Cholesterol (again)

[Jo_the_boat]

I've come across an article by Dr Joseph Mercola printed in The Huffington Post (UK paper)

It's interesting and explains the same theories about cholesterol as found in Malcolm Kendrick's book.
Although they reach the same conclusions this is less technical and explains things well.
Whether you agree with it or not, or if indeed it is correct, that's down to you, but it's worth a read.

There is so much confusing / misleading stuff out there that I am (still) having trouble deciding if cholesterol will further damage my knackered old arteries and whether I should take statins. According to this it doesn't and I shouldn't. This debate has been done to death on here really but in my case it's relating to PAD rather than diabetes.

https://www.huffingtonpost.com/dr-mercola/the-cholesterol-myth-that_b_676817.html

 

[Guzzler]

The point in the article that struck me was the use of the term 'bad cholesterol'. Perhaps it was oversimplifying things a bit there are a whole range of cholesterol particles and the one that is the baddie is sdLDL (small dense LDL) which is not routinely tested for by the NHS. TC is indeed a useless predictor, the best measurement we have re CVD/CHD is the ratio between HDL and Triglycerides but if you view Ivor Cummins' lecture 'The Cholesterol Conundrum' apparently even this measurement is 'noisy'. How all this relates to PAD I do not know. I am sure you have learned all this in your research but it doesn't hurt to go back to basics.

 

[Guzzler]

@Jo_the_boat

Have you seen Prof. Ken Sikari's' lectures on YouTube? He makes a tough subject easy to follow and is honest about what science does not yet know about cholesterol.

 

[DavidGrahamJones]

There is so much confusing / misleading stuff out there that I am (still) having trouble deciding if cholesterol will further damage my knackered old arteries and whether I should take statins.

It's always going to be a tough call. In my case I have a family history where CVD seems to be the prevailing cause of death. I was always intrigued that the target was reducing all the time, who decided?

I took statins for 17 years during which time I put up with a lot of muscle pain for which my GP at the time had a different cause every time I spoke to him. There was also poor sleep and "brain fog". I vacillated for ages because my experience said one thing and my doctors were saying something else. At least I gave statins a go, my final decision was totally down to my personal experience.

In the end and as a result of lowering carb intake my cholesterol dropped sufficiently for me personally to say goodbye to statins. My annual checks for total cholesterol are normally about 4.

Here's a graph produced by the British Heart Foundation, the dotted red line showing the cholesterol levels of those dying from CVD. Note how the number of deaths increase above 220 mg/dL which I calculate to be about 5.4. Interestingly there's an increase in deaths as you go below 5.4.

Obviously I'm not a doctor so technically I can't even comment on that graph although it would seem that a total cholesterol of 5.4 seems to be some sort of optimum number. Although produced by the BHF and the World Health Organisation, it is 15 years old. It would be interesting to get a more up to date version. It's out there somewhere but I've struggled to trawl through all the data available.

 

[CherryAA]

From everything I've read I concluded I want - low trigs, high HDL . and a sensible ratio of LDL to that HDL. I don't care what the total cholesterol comes out as .

Interestingly even where LDL is a problem and even if that is the small dense stuff ( apoB) - it seems that it may only be a problem in the presence of High Insulin !

I'm personally coming to the view that I would like quite high cholesterol as long s I have low Trigs and high HDL. jsut what an LCHF diet will deliver! What I do want is low insulin levels ( actually as close to 3 IuI as I can - though 12 is in the chart below ) and low glucose. Statins don't help either of those so they seem to be pretty pointless !

http://www.nejm.org/doi/full/10.1056/NEJM199604113341504

 

[CherryAA]

http://vernerwheelock.com/285-the-contribution-of-engineers-to-nutrition/

this is a great summary paper which puts cholesterol into context with links.

 

[bulkbiker]

Check this out

 

[Guzzler]

Check this out

Had not seen this fella before. What a legend.

 

[Jo_the_boat]

Thanks to all who replied.
Prof. Sultan's views there are very clear - most importantly very current.
I watched the Ken Sikari one too. Incidentally that led on to an updated video from Ivor Cummins which was a similar message but with updated graphics and clearer.
Having seen videos like these and read various articles I ask myself: would I feel happier had I followed both GP / DN / CV specialist and started Statins. Of course the answer is no - I wouldn't, in fact I would probably have had another mini-adrenaline rush believing I was doing more harm than good.
What I would love to hear (at least on a one-to-one basis) from my HCPs is an acknowledgement that there is a good chance that the LCHF / statin-free route I have chosen is non-damaging, and may be beneficial. But right now I don't.
Thanks for your frank post David. There wasn't a graph attached but we get the picture and your statin choice despite your family history. I don't have a family history (as far as I know) but I do have CVD to some degree (a further battery of tests will determine the extent) so I need to make a decision.
You have all helped, so thanks.

 

[DavidGrahamJones]

There wasn't a graph attached

That was the brain fog in action. PDF now attached. It's an interesting graph.

 

[Jo_the_boat]

That was the brain fog in action. PDF now attached. It's an interesting graph.

