Statins

[Grateful]

I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

At this point I gently pushed back, saying that I would much prefer to try diet and lifestyle changes first. My argument was that if I start taking the statins immediately, I will never know whether non-drug alternatives could do the trick on their own.

The nurse said that the recommendation is for cholesterol to be 5 or below, and for anyone who has been diagnosed with diabetes, 4 or below. She said that because my cholesterol is high, I am at higher risk of a cardio-vascular event.

I then asked her to check what my cholesterol was, the last time it had been checked. This was 15 months ago (at the time of my NHS "MoT") and at that time the numbers were almost exactly the same as they are now. At the time, the nurse casually mentioned that the numbers were high but took no further action.

Today I told the diabetes nurse it looks like I have been living with high cholesterol for at least 15 months, so I don't personally have a problem with taking a few extra weeks during which I can try to use diet-only to bring the number down. At this point she actually agreed with me and gave me three months to get the number down without drugs. We will re-assess at the end of April. (She said I could keep the prescription because it is valid for 6 months!)

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

 

[bulkbiker]

[QUOTE="Grateful, post: 2202632, member: 438800"

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?[/QUOTE]

far from Devils advocate you are being an informed patient.
Your nurse is also a couple of years out of date on the 4.0 for T2’s as opposed to 5.0 for the “normies “ . Did you happen to get a figure for your triglyceride levels?
The trig/HDL ratio is now thought to be more important in terms of CVD ...

 

[Member496333]

The whole thing is an absolute nonsense unless you actually have heart disease. Only in my non-medical and completely uninformed opinion, of course.

The last time my DN insisted that it was recommended to be below five, I said it was recommended not to mention it to me again. So far so good...

 

[Bluetit1802]

Before you (or your nurse and doctor) can make any decisions on statins, you need the full breakdown of HDL, LDL and triglycerides. From that you can work out your trigs/HDL ratio. This should be ideally under 0.87, but not at all bad if it is a little higher. You also need to fast for 12 hours or thereabouts before the test or the results for the trigs can be skewed. Your nurse is far behind the times putting emphasis on the total cholesterol. Even NICE no longer recommends this. Sadly, the NHS is still handing out statins like sweeties to children.

If you don't have these figures to hand you can ask for a print out of the test results or view them on-line.

 

[Grateful]

So this is all very new to me. Here are the results of my blood tests a couple of weeks ago:

Serum cholesterol: 6.5 mmol/L
Serum HDL cholesterol level: 1.8 mmol/L
Ratio of the above: 3.6
Serum triglicerides: 1.9 mmol/L
Calculated LDL cholesterol level: 3.84 mmol/L
Se non HDL cholesterol level: 4.7 mmol/L

I am very new to all this, but according to my calculation, the trigs/HDL ratio (as mentioned by @Bluetit1802) is 1.05 (assuming that I understand how to do the maths). This is higher than the ideal ratio of 0.87 but how concerning is it really?

 

[Brunneria]

Hi @Grateful

Good to see you back posting again!

The thing about the trig reading is that it varies. A lot. Actually all your cholesterol readings vary - not as much as blood glucose, but they still vary from day to day.

The trig reading is particularly interesting (to me ) because of the things that make it vary - and which then has an obvious knock on effect on your Trig/HDL ratio.

From memory, carbs, alcohol and fructose have a significant effect on raising Trigs, but I suggest you do a bit of reading on it.
My own Trigs were the highest they have ever been where I had a family celebration meal out the day before, a couple of years ago. Big 3 courser, with a fair number of carbs and the most delicious dessert of fruit, ice cream and choc. Oh, and wine. I never usually drink, so I am sure that was a contributory factor too. Interestingly, my Trigs the day after that little lunch were 1.8, whereas all my other test for the last few years have been around the 0.8-1.1 area.

 

[Grateful]

[QUOTE="Grateful, post: 2202632, member: 438800"
Your nurse is also a couple of years out of date on the 4.0 for T2’s as opposed to 5.0 for the “normies “ .

