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

[Tyro]

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.

I'll second the niacin advice. DW was taking a statin and getting some of the worst S/E. A little research on the web uncovered that many people do as well on niacin as they do on statins alone or statins + niacin. It's worked so well for her, that she's been able to lower her dose in half.

The worst S/E of niacin (for most) is the niacin flush, but that's got an easy fix. One aspirin or 500 mg. vitamin C taken 1/2 to 1 hr. before the niacin will counter the flush (but not the benefit).

Tyro

 

[haha]

I wonder if the guys taking niacin could mention the dose, and the form. Just regular flushing niacin?

@ Don- I eat lots of egg yolks, and always have usualy with normal cholesterol numbers. I really didn't plan to cut out on red meat until very recently- I just started out cutting down on dairy, and mainly I always eat more fish starting about April until mid-October because fish is cheaper and we have the summer salmon runs. I attributed most of my LDL improvement to more regular exercise, and summer fish replacing a lot of meat.

Since meeting the guy who cut his total C from 330 to 170 about one month ago on almost no red meat I decided to see what I could do with this also. So I have really just gotten religion maybe 3 weeks ago.

I think the next particle test will show what is possible for me with continued exercise, and more fish and chicken and less red meat.

@ DFW-when I ate red meat more, I paid no attention to lean cuts. When we eat low carb, most of us crave fat. I still eat pork rinds. Only now I don't butter them, just dip them in Canola mayo. Butter tastes better.

Ha

 

[oldphd]

I always thought NMR was the same as MRI, with the name changed to avoid the negative reaction to the words "Nuclear Magnetic Radiation".

MRI is based on NMR, but is enhanced by adding gradient magnetic fields to allow for spatial identification. NMR only identifies the quantity of a targeted molecule type in a homogenous sample. MRI adds the ability to have spatial recognition which allows for 3D images.

Think of dividing the sample into cubes of some dimension and then you identify the quantity in each individual cube. Put them together and you have the image.

 

[Alan]

MRI is based on NMR, but is enhanced by adding gradient magnetic fields to allow for spatial identification. NMR only identifies the quantity of a targeted molecule type in a homogenous sample. MRI adds the ability to have spatial recognition which allows for 3D images.

Think of dividing the sample into cubes of some dimension and then you identify the quantity in each individual cube. Put them together and you have the image.

Excellent - thanks for the explanation.

 

[haha]

MRI is based on NMR, but is enhanced by adding gradient magnetic fields to allow for spatial identification. NMR only identifies the quantity of a targeted molecule type in a homogenous sample. MRI adds the ability to have spatial recognition which allows for 3D images.

Think of dividing the sample into cubes of some dimension and then you identify the quantity in each individual cube. Put them together and you have the image.

Is the sample used just a spot of serum on filter paper, or serum in a tube, or ?

They are able to characterize type of particle and
average size, max and min size, etc.

Could you also explain this?

Ha

 

[rbmrtn]

I wonder if the guys taking niacin could mention the dose, and the form. Just regular flushing niacin?



I think the next particle test will show what is possible for me with continued exercise, and more fish and chicken and less red meat.

Ha

Here is some info on niacin...

Lowering Cholesterol with Niacin/Nicotinic acid? - Cholesterol Information Produced by Doctors For Patients Experiencing High Cholesterol Levels

It is the flushing kind and should be of the form nicotinic acid, there are other formulations. You can get it online from Pilgrims Pride. It really seems to work.

Have you looked at your triglycride/HDL ratio ? I have were this is a very good indicator as to the LDL particle size. Less than 2 and you should have "fluffy" LDL. Just curious if that matches your particle test results.

Something else to look at is red yeast rice

http://www.umm.edu/altmed/articles/red-yearice-000323.htm

 

[oldphd]

"Nuclear Magnetic Radiation"

D'oh! Just caught your original quote which wasn't correct (pulled from my restatement but originally by Alan), NMR stands for Nuclear Magnetic Resonance (not radiation). It's based on the natural frequency (Larmor frequency) of the molecule, which is proportional to the strength of the magnetic field. MRI stands for magnetic resonance imaging. Since the Larmor frequency is proportional to the field strength, varying the field strength allows for the excitation of only a subset of the targeted molecules. Many imaging protocols and signal processing for efficiency lead to the ability to create the images.

