Another potential nail in LDL's coffin ?

librarising

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Am I understanding all this correctly? Do not not fast before a blood draw to measure Cholesterol but do fast for a Triglyceride count? As all counts are normally taken from one blood draw how should we manage this?
What are you referring to ? The video ?
 

Oldvatr

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Sorry, that is a poorly worded sentence. I should update it...

Basically, I'm saying reference ranges for low to high risk is probably different for those on a low carb diet over those on a high carb diet. A low carb diet has an appropriate reason to send out and traffick more VLDLs at any given time, given it is part of its core energy distribution. Whereas a high carb diet shouldn't be trafficking as many VLDLs given its primary energy is glucose/glycogen. Thus, it may well be a sign of trouble for the carb-centric diet at a certain RC level where it isn't for the low carber because it's routine.

Again, all of this comes back to the VLDLs themselves aren't the problem, it's the fact they are either (1) in a traffic jam (hyperinsulinemia/past fat threshold) or (2) higher quantities in order to fight disease (see Siobhan's upcoming piece). Either way, it can be a reflection of a broken system so long as one keeps the correct context in mind (how much VLDLs expected due to being fat-centric vs carb-centric).

I hope I articulated that a lot better.

tl:dr More VLDLs are appropriate on a fat-centric diet and may thus skew the RC ranges.
I think I catch your drift. To my mind a Keto diet has higher VLDL traffic, but it is controlled and expected and so is ok for low carbers. This extra traffic results in a higher LDL distribution too, again a natural and ok thing to occur. But high LDL for a carb heavy diet spells trouble since the mechanism of control may be faulty due to Insulin Resistance etc.. The latest thinking is that high carb traffic (bgl glucose) with high lipids leads to more congestion in the blood, with more collisions giving rise to increased inflammation / damage to LDL creating sLDL remnants as free trigs (i.e. RC) and it is these damaged trigs that lead to plaque buildup. That is how I see it at the moment.
 
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Oldvatr

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Sorry, yes.
The test for full lipid panel should be a fasting test. Eating temporarily distorts the lipid balance and will give a higher TG value that is not a true indication of your normal status. It is I think due to the excess lipids in circulation that have not yet been hoovered up by the HDL and returned to the liver for recycling.

Edit to add: I should advise fasting for any cholesterol or lipid panel since the perturbation due to eating could skew the results temporarily, and I would expect TC to go up probably due to LDL increasing but HDL lagging, so NOT in your favour as regards GP's and statins.
 
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Guzzler

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The test for full lipid pnel should be a fasting test. Eating temporarily distorts the lipid balance and will give a higher TG value that is not a true indication of your normal status. It is I think due to the excess lipids in circulation that have not yet been hoovered up by the HDL and returned to the liver for recycling.

Thank you. Then a 12 hour fast should, by rights, be suffient.
 

Guzzler

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The test for full lipid panel should be a fasting test. Eating temporarily distorts the lipid balance and will give a higher TG value that is not a true indication of your normal status. It is I think due to the excess lipids in circulation that have not yet been hoovered up by the HDL and returned to the liver for recycling.

Edit to add: I should advise fasting for any cholesterol or lipid panel since the perturbation due to eating could skew the results temporarily, and I would expect TC to go up probably due to LDL increasing but HDL lagging, so NOT in your favour as regards GP's and statins.

Just to answer your edit. This was in the back of my mind, really. I would prefer a true(r) picture of my panel results but with regards to GP/Statins I need to understand those results so as to convince HCPs that I am cognizant of the decisions I am making and perhaps stop the nagging at every appointment which is now actually putting me off seeing a GP.
 

