Low Carb............now with high cholesterol

[moragm45]

I've been diabetic for 24 years and have always controlled it quite well. I've been following a low carb diet for a few months and my blood sugars have been brilliant. I've felt great and full of energy for the first time in years. But...................my cholesterol has shot up! I was doing very well with the tablet I had been on for about a year, then my doctor changed it as the one I was on was no longer recommended for diabetics. The new meds made me ill. After getting my bloods done a few days ago my doctor has now called me in to discuss my cholesterol which is high for the first time! I don't want to change from the low carb diet but I know my doctor is going to tell me to and will blame the "high fat" for my increased cholesterol. Any ideas to bring down my cholesterol would be greatly appreciaated

 

[SamJB]

Same here. I'm on statins since yesterday.

 

[VickiT11979]

I'm expecting this to turn into yet another of those threads with arguments about whether high cholesterol is bad or not & whether statins improve outcomes or not - hope not however.
I've been eating less carbs for 11weeks now, amount varies but usually 60-80g/day, at most 130g very rarely (tbh this has only been when I've eaten out, guessed my bolus wrong & needed lots of carbs to correct hypos). I've eaten more saturated & unsaturated fat & more protein, but mainly fat.
I'm going to get a HbA1c & lipids done in 2weeks, but if my average BG from home tests (7.4 last 30days) correlates with my HbA1c, it should be lower - I hope by a fair bit. But what if my LDL chol has shot up?

I've been chasing the medical evidence to try to work out how much I'm reducing my risks by reducing my HbA1c, and then I intend to do the same but for increased risk & cholesterol.
I can't actually find an answer that's relevant to my exact situation, but here's what I've got so far:
The DCCT trial is the big landmark trial in type 1 diabetics, from 1983. It was 1440 type 1s age 13-39, who'd been diagnosed 5-15years, half treated normally (back then that meant 2 mixed injections daily & occasional finger prick BG tests) & half treated more like we are now. HbA1c was 8.6-9.1% in the normals & 7-7.3% in the intensive treatment group, and this went on for 6.5yrs. Those with a HbA1c of around 7% had hugely reduced risks of diabetic eye, nerve & kidney disease. They looked at the same people 10yrs after this finished, by which time they both had average HbA1cs of around 7%, and those who had been intensively treated earlier still had much lower complications, plus lower heart disease & cardiovascular death.
What worries me is that I infer from that, that it's tight control within the first 15years of diagnosis which seemed to be the important factor.

Or I could say, that it proves that having a HbA1c of 8.6-9% within 5-15yrs from diagnosis leads to higher risks in the long term, even if you improve control later.
I'm one of those diabetics getting normal care back in the eighties, and can't remember, but expect that my HbA1cs were not great.

There's no definite scientific evidence that I've seen so far that tells me that I will reduce my risks as a type 1, 33years from diagnosis, by improving my HbA1c from my previous 7.1% to, say, 6.1%. I can infer that, but I've not seen clear proof.
This would apply to Morag as well, but not to you Sam, as you've only been diagnosed 9 years.

Whereas I have no idea right now if there's proof of increased risk with a higher cholesterol, but if there is, then I should probably go back to my previous high carb diet.

It's a conundrum!

Any experts on the research studies in type 1 out there?

 

[SamJB]

Hi Vicky,
I need to dig the links out, but an hba1c in the 6s means that your risk of cardiovascular disease is twice that of the non-diabetics, in the 7s you are 3 times the risk. The minimum mortality rate occurred at a total cholesterol level of 4.2. A level of 6 increases the mortality rate by 1.5.

So having a high cholesterol level and an hba1c in the 6s is less risky than an hba1c in the 7s and a low cholesterol.

 

[VickiT11979]

Thanks Sam,

Links to specific studies would be brilliant. Was it including type 1s, and people with diabetes for many years? Or maybe I'm over thinking all this :crazy:
Those numbers you give really help to objectively compare the effects of what I'm doing. How do you feel about being on statins? I actually asked my hospital team if they thought I should be on them last Nov, the middle grade Doc I saw wasn't sure but the consultant said no cos my HDL was high & BP & kidneys are normal. Some guidelines say all type 1s over 35 should be on them, or earlier if any other cardiovascular risks, whatever the lipid levels, but I don't really want to if I don't have to. Maybe I do now though...will see what bloods show.

