and the NMR test, which only comes from one lab, is a blood test and stands for Nuclear Magnetic Resonance.

LipoScience - NMR Technology

Ha

 

[braumeister]

Even though "everybody knows" that red meat is harmful, I've never actually seen any evidence that this is so (and the JAMA study that came out in April certainly doesn't qualify IMHO), and certainly no convincing hypothesis as to WHY this should be so.

I'm always happy to be educated, but still pretty thoroughly skeptical on this specific issue.

 

[Free To Canoe]

NMR-nuclear-magnetic resonance is a long standing chemical analysis technique which involves resonating the polar molecules with a very stong magnetic field to identify the chemicals.

When I read the title, I was sure this was a thread to bait T-Al in. This is interesting and I want to keep it on my radar.

 

[haha]

Even though "everybody knows" that red meat is harmful, I've never actually seen any evidence that this is so (and the JAMA study that came out in April certainly doesn't qualify IMHO), and certainly no convincing hypothesis as to WHY this should be so.

I'm always happy to be educated, but still pretty thoroughly skeptical on this specific issue.

I was skeptical too, but I had never been able to do anything with my LDL when I was still eating my hamburger, lambchops, and steaks. Incidentally, I do not see my role as educating anybody. I am only relating my experience, my friend’s experience, and now we have Alan's wife's experience to throw in.

One thing to remember is that we are not all identical. So something that because of genetic differences may be very important for a minority subgroup will not necessarily show up in trials containing a large number of people who do not have this genetic relative inability to deal with red meat. In a large trial with a large number of people without this genetic susceptibility, and a smaller number with it, the effect will not show. It would, if data from every subject were presented, as in a scatter plot or other graphical means. But MDs either have no understanding of how much is lost by using their statistical packages, or perhaps don't care.

One thing I always did notice reading these meat feeding studies, it was never suggested that red meat helped anything, merely that there was no statistical harm.

I have read every available relevant study, and I am personally convinced that a high LDL particle count is not a good thing. By extension, anything that lowers this particle count is a good thing. It appears that it is not the amount of LDL-C in the blood that messes up arteries, but the number of particles. The particles seem to be able to insert themselves into the arterial lining, whereupon an inflammatory response is set up and macrophages and other cells are attracted, forming the atherosclerotic plaque.

And each of us is his own best experiment. I would not disqualify any dietary intervention solely because of what doctors call evidence based medicine. IMO they do not understand the complexity of the issues.

Ha

 

[braumeister]

IMO they do not understand the complexity of the issues.

Hardly anyone does, I think.

But it's good that we're beginning to get a tentative handle on things like this.

 

[Mulligan]

I agree Ha, that diet can lower your numbers. Mine were drifting higher though still in acceptable range. I added oatmeal mixed with apple and walnuts daily for my breakfast and cut down my potato chips and junk food (though I could do better if needed). This alone dropped my total cholesterol count from 184 to 166, and my triglycerides were almost slashed in half to 83. This is obviously not low carb, but I do believe oatmeal helps reduce bad cholesterol so I am continuing. I would like to reduce my carbs but it wont happen until I take an active interest in cooking more meat. If I get that I have no urge for bread or legumes. But if I don't, I head straight for the lasagna, spaghetti, etc. Tonight I finally tried the crook-pot chicken with cream of mushroom added and loved it. I have enough for 3 more days. My problem is trying to get my HDL levels higher which is not very easy to do.

 

[rgarling]

...

At this point we agreed that I might try some diet and exercise changes to see if I can bring down that total LDL-particle count. Staying with a very low carb approach, I just switched from butter to olive oil for cooking, and ate more fish. In 6 months my particle count is now normal, and I have almost 0 small particles.
...

Congratulations on your results.

How much red meat were you consuming prior to the experiment? Once you started eating more fish, how much did your red meat consumption fall?

Generally, I think displacing meat consumption with fish & shellfish is a good idea; however, displacing seafood and red meat with chicken is not so good.

 

[haha]

Congratulations on your results.

How much red meat were you consuming prior to the experiment? Once you started eating more fish, how much did your red meat consumption fall?

Generally, I think displacing meat consumption with fish & shellfish is a good idea; however, displacing seafood and red meat with chicken is not so good.

Thank you. I can't really answer you question, because I never quantified it. But beef was my main protein prior to the change, and fish is now. For example, yesterday I had salmon salad for lunch, and salmon patties for dinner.

Today I had a sardine salad for lunch, and will have an albacore steak for dinner. I also have mastered making curries with shrimp or scallops or squid, and with various whitefish such as rockfish or cod or haddock.

My red meat consumption at present is no more than one meal/week, and this is usually when I eat at someone else's house. No way am I going to be a food crank when I am a guest, even if I am a terrible crank at home. For me, doing without red meat means wanting a lot more spice and strong flavors, pepper, hot curry, etc.

