Cholesterol madness

[braumeister]

Had my semiannual checkup today and we went through the usual pointless conversation:
"I'd really like to see you on a statin"
"Not a chance"
"OK, next topic ..."

As some here may remember, I'm an extreme skeptic about statins and the cholesterol hypothesis in general. My total cholesterol and LDL levels have always been high, but my HDL and triglyceride levels are outstanding, which is all I care about.

Anyway, the doc brought up a new one this morning, with a wink since he knew what my reaction would be. It seems that some prominent cardiologists are going far beyond the standard LDL goal of 100 or less, and now want your LDL level to be less than your age. Why? Because they have new drugs that can bring it down that low.

 

[Teacher Terry]

How ridiculous! My doctor knows better than to bring up the subject.

 

[RAE]

The whole notion that LDL is the "bad cholesterol" is flawed, as Dr. David Perlmutter explains here:

https://www.drperlmutter.com/ldl-friend/

Your doctor, like most doctors, has obviously not kept up with current research on LDL and cholesterol. I would suggest that you switch doctors, but it probably wouldn't do any good, as the vast majority of doctors will continue to push statins and other drugs to control things that are not causing any harm in the first place.

I will be having my annual exam/blood test at the doc's office this fall, and I will probably get the same advice that you just got (although he knows how I feel about statins). So I mainly go for the blood test (covered by insurance), the results of which I will interpret myself, as I always do.

 

[braumeister]

Your doctor, like most doctors, has obviously not kept up with current research on LDL and cholesterol. I would suggest that you switch doctors, but it probably wouldn't do any good, as the vast majority of doctors will continue to push statins and other drugs to control things that are not causing any harm in the first place.

Exactly.
In fact, I did switch doctors over a year ago, mainly because the previous one was pushing the pills a little too hard.

The current doc is much more understanding, and admits that he only mentions the drugs because he's expected to. He doesn't give me any static about it which I appreciate. I'm perfectly capable of interpreting my own lab results.

 

[eytonxav]

My PCP wants my LDL to be < 70 due to diabetes, HBP (totally controlled) and a family history of heart disease. About 6 months ago he switched me from Simvastatin to Rosuvastation because my LDL was 73. Now my LDL is 52. Unfortunately I rarely get my HDL to hit 40, although my Tryglicerides always stay pretty low (last reading 69). At first I thought muscle soreness was occurring after the switch, but now am not so sure.

 

[RAE]

The current doc is much more understanding, and admits that he only mentions the drugs because he's expected to.

I understand. My doctor probably does it for the same reason. It does illustrate, though, just how messed up medical care has become these days (I'm not talking about medical care for trauma, etc.....I have no problem with that type of care). The doctors are "expected" to push drugs that at least some of them know are not necessary, and could possibly even cause harm, because to do otherwise would incur the wrath of their employer, the big drug companies, and whatever else makes up "mainstream medicine". The system is really broken, in my view - sound medical advice is being overshadowed by the drive for profit. The only way to really know if you should take what is being prescribed is to do your own research first. That takes time and effort, and the big drug companies know that the vast majority of patients won't go that far, so it just goes on and on.....

 

[sengsational]

Any doctor that prescribes a statin based on calculated LDL or without running the Apo B blood test should be fired.

 

[RAE]

My PCP wants my LDL to be < 70 due to diabetes, HBP (totally controlled) and a family history of heart disease. About 6 months ago he switched me from Simvastatin to Rosuvastation because my LDL was 73. Now my LDL is 52.

You might want to show your doctor this recent research paper on cholesterol, LDL, and heart disease (first link is a short article about the paper, the second link is the paper itself):

‘Bad Cholesterol’ May Not Be So Bad After All - University of South Florida

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391

Quote from one of the paper's co-authors:

“There have been decades of research designed to deceive the public and physicians into believing that LDL causes heart disease, when in fact, it doesn’t,” said David Diamond, PhD, a professor in USF’s Departments of Psychology and Molecular Pharmacology & Physiology, and a co-author of the article. “The research that has targeted LDL is terribly flawed. Not only is there a lack of evidence of causal link between LDL and heart disease, the statistical approach statin advocates have used to demonstrate benefits has been deceptive.”

And here is an excerpt from the paper itself:

"Elderly people with high LDL-C live the longest

If high LDL-C was the major cause of atherosclerosis and CVD, people with the highest LDL-C should have shorter lives than people with low values. However, in a recent systematic review of 19 cohort studies including more than 68,000 elderly people (>60 years of age), we found the opposite In the largest cohort study, those with the highest LDL-C levels lived even longer than those on statin treatment."

 

[braumeister]

My PCP wants my LDL to be < 70 due to diabetes, HBP (totally controlled) and a family history of heart disease.

Yes, I would never discourage the use of cholesterol-lowering medications for those with significant risk factors (like you).

My objection is for the wanton prescription of them for others (like me).