 

[VickiT11979]

I've found another article stating that "Each 1% increase in HbA1c poses 15-18% relative risk of cardiovascular disease in T1DM & T2DM respectively", but there's no reference for this. It was a review article published July 11.
Furthermore, I think your figures (now I've read them properly) say that increasing your HbA1c from 6% to 7% increases your CV risk from 2x to 3x, or in other words, by 1.5. This is the same figure you give for increased risk of death with a chol of 6 versus 4.2. I think the relative risk reduction going from 7% to 6% is 0.33 (so if your risk was 3, it's now 2, down by 1/3).

It looks like the reduction in CVD risk by 1/3 (33%) from reducing HbA1c would be cancelled out by the increase death risk of 1.5 (or an extra 50%) from increasing cholesterol, and death is worse than angina, so I'd actually choose to lower my cholesterol instead of my HbA1c if I had to choose between them.

My only other query would be why total cholesterol is the thing linked to mortality, when part of this is HDL which is the protective stuff. My TC last Nov was 6.1, but HDL was 2.8 & triglycerides 1.4, and like I said, I was advised I shouldn't take statins.

 

[viviennem]

I've been diabetic for 24 years and have always controlled it quite well. I've been following a low carb diet for a few months and my blood sugars have been brilliant. I've felt great and full of energy for the first time in years. But...................my cholesterol has shot up! I was doing very well with the tablet I had been on for about a year, then my doctor changed it as the one I was on was no longer recommended for diabetics. The new meds made me ill. After getting my bloods done a few days ago my doctor has now called me in to discuss my cholesterol which is high for the first time! I don't want to change from the low carb diet but I know my doctor is going to tell me to and will blame the "high fat" for my increased cholesterol. Any ideas to bring down my cholesterol would be greatly appreciaated

Make sure you get a full lipid profile, not just a "total cholesterol" figure, and get your GP to go through it with you carefully, explaining everything to you.

Cholesterol/lipid profile figures for non-diabetics should be as follows:

Total - less than 5.18
HDL - above 1.2, and the higher the better. This is the "good" stuff.
LDL - less than 3. This is the "bad" stuff.
Triglycerides - below 1.7 and the lower the better. Even worse "bad" stuff.

Very important is the Total :HDL ratio. The target is below 5:1, and preferably below 3.5:1.

My GP pays much more attention the the Total:HDL ratio than to the Total just by itself.

Opinions can vary about optimum levels. My GP is happy if my total is in the mid-5s, as long as the Total:HDL ratio is okay. Many GPs prefer diabetics to have a Total level in the 4s or even the 3s, but if the lipid profile is as above and the ratio is okay, it's worth asking why the Total figure is so important. I'd be very interested to hear the answer!

A low-carb diet can cause an increase in triglyceride levels in the first few weeks, as the body goes into ketosis and the stored fat gets "liberated" for burning. This higher phase shouldn't last long, and after that low-carbing should lower your Total cholesterol and improve your lipid profile. My best-ever lipid profile was after 18 months on Atkins Induction, about 7 years ago (I wasn't diabetic then). Most of your cholesterol is made by your liver; only about 20% comes from dietary fat intake.

Your brain can't function properly without cholesterol, and it is the cholesterol under your skin that metabolizes sunlight into Vitamin D. We are supposed to have some in our system!

If you are offered statins, ask why, and then ask why the daily amount? 40mg daily is usual (for Simvastatin), but that always seems rather high to me. If your cholesterol really is high, then statins will help and you should probably take them. Many people can do so for years without any problems. Others get side-effects, so ask about that, and then ask if you can have your cholesterol regularly reviewed for a while - every 3 months, perhaps - so that you know how you're going on with them. Meanwhile, read up about statins - the pros and the cons - and keep an eye out for side-effects, though don't blame everything on the tablets (too easy to do :lol: ).

Finally: I know of at least 4 medical professionals who won't take statins themselves, and who will only prescribe them as a last resort.

I hope you get a good discussion going with your doctor; I will always follow my GP's advice, but I like to discuss things with him from a position of strength - ie, well armed with information and questions. I think he respects me for it ! :crazy:

Viv 8)

 

[SamJB]

Sorry Vicky, what I said does sound confusing. Let me start again!

