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

[haha]

Niacin has been taken in medicinal doses for 50 years or so. Although the possibility of liver damage is always mentioned with niacin, in fact, it seems to be very rare. As for flushing every piece of advice I have read from Mayo and elsewhere suggests that it is not harmful and I have never read even an anecdote that suggests otherwise. So, I am not worried about flushing. If new evidence were to appear I would reconsider. However, some people who take niacin stop taking it because they can't stand the flushing. So, it might indeed be a problem for you.

Niacin also has additional benefits that statins do not have, such as raising HDL and improving lipoprotein a. Parson's large study in the 70's with niacin had as its endpoint a 10% reduction in mortality. At the time of his book in the late 90's that was the only study of anti-cholesterol that showed a reduction of mortality rather than a reduction of cholesterol.

Because statins are newer drugs the extent of the side effects may still offer unpleasant surprises such as the research I referenced above that finds an incidence of muscle pain/weakness in 25% of statin users who also exercise. The muscle pain may last for years after stopping the statin. Further side effects of long term use may be shown in the future for all we know.

We manage cholesterol levels in the hope of reducing risk of serious illness in the future. So, it is a preventative, not a treatment for an actual illness that is present. In my own case the painful side effects of statin-induced myopathy turned out to be the more serious medical problem I have actually experienced as an adult, in terms of severity, duration, and unavailability of treatment. That is a pretty unfortunate outcome for a medicine that is only a preventative.

In my opinion given the effectiveness, lower risk profile and substantially lower cost of niacin, the appropriate question is why isn't it the first-line treatment for cholesteremia?

If this is in fact true, my guess as to the reason would be that there are no drug reps pushing it, and little industry sponsored research doing the same, and no cushy positions and honoraria for investigators extolling niacin's wonders.

Ha

 

[tmm99]

Hey ha,

Sorry to hear you had to give up beef/butter, but congratulations that your chicken/fish with minumal saturated fat did the trick for you. I love my saturated fats!! I hope I won't have to give it up. I am now moving toward coconut oil (saturated but medium chain instead of long chain like beef), but coconut oil does raise LDL (but it is supposed to raise HDL even more). I will see...

One thing I want to know... You mention you ate grassfed beef - was it most of the time? And it still raised your LDL compared to chicken/fish? I am a little surprised, because my understanidng is that the amount of saturated fat in grassfed beef (about 10% of fat is saturated) is as low as what's in a chicken breast. And grassfed beef contains more omega-3 than chicken. This is not to say I'd rather eat grassfed beef than pasture fed chicken though. (I don't really like grassfed beef.)

 

[haha]

One thing I want to know... You mention you ate grassfed beef - was it most of the time? And it still raised your LDL compared to chicken/fish? I am a little surprised, because my understanidng is that the amount of saturated fat in grassfed beef (about 10% of fat is saturated) is as low as what's in a chicken breast. And grassfed beef contains more omega-3 than chicken. This is not to say I'd rather eat grassfed beef than pasture fed chicken though. (I don't really like grassfed beef.)

I'm sleepy now, and I wil answer this more completely tomorrow. But here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.

As far as I am concerned, although I am still not fully into chicken, as I have said earlier I could be happy eating only organisms that got pulled out of the ocean! I think the Japanese and the Norwegians have pretty well shown that if you avoid toxic species, you can live fine on fish. I always get wild, fresh when I can and frozen or canned otherwise, Today I had fresh wild shrimp salad for lunch, and rockfish curry for dinner.

Ha

 

[tmm99]

I'm sleepy now, and I wil answer this more completely tomorrow. But here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.

As far as I am concerned, although I am still not fully into chicken, as I have said earlier I could be happy eating only organisms that got pulled out of the ocean! I think the Japanese and the Norwegians have pretty well shown that if you avoid toxic species, you can live fine on fish. I always get wild, fresh when I can and frozen or canned otherwise, Today I had fresh wild shrimp salad for lunch, and rockfish curry for dinner.

