Cholesterol Guru's Info please!

[CondorX]

So I had my first bloods following diagnosis of T2 in April 2019. Have been eating strictly LCHF since diagnosis. Am due to see the DN again next week and I need some ammunition to counter the "you really MUST go on statins" argument. I was at the GP surgery today with my partner and the GP looked up my results quickly and my HbA1c has gone down from 7.1% to 6, which I guess is good, but he got a bit panicky about my cholesterol which is apparently 8.4.......not sure what the breakdown is, LDL and HDL, will get that from the nurse next week so I can analyse it better.

I have lost about 13kg so far since April and still losing weight, albeit slower than at first - need to get to about 65kg and am at 69.9kg now - started off at 82kg.
I brushed off his plea to prescribe statins and said as I was still losing weight, the cholesterol levels would come down once my weight loss had stabilised.

The DN is actually quite nice and likes meeting up with me - I gave her a copy of the Jason Fung book Diabetes Code and she is open to LCHF diets etc, she is quite progressive as far as DN go.

I have read a lot about Cholesterol which has destroyed all the myths we were taught at medical school, but I just wondered if I was on the right track cholesterol wise..........hence request for some input from the Cholesterol gurus here, @bulkbiker and others.......or should I be concerned? My diet is very low carb - oily fish, meat, salads, green veg, berries, butter, double cream and cheese and lots of eggs, coffee, water .........totally cut the carbs and am having under 30g carbs a day at present.

 

[mazza 2]

Hi, your diet seems great. As you said, your weight loss will affect your cholesterol but it will reach it's level once you stabilise your weight. I think you need to ask for your break down - Ldl Hdl, Trigs as this will give you the ratios. Others will be able to advise you better than me, but I believe they need the break down before they can give you a proper opinion.

 

[Rachox]

I’m not a guru by any means, but as you already know, weight loss results in total cholesterol going up to levels which give GP’s palpitations! Mine does with a total of 6.6, but I have perfect ratios! You’ll need to work out your ratios too when you have breakdowns. So at least I can provide two calculators for you:
https://cholesterolcode.com/new-report-tool-launched/
http://www.hughcalc.org/chol-si.php
Then remember bottom line is you do not have to accept Statins, yours HCPs are there to advise not dictate. If you have done your research and can discuss things in a knowledgeable manner, then your HCPs should accept your decision.

 

[jjraak]

So I had my first bloods following diagnosis of T2 in April 2019. Have been eating strictly LCHF since diagnosis. Am due to see the DN again next week and I need some ammunition to counter the "you really MUST go on statins" argument. I was at the GP surgery today with my partner and the GP looked up my results quickly and my HbA1c has gone down from 7.1% to 6, which I guess is good, but he got a bit panicky about my cholesterol which is apparently 8.4.......not sure what the breakdown is, LDL and HDL, will get that from the nurse next week so I can analyse it better.

I have lost about 13kg so far since April and still losing weight, albeit slower than at first - need to get to about 65kg and am at 69.9kg now - started off at 82kg.
I brushed off his plea to prescribe statins and said as I was still losing weight, the cholesterol levels would come down once my weight loss had stabilised.

The DN is actually quite nice and likes meeting up with me - I gave her a copy of the Jason Fung book Diabetes Code and she is open to LCHF diets etc, she is quite progressive as far as DN go.

I have read a lot about Cholesterol which has destroyed all the myths we were taught at medical school, but I just wondered if I was on the right track cholesterol wise..........hence request for some input from the Cholesterol gurus here, @bulkbiker and others.......or should I be concerned? My diet is very low carb - oily fish, meat, salads, green veg, berries, butter, double cream and cheese and lots of eggs, coffee, water .........totally cut the carbs and am having under 30g carbs a day at present.

until the others WAY more knowledgeable then me arrive.

this
https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/page-11#post-2119182 thread,
was very informative, but a little over my head,

but this post from it however, made perfect sense to me..
https://www.diagnosisdiet.com/food/...Q69zn_Wi-yJaO537I8BaSuy8KJw5L2Jf_lSp7OIjZRmNE

and personally a fascinating little fact i was so unaware of.
Go cholesterol, it's like our very own paramedic surging around inside us.

