Cholesterol on a Low Carb Diet

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
This may be common knowledge, and it may not be. It wasn't to me, so I did a bit of research into it because to be honest, I seem to correct my diabetic nurse more often than I listen to her. I'm not confident she has a good understanding of low carb diets. It's probably not her fault, but the science really does need to hit doctor's surgeries one day before we all end up on pointless medication for no apparent reason.

Okay, here's the latest development. After dropping over four stone in weight as a T2 diabetic using a low carb diet (20g carbs a day, and no exercise because I'm a lazy sod), and keeping my blood sugar levels down to normal throughout the last year, I expected diabetic remission. I earned it, right? I'm a lightweight, non-diabetic, low blood sugar wonder these days, who can still eat a chocolate eclair when I want one (7g carbs each, from Asda frozen foods--a lovely treat after ketosis).

But because my cholesterol went up a point, I'm stuck with more diabetes checks in May 2014. Why? Since when is cholesterol anything to do with diabetes, and more to the point, is it actually high cholesterol?

The answers are: It has nothing to do with diabetes, and no--the cholesterol measurement in a standard test doesn't mean you're at risk from heart disease. In fact, it doesn't mean anything at all.

So here are the numbers I was given by the nurse:
Starting cholesterol (pre diet) = 6.9 (blood sugar = high/diabetic) (weight = 15 stone 3lbs)
Midway cholesterol (2 months on a keto diet) = 4.1 (blood sugar = low/no longer diabetic) (weight = 12 stone 7lbs)
Endgame cholesterol (7 months on a keto diet) = 5.3 (blood sugar = low/no longer diabetic) (weight = 10 stone 10 lbs)

Okay, so that cholesterol looks bad, doesn't it? Everything else is good though. This confused me. I feel healthy, I look healthy and I'm not diabetic. What's with the hinky cholesterol results?

The nurse didn't give me much advice that I was willing to take. She told me to cut down my fats, but I know that those are my energy source, and they're good for me, so I wasn't taking that advice.

So I came home and did my research. I also asked the wonderful woman who advised me on my diet in the first place. She's always right and saved me from the dreaded medication in the beginning by getting me on a keto diet in the first place (my hero).

So here's the breakdown for anyone with the same concerns I had about cholesterol:

Cholesterol comes in three forms, but the ones that we care about are called HDL and LDL. If your levels are 1 part HDL and 2 parts LDL, then you're healthy. The number on the cholesterol (5.3 is mine right now) don't mean anything because it's how many parts are good cholesterol (HDL) and how many are bad cholesterol (LDL). The ratio of 2:1 (2 parts LDL and 1 part HDL) is the healthy level.

I didn't get a breakdown of my 5.3 cholesterol, so I don't actually know if I'm in the good or bad side of that equation. The number of the weight is meaningless. If for example 4.3 of that 5.3 result are HDLs, then I'm the healthiest person alive in terms of cholesterol levels. HDLs are protective cholesterols that prevent arteries clogging up. LDLs are the nasty cloggers. If you have just one third of protective cholesterols in your blood, then you're gonna be fine.

Another interesting fact is that high fat diets lead to larger chunks of LDL cholesterol. Chunks so large they are too big to stick to artery walls. So on a high fat diet, you're less likely to get blocked arteries. Here's more info on that: http://lowcarbdiets.about.com/od/faq/f/carbcholesterol.htm

Looking around to confirm it all, I checked this site out. For science geeks, this defines the ratios really well in terms of use. I thought it was an interesting article about it all:
http://eatingacademy.com/how-low-carb-diet-reduced-my-risk-of-heart-disease

And finally, I asked the wonderful woman who set me on the low carb path, and her own results made me really curious about what my LDL:HDL breakdown is because I'm now convinced that my diabetic nurse doesn't understand cholesterol results at all. Here's what my guru said:

Did you get a breakdown on the cholesterol? An overall figure is useless without a breakdown showing the ratio between LDL and HDL cholesterol. Normally, the ideal is to have a ratio of one third HDL (good) cholesterol to two thirds LDL (bad). If the LDL is more than three times the HDL, they start getting concerned. At 3:1, you are considered to have a low risk of heart problems.

When I last got a blood test done, my total cholesterol was about 5.2 or something similar, and they looked at the breakdown. And nearly had collective heart attacks. My HDL was higher than my LDL. They had never seen that before, and wanted to know how I did it. My risk was pretty much zero.

So I'd have a look at the breakdown.

But in any case, you are right. Cholesterol has nothing to do with blood sugar or diabetes. And it's not a predictor of anything except your likelihood of being prescribed statins. As many people with low cholesterol have heart attacks as with high cholesterol. Reducing cholesterol does nothing to improve your life expectancy.