Big difference. There is some valid research showing a benefit for those at risk (particularly those who have already experienced a coronary heart disease "event"), but none whatever for those of us with no risk factors.

 

[robnplunder]

My cholesterol have been borderline to above bad. But the ratio between good/bad cholesterol have been OK. My doctor mentions taking drug every time I visit and my answer has been always "not this time." Every cholesterol drug I took had side effects that I can't stand. I don't think I will ever take another cholesterol drug again.

 

[mamadogmamacat]

Timely post for me.
Will be having blood drawn this week for annual tests, and see the Dr in early June.

Statins are no longer mentioned, other than when the nurse takes vitals and confirms what medicines I am taking and which ones I'm allergic to.
I'm listed as allergic to statins and also one family of antibiotics.

So. perhaps if you get yourself listed as officially allergic to statins that will end this type of drug pushing on your doctor's part.
This electronic medical records push has its advantages

 

[Teacher Terry]

If I remember correctly the studies were all done on men.

 

[mamadogmamacat]

TT, yes that was something i wish I had known and fully researched prior to my six week long statin joint destroying disaster.

 

[audreyh1]

Had my semiannual checkup today and we went through the usual pointless conversation:
"I'd really like to see you on a statin"
"Not a chance"
"OK, next topic ..."

As some here may remember, I'm an extreme skeptic about statins and the cholesterol hypothesis in general. My total cholesterol and LDL levels have always been high, but my HDL and triglyceride levels are outstanding, which is all I care about.

Anyway, the doc brought up a new one this morning, with a wink since he knew what my reaction would be. It seems that some prominent cardiologists are going far beyond the standard LDL goal of 100 or less, and now want your LDL level to be less than your age. Why? Because they have new drugs that can bring it down that low.

That’s interesting - a new informal guideline, pushed by new medicines. What a surprise!

 

[audreyh1]

Yes, I would never discourage the use of cholesterol-lowering medications for those with significant risk factors (like you).

My objection is for the wanton prescription of them for others (like me).

Big difference. There is some valid research showing a benefit for those at risk (particularly those who have already experienced a coronary heart disease "event"), but none whatever for those of us with no risk factors.

Another one who doesn’t accept statin treatment for no risk factors - especially for women.

My total cholesterol, LDL and triglycerides have been creeping up the last couple of years. I suspect this is exactly correlated with having entered menopause in that timeframe. Interestingly, my HDL is higher than usual, now above 60 which is good news, but that also pushes up total cholesterol.

Anyway, my doc says he doesn’t care about the total cholesterol, but wants to attack the creeping triglycerides and get them way down. He prescribed a strict LCHF diet designed to cause ketosis. I’d been thinking over the past year that I would have make some kind of serious low carb change before too long, so I was already motivated to make the change. We’ll see!

FWIW my doc’s target for triglycerides is below 80.

 

[eytonxav]

You might want to show your doctor this recent research paper on cholesterol, LDL, and heart disease (first link is a short article about the paper, the second link is the paper itself):

‘Bad Cholesterol’ May Not Be So Bad After All - University of South Florida

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391

Thanks, I've shown him other studies in the past, but he is undeterred in my case due to my individual risk factors which Braumeister also alluded to. I do not see why anyone without risk factors needs to be on a statin, as cholesterol is a building block for many of the bodies hormones that depend on it, and it can cause other negative effects. I've been on a statin for over 20 years, and it makes me wonder if that contributed to my coming down with diabetes about 10 years ago.

 

[Teacher Terry]

Neither my husband or I even care what our numbers are. Yes diabetes can be a side effect of statins.

 

[RAE]

my doc says he doesn’t care about the total cholesterol, but wants to attack the creeping triglycerides and get them way down. He prescribed a strict LCHF diet designed to cause ketosis. I’d been thinking over the past year that I would have make some kind of serious low carb change before too long, so I was already motivated to make the change. We’ll see!

FWIW my doc’s target for triglycerides is below 80.

Interesting. Your doc is at least focused on the right thing (triglycerides), and not on LDL and cholesterol. And the fact that he prescribed a diet to help achieve lower triglycerides is pretty amazing to me......most doctors ignore diet, and talk only about available drugs to control various things.

It's good to keep triglycerides low, but keep in mind that the ratio of triglycerides to HDL has been shown to be the best predictor of heart disease risk. If you are below 2.0 (which it sounds like you are), you are in good shape (low risk). If you can get it down to, or below 1.0, that is even better, so no harm in trying the LCHF diet to lower it further. Triglyceride levels are closely tied to carb consumption, so my guess is that you will lower your triglyceride level if you follow the LCHF diet for a while. Going so low-carb that you achieve ketosis is difficult to achieve for a lot of people, and may not really be necessary for someone like you. Personally, ketosis does not work for me; if I lower my carb consumption to near zero, I can't maintain my desired weight (no matter how much fat/protein I eat). Let us know how it works for you........