I guess I justify it to myself is that having an hba1c in the 6s means that my relative risk of complications is near 1, except for cardiovascular disease, where its 2. If I can take statins to reduce my cholesterol to be in the 4s that puts my relative risk of cardiovascular disease at 2. Whereas if I didn't low carb and didn't take statins my hba1c would be in the 7s and cholesterol in the 4s. My risk would then be 3.

Clear as mud?!

And I used total cholesterol as that was the only statistic in my head at the time! TC is mostly made of LDL (which turns into HDL once it has dumped fats into your cells), which is why it has been used as an indicator.

 

[alaska]

Just a note about the fact that there is also the consideration of pattern A and pattern B LDL:
http://www.healthcentral.com/cholesterol/c/7986/116328/ldl-pattern

Pattern A -a larger form of LDL particles
Pattern B -a smaller form of LDL particles

Research indicates that pattern B represents a significantly higher risk cardiovascular health than pattern A.

I understand it's relatively rare to undergo a test for the different patterns of LDL in the UK. As far as doctors are concerned here, if you have high LDL then you're at significantly higher risk of heart disease.

Having done some (though far from extensive) reading around the subject, it seems that a higher LDL value combined with normal or low triglyceride levels is more more indicative of the safer pattern A type of LDL.

I'd be interested to read if anyone has more knowledge on this area.

Ed

 

[VickiT11979]

Sam, yes that makes sense & I understand your reasoning. Thank you for coming back & clearing it up.

Ed, I have heard what you said elsewhere, that people eating low carbs tend to have large "fluffy" LDL particles versus the bad small LDL particles, but thought we couldn't test in the UK to find out which we had. Using the triglycerides sounds like our best option. Do you know what triglyceride level is considered to be low?

 

[viviennem]

They don't usually test for LDL particle size in the UK - probably because it's expensive!

Triglycerides should be below 1.70, and the lower the better. High is over 2.26. My lowest ever was 0.65, and I have heard of people with even lower levels than that. I don't think it's possible to have too low a triglyceride reading.

Viv 8)

 

[moragm]

Thanks everyone. I appreciate your time to answer :clap: xx

 

[MartinAU]

I have recently found out that I have high cholesterol. (211 with high LDL). Doc says that it is attributable to family history as I am in good physical shape, and that I will probably have to start taking meds, which I am opposed. I started searching for different things on how to lower cholesterol but there is so much information that I am lost.

 

[stuffedolive]

I'm waiting for my latest Cholesterol and Hba1c results after 10 weeks low-carbing but I do have my latest BP ... 104/70

 

[viviennem]

I'm waiting for my latest Cholesterol and Hba1c results after 10 weeks low-carbing but I do have my latest BP ... 104/70

Excellent BP - well done! :thumbup: :clap: :clap: :clap:

Viv 8)

 

[Andy12345]

sheeeesh, im really interested in this subject, unfortunatly i dont understand a word of it lol, shame

 

[hanadr]

What do you call HIGH cholesterol?
You need to know what kind of cholesterol is high in your case. LDL should be low, but HDL should be quite high. the HDL /total cholesterol ratio is more important than the raw figuresd. It should be as high as possible.
there's actually no evidence that total cholesterol in single figures hurts anyone.
Hana

 

[stuffedolive]

I'm waiting for my latest Cholesterol and Hba1c results after 10 weeks low-carbing but I do have my latest BP ... 104/70

I just got my figures back.

Total Chol down from 6.7% to 4.9%
Ratio down fom 4.2to 3.1
HDL stayed the same at 1.6 - so my LDL must have come down significantly
Triglycerides down from 1.1 to 0.7
Blood pressure down from 120/80 to 104/70

make of that what you will...

 

[lucylocket61]

I was doing very well with the tablet I had been on for about a year, then my doctor changed it as the one I was on was no longer recommended for diabetics. The new meds made me ill. After getting my bloods done a few days ago my doctor has now called me in to discuss my cholesterol which is high for the first time! I

Why do you think the low carbs have caused this rise? It appear that you have changed meds, and they didnt suit. I would be inclined to stay with the low carbs, and take the new statins for a little while to see if your cholesterol comes down on pills which suit you. If not, then look at the low carbing.

But at the moment i appears that two things have changed, and you dont know which one has caused the rise. You dont say how the pills caused problems, or which pills they were, but maybe they werent working for you properly, and the new ones will.