OK, probably TMI for the ER forum, but if you're interested there's enough info to do a search.

 

[oldphd]

Is the sample used just a spot of serum on filter paper, or serum in a tube, or ?

They are able to characterize type of particle and
average size, max and min size, etc.

Could you also explain this?

Ha

Well, I'm not actually capable of designing MRI protocols, but I did stay at a Holiday Inn once.

A significant advantage of MRI compared to other imaging techniques like x-rays is the ability to distinguish soft tissue.

The imaging protocol is designed to look for a specific molecule with a particular resolution of whatever is in the field. There are many protocols and they are custom designed to look for whatever the physician suspects may be a problem, or wants to rule out. Breast cancer? Torn knee ligament? Brain function response (fMRI)?

Molecules in a magnetic field have a natural frequency known as a Larmor frequency which is proportional to the magnetic field strength. These frequencies are in the MHz range. In the case of MRI for humans, since the body is made up substantially of water, hydrogen is in abundance and what is typically searched for.

The MRI protocol consists of varying the magnetic field in 3 directions, emitting an RF signal, and measuring the RF response. The design of the sequence and the strength of the static/local field all control the end resolution.

Specific imaging protocols are selected based on what's being searched for. There are different weights (T1, T2, etc.) as well. While we think of diagnostic imaging for people, it is used on other things, inanimate objects, etc. What can I say, it's a specialized field and I just scratch the surface, apologies to anyone who reads this and knows more than I and finds errors.

 

[Khufu]

I wonder if the guys taking niacin could mention the dose, and the form. Just regular flushing niacin?
Ha

I take 1500 mg of enduracin (from endur.com) each night before going to bed. Enduracin is a form of immediate release niacin embedded in a wax matrix for timed release. The product has been around for 50 years or more and was used by Dr. Parsons who did the major study on niacin in the 70's that showed reduced mortality.

When the 1500 mg dose was effective I tried lowering it to 1000mg, but the cholesterol bounced right back up. I have since read that 1500 mg is the typical threshhold for an effective dose. Enduracin like other forms sometimes produces a warm flash. I would say once or twice a year it is enough to be very noticeable, but it is not really a problem for me.

Enduracin is cheap. A month's supply costs me about $8. There is a prescription form called Niaspan. Some forms, such as "inositol hexanicotinate" have no flush, but also have no effect on cholesterol levels.

Parsons wrote a book on niacin that is worth reading although a little dated now, "Cholesterol Control Without Diet."

Immediate release niacin is also effective, but then you have to take it several times a day.

 

[Khufu]

Something else to look at is red yeast rice

Red yeast rice

Red yeast rice is just a statin. If I were going to take a statin I would only take pharmaceutical grade, not red yeast rice.

 

[haha]

Have you looked at your triglycride/HDL ratio ? I have were this is a very good indicator as to the LDL particle size. Less than 2 and you should have "fluffy" LDL. Just curious if that matches your particle test results.

Thank you for the link rbmartin. Yes, my small particles are almost nonexistent, and my triglyceride LDL ratio is less than 1/2. Nevertheless, I had and still have a pretty high number of particles (almost all large.) Recent data from a study called ( I think) "The Framingham Offspring Study" seem to show that large LDL particles are still plenty small enough to penetrate the arterial wall, and it is the total number of LDL particles that is controlling.

Recently I had an opportunity to speak with a rep from Liposcience in my Doc's office, and he explained this information and the studies.

@Khufu and oldphd, thank you for your information.