Ha

I am getting sleepy too, so I will read your article tomorrow, but I know!! (about good eating!) You were mentioning sea urchin and salmon roe in another thread and you were making me hungry! I bought 30lbs of fresh frozen sashimi-quality sockeye salmon (my fav) along with 10 lbs of scallops from a WA fishery a while back and they are sooo good. I only need to sear the salmon on the surface and I eat my scallops raw as sashimi. MMMmmmm!! I got about 5 lbs of Hake at Trader Joe's the other day too (I like them better than Cod since Heke is more tender and even flakier.) Maybe I eat more fish to counteract the other crap I eat...

Maybe all the fish you've been eating are doing you good, which actually wouldn't even be a bit surprising.

 

[braumeister]

We manage cholesterol levels in the hope of reducing risk of serious illness in the future.

I'm not convinced there is any validity to the hypothesis that elevated cholesterol levels are harmful, so put me firmly in the skeptics' camp.

Thanks for the niacin information, though. Interesting even if not tempting.

 

[donheff]

here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.

Very good interview Ha. Krauss largely exhibits the traits you want to see in a scientist - an open mind and enthusiasm at the learning impact of contrarian results. I'm looking forward to the follow-on studies he references.

One sad takeaway -- the bacon, blue cheese burgers I have been gleefully gobbling down may be the poster child of bad practices. But a bacon, blue, turkey-burger could be just the ticket (with low carb toast instead of a bun).

 

[BooBoo]

Nictonic acid is the form that's been shown to work. At first, DW was prescribed Niaspan® -- an extended release prescription form -- 500 mg. at bedtime (some folks don't notice the flushing if it occurs while asleep). After paying an exorbitant amount, we found that the exact same thing (extended release nictonic acid) can be gotten OTC for about 1/10 the price of Niaspan. The doctor didn't know it was available OTC until we advised him, but he's on board (he hates Big Pharma).

After her numbers came back as improved as they did, she's dropped the dosage to 250 mg.

Tyro

I am using Niacin (Inositol hexanicotinate) 500 Mg. non flush per doctor’s recommendation. I asked about increased dosage and he said it was OK to increase as much as I could tolerate. To date, I have not increased dosage and have not noticed any side effects with 500 Mg. other than possibly aggravating gout which may have been aggravated to due sugar consumption.

Not convinced that high LDL is really a problem, but if figure a vitamin is a much lesser of an evil than a drug, recognizing that a vitamin could be just like a drug. I am convinced, that for me, statins are poison.

 

[rgarling]

Link to Dr. Krauss' study: Sign In

Comments:
The study criteria would allow fairly unhealthy individuals, so they are not necessarily studying a healthy population

The baseline diet is very high in carbohydrate (50% E).

The study diet is high in carbohydrate (31% E)

The study diet is very high in protein (31% E)

The trial periods are short (21 days).

I think the study is more likely to be showing the effects of ingesting high protein (17% more than baseline) in a high carbohydrate diet.

 

[Lsbcal]

Ha got me to thinking about my lunches. I am going to focus more on healthy lunches now. Some fish lunches that come to mind:
1) tomato packed sardines with piece of bread
2) small shrimp sandwich
3) smoked salmon with soft (whipped) cream cheese on bagel
4) tuna sandwich

For meat oriented sandwiches, I could switch to just eating a half sandwich. I never liked too much meat on the sandwich anyway. Would then supplement with more vegetables like carrots, pickles, lettuce, tomatoes.

Is the cream cheese in moderate quantity a no-no?

Any other easy to prepare ideas?

 

[Chuckanut]

For what it is worth, here is video of a talk about saturated fat given by a doctor who is a professor of cardiothorasic surgery at a distinguished (IMHO) school of medicine.

 

[Chuckanut]

Often the LDL particle count is concordant with LDL-C, but not always.

Ha

Thanks for the information on the lab. Does their cholesterol count differentiat between the big fluffy LDL and the smaller, nasty LDL particles? That seems important these days. My latest results from my physical don't show this, just a total LDL.

 

[braumeister]

Thanks for the information on the lab. Does their cholesterol count differentiat between the big fluffy LDL and the smaller, nasty LDL particles? That seems important these days. My latest results from my physical don't show this, just a total LDL.

You can estimate this quickly by just looking at your triglycerides/HDL ratio.

A ratio above 3.5 would be enough to worry you, while a ratio under 2.0 would give you some comfort that you have mostly the big, fluffy LDL particles.

My ratio is 1.1, and I attribute it mainly to my LCHF diet.