 

[braumeister]

Going so low-carb that you achieve ketosis is difficult to achieve for a lot of people

I would say most people. But if you stick to a really LCHF diet for about three weeks it becomes much easier.

I'm another one who doesn't really go that far, at least any more. Partly because DW has told me that when I'm in ketosis my breath will drop a charging rhino at 50 paces.

But my trig/HDL ratio stays right about 1.2 without any real effort so I don't see the need to be extreme.

 

[razztazz]

FWIW my doc’s target for triglycerides is below 80.

My doctor says triglycerides are meaningless and no attention needs to be paid to them. I kid yous not

 

[nativenewenglander]

Another one who doesn’t accept statin treatment for no risk factors - especially for women.

My total cholesterol, LDL and triglycerides have been creeping up the last couple of years. I suspect this is exactly correlated with having entered menopause in that timeframe. Interestingly, my HDL is higher than usual, now above 60 which is good news, but that also pushes up total cholesterol.

Anyway, my doc says he doesn’t care about the total cholesterol, but wants to attack the creeping triglycerides and get them way down. He prescribed a strict LCHF diet designed to cause ketosis. I’d been thinking over the past year that I would have make some kind of serious low carb change before too long, so I was already motivated to make the change. We’ll see!

FWIW my doc’s target for triglycerides is below 80.

I started a LCHF diet on 12/17 and have lost 38lbs. At 58 I feel better than I have since my late 30's. The diet worked well for me, but it takes willpower. plus getting used too. What I also found was I now only eat breakfast around 10 am and dinner at 7 pm. I never get hungry during the day even skiing from 9am to 3pm. The higher fat fills you up.

 

[audreyh1]

I would say most people. But if you stick to a really LCHF diet for about three weeks it becomes much easier.

I'm another one who doesn't really go that far, at least any more. Partly because DW has told me that when I'm in ketosis my breath will drop a charging rhino at 50 paces.

But my trig/HDL ratio stays right about 1.2 without any real effort so I don't see the need to be extreme.

Doc is having me target 20g carbs, which is very low, but nowhere near 0 carbs. I suspect I could get away with a higher target like 30 to 50. I cut out all starches/sugars/fruits for a week, then started the carb counting once I found an app. It didn’t take me long to get into ketosis. I didn’t have acetone breath thank goodness, but I had a few other symptoms, most seemed mild, so I got some ketostix and the ketones in my urine were moderate to high.

 

[audreyh1]

Interesting. Your doc is at least focused on the right thing (triglycerides), and not on LDL and cholesterol. And the fact that he prescribed a diet to help achieve lower triglycerides is pretty amazing to me......most doctors ignore diet, and talk only about available drugs to control various things.

It's good to keep triglycerides low, but keep in mind that the ratio of triglycerides to HDL has been shown to be the best predictor of heart disease risk. If you are below 2.0 (which it sounds like you are), you are in good shape (low risk). If you can get it down to, or below 1.0, that is even better, so no harm in trying the LCHF diet to lower it further. Triglyceride levels are closely tied to carb consumption, so my guess is that you will lower your triglyceride level if you follow the LCHF diet for a while. Going so low-carb that you achieve ketosis is difficult to achieve for a lot of people, and may not really be necessary for someone like you. Personally, ketosis does not work for me; if I lower my carb consumption to near zero, I can't maintain my desired weight (no matter how much fat/protein I eat). Let us know how it works for you........

My ratio of triglycerides to HDL is slightly above 2, so definitely some room for improvement.

He has me targeting 20g carbs. I seemed to hit ketosis fairly quickly, so I suspect I could maintain ketosis with a higher target like 30-50, but I will do 20 for now. I could definitely lose 10 pounds. It’s been gradually accumulating around my middle.

 

[audreyh1]

Thanks, I've shown him other studies in the past, but he is undeterred in my case due to my individual risk factors which Braumeister also alluded to. I do not see why anyone without risk factors needs to be on a statin, as cholesterol is a building block for many of the bodies hormones that depend on it, and it can cause other negative effects. I've been on a statin for over 20 years, and it makes me wonder if that contributed to my coming down with diabetes about 10 years ago.

It’s very unfortunate that it wasn’t understood until recently that statin use increased the risk of developing diabetes.

 

[robnplunder]

Anyway, my doc says he doesn’t care about the total cholesterol, but wants to attack the creeping triglycerides and get them way down. He prescribed a strict LCHF diet designed to cause ketosis. I’d been thinking over the past year that I would have make some kind of serious low carb change before too long, so I was already motivated to make the change. We’ll see!

FWIW my doc’s target for triglycerides is below 80.

My triglycerides is down to 70. I suspect it is largely due to my intermittent fasting diet (shed 10% of my weight). I was also hoping it'd (diet + reduced weight) lower my cholesterol. It only improved by little, not enough to know if the diet did anything.