Oldvatr

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Just to answer your edit. This was in the back of my mind, really. I would prefer a true(r) picture of my panel results but with regards to GP/Statins I need to understand those results so as to convince HCPs that I am cognizant of the decisions I am making and perhaps stop the nagging at every appointment which is now actually putting me off seeing a GP.
I have my GP under control LOL. I think the difficulty is that the evidence against statins is not recognized by mainstream medicine, and until HCP training changes, then they will promote the NICE guidelines. Few HCP's have time to research on their own so it will take time for subjects like TG being the new 'Bad Boy' to replace LDL in their minds. The studies that show that statins are ineffecive for most women and not suitable for those of advancing age etc are what are termed meta studies and this type of statistcal analysis has not been fully accepted by the authorities as a valid model to base treatment decisions on. So speak nicely to your doctor in the 10 minutes a year that you get for this, and Good Luck. There are postings on this forum that have links to the new research, so a trawl can give you ammunition to use, but the GP has a legal duty of care, and that means following official guidelines. At the end of the day, you have a right to refuse treatment, and that can only be overruled in a court of law or by section under the mental health act. Just as you can discharge yourself from Hospital, then although they can apply for a court order, it is unlikly to be over taking statins against your will. I find that accepting the meds in the scrip then losing them is sometimes the prudent way forward with neither party losing face. Works for me......
 

Bluetit1802

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I need to understand those results so as to convince HCPs that I am cognizant of the decisions I am making and perhaps stop the nagging at every appointment which is now actually putting me off seeing a GP.

You don't need to convince them. That may well be convinced anyway, or may be a lost cause, but as they are advised by NICE to offer them this is what they have to do. All you need do is say "no thank you". You don't have to justify yourself. You can also ask for something appropriate to be put in your notes.
 

Guzzler

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You don't need to convince them. That may well be convinced anyway, or may be a lost cause, but as they are advised by NICE to offer them this is what they have to do. All you need do is say "no thank you". You don't have to justify yourself. You can also ask for something appropriate to be put in your notes.

Offering is not done, it is more akin to bullying. I am determined that until actual proof tells me that lowering cholesterol aids health/risks then I will not even accept a prescription never mind have it filled. I am seriously considering 'telling' my GP that I will withdraw consent to full lipid panels being added to the lists of tests being ordered if ever the mere mention of TC is made again. I do not know if I am legally at liberty to do this and would prefer not to but this would solve my problem.
My last results viewed online gave only TC and Non HDL so it was pretty useless anyway. I would much rather keep my GP from thinking I am non compliant but I am his patient not his bezzy mate.
 

Oldvatr

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.......... I am seriously considering 'telling' my GP that I will withdraw consent to full lipid panels being added to the lists of tests being ordered if ever the mere mention of TC is made again. I do not know if I am legally at liberty to do this and would prefer not to but this would solve my problem.
My last results viewed online gave only TC and Non HDL so it was pretty useless anyway. I would much rather keep my GP from thinking I am non compliant but I am his patient not his bezzy mate.
Don't throw your toys out of the pram just yet, especially on what seems to be a matter of principle. Simply take the scrip, get the meds, put them in the bin if you do not want to use them. The GP is not watching you take your meds, unless you are in hospital with a nurse administering. This way both of you tick your own boxes, and live happily after. Otherwise it will cause angst and could end up with the practice taking you off their books as has happened to others.

If your diet is successful then your lipids should fall naturally and look like "the statins are working" instead of languishing in landfill (or be a good girl and drop them into the local pharmacy for recycling if your conscience worries you)

You have a legal right to refuse treatment. They have a legal right to apply for a court ruling in their favour if they consider you are in danger of harming yourself, but I doubt if refusing Big Pharma is in that category in this case.

https://www.verywell.com/do-patients-have-the-right-to-refuse-treatment-2614982

And for the opposiion
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf
 
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AtkinsMo

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I found straightforward assertiveness worked, and also always booking appointments with the same person. So then the argument is settled. The simple statement “ There are no circumstances when I would consider taking Statins”, does a power of good.
 