Ha

 

[donheff]

On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

The flushing can make your skin redden and possibly feel warm to the touch. While annoying, this flushing isn't harmful. If you have flushing, talk to your doctor about taking an aspirin shortly before you take your niacin. Aspirin can counteract this flushing effect. Also, avoiding hot drinks and alcohol can decrease flushing. Versions of niacin with reduced flushing effects also are available by prescription.
Other possible side effects include:

• Upset stomach
• Headache
• Dizziness
• Liver damage
• Increased blood sugar

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects

Most people don't notice side effects from statins especially at low doses. Most people do experience flushing with niacin and need to treat that effect to be satisfied with the drug. For Ha the safest approach would appear to be the dietary changes he has made if the LDL reduction holds up over time.

Edit: and why the insistence that the flushing isn't harmful? Has that been carefully studied or just assumed? Something significant is going on here.

 

[Chuckanut]

I think the next particle test will show what is possible for me with continued exercise, and more fish and chicken and less red meat.
Ha

Do you have to get these tests from the doctor's office? I would like to experiment with what works and doesn't work for me and my cholesterol level, but the idea of runing to the doctor's office to constanly get tested is a negative. Still, I suppose if one must to it to be healthy, then one must do it

 

[Lsbcal]

I read the posts here, very interesting and thanks to Ha for starting this. I think genetically I tend to high cholesterol. What has worked for me:

1) Mediterranean diet: lots of chicken, fish, vegs, fruits.
2) Glass of wine per night. Maybe I'm kidding myself on this one.
3) Exercise: at least 20 miles running per week.
4) Doctor suggested Red Yeast extract (and he's not into alternative medicines as a rule). This reduced total cholesterol by maybe 20 to 30 points. Have taken for years now. Apparently there are some "natural" statins in this.

The above has given be a good cholesterol ratio and acceptable total cholesterol.

I eat plenty of chocolate based sweets, my downfall perhaps.

 

[donheff]

4) Doctor suggested Red Yeast extract (and he's not into alternative medicines as a rule). This reduced total cholesterol by maybe 20 to 30 points. Have taken for years now. Apparently there are some "natural" statins in this.

The above has given be a good cholesterol ratio and acceptable total cholesterol.

Even more than niacin I would wonder why not just take a low dose of lovastatin since that is what this stuff allegedly contains?

 

[haha]

Do you have to get these tests from the doctor's office?

SInce Medicare pays for this test, I got it at my MD's. However, the first time I got it my then doctor was not interested, so I bought it myself from privatemdlabs.com. You can buy almost any test, from this place or many others. I think the demand really got going when people wanted to be anonymously tested for STDs.

They give you a chit for a local lab; often it is LabCorp. In the case of the nmr test, the sample is sent to Liposcience in Raleigh, as this is the only lab that does this test. The results are emailed within a couple days.

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

Ha

 

[Lsbcal]

Even more than niacin I would wonder why not just take a low dose of lovastatin since that is what this stuff allegedly contains?

I found some mention of Lovastatin here: Red yeast rice - Wikipedia, the free encyclopedia

Lovastatin became the patented, prescription drug Mevacor for Merck & Co. Red yeast rice went on to become a contentious non-prescription dietary supplement in the United States and other countries.

So is Lovastatin a lower risk alternative to Red Yeast Extract? I have an open mind on this one so am just trying to get more info. The Wiki article above does make me wonder now. Or maybe I should just drop the Choleast and see how the next cholesterol count looks. Hmmm.

 

[rgarling]

...

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

Ha

Here is an example of a discordant nmr lipid test:
================
LDL Particle Number
LDL-P 2311 H nmoi/L <1000

Lipids
LDL-C 138 H mg/dL <100
HDL-C 63 mg/dL >=40
Triglycerides 65 mg/dL <150
Cholesterol, Total 214 H mg/dL <200
LDL and HDL Particles
HDL-P (Total) 38.5 umoi/L >= 30.5
Small LDL-P 826 H nmoi/L <= 527
LDL Size 20.9 nm > 20.5

Insulin Resistance Score 19 <= 45
Hep B Surface Ab 9.43 H Index Value 0.00-0.99
Vitamin D, 25-Hydroxy 45.5 ng/mL 30.0-100.0
===============

5'2" 120lb 60 year old female with good blood pressure, healthy and active. Her LDL-C (138) is at about 50% (expected non-medicated value) while her LDL-P (2311) is about 95% (higher than 95% of the population), hence the discord. (She tests at 50% via one measurement method and 95%+ using a different method purportedly measuring the same thing.) In this case, her normal lipid panel doesn't look too bad (TC 214, LDL 138, HDL 63, Trigs 65) but her nmr profile looks dismal (LDL-P is off the charts @2311and small LDL-P is a little high).