Do NOT let them put you on statins. In the next episode, I'll explain the concept of NNT to you, and you'll go through the roof.



So, I'm dying to find out what NNT is, but I'll be saying 'no thank you' to statins and requesting a breakdown of my cholesterol levels. Someone should do an article about backwards medical practices vs dieting realities based on science. Since when was medical science based on heresay and creativity? I expect it to be based on fact and scientific study. But with diets, that appears to be too much to ask for.

Overall: The doctor =0 / The internet and a friend =2 (doctors, you fail).
 
  • Like
Reactions: 2 people

kentish maid

Well-Known Member
Messages
109
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
people who tell me I don't need to test my blood
I also have this problem my surgery cannot do a lipid profile my cholesterol was 5.3 I was also told to cut out fats which I ignored.
 

CollieBoy

Well-Known Member
Messages
2,974
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Hi carb Foods
Claire, another aspect, once you get a breakdown of your lipids is what do your ratios suggest about your LDL makeup.
http://care.diabetesjournals.org/conten ... 9.full.pdf looks at whether it is likely to be big/fluffy or small/dense.
My consultant raves that my LDL is too high but this suggests that my lDL may be the good type :) :) As the NHS are unlikely to spring for anything more costly than a calculation of LDL rather than a proper test of LDL present this statistical model will have to do us.
 

dawnmc

Well-Known Member
Messages
2,431
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
Just tried to pm you Claire but apparently you do not exist!!!!!
 

Yorksman

Well-Known Member
Messages
2,445
Type of diabetes
Type 2
Treatment type
Diet only
Total cholesterol is a rough guide which may prompt a test for a full lipid profile. It has the benefit, unlike a full lipid profile, that it doesn't need to be a fasting test. A 'full' lipid profile often comprises, LDL, HDL, Total, Triglycerides and VLDL. There is a bit of a knee jerk reaction to LDL, HDL and Total because of a perceived association with coronary heart disease. If you have any illness at all which has any possible association with heart disease, you will have your cholesterol monitored.

Triglycerides and VLDL are probably more important for an indication of how your pancreas and liver are getting along and you are right Claire, the condition of your heart, whilst important, is not immediately important for the state of your diabetes. Total cholesterol, a quick and dirty test, is just a quick check, keeping an eye on things heart related. The mistake of many GPs is to ignore the trigs. Many associate trigs with alcohol and liver damage. True, this is a test but trigs are fatty acids, and you might think of them as sort of intermediate stages between fat and glucose. They can go either way, ending up as glycogen or as deposited fat, depending on the complex chemistry which is involved. The quick wiki explanation is: "As a blood lipid, they help enable the bidirectional transference of adipose fat and blood glucose from the liver. There are many triglycerides: depending on the oil source, some are highly unsaturated, some less so."

Sugars and refined carbohydrates increase triglyceride levels so it is an important indicator, often overlooked, for people with diabetes. The GPs tend to concentrate on LDL and HDL and the heart whereas more attention should be paid to any sign of a build up of trigs in the liver and pancreas. VLDL is assembled in the liver from triglycerides and is too, an indicator. It aids in the transport of substances generated in the organs.

The following statement by Roy Taylor ought to be nailed to the desk of every GP:

"The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function."

But, when they order the full lipid profile, LDL and HDL are the headline grabbers and high trigs are just associated with heavy drinking.
 
C

catherinecherub

Guest
NNT is an abbreviation used by medics and relates to the number that needs treatment. It applies to any blood/urine tests that your Dr. may arrange. If your tests fall within an acceptable limit, then there will be no need for treatment.
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
kentish maid said:
I also have this problem my surgery cannot do a lipid profile my cholesterol was 5.3 I was also told to cut out fats which I ignored.

It seems a lot of people hit 5.3 and have perfectly healthy hearts. I'm with you on ignoring the advice about cutting fats. I think it's outdated information. I might ask my friend if she knows there the lipid test can be done privately. I'm trying to teach my diabetic nurse about the diet. She's a nice lady. I'm sure if she had the right information, she'd help a lot more people.
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
FergusCrawford said:
Claire, another aspect, once you get a breakdown of your lipids is what do your ratios suggest about your LDL makeup.
http://care.diabetesjournals.org/conten ... 9.full.pdf looks at whether it is likely to be big/fluffy or small/dense.
My consultant raves that my LDL is too high but this suggests that my lDL may be the good type :) :) As the NHS are unlikely to spring for anything more costly than a calculation of LDL rather than a proper test of LDL present this statistical model will have to do us.