Regarding chicken, a lot of bloggers and gurus talk it down because of omega-6, but I don't know of any reason to think this is meaningful, and chicken is a lot cheaper than fish or shellfish. Certified Wild American shrimp is always at least $12/#. Fresh squid are cheaper when I can easily get them, and they are easy to clean and very tasty prepared many different ways.

IMO there is a even more stretching to differentiate one's blog or book or commercial appeal in the paleo-low carb word than in the retirement-investment world, and that is saying a lot.

Ha

 

[haha]

I agree Ha, that diet can lower your numbers. Mine were drifting higher though still in acceptable range. I added oatmeal mixed with apple and walnuts daily for my breakfast and cut down my potato chips and junk food (though I could do better if needed). This alone dropped my total cholesterol count from 184 to 166, and my triglycerides were almost slashed in half to 83. This is obviously not low carb, but I do believe oatmeal helps reduce bad cholesterol so I am continuing. I would like to reduce my carbs but it wont happen until I take an active interest in cooking more meat. If I get that I have no urge for bread or legumes. But if I don't, I head straight for the lasagna, spaghetti, etc. Tonight I finally tried the crook-pot chicken with cream of mushroom added and loved it. I have enough for 3 more days. My problem is trying to get my HDL levels higher which is not very easy to do.

Vigorous, regular, aerobic exercise usually helps.

But also, the most recent thinking from lipidologists is that what dominates with respect to athersclerosis is LDL particle number, and nothing else. There is a lot of reliable scientific information about this on the web, not just guru-ology.

So when you lower your LDL, which you have already done, you directly help arterial health. If you don't have a particle test available, a fairly good substitute is is non-HDL cholesterol. You just take TC, and subtract all the stuff that is not HDL, and this gives you the number you are after.

IIRC, many recent efforts by pharmaceutical companies to develop HDL increasing drugs have been dropped, because of recent evidence that whatever HDL does, it does not seem to be directly related to atherosclerosis. And raising HDL-C with drugs doesn't seem to affect arterial disease. HDL may mainly be a marker for some particular genetic makeup, although this is speculative.

Ha

 

[Alan]

And each of us is his own best experiment. I would not disqualify any dietary intervention solely because of what doctors call evidence based medicine. IMO they do not understand the complexity of the issues.

Exactly.

DW had great success with her chol numbers replacing much, not all, of our red meat to fish and shellfish. (very easy as we were living in South Louisiana at the time). My chol numbers were normal and even though my diet changed as well as DW's, my numbers stayed the same. (I also got annual physicals through work).

Congratulations on your results.

How much red meat were you consuming prior to the experiment? Once you started eating more fish, how much did your red meat consumption fall?

Generally, I think displacing meat consumption with fish & shellfish is a good idea; however, displacing seafood and red meat with chicken is not so good.

I can't really answer you question, because I never quantified it. But beef was my main protein prior to the change, and fish is now. For example, yesterday I had salmon salad for lunch, and salmon patties for dinner.

Today I had a sardine salad for lunch, and will have an albacore steak for dinner. I also have mastered making curries with shrimp or scallops or squid, and with various whitefish such as rockfish or cod or haddock.

Regarding chicken, a lot of bloggers and gurus talk it down because of omega-6, but I don't know of any reason to think this is meaningful, and chicken is a lot cheaper than fish or shellfish. Certified Wild American shrimp is always at least $12/#. Fresh squid are cheaper when I can easily get them, and they are easy to clean and very tasty prepared many different ways.

We also eat very little chicken. This last 3 days (I can't recall more than than ) DW has cooked for our main meal, cod curry, shrimp with couscous and veggies, and today she cooked salmon and chili burgers (that we buy from HEB).

We eat red meat maybe once a week, and on Saturday we rode our bicycles to a restaurant for breakfast and I had poached egg and kobe beef benedict.

 

[Khufu]

It's great that your diet and exercise program is so effective. If at some point that is not enough, don't take statins whatever you do. The NY Times reports on a study of statin users:

More than 20 million Americans are taking statins, and by most estimates, at least 10 percent of them will experience some degree of muscle achiness or fatigue. That proportion rises to at least 25 percent among people taking statins who regularly exercise, and may be 75 percent or higher among competitive athletes.

Phys Ed: Do Statins Make It Tough to Exercise? - NYTimes.com

I took a statin for five years with no apparent side effects. Then I started to exercise seriously, lost a lot of weight, and began experiencing strong muscle pain that did not go away when I discontinued the statin. The link between statin-induced myopathy and exercise was apparently not known at the time. Niacin has been working well for me for the past 5 years in keeping my lipids in the optimal/acceptable range along with diet restrictions and exercise.

