cholesterol and diabetes

[xyzzy]

Hmmmph. My TC = 3.6 mmol/l. Which is much lower than the "safe" band. (Despite eating as much saturated fat as I can lay my hands on).

Isn't total cholesterol supposed to be a pretty pointless number anyway and that the better one is the ratio between total and hdl i.e the number you get by dividing your total by your hdl as that takes into account that you may have a high total because your good hdl cholesterol is high?

 

[borofergie]

Isn't total cholesterol supposed to be a pretty pointless number anyway and that the better one is the ratio between total and hdl i.e the number you get by dividing your total by your hdl as that takes into account that you may have a high total because your good hdl cholesterol is high?

Yes - it's a completely made up number that mixes units (always a bad sign). It doesn't have any physical meaning, and is basically the end-result of some dodgy line-fitting experiement.

My problem is that my HDL is low compared - but this is supposedly OK in the context of low LDL and low Trigs. This is exactly the type of insight that you don't usually get from your GP, and an illustration of why it is sometimes necessary to do your own research.

In fact 3 successive GPs have told me that my "cholesterol is very good, if a little low" without ever giving me the actual numbers, or proposing a strategy to rectify it.

 

[phoenix]

It's not just CVD that we are at risk of. Another factor is retinopathy risk one of the factors mentioned on the Good hope hospital site is the importance of reducing total cholesterol levels,
As mentioned on another thread many people are diagnosed with background retinopathy, some already have developed some at T2 diagnosis and the vast majority of T1s when they have had the condition for some years.

The results and conclusions from a lipid analysis done as part of the Early Treatment Diabetic Retinopathy Study

Patients with elevated total serum cholesterol levels or serum low-density lipoprotein cholesterol levels at baseline were twice as likely to have retinal hard exudates as patients with normal levels. These patients were also at higher risk of developing hard exudate during the course of the study. The risk of losing visual acuity was associated with the extent of hard exudate even after adjusting for the extent of macular edema.

These data demonstrate that elevated serum lipid levels are associated with an increased risk of retinal hard exudate in persons with diabetic retinopathy. Although retinal hard exudate usually accompanies diabetic macular edema, increasing amounts of exudate appear to be independently associated with an increased risk of visual impairment. Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity. The observational data from the Early Treatment Diabetic Retinopathy Study suggest that lipid lowering may also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.

The hard exudates they mention are lipids leaking from damage to tiny vessels that are deposited on the retina. http://www.ncbi.nlm.nih.gov/pubmed/8790092
http://www.netdoctor.co.uk/diseases/fac ... opathy.htm

 

[Daibell]

Hi. My personal view on some of this, but not based on any research only observation, is that the NHS tends to be over concerned with cholesterol and blood pressure at quite low levels but is often happy for HBa1c to raise quite high before taking firm action. Fats, salt, cholesterol and blood pressure tend to be flavour of the moment. Obviously important but are they as important as high HBa1c; I doubt it.

 

[borofergie]

Hi. My personal view on some of this, but not based on any research only observation, is that the NHS tends to be over concerned with cholesterol and blood pressure at quite low levels but is often happy for HBa1c to raise quite high before taking firm action. Fats, salt, cholesterol and blood pressure tend to be flavour of the moment. Obviously important but are they as important as high HBa1c; I doubt it.

Which is the heart of the problem. They are stuck in the trap of the false lipid-hypothesis, and end up promoting a diet that promotes bad HbA1c and bad cholesterol.

In the words of the football chant : "they don't know what they're doing".

Which is reflected in the dreadful HbA1c scores that most T2 diabetics obtain:
Percentage of registered Type 2 patients in England

HbA1c >= 6.5% (48 mmol/mol = 72.5%
HbA1c > 7.5% (58 mmol/mol) = 32.6%
HbA1c >10.0% (86 mmol/mol) = 6.8%

 

[noblehead]

It's not just CVD that we are at risk of. Another factor is retinopathy risk one of the factors mentioned on the Good hope hospital site is the importance of reducing total cholesterol levels,
As mentioned on another thread many people are diagnosed with background retinopathy, some already have developed some at T2 diagnosis and the vast majority of T1s when they have had the condition for some years.

The results and conclusions from a lipid analysis done as part of the Early Treatment Diabetic Retinopathy Study

Patients with elevated total serum cholesterol levels or serum low-density lipoprotein cholesterol levels at baseline were twice as likely to have retinal hard exudates as patients with normal levels. These patients were also at higher risk of developing hard exudate during the course of the study. The risk of losing visual acuity was associated with the extent of hard exudate even after adjusting for the extent of macular edema.

These data demonstrate that elevated serum lipid levels are associated with an increased risk of retinal hard exudate in persons with diabetic retinopathy. Although retinal hard exudate usually accompanies diabetic macular edema, increasing amounts of exudate appear to be independently associated with an increased risk of visual impairment. Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity. The observational data from the Early Treatment Diabetic Retinopathy Study suggest that lipid lowering may also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.