Yep, I read that the density is relevant, and as my friend said, there isn't any evidence that cholesterol causes a heart attack anyway. I suspect my doctor will not have the answer on my HLD or LDL, still, I'm going to ask :p.
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
dawnmc said:
Just tried to pm you Claire but apparently you do not exist!!!!!

Honest, I do. Someone else just PM'd me. Give it another try if it's private. It must have been a bug. If it's still doing the same thing, I'll try PMing you. Let me know :)
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
Yorksman said:
Total cholesterol is a rough guide which may prompt a test for a full lipid profile. It has the benefit, unlike a full lipid profile, that it doesn't need to be a fasting test. A 'full' lipid profile often comprises, LDL, HDL, Total, Triglycerides and VLDL. There is a bit of a knee jerk reaction to LDL, HDL and Total because of a perceived association with coronary heart disease. If you have any illness at all which has any possible association with heart disease, you will have your cholesterol monitored.

Triglycerides and VLDL are probably more important for an indication of how your pancreas and liver are getting along and you are right Claire, the condition of your heart, whilst important, is not immediately important for the state of your diabetes. Total cholesterol, a quick and dirty test, is just a quick check, keeping an eye on things heart related. The mistake of many GPs is to ignore the trigs. Many associate trigs with alcohol and liver damage. True, this is a test but trigs are fatty acids, and you might think of them as sort of intermediate stages between fat and glucose. They can go either way, ending up as glycogen or as deposited fat, depending on the complex chemistry which is involved. The quick wiki explanation is: "As a blood lipid, they help enable the bidirectional transference of adipose fat and blood glucose from the liver. There are many triglycerides: depending on the oil source, some are highly unsaturated, some less so."

Sugars and refined carbohydrates increase triglyceride levels so it is an important indicator, often overlooked, for people with diabetes. The GPs tend to concentrate on LDL and HDL and the heart whereas more attention should be paid to any sign of a build up of trigs in the liver and pancreas. VLDL is assembled in the liver from triglycerides and is too, an indicator. It aids in the transport of substances generated in the organs.

The following statement by Roy Taylor ought to be nailed to the desk of every GP:

"The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function."

But, when they order the full lipid profile, LDL and HDL are the headline grabbers and high trigs are just associated with heavy drinking.

Thanks, that's a great explanation of it all. I'm pretty sure I don't have a problem. I don't drink alcohol lol. I mean, it's possible, I'm sure, that I don't have perfect cholesterol, but I suspect from the amount of fat on my body right now, that I'm using them all for energy. I'll see if I can get a full lipid profile, then I'll have my answer.
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
catherinecherub said:
NNT is an abbreviation used by medics and relates to the number that needs treatment. It applies to any blood/urine tests that your Dr. may arrange. If your tests fall within an acceptable limit, then there will be no need for treatment.
Yep, my friend sent me the NNT thing. it listed all the pointless medications people get put on when they don't actually need them:

NNT is Number Needed to Treat. It's the number of people who have to take a drug for one person to have a good outcome. For instance, if you are taking antibiotics for a stomach infection H pylori, the NNT is 1.1. 11 people need to take it for ten to have a good outcome.

That's a brilliant NNT. Most of the time, with effective medications, the NNT is 3 or 4, so three or four people take it and one will have a good outcome. That's considered effective and acceptable.

For someone who has not had a heart attack, what do you think the NNT is for statins? How many people have to take it for a year for one person not to have a heart attack?

Go on, take a guess.

Wrong!

The answer is 450. That's right, 450 have to take statins for a year for ONE not to have a heart attack. And the rate of serious adverse reactions to statins is about 10%. So 45 people will have a serious bad reaction like muscle failure or kidney damage, to prevent one not having a heart attack.

Even if you have previously had a heart attack, the NNT for statins is 250.


It's kind of scary that doctors do that to their patients.
 

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I think that you would have more information on which to make a decision ie a full lipid panel but it also depends on your other risk factors.
There are some people who develop very high cholesterol (higher than yours is at the moment) on a low carb diet which Dr Dayspring a lipidologist and largely low carb advocate suggests needs either treating with statins or diet modification

http://www.lecturepad.org/dayspring/lip ... ase291.pdf
One year is not really a good indicator, so it's unsurprising that you found those figures. The normal view is a long term one,
For some time, UK and US guidelines have recommended statins for primary prevention in patients with a 20% or greater estimated risk of cardiovascular disease over 10 years. In a new American College of Cardiology/American Heart Association guideline, this recommendation has changed radically to include moderate-to-high intensity statin treatment for patients aged 40—75 years with a predicted 7·5% or higher 10 year cardiovascular risk, without a requirement for monitoring of lipid concentrations.
http://image.thelancet.com/journals/lan ... 40-6736(13)62405-8/fulltext