 

[haha]

It's great that your diet and exercise program is so effective. If at some point that is not enough, don't take statins whatever you do. The NY Times reports on a study of statin users:

More than 20 million Americans are taking statins, and by most estimates, at least 10 percent of them will experience some degree of muscle achiness or fatigue. That proportion rises to at least 25 percent among people taking statins who regularly exercise, and may be 75 percent or higher among competitive athletes.

Phys Ed: Do Statins Make It Tough to Exercise? - NYTimes.com

I took a statin for five years with no apparent side effects. Then I started to exercise seriously, lost a lot of weight, and began experiencing strong muscle pain that did not go away when I discontinued the statin. The link between statin-induced myopathy and exercise was apparently not known at the time. Niacin has been working well for me for the past 5 years in keeping my lipids in the optimal/acceptable range along with diet restrictions and exercise.

Thanks for this very informative post. I am glad the niacin is working for you. Do you still have the muscle pain?

I think we should always try non-dangerous stuff if we have issues to address. I would hate anything that made me throttle back exercise, as I have loved it my whole life, and in some regards have a self-identification with it.

Ha

 

[web_diva]

I assume you were eating all regular non-organic animal products. I can't help but wonder what the results would be if you were eating organic grass fed beef and butter made from raw unpasteurized milk...here is a blurb I like to post on the cholesterol and heart disease threads because it is thought provoking and carefully cited.

"...a study comparing Jews when they lived in Yemen, whose diets contained fats solely of animal origin, to Yemenite Jews living in Israel, whose diets contained margarine and vegetable oils, revealed little heart disease or diabetes in the former group but high levels of both diseases in the latter.14 A comparison of populations in northern and southern India revealed a similar pattern. People in northern India consume 17 times more animal fat but have an incidence of coronary heart disease seven times lower than people in southern India.15 The Masai and kindred tribes of Africa subsist largely on milk, blood and beef. They are free from coronary heart disease and have excellent blood cholesterol levels.16 Eskimos eat liberally of animal fats from fish and marine animals. On their native diet they are free of disease and exceptionally hardy.17 An extensive study of diet and disease patterns in China found that the region in which the populace consumes large amounts of whole milk had half the rate of heart disease as several districts in which only small amounts of animal products are consumed.18 Several Mediterranean societies have low rates of heart disease even though fat—including highly saturated fat from lamb, sausage and goat cheese—comprises up to 70% of their caloric intake. The inhabitants of Crete, for example, are remarkable for their good health and longevity.19 ...
In Okinawa, where the average life span for women is 84 years—longer than in Japan—the inhabitants eat generous amounts of pork and seafood and do all their cooking in lard.22 ...
The relative good health of the Japanese, who have the longest life span of any nation in the world, is generally attributed to a lowfat diet. Although the Japanese eat few dairy fats, the notion that their diet is low in fat is a myth; rather, it contains moderate amounts of animal fats from eggs, pork, chicken, beef, seafood and organ meats. With their fondness for shellfish and fish broth, eaten on a daily basis, the Japanese probably consume more cholesterol than most Americans. What they do not consume is a lot of vegetable oil, white flour or processed food (although they do eat white rice.) The life span of the Japanese has increased since World War II with an increase in animal fat and protein in the diet.23 ...
As a final example, let us consider the French. Anyone who has eaten his way across France has observed that the French diet is just loaded with saturated fats in the form of butter, eggs, cheese, cream, liver, meats and rich patés. Yet the French have a lower rate of coronary heart disease than many other western countries. In the United States, 315 of every 100,000 middle-aged men die of heart attacks each year; in France the rate is 145 per 100,000. In the Gascony region, where goose and duck liver form a staple of the diet, this rate is a remarkably low 80 per 100,000.25 This phenomenon has recently gained international attention as the French Paradox. ..."

The Skinny on Fats - Weston A Price Foundation

 

[haha]

I assume you were eating all regular non-organic animal products.

This assumption would be incorrect. Though I am sure what you say worked for many people, it did not for me.

Ha

 

[Chuckanut]

I am not sure that organic food makes a difference in LDL. I would like to see scientific evidence that it does, not anecdotal stories.

We need more Science and fewer stories.

I have purchased grass fed beef. It's good. It's also very expensive and makes me wonder why I don't just buy more fish. Time to pick up some salmon patties. And tillapa.

 

[Ally]

I can't take statins- they make my stomach soooo sick. I found that changing away from so much beef, eating more fish and walking most days got it in the normal range.

 

[Khufu]

Thanks for this very informative post. I am glad the niacin is working for you. Do you still have the muscle pain?

I think we should always try non-dangerous stuff if we have issues to address. I would hate anything that made me throttle back exercise, as I have loved it my whole life, and in some regards have a self-identification with it.