Her wording was quite careful about 4.0 being the number for "anyone who has ever been diagnosed with diabetes". But this strikes me as a bit strange if your T2 is controlled (A1c at normal levels) and has been controlled for an extended period of time -- in my case, fully controlled since my diagnosis three years ago. While I realise that T2 is a chronic disease, I had thought the CV dangers (and other consequences of T2) were not substantially "in play" if the disease is under tight control.

Part of my thinking is influenced by observing another generation (my parents, parents-in-law, and other elderly people) who ingest an amazing cornucopia of pills all day: for blood pressure, for cholesterol, for (fill in the blank). While I realise that I am unlikely to reach extreme old age without taking at least some drugs, it makes sense to try to delay this for as long as possible unless the treatment truly adds many years to your life.

 

[Sangre]

I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

At this point I gently pushed back, saying that I would much prefer to try diet and lifestyle changes first. My argument was that if I start taking the statins immediately, I will never know whether non-drug alternatives could do the trick on their own.

The nurse said that the recommendation is for cholesterol to be 5 or below, and for anyone who has been diagnosed with diabetes, 4 or below. She said that because my cholesterol is high, I am at higher risk of a cardio-vascular event.

I then asked her to check what my cholesterol was, the last time it had been checked. This was 15 months ago (at the time of my NHS "MoT") and at that time the numbers were almost exactly the same as they are now. At the time, the nurse casually mentioned that the numbers were high but took no further action.

Today I told the diabetes nurse it looks like I have been living with high cholesterol for at least 15 months, so I don't personally have a problem with taking a few extra weeks during which I can try to use diet-only to bring the number down. At this point she actually agreed with me and gave me three months to get the number down without drugs. We will re-assess at the end of April. (She said I could keep the prescription because it is valid for 6 months!)

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

Lots of nonstarchy plant foods and exercise! Statins make me really ill. Weakness, extremely low blood pressure, and aches & pains in every joint. I use a product available in the US called Cholest-off and it has lowered my bad LDL cholesterol. The Green Keto diet has raised my good HDL cholesterol, along with lowering my Ha1c. Cholesterol, in and of itself, is not a bad thing. It is actually the body’s way of protecting our blood vessels. High cholesterol is rather a symptom of inflammation. It would be best to go after the inflammation instead of the LDL. It could be gut, liver, pancreas, or other kind of inflammation. Stop eating processed foods. Limit carbs to less than 50 net grams per day. Eat organic grass fed, free range, wild caught animal products. And HUGE amounts of nonstarchy veggies. Eliminate industrial oils in favor of coconut, olive, or avocado oils. This has worked miracles for me! I hope it can work for you!

 

[Bluetit1802]

I agree with @Sangre particularly as regards the inflammation aspect. Have you read up on the roles Omega 3 and Omega 6 play? Omega 6 is a necessary part for various things but it does cause inflammation. Omega 3 is its opponent. It reduces inflammation. You need to eat foods with the right balance of both. According to what I read, the typical American diet has a ratio of somewhere round 1:20 omega3/omega6. The ideal ratio is more like 1:2 omega3/omega6. To help reduce inflammation and trigs, whilst increasing HDL (the good cholesterol), it is a good idea to chose foods rich in omega 3 and low in omega 6. There are plenty of lists of these on Google. Carbs are also known to decrease HDL, and the higher the HDL the better.

By the way, another unwanted side effect of statins is they raise BG levels, and research has shown they have actually caused non-diabetics to become diabetic.

There is an excellent thread on the forum started by @bulkbiker with pages and pages of informative videos on cholesterol and statins that you may like to read, but you will need several days to get through them all!
https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/

Nice to have you back on the forum.

 

[KK123]

Before you (or your nurse and doctor) can make any decisions on statins, you need the full breakdown of HDL, LDL and triglycerides. From that you can work out your trigs/HDL ratio. This should be ideally under 0.87, but not at all bad if it is a little higher. You also need to fast for 12 hours or thereabouts before the test or the results for the trigs can be skewed. Your nurse is far behind the times putting emphasis on the total cholesterol. Even NICE no longer recommends this. Sadly, the NHS is still handing out statins like sweeties to children.

If you don't have these figures to hand you can ask for a print out of the test results or view them on-line.