I don't think there is enough data available yet to know what this means to an individual for the long haul; however, being in the 95% percentile should be unsettling.

 

[haha]

Here is an example of a discordant nmr lipid test:
================
LDL Particle Number
LDL-P 2311 H nmoi/L <1000

Lipids
LDL-C 138 H mg/dL <100
HDL-C 63 mg/dL >=40
Triglycerides 65 mg/dL <150
Cholesterol, Total 214 H mg/dL <200
LDL and HDL Particles
HDL-P (Total) 38.5 umoi/L >= 30.5
Small LDL-P 826 H nmoi/L <= 527
LDL Size 20.9 nm > 20.5

Insulin Resistance Score 19 <= 45
Hep B Surface Ab 9.43 H Index Value 0.00-0.99
Vitamin D, 25-Hydroxy 45.5 ng/mL 30.0-100.0
===============

5'2" 120lb 60 year old female with good blood pressure, healthy and active. Her LDL-C (138) is at about 50% (expected non-medicated value) while her LDL-P (2311) is about 95% (higher than 95% of the population), hence the discord. (She tests at 50% via one measurement method and 95%+ using a different method purportedly measuring the same thing.) In this case, her normal lipid panel doesn't look too bad (TC 214, LDL 138, HDL 63, Trigs 65) but her nmr profile looks dismal (LDL-P is off the charts @2311and small LDL-P is a little high).

I don't think there is enough data available yet to know what this means to an individual for the long haul; however, being in the 95% percentile should be unsettling.

Wow! How did you get this?

Ha

 

[Tyro]

I wonder if the guys taking niacin could mention the dose, and the form. Just regular flushing niacin?

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

 

[Mulligan]

On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

The flushing can make your skin redden and possibly feel warm to the touch. While annoying, this flushing isn't harmful. If you have flushing, talk to your doctor about taking an aspirin shortly before you take your niacin. Aspirin can counteract this flushing effect. Also, avoiding hot drinks and alcohol can decrease flushing. Versions of niacin with reduced flushing effects also are available by prescription.
Other possible side effects include:


[*]Upset stomach
[*]Headache
[*]Dizziness
[*]Liver damage
[*]Increased blood sugar

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects

Most people don't notice side effects from statins especially at low doses. Most people do experience flushing with niacin and need to treat that effect to be satisfied with the drug. For Ha the safest approach would appear to be the dietary changes he has made if the LDL reduction holds up over time.

Edit: and why the insistence that the flushing isn't harmful? Has that been carefully studied or just assumed? Something significant is going on here.

I also wonder about this, too. If you are taking niacin to avoid statins but have to take aspirin to counteract symptoms, doesn't aspirin sometimes cause symptoms, too? For that matter many people just take the aspirin to prevent heart attacks. So skip the niacin and go straight to aspirin? I take krill oil, but that is it. Working on a disciplined diet is my main priority. Lucky for me, yesterday I turned on the news just in time to hear people with AB blood type have more heart attacks than other blood types. Really made my day.

 

[Tyro]

On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

If you consider vitamin B3, an essential human nutrient, to be just another drug, then I won't argue that point.

Mayo cites statins as having similar side effects, and more, but Mayo is known to be one of the more conservative medical sources.

WebMD lists statin side effects as:

The most common statin side effects include:

• Headache
• Difficulty sleeping
• Flushing of the skin
• Muscle aches, tenderness, or weakness (myalgia)
• Drowsiness
• Dizziness
• Nausea and/or vomiting
• Abdominal cramping and/or pain
• Bloating and/or gas
• Diarrhea
• Constipation
• Rash

Statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take.