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Guzzler

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Don't throw your toys out of the pram just yet, especially on what seems to be a matter of principle. Simply take the scrip, get the meds, put them in the bin if you do not want to use them. The GP is not watching you take your meds, unless you are in hospital with a nurse administering. This way both of you tick your own boxes, and live happily after. Otherwise it will cause angst and could end up with the practice taking you off their books as has happened to others.

If your diet is successful then your lipids should fall naturally and look like "the statins are working" instead of languishing in landfill (or be a good girl and drop them into the local pharmacy for recycling if your conscience worries you)

You have a legal right to refuse treatment. They have a legal right to apply for a court ruling in their favour if they consider you are in danger of harming yourself, but I doubt if refusing Big Pharma is in that category in this case.

https://www.verywell.com/do-patients-have-the-right-to-refuse-treatment-2614982

And for the opposiion
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf

You are right, of course. I will end up 'playing the game' one way or another. Thank you for the links.
 

Bluetit1802

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My notes say "statins refused" on every occasion they have been mentioned. My nurse no longer mentions them, ever. My GP pushed them on me after my diabetes diagnosis brought me over the 10% Q-risk. I knew no better and accepted them, but once I knew better I stopped taking them. After a summer of discussions she gave up and told me to take an aspirin instead. They have never been mentioned again. (and I don't take aspirin either)

The "statins refused" entry covers them from any possible repercussions. It is all that is needed.
 

Guzzler

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My notes say "statins refused" on every occasion they have been mentioned. My nurse no longer mentions them, ever. My GP pushed them on me after my diabetes diagnosis brought me over the 10% Q-risk. I knew no better and accepted them, but once I knew better I stopped taking them. After a summer of discussions she gave up and told me to take an aspirin instead. They have never been mentioned again. (and I don't take aspirin either)

The "statins refused" entry covers them from any possible repercussions. It is all that is needed.

This is what I am hoping for (I remember you telling me about this before). But to give you perspective, you may remember that I had seen the GP to request a rereferral to ENT. He turned to his screen and I thought he was searching for the details on my notes about hearing impairment but he turned back to me and talked of nothing but TC/Statins. I know I'm not the sharpest knife in the drawer but someone has to explain to me how a high TC makes one deaf. I got my referral but I felt that it was almost being held to ransome.
 

DaveKeto

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Yes -- Please fast at least 8 hours, preferably 12 before taking a lipid panel. When eating a meal, you WILL have fat packaged into chylomicrons as TG, which WILL increase your serum TG levels (and again, note that TG is part of what is used in the Friedewald calculation for LDL-C). This isn't speculative, it's simple molecular accounting.

The only question is how long it takes for the very last chylomicron to be cleared by the liver from the food you ate -- and there's disagreement in studies there. What I can tell you is that there's basically no disagreement that it will be cleared after 12 hours of fasting.

Moreover, there are many other non-lipid blood markers that can be impacted in the wake of a fed state. And note that the fed state length of time/process is highly varied by the meal and individual's metabolic health itself. This is why the new change in the guideline is so outrageous to me.
 
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Safi

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Most of this stuff is over my head & it seems the more I read the more confused I become :banghead: Can anybody ( maybe @DaveKeto ) tell me if the fact that my cholesterol is low (LDL 1.8, HDL 2.7, Trigs .36) is in any way a problem or indicative of my not being an efficient fat burner? Would love to know!
 

Oldvatr

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Most of this stuff is over my head & it seems the more I read the more confused I become :banghead: Can anybody ( maybe @DaveKeto ) tell me if the fact that my cholesterol is low (LDL 1.8, HDL 2.7, Trigs .36) is in any way a problem or indicative of my not being an efficient fat burner? Would love to know!
Your cholesterol results have all moved in the right direction. Your LDL has dropped, your HDL has risen, and your trigs have also fallen. I would be very happy to have a set like yours. Although I am not an expert, I would say that you are on target as regards lipids and fat burning. The question is how is the weight and waistline doing?