This was from the Heart Protection study It's a good visual way of showing the NNT over 5 years.
http://www.nntonline.net/ebm/newsletter ... tatins.asp

As we are people with diabetes it's those people that we should be looking at.
The Cards study was actually stopped because it became unethical to continue with a non treatment group. The number needed to treat was 32 over 4 years (outcome major CVD event) This study is probably not applicable to you since these were people with diabetes but also another risk factor(hypertension ,retinopathy , current smoking or albuminuria) They were mainly male and over 60. (there are however people on this forum with similar risk factors)
http://www.rxfiles.ca/rxfiles/uploads/d ... -CARDS.pdf

These are the NNT from several trials including non diabetics :
With lovastatin, although over 9,000 people have been in trials, the trials were only for one year on average, and with low numbers of events. So the NNT is high at 187.

With pravastatin over 6,500 people were involved with trials going on for nearly four years on average. The number of events with controls was 15% and the NNT was 27.

With simvastatin, just under 5,000 people were studied, but for over five years. there was a large number of events with controls (33%), and the NNT was low at 10
http://www.medicine.ox.ac.uk/bandolier/ ... b47-2.html

There is a further slightly updated article here (which sorts put the outcomes into separate groups)
http://www.medicine.ox.ac.uk/bandolier/ ... atout.html

There is a much more recent trial with more women in, I haven't time but will look it up later.
edited to delete repeated section
 
Last edited by a moderator:

mpe

Well-Known Member
Messages
300
Claire87 said:
This may be common knowledge, and it may not be. It wasn't to me, so I did a bit of research into it because to be honest, I seem to correct my diabetic nurse more often than I listen to her. I'm not confident she has a good understanding of low carb diets.

Not an uncommon experience.

But because my cholesterol went up a point, I'm stuck with more diabetes checks in May 2014. Why? Since when is cholesterol anything to do with diabetes, and more to the point, is it actually high cholesterol?

The answers are: It has nothing to do with diabetes, and no--the cholesterol measurement in a standard test doesn't mean you're at risk from heart disease. In fact, it doesn't mean anything at all.

There does appear to be a connection between LOW cholesterol and insulin resistance. The total cholesterol probably does have some meaning, just not the same meaning many people (including medical professionals) assume.

So here are the numbers I was given by the nurse:
Starting cholesterol (pre diet) = 6.9 (blood sugar = high/diabetic) (weight = 15 stone 3lbs)
Midway cholesterol (2 months on a keto diet) = 4.1 (blood sugar = low/no longer diabetic) (weight = 12 stone 7lbs)
Endgame cholesterol (7 months on a keto diet) = 5.3 (blood sugar = low/no longer diabetic) (weight = 10 stone 10 lbs)

Okay, so that cholesterol looks bad, doesn't it? Everything else is good though. This confused me. I feel healthy, I look healthy and I'm not diabetic. What's with the hinky cholesterol results?

Actually it looks very GOOD. Close to the ideal level for a woman.
The "hinky" figure is the midway point. Which those obsessed with the "low is better meme" would probably say is good.

So here's the breakdown for anyone with the same concerns I had about cholesterol:

Cholesterol comes in three forms, but the ones that we care about are called HDL and LDL. If your levels are 1 part HDL and 2 parts LDL, then you're healthy. The number on the cholesterol (5.3 is mine right now) don't mean anything because it's how many parts are good cholesterol (HDL) and how many are bad cholesterol (LDL). The ratio of 2:1 (2 parts LDL and 1 part HDL) is the healthy level.

Cholesterol comes in TWO forms. Either on it's own or part of an ester. (In practice this only appears significent in the small intestine.)
LDL and HDL are types of lipoprotein (not of cholesterol). There are five types in humans.
Lipoproteins are containers used to enable lipids, which do not disolve in water, to be transported in blood.
Cholesterol is ONE of the lipids present in the human body.

The whole "good cholesterol", "bad cholesterol" idea is utter nonsense. Since it's based on a misunderstanding.
 
  • Like
Reactions: 4 people

mpe

Well-Known Member
Messages
300
Claire, another aspect, once you get a breakdown of your lipids is what do your ratios suggest about your LDL makeup.
http://care.diabetesjournals.org/conten ... 9.full.pdf looks at whether it is likely to be big/fluffy or small/dense.
My consultant raves that my LDL is too high but this suggests that my lDL may be the good type :) :)

Do you mean HDL? Most tests ignore IDL.

As the NHS are unlikely to spring for anything more costly than a calculation of LDL rather than a proper test of LDL present this statistical model will have to do us.