Yes thanks. In actual fact I was 5.2 total cholesterol at my last test - lowest CVD risk according to your chart.
But interpreting these figures is where I'm struggling to get my head round it (pretty thick!)....
Am I right saying that (approx) 6 people in 1000 will die of all-cause-mortality (ACM) at 5.4% TC and 12 people in 1000 at 6.5% TC.
That's a rise from 0.6% to 1.2%. That rise is significant but 1.2% still pretty low.
% rise in CVD is more pronounced with higher TC but the mortality figure at the higher end is 0.8%

Based on these figures there is definite evidence that keeping your TC around 5.5 is beneficial for ACM and CVD but the vast majority of ailments, including diabetes is barely distinguishable - lost in the morass of lines at the bottom of your graph.

The other point is that presumably this graph shows the tendency to develop various conditions. What it doesn't show is the effect that TC has on those who already have them.

Then add into the mix more current thinking and the possible over-treatment of conditions with drugs (inc. Satins and all the 'benefits' they bring)

Have I got this horribly wrong?

 

[Guzzler]

A 13 minute video for those who may just be starting out on finding out the basics.

 

[DavidGrahamJones]

Am I right saying that (approx) 6 people in 1000 will die of all-cause-mortality (ACM) at 5.4% TC and 12 people in 1000 at 6.5% TC.

Quite correct, the blue line being all cause mortality. Be kind to yourself, unless you're using graphs all the time, it's been a long time since most of us have had to get to grips with graphs. Nearly 50 years for me.

I'm always intrigued as to why this sort of data is almost hidden, should I join the conspiracy theorists and say it's because the pharmaceutical companies don't want it widely known that while we're being told that we should get our cholesterol lower and lower(so their drug is prescribed more and more?), 5.4 looks like it's a good number.

There is so much confusing / misleading stuff out there that I am (still) having trouble deciding if cholesterol will further damage my knackered old arteries and whether I should take statins.

Like you I just became more and more confused, the more I read, although when reading those who are against statin therapy for all (saw rumours of it going into water, there's a scare story to reckon with), I had to ask myself, What do they gain by going against the norm, book sales? Whereas the likes of certain individuals who poo poo the mere idea of there being side effects can be shown to have a conflict of interests, they get money from the pharmaceutical companies. Whereas if in a court of law, if there was any relationship between the defendant, judge, and jury, it would be a mistrial.

 

[DavidGrahamJones]

Quite correct, the blue line being all cause mortality.

I just wanted to draw your attention to a comment in red, by the dotted read line (CVD line). "Cardiovascular disease and total cholesterol are weakly correlated".

I'd like to think that the BHF and WHO knew what they were talking about.

 

[Jo_the_boat]

It's slewed / sensationalized figures too. I've made these figures up but they are the type of thing we're presented with.......

"XXX drug reduces your chance of a Cardiovascular event by 30+% within the next 5 years.."
When you actually see the figures, 2 people in 100 have a CV event while taking drug X.
3 people in 100 have a CV event who take a placebo.
Yes that's an increase of 30+% over those who don't take it, but the 3 figure is still very low and doesn't take into account any side-effects of drug X.
Also by taking drug X all-cause-mortality actually goes up after taking the drug.
I've seen these types of figures in a number of presentations and it just shows how misleading it can all be.

 

[Jo_the_boat]

I just wanted to draw your attention to a comment in red, by the dotted read line (CVD line). "Cardiovascular disease and total cholesterol are weakly correlated".

I'd like to think that the BHF and WHO knew what they were talking about.

Up the top of the graph, also in red....does this indicate lower cholesterol may mean a higher risk if cardiovascular mortality??

Lower cholesterol < > More
infectious and parasitic diseases
and possibly higher
cardiovascular mortality

 

[bulkbiker]

I do have CVD to some degree (a further battery of tests will determine the extent) so I need to make a decision.

Have any of your HCP advised you to have a Coronary Artery Calcium score scan done? It actually looks at calcification in the arteries themselves rather than using various proxies (like cholesterol). If not ask them why not?
I think that the NHS can do them but don;t seem to very often. I had mine done privately at the Rivers Hospital in Hertfordshire for just over £250 the cheapest I could find.

 

[Jo_the_boat]

Have any of your HCP advised you to have a Coronary Artery Calcium score scan done? It actually looks at calcification in the arteries themselves rather than using various proxies (like cholesterol). If not ask them why not?
I think that the NHS can do them but don;t seem to very often. I had mine done privately at the Rivers Hospital in Hertfordshire for just over £250 the cheapest I could find.

Yes, thanks. Saw reference to CAC scan on an Ivor Cummings video. It's on my list along with CTs, angiograms etc. Just got to plough through all the scheduled tests first!

 

[bulkbiker]

Yes, thanks. Saw reference to CAC scan on an Ivor Cummings video. It's on my list along with CTs, angiograms etc. Just got to plough through all the scheduled tests first!

Good luck... ! My surgery had of course never heard of it.. (or so they claimed).

 

[DavidGrahamJones]

does this indicate lower cholesterol may mean a higher risk if cardiovascular mortality??

Possibly, I think they've covered their options a bit by using the word possibly.