A couple of references:
Assessment of LDL particle size by trig... [J Atheroscler Thromb. 2003] - PubMed - NCBI
The Cholesterol Delusion And Why LDL Particle Size (and Trig/HDL Ratio) Is So Important

 

[Mulligan]

You can estimate this quickly by just looking at your triglycerides/HDL ratio.

A ratio above 3.5 would be enough to worry you, while a ratio under 2.0 would give you some comfort that you have mostly the big, fluffy LDL particles.

My ratio is 1.1, and I attribute it mainly to my LCHF diet.

A couple of references:
Assessment of LDL particle size by trig... [J Atheroscler Thromb. 2003] - PubMed - NCBI
The Cholesterol Delusion And Why LDL Particle Size (and Trig/HDL Ratio) Is So Important

Following up and reading your links and then read something that appears in agreement with you.

Therefore, in adults, the triglyceride/HDL-"good" cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).

Or more precisely, the triglyceride/HDL ratio:

2 or less is considered ideal
4 - high
6 - much too high
And, since HDL (high density lipoprotein) is protective against heart disease, the lower the ratio, the better.

In other words, the lower your triglycerides, or the higher your HDL, the smaller this ratio becomes.

It is now believed that the triglycerides/HDL ratio is one of the most potent predictors of heart disease.




A Harvard-lead study author reported:

"High triglycerides alone increased the risk of heart attack nearly three-fold.

And people with the highest ratio of triglycerides to HDL -- the "good" cholesterol -- had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.

The ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio (Circulation 1997;96:2520-2525)."

My ratio isn't as good as yours but I checked my records and went from about a 4 to 1 ratio (tri's were real high) to 2.1 to 1 ratio in one year and all I did was eat oatmeal with apple and walnuts daily, cutting back on favorite food group (potato chips) and taking fish oil. My triglycerides were slashed in half down to about 80. I never really followed triglycerides and didn't really know how important they are in relation to risk of coronary problems.

 

[Normah]

Dilemma on statins

It's a dilemma for people who are told by their doctors they need to take a statin drug to lower cholesterol. Some people get no side-effects from statins, at least not ones they notice - which is kind of scary in itself, that you could be losing your memory, for example, without realizing it. Other people have pretty obvious side-effects. I was in that category with muscle pain, weakness, lousy digestion, chronic fatigue but couldn't sleep well. I often heard coenzyme q10 suggested with statins, but it didn't help me at all. One thing that does help a lot is biocritical priora which is also natural and has coenzyme q10 in a special formula. I for one, get peace of mind knowing that my cholesterol is lower, and since I don't have to struggle with side-effects, I have more energy to spend on the things that are important to me. Not everyone is able to just change diet and exercise more, though at least we should try to do our best at that too. Easier said than done if you ask me.

 

[donheff]

Not everyone is able to just change diet and exercise more,

Not true although it might not bring your cholesterol numbers into line

Easier said than done if you ask me.

True

 

[Tyro]

Triglycerides

Many people -- including many doctors -- are still under the impression that high triglycerides are due solely to high protein/high fat diets. Much emphasis (while they mention carbs) is still put on fats on many of the medical websites. As it turns out, bad carbs (sugar, HFCS) can have much more effect on triglyceride levels than proteins & fats for some people. A few years back I went on a high protein/high (good) fat/low carb diet, and my triglyceride levels dropped like a stone (after decades of low-fat diets that did nothing).

Everyone's metabolism is different, which is why no single diet works for everyone. Finding what one's metabolism likes and dislikes is the key, but that can take some effort (trial & error).

Tyro

 

[haha]

One thing I want to know... You mention you ate grassfed beef - was it most of the time? And it still raised your LDL compared to chicken/fish? I am a little surprised, because my understanidng is that the amount of saturated fat in grassfed beef (about 10% of fat is saturated) is as low as what's in a chicken breast. And grassfed beef contains more omega-3 than chicken. This is not to say I'd rather eat grassfed beef than pasture fed chicken though. (I don't really like grassfed beef.)

Hello again tmm99. I ate grassfed been only some of the time. To me, it seemed expensive and tough. Also, I was eating grassfed ground beef from Trader Joe, and really, I didn't like it much compared to much fatter ground meat from QFC.