The hard exudates they mention are lipids leaking from damage to tiny vessels that are deposited on the retina. http://www.ncbi.nlm.nih.gov/pubmed/8790092
http://www.netdoctor.co.uk/diseases/fac ... opathy.htm

That's interesting reading Phoenix and hence why Opthamologist advise patients to control not only their BG and BP but also their cholesterol levels. You could post this on CatladyNZ diabetic retinopathy thread :thumbup:

 

[librarising]

All capitals added by me for emphasis

phoenix wrote
These data demonstrate that elevated serum lipid levels are ASSOCIATED WITH an increased risk of retinal hard exudate in persons with diabetic retinopathy.

Conclusion from the same study
http://www.ncbi.nlm.nih.gov/pubmed/8790092

Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity.The OBSERVATIONAL data from the Early Treatment Diabetic Retinopathy Study SUGGEST that lipid lowering MAY also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision MAY be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.

Same old problems with study results. Correlation does not mean causation.
Use of A causes B, B causes C, therefore A causes C. That's bad science.
Perhaps high carbs were causing high cholesterol. Can't tell from this OBSERVATIONAL study.
I'll wait for better science to come along.

Geoff (looking suspiciously at any study that links or associates anything with anything else.)
ps No, I don't work in the world of studies, but I do have a brain.

 

[phoenix]

So no matter how many studies that associate the damage cause by deposition of a substance ( which just happens to be a lipid ) with increasingly high levels of cholesterol in the blood? You will say correlation doesn't prove causation.
That's fine but hardly pragmatic
I can find lots of such studies but no-one would want a long list of studies.
How about this one that showed that reduction in lipid levels was associated with reduction in the hard exudates whereas thoe whose lipid levels increased also showed an increase in the exudates. Sadly it was a retrospective observational study and therefore the writers use the careful language of might and may.
http://www.ncbi.nlm.nih.gov/pubmed/20508046
Perhaps rather than observing retrospectively one could do a prospective trial and deliberately increase cholesterol levels in one group of people with background retinopathy , whilst lowering lipid levels in another. It would hardly be ethical.
Whilst you are waiting for better science ,I'll continue to carry on doing what I'm doing as I have a relative good lipid profile, including a good HDL for a post menopausal woman (often falls after menopause) .
Quite frankly I'd prefer to defer to those who are both better acquainted with the literature and also have to treat retinopathy as part of their every day life.
http://medweb.bham.ac.uk/easdec/pre-proliferative.html

 

[Sid Bonkers]

All capitals added by me for emphasis

Conclusion from the same study
http://www.ncbi.nlm.nih.gov/pubmed/8790092

Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity.The OBSERVATIONAL data from the Early Treatment Diabetic Retinopathy Study SUGGEST that lipid lowering MAY also decrease the risk of hard exudate formation and associated vision loss in patients with diabetic retinopathy. Preservation of vision MAY be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.

Red colour added by me for emphasis

Funny how we read the same thing and come to a totally different opinion isnt it?

 

[borofergie]

Perhaps rather than observing retrospectively one could do a prospective trial and deliberately increase cholesterol levels in one group of people with background retinopathy , whilst lowering lipid levels in another. It would hardly be ethical.
Whilst you are waiting for better science ,I'll continue to carry on doing what I'm doing as I have a relative good lipid profile, including a good HDL for a post menopausal woman (often falls after menopause) .

That'd be interesting - I wonder how they'd go about deliberately increasing cholesterol levels? Following the reverse of the advice they currently give (replacing saturated fat with carbs and PUFAs) they'd probably suggest a diet high in saturated fat, low in carbohydrates and PUFAs.

Now I wonder what a diet like that would do for your cholesterol?

• Total = 3.6 mmol/l
• HDL = 0.9 mmol/l
• Trigs = 0.99 mmol/l
• LDL = 2.2 mmol/l

 

[librarising]

phoenix wrote
You will say correlation doesn't prove causation.

Why do people keep making things personal ?

Any good researcher or scientist will tell you that. Why say 'you' ?

When I discovered that most current medical belief is founded on hypotheses, and was shown how this is maintained via a number of non-scientific methods, medical 'experts' lost any allegiance I may have had for them.

It's all very simple

Geoff

 

[borofergie]

So no matter how many studies that associate the damage cause by deposition of a substance ( which just happens to be a lipid ) with increasingly high levels of cholesterol in the blood?

Then it's a pity that they don't actually measure the amount of cholesterol in the blood, LDL-C and HDL-C just measure the amount of cholesterol carried by individual LDL and HDL particles. LDL-C and HDL-C don't tell us anything about the number of lipoprotein particles, nor do they tell us anything about the size of said particles.