(and more).
​

Statins have also been linked to being a cause, and factor in, neuropathies:

Numerous studies have reported that peripheral neuropathies often developed in subjects that used statin drugs for a period of one to seven years. The incidence rate is one in 2200 persons and is often permanent even after stopping the statin drug.
Researchers studied over 500,000 individuals taking statin drugs. They found that taking statin drugs for one year increased their risk of developing neuropathies by 15%, after two years the risk rose to 26%.
Statins Linked to Peripheral Neuropathies: Cholesterol Drugs Linked to Peripheral Neuropathies | Suite101.com

(Also Google: statins peripheral neuropathy)
​

Much more can be found by Googling: statins adverse effects
Much more can be found by Googling: dangers of statin drugs
Much more can be found by Googling: statin drugs liver disease

Given my DW's cholesterol, my own peripheral neuropathy (NOT due to statins), and our other medical concerns, we've researched this matter (statins vs. niacin) fairly thoroughly, and both concluded that niacin is the preferred (safer) way to go for us. YMMV.

Tyro

 

[Tyro]

If you are taking niacin to avoid statins but have to take aspirin to counteract symptoms, doesn't aspirin sometimes cause symptoms, too?

That's a valid point. There are some things to keep in mind about niacin flush. First, not everyone experiences it. It depends on the dosage and release rate; ER formulations produce less flush than IR formulations. It's often recommended taking at bedtime; flush is less noticed while asleep. Once the body acclimates, the flush usually abates, so countering it with another agent is often a temporary situation. If aspirin is a problem, niacin flush can also be countered with vitamin C (either ascorbic acid or Ester C).

There are pros & cons with any remedy or treatment. If niacin flush (or any other side effect of any medication or supplement) is intolerable, then of course it makes sense to investigate alternatives.

Everyone is different, and should decide the best thing for themselves. Information and knowledge are power, so I would encourage anyone to research this themselves -- being proactive in their own medical care.

Tyro

 

[web_diva]

haha, sounds like you are really committed to getting those numbers in line. I am glad that they are at a level you and your doctor are pleased with. I go in with another couple of families on a grass fed organic yearling each fall and we stock our freezers. So much more affordable that way. Wish it was as easy for me to get raw milk...it's a hassle.

I find it unsettling how little modern medicine knows about cholesterol. It is the building blocks for all hormones in our body and absolutely essential. There is evidence to suggest there is a lot more to it than we know. It's pretty common knowledge that statins are bad news and was glad to see it mentioned in this thread. Plenty on Merola.com about that. I have found this thread really interesting.

Because we know so little, that's why i like to fall back on traditional wisdom and diets...unfooled around with foods. Chuckanut, if you were referring to my summary post from the Weston A. Price foundation as an "anecdotal story", please see the link I provided and the science there.

 

[Khufu]

On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

The flushing can make your skin redden and possibly feel warm to the touch. While annoying, this flushing isn't harmful. If you have flushing, talk to your doctor about taking an aspirin shortly before you take your niacin. Aspirin can counteract this flushing effect. Also, avoiding hot drinks and alcohol can decrease flushing. Versions of niacin with reduced flushing effects also are available by prescription.
Other possible side effects include:

• Upset stomach
• Headache
• Dizziness
• Liver damage
• Increased blood sugar

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects

Most people don't notice side effects from statins especially at low doses. Most people do experience flushing with niacin and need to treat that effect to be satisfied with the drug. For Ha the safest approach would appear to be the dietary changes he has made if the LDL reduction holds up over time.

Edit: and why the insistence that the flushing isn't harmful? Has that been carefully studied or just assumed? Something significant is going on here.

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. For most of us, including myself, the flushing largely disappeared after the first month anyway.

In considering the full risk profile it is well to enumerate the possible side effects as you have done, but then you also have to consider their frequency. As far as I am aware, none of the side effects from niacin have frequencies that approach statin-induced myopathy which, according to the Times article, affects 10% of users unless they are physically active in which case it is 25% or more. None of the doctors I discussed niacin with ever offered even a single case of side effects from niacin, other than flushing.

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?