I think someone wrote earlier than he felt that for many of us who live on the coasts, the cheapest way to get wild meat is wild ocean fish and shellfish. Since I like this better anyway, I think this will be the largest part of my protein.

Ha

 

[Dawg52]

Mevacor..........the wonder drug. I pay $9.62 for a 90 day supply. A pretty cheap way to keep all my numbers in good shape. No side effects that I can tell. Did I mention it cost $9.62?

I do eat reasonably well, but I'm not given up beef entirely. I like a good juicy burger once a week and a steak maybe once a month. I do eat a lot of baked chicken and fish. Not really a sacrifice as I enjoy both. But I do eat them fried on occasions. I'm southern you know.

So count me in the somewhat balanced but lazy camp.

 

[LOL!]

Ha got me to thinking about my lunches. I am going to focus more on healthy lunches now. ...
Any other easy to prepare ideas?

Easy prep salads are something to consider. One can buy all the ingredients fresh on the weekend and then "build" salads in those plastic chinese food containers that are like shallow round dishes. I don't even wash the ingredients but just put them in the bowls:

1. Bag/container of baby spinach, lettuce or other greens.
2. Cherry tomatoes
3. Small carrots
4. Slice a mushroom or two and divide among the 4 to 5 salads you are making
5. Fresh blueberries
6. Craisens, raisens, dried cranberries, or dried cherries
7. Walnuts, pecans, or other nuts
8. Protein (see below).

So except for the mushrooms, no cutting, slicing or other prep needed. Just divide up the bits and pieces into the containers.

A bag of croutons and bottle of salad dressing and you are good to go.

The 8. Protein usually comes from leftovers, but could be a boiled egg. Example of leftovers: Fajita meat, barbecue meat, cheese stick, grilled fish or salmon, roast beef, leftover chinese food, edamame, etc. Whatever you have in the fridge and it doesn't have to be much because the salad is lots to eat. This also makes each salad slightly different so you aren't bored eating the same thing every day.

OK, you have to like salad and you have to not worry about washing anything, but if you are OK with that, the lunch meal is cheap and easy to prepare. It's almost as if you went out in the woods and found the bits and pieces yourself and made lunch from it. Of course, you went to the grocery store instead.

 

[tmm99]

Hello again tmm99. I ate grassfed been only some of the time. To me, it seemed expensive and tough. Also, I was eating grassfed ground beef from Trader Joe, and really, I didn't like it much compared to much fatter ground meat from QFC.

I think someone wrote earlier than he felt that for many of us who live on the coasts, the cheapest way to get wild meat is wild ocean fish and shellfish. Since I like this better anyway, I think this will be the largest part of my protein.

Ha

I can relate. I don't like grass fed beef much either. I would eat pasture fed chicken and pork over feedlot kind any time (there is a huge difference in the taste and smell to me.), but grass fed beef? Not so much.

 

[Lsbcal]

Easy prep salads are something to consider. One can buy all the ingredients fresh on the weekend and then "build" salads in those plastic chinese food containers that are like shallow round dishes. I don't even wash the ingredients but just put them in the bowls:

1. Bag/container of baby spinach, lettuce or other greens.
2. Cherry tomatoes
3. Small carrots
4. Slice a mushroom or two and divide among the 4 to 5 salads you are making
5. Fresh blueberries
6. Craisens, raisens, dried cranberries, or dried cherries
7. Walnuts, pecans, or other nuts
8. Protein (see below).
...

Good idea LOL. I'll try this a few times per week to start.

We do have salads, sometimes big ones at dinner. And in the morning I make a fruit bowl with items from 5, 6, and 7 above. Personally, I'd wash everything as have heard and read this is a good practice.

Actually it's quite fast and easy to make a lunch with items 2, 3, 4 plus a half sandwich. Might add things like radish, olives, etc. Finger foods that don't have to be cut up.

 

[a]

I take a 1-lb. bag of frozen vegetables ($1.50 a bag) to work each morning and put it on a desk that is warm from cables running underneath it. By lunchtime it's thawed enough to eat.

Pluses:
-The most convenient ever. Zero preparation time.
-Never worry about fresh-bought vegetables spoiling in fridge because I didn't eat them fast enough.

Minuses:
-Melted vegetable water sometimes flows out from bag onto desk. Put it on top of throwaway paper.