A model which is useless for determining number of LDL particles or which proportion are pattern A, pattern B or pattern I. (As well as which are actually LP(a).)

To find this out you need to look at the intact lipoproteins. The lipids inside may be of little to no importance when it comes to vascular issues.
 
  • Like
Reactions: 2 people

mpe

Well-Known Member
Messages
300
For those who have got their full lipid results try this Cholesterol HDL, LDL, Triglycerides Ratio Calculator

http://www.hughchou.org/calc/chol-si.php

A "full" lipid result would cover considerably more than two lipids inside two (out of five) classes of lipoproteins. Even without listing all the esters and/or separating them into alcohols and (organic) acids.

Lipids are a rather diverse group of compounds. The only thing they have in common is that they don't disolve in water.
 

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
Thanks for all the replies everyone, especially MPE for the information. I'm very relieved that my numbers are on the 'healthy range'. I'm not too worried by the cholesterol, although I am going to ask if I can get some tests done that will explore it on a deeper level. I'm just curious what kind of results come back, assuming they offer that kind of test at my local surgery.

Hopefully, all these posts will help answer other people's questions about cholesterol too, I know they helped me. The one thing I will say is avoid Statins like the plague. The NNT on them is deadly imo. The side effects of that stuff is just beyond awful, and you probably won't need them on a low carb diet. Statins are offered to people far too often with little evidence of cholesterol problems. I got offered them. I'm glad I turned them down.

Looking at the lipids and causes for those grainy ones that attach to your arteries, the fats that cause it seem to predominantly be: margarine and vegetable oils etc. These are fats that replaced butter in the 1970's when the low fat diet became the recommended one. Since that recommendation there have been rises in heart disease, diabetes and obesity every single year to a point where obesity and diabetes are becoming an epidemic.

It really is time for the health organisations to begin studies on obesity, diabetes and heart diesease in correlation with diet. Just from my own results, I can see a massive difference in my health by going low carb. In the past I've done a low fat diet (also dropping 5 stone) and I did not come out of it healthy. As someone who has tried both diets, I can see a real difference in my overall health on a low carb diet, whereas on a low fat one, I just made myself ill. Low carb doesn't even feel like a diet. It's just eating things I love and skipping manufactured **** in my experience. :)
 
  • Like
Reactions: 4 people

Claire87

Well-Known Member
Messages
124
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Brain tumours
My doctor, who is a pretty good guy, has agreed to have my triglycerides/HDLs tested to see what comes back. I'll post the results when I get them. :)
 
  • Like
Reactions: 3 people

Fremmy

Newbie
Messages
3
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Soryr, not an answer to your actual question, but just a comment regarding something you said at the beginning.
We all will eventually end up on pointless medication because that is what they are trying to do. It feeds into the pharmaceutical industry. Its like Cancer etc.. there are 'cures' out there, but they do NOT go for natural, the pharmaceutical industry (worth a number i cannot count to!) does not research alternatives, that also includes foods we already have. Sadly.

Like I said in my own post earlier, my nurse encouraged me to go back eating more carbs as I need this for brain activity and energy, when Im losing weight AT LAST and feeling ALOT better without all the ****** carbs (excuse my french) that on top of everything make me CRAVE naughty foods. Why making it more difficult for me to lose weight and holding me back even more now I have found something that is working for me? In all my previous appointments with my GPs, asking and begging for help to lose weight, NO ONE ever helped me. You just get dumped into this box of 'exercise and eat healthily'.
To go back to what i originally wanted to say, well my nurse encourages me to eat carbs for certain reasons, when you tell me about Ketosis, so she should know about that instead of holding me back from losing more weight and feeling better with myself! I find it shocking and tbh i shall do some more research on that subject and will have a word with her about that (no doubt she's find something else to say why i still need carbs). I do still eat carbs but very little and not every day. Have tried to stick to once or twice a week. Thats enough!
 

Totto

Well-Known Member
Messages
2,831
Type of diabetes
Type 2
Treatment type
Diet only
Total cholesterol test is of no use whatsoever. You might want to know your ldl/hdl ratio and your triglycerides, but mostly you want to know about the lipoproteins.Your GP nor DSN may no know what this is, worse for them! And you most certainly don't want to go statins.

I had high cholesterol a few years ago, alongside with high LDL and low HDL. My thyroid levels were normal but very close to out-of-range. Did anybody pay attention? No. Symptoms are of no value, right?

Cholesterol readings can be an indicator of bad diet and of hypothyroidism, probably of other things as well, but total cholesterol is of no value at all. IMHO.
 
  • Like
Reactions: 5 people