Ha

I still have a little neck pain. Can't tell if it's a residual effect of the statin or another problem.

Non-dangerous is certainly better, but often we cannot tell. One of the ill-effects of defensive medicine as practiced in the US is that doctors have a strong interest in limiting themselves to the most widely used treatments, such as statins. I have never heard of a doctor that recommended niacin. Mine didn't. From the doctor's point of view any treatment that varies from the standard of the day puts him at greater risk of a liability lawsuit. This is not merely conjecture on my part, but the explanation that this doctor himself gave me when I announced my intention to stop the statin. "So," I asked him, "you want me to take a pill to protect you from a lawsuit?" And then I changed doctors and medication.

 

[rgarling]

... But beef was my main protein prior to the change, and fish is now. For example, yesterday I had salmon salad for lunch, and salmon patties for dinner.

Today I had a sardine salad for lunch, and will have an albacore steak for dinner. I also have mastered making curries with shrimp or scallops or squid, and with various whitefish such as rockfish or cod or haddock.

...

Regarding chicken, a lot of bloggers and gurus talk it down because of omega-6, but I don't know of any reason to think this is meaningful, and chicken is a lot cheaper than fish or shellfish. Certified Wild American shrimp is always at least $12/#. ...

A diet primarily of fish and seafood is very much in line with the "aquatic ape" theory of human evolution. If it is true, then our genome is very much optimized to that diet. As you are finding, it works for many (most?) people.

Regarding chicken, omega 6 content is the issue (plus the lack of fat). If you have an optimal omega 6 - omega 3 ratio without supplements, then avoiding chicken is probably overkill.

 

[donheff]

Ha. Did you continue eating some red meat during this period or did you drop it all? How about butter?

And finally, what about egg yolks? I read a about a recent Canadian study finding egg yolks were as bad for arterial plaque as smoking. That is something I plan to ignore (my family seems immune) but is an issue for DW. Eggs (and bacon) are a big source of my protein/fat.

 

[BooBoo]

I would like to share my personal “quest” with cholesterol. I have been “diagnosed” with high cholesterol for many years and have been on various regimens to control my cholesterol. High cholesterol runs in my family. I always have exercised regularly and have never had a weight problem. My total cholesterol without any medications is usually 275. Early on, prior to widespread use of statins, I tried a vegetarian diet for one year. After that year, I was excited to have my blood work completed and much to my chagrin. My result was 275. I am no longer a vegetarian. I still watch my diet and still avoid most high cholesterol foods, eggs being an exception. I tried psyllium and still use on a regular basis with no effect. My brother was prescribed Lipitor and had good results and suggested I take a statin as well. My doctor prescribed Lipitor (10MG) for me as well. My cholesterol came down to 218. I increased my exercise level and my HDL went up about 10 points. I told the doctor about some minor joint pain related to Lipitor. He changed to prescription to 20 MG of simvastatin. My cholesterol was now below 200. Everyone was happy except my DW, she did not like me taking meds and was nagging me to quit taking those pills. I decided to humor her and stopped taking the simivastin. I was having severe joint pain which I attributed to “old” age (55). After two weeks all my joint pains were gone as well as and some other “old age” pains of which I did not even realize were related to statin. Random muscle spasms I was having were gone. My cholesterol went back up. My doctor called with results. I explained my cure and he suggested niacin. After using niacin for several months, I had my blood work completed and with niacin my cholesterol was 211. The problem is that niacin aggravated my occasional gout condition. After doing more research I found that this is a known side effect of niacin. (Doctor never mentioned this). After doing more research on this forum and others I became more aware of the effects of sugar and processed foods. (Dr. Lustic and others). I have eliminated the vast majority of sugar and processed foods from my diet. After several weeks, I lost 5 pounds, which prior to this I could never loose no matter how hard I tried with more exercise and lower intake of foods. I have also noticed my blood pressure is 7 to 10 points lower. I never had a blood pressure problem, high was 125/80 for me. I was 112/75 during my recent annual physical. I feel great and have not had any gout issues, only time will tell for sure. I know there is a link between alcohol and gout, but have refused to give up my occasional beer and wine. (You have to draw the line somewhere). My conclusion at this time.
1) Avoid statins
2) Exercise will increase HDL, but only to a point
3) Reduce sugar and processed food consumption (I could still reduce further)
4) Niacin seems to help reduce cholesterol, but need more time to confirm

Still not sure if gout was related to sugar consumption, but have not had any major attacks since reducing sugar.

 

[eytonxav]

Ha,

Congrats on the good progress with your numbers. As to the red meat, were you eating the leanest cuts? While it would be hard for me to entirely eliminate red meat, I do try to eat more chicken, turkey and salmon, but all in all, I've always had a problem getting enough daily protein into my diet.