Both LDL-C and HDL-C, the standard, basic readings you get from the lab, do not reflect the number of LDL or HDL particles – the number of lipoproteins – in your serum. Instead, they reflect the total amount of cholesterol contained in your LDL and HDL particles. Hence, the “C” in LDL/HDL-C, which stands for “cholesterol.” Measuring the LDL/HDL-C and then making potentially life-changing health decisions based on the number is like counting the number of people riding in vehicles on a freeway to determine the severity of traffic. It’s data, and it might give you a rough approximation of the situation, but it’s not as useful as actually counting the number of vehicles. A reading of 100 could mean you’re dealing with a hundred compact cars, each carrying a single driver, or it could mean you’ve got four buses carrying 25 passengers each. Or it could be a couple buses and the rest cars. You simply don’t know how bad (or good) traffic is until you get a direct measurement of LDL and HDL particle number.

http://www.marksdailyapple.com/how-to-i ... z25WiNck9Y

And remember kids - the correlations between TC and CVD were derived from people eating the standard Western high-carbohydrate diet. No low-carbers were among the groups they analysed. Ever.

 

[Etty]

The hard exudates they mention are lipids leaking from damage to tiny vessels that are deposited on the retina.

Shouldn't they be more concerned with what causes the damage to the tiny vessels rather than what is leaking out of the tears? If cholesterol is there to help repair the damage, is it likely that it is the cause of the damage in the first place?

 

[phoenix]

Etty,
if my antibodies hadn't attacked my beta cells my glucose balance wouldn't have gone haywire and caused the problems. They haven't a remedy yet.
Pragmatically , I think it is better to be aware of things that can reduce risk of complications
Many people discover they have background retinopathy at or soon after diagnosis.
I'm T1.5, my has ranged from 6%, 3 months after diagnosis to 4.9% . It's mostly in the mid/high 5s. I have been diagnosed with diabetes for 7 years. During that time I can't blame glucose control but background retinopathy is there and certainly I don't want it to deteriorate. If keeping lipids down helps reduce the risk, then that's what I'll do.

 

[noblehead]

Shouldn't they be more concerned with what causes the damage to the tiny vessels rather than what is leaking out of the tears? If cholesterol is there to help repair the damage, is it likely that it is the cause of the damage in the first place?

Etty,

Take a good read of following which is an excellent site that explains just about everything there is to know about diabetic retinopathy:

http://medweb.bham.ac.uk/easdec/

 

[librarising]

Mileana wrote
Geoff. The stuff you linked me the other day is helpful in understanding the points you are making and enable people to make informed choices.

Here's some more to be going on with from THINCS (The International Network Of Cholesterol Sceptics)

http://www.thincs.org/discuss.htm

and these are the members and their credentials

http://www.thincs.org/members.htm

Happy reading

Geoff

 

[xyzzy]

If keeping lipids down helps reduce the risk, then that's what I'll do.

With you on this one Phoenix. I see no problem in reducing risk it seems an obvious thing to do. The issue (for me) is about prioritizing the risks so personally lipids currently come fourth behind hBA1c, blood pressure and weight. Life rarely presents the opportunity to minimise all risks as much as we would like to or as good as that may be. I do not want to sound too skeptical about the current research but it would be nice to find some where in the data you could simply see the effect of cholesterol levels when other risk factors are held constant so for example the outcomes of people who had such and such a cholesterol level but all had hBA1c's in a very tight range.

 

[noblehead]

If keeping lipids down helps reduce the risk, then that's what I'll do.

With you on this one Phoenix.

I'm with the both of you on reducing the risks.

I don't (despite what some may say) have any problems with these 'sceptics' releasing books and people buying them, after all there's some good money to be made from being controversial and they'll always be a small minority that will buy into their theories, the line is crossed when it is circulated on the forum and people who are new here are made to believe that they shouldn't be too concerned about their cholesterol levels.

This from the AHA (American Heart Association) sums the risks up beautifully:

''High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk.''

 

[borofergie]

I don't (despite what some may say) have any problems with these 'sceptics' releasing books and people buying them, after all there's some good money to be made from being controversial and they'll always be a small minority that will buy into their theories.

:shock:

More rampant Bibliophobia. This is really quite tedious. Not everyone that writes a book is motivated purely by money (probably no more than many Doctors or Consultants). Even if they are, it doesn't automatically make their message wrong.

Education is very rarely a bad thing. You just need to make sure that you read books from people expressing a variety of views. The word that is used to describe someone that doesn't read any books is "ignorant".

 

[jopar]

If a book is expressing a controversial view point, the author usually uses a 'sales pitch' style of writing mainly because they've got to 'sale' the idea to the reader!

Another problem, is that normally the author concentrates his/her theory around a singular subject/risk factor in the case of Cholesterol controversial books, it means in general the author is bases all information and risk factors involved on an 'healthy' individual and not on individuals who may have other factors to consider...

For the reader it's important to keep this in mind, that yes it might say in an healthy individual the risk factor is neither here or there, but if you have a chronic medical condition then their may be impacts from other risk factors that impact on what is actually being said!

When it comes to 'risk factors' it's only the individual who can really make the decision what 'risk factors' are relevant to them, and at what level is acceptable to them!

But I do think that it's a mistake to think, that it's only one thing that bumps up the cholesterol though so advocating that it's 'fats' or 'carbohydrates' only that causes high cholesterol is wrong...

As I dis-spell both theories, I eat complex carbs and I also eat saturated fats, (I don't follow a reduced fat diet) yet my cholesterol levels are good, so can only assume that there's something else going on apart from just the food we chose to eat!