Hi Bluetit, I think you'll find the decision s already made as far as the Nurse or Doctor is concerned, 'Diabetes?, statins'. Mine is high, 8.1 (HDL 2.45, Trigs 0.5 and the rest LDL). I have argued against taking statins and quoted my decent ratios to no avail. I have refused to take any (and won't) but get fed up with them going on about it. My hba1c is good (they say too low at 38) and I do follow a very healthy lifestyle (No booze/cigs), lots of exercise, good weight etc and when I asked what was the point of all that then if they are still going to dish out pills they said 'Diabetes means you're at risk whether it's controlled or not'!

 

[Grateful]

'Diabetes means you're at risk whether it's controlled or not'!

Very interesting. I don't understand the rationale, but that doesn't necessarily mean that this statement is incorrect. But I worry about its blanket nature, and would need some stringent proof.

 

[bulkbiker]

Hi Bluetit, I think you'll find the decision s already made as far as the Nurse or Doctor is concerned, 'Diabetes?, statins'. Mine is high, 8.1 (HDL 2.45, Trigs 0.5 and the rest LDL). I have argued against taking statins and quoted my decent ratios to no avail. I have refused to take any (and won't) but get fed up with them going on about it. My hba1c is good (they say too low at 38) and I do follow a very healthy lifestyle (No booze/cigs), lots of exercise, good weight etc and when I asked what was the point of all that then if they are still going to dish out pills they said 'Diabetes means you're at risk whether it's controlled or not'!

I’ll be very interested what my doc says to me after my recent test results.. with total at 8.2 but great trigs and HDL ... it’s a new doc so let’s see what he thinks he knows about cholesterol...

and @Bluetit1802 I know you know that LDL ain’t “bad” cholesterol...not even cholesterol....

 

[KK123]

Very interesting. I don't understand the rationale, but that doesn't necessarily mean that this statement is incorrect. But I worry about its blanket nature, and would need some stringent proof.

Hi Grateful, just for clarification of others reading my quote in your post, it wasn't me saying this, I was just quoting what this Consultant said. x

 

[Listlad]

I have the full test in a few weeks. After a year of lchf it will be interesting to see my cholesterol results and what my surgery have to say after the results come through.

 

[KennyA]

Recognise this problem. My cholesterol has always been in the 7.4-7.6 range ever since first test, at least 20+ years back. Didn't vary no matter what weight or level of fitness I was at, which has included at times very high levels of fitness and activity. Current GP reckoned I have possibly got naturally high level. Offered statins but always refused as not prepared to take something with at best 99% chance of having no benefit. But - this month blood test done at first DPN appointment shows cholesterol up to over 8. BP still low. Weight dropping on LC/HF. Statins back on hard sell offer. Still don't want to take them and have said to let me try diet etc first. I understand that fasting (which I'm doing) can raise cholesterol levels and I know that there are increasingly questions over statin efficacy. I'm digging my heels in.

 

[BrianTheElder]

Hi @Grateful

The thing about the trig reading is that it varies. A lot. Actually all your cholesterol readings vary - not as much as blood glucose, but they still vary from day to day.

Which is why the best check for triglycerides is TC/HDL < 3.5 - better than directly measuring trigs, which are too variable.

 

[bulkbiker]

Recognise this problem. My cholesterol has always been in the 7.4-7.6 range ever since first test, at least 20+ years back. Didn't vary no matter what weight or level of fitness I was at, which has included at times very high levels of fitness and activity. Current GP reckoned I have possibly got naturally high level. Offered statins but always refused as not prepared to take something with at best 99% chance of having no benefit. But - this month blood test done at first DPN appointment shows cholesterol up to over 8. BP still low. Weight dropping on LC/HF. Statins back on hard sell offer. Still don't want to take them and have said to let me try diet etc first. I understand that fasting (which I'm doing) can raise cholesterol levels and I know that there are increasingly questions over statin efficacy. I'm digging my heels in.

Your body your choice.. no way would I ever take them.

 

[Bluetit1802]

and @Bluetit1802 I know you know that LDL ain’t “bad” cholesterol...not even cholesterol....

You know I know you know I know that LDL isn't bad ....

 

[Mike d]

Still waiting for a member's poll ....

 

[Tophat1900]

You know I know you know I know that LDL isn't bad ....

Now we all know!