We think of insulin as a blood sugar regulator,
but its real job is to be a GROWTH HORMONE.

Insulin is supposed to turn on when we need to grow.
What do we need to make in order to grow? More cells.
What do we need to form new cells? Cholesterol.
So, at times when we need to grow (babies, teenagers, pregnant women),
insulin turns the enzyme HMG-CoA reductase ON,
which tells cells to make more cholesterol, so we can build new cells.

Sounded a lot easier to grasp like that, then some papers and files i've looked over.

 

[bulkbiker]

my HbA1c has gone down from 7.1% to 6

In 4 months.. brilliant well done.

I have lost about 13kg so far since April and still losing weight,

Excellent and yes that could well be why your cholesterol levels are elevated.

I brushed off his plea to prescribe statins and said as I was still losing weight, the cholesterol levels would come down once my weight loss had stabilised.

Agree 100%

should I be concerned

I'd say no way but maybe get the full lipid panel before saying for sure.
How long had you fasted before the blood was taken... that can play quite a big part in influencing some of the figures?

 

[Ryhia]

Just want to say really well done on your blood results.

I'll leave others to answer the cholesterol question.​

 

[Brunneria]

My suggestions would be:

Just make sure the test is a fasting one (even if they tell you it doesn’t matter!)

And get the breakdown of the results, incl trigs, then run them through the hughs calc calculator to get the ratios and the assessment of the ratios

Personally, I wouldn’t accept a statin prescription from a doc who didn’t show a comprehensive knowledge of the research, the difference between relative and absolute risk, the controversies about the research, the ratios, the relevance of trigs to heart disease, the different types/sizes of LDL, and who could justify (with evidence) why an older woman like myself would benefit from lowered cholesterol when all cause mortality research shows better longevity for older women with higher cholesterol.

If they can do all that AND still justify why my body would benefit from a statin, I would definitely be listening, not necessarily agreeing but definitely listening...

 

[JohnEGreen]

They have now come up with a pill that contains Aspirin plus a Statin and two blood pressure lowering drugs all in one cheap pill heady days indeed.

 

[Tophat1900]

If your GP is reaching for the prescription pad based on just the total cholesterol number, then chances are he or she has little knowledge on the subject. I also agree completely with what @Brunneria has said above.

 

[DavidGrahamJones]

. . . . . but he got a bit panicky about my cholesterol which is apparently 8.4.......

I've always been intrigued by the question of what our total cholesterol level should be, a number which some would argue isn't that useful without the HDL, LDL, trigs. Since my diagnosis of type II in 1997 I was prescribed atorvastatin and my endocrinologist was happy with my total cholesterol being 7. Over the years while that number decreased the amount of atorvastatin was increased.

I had experienced the muscle pain, brain fog and poor sleep from the start and although it was tolerable in the beginning it became intolerable. It was frustrating that my GP at the time gave me a different excuse for my muscle pain, every time I brought the subject up. Even more frustarting when I found a Merk Pharmaceutical patent dated 1990 which was going to add CoQ10 to the statin to prevent "impending muscle pain" (https://www.functionalmedicineuniversity.com/statin-CoQ10.pdf). For me, the major breakthrough was going onto a low carb diet (not high fat), eating less than 50gms of carb a day and much nearer to 30 gms. Not only did my BG drop so much that I stopped taking Gliclazide and Januvia, but my total cholesterol dropped dramatically and I stopped taking Atorvastatin.

I'm pleased to say that my total cholesterol dropped to about 4 without atorvastatin but I have noticed that if I inrease cheese or full cream then my TC will go up to just over 5. You might be interested in this graph. I've added cholesterol measurements in units that I think most of us recognise and you can see that looking at the dotted red line where it actually says "cardiovascular disease and total cholesterol are weakly correlated", the incidence of cardiovascular disease increases above 5.4 or there abouts. It also increases below that number, maybe it's the optimum?
There was also a straw poll that is quite interesting, I can't remember which medical journal BMJ/Lancet, but in that poll of 500 GPs, 60% said that they would not prescribe a statin to a family member or friend. Even my GP had to admit that she wouldn't prescribe a statin to a family member, although she did jokingly say she could think of one.

All the best.

 

[CondorX]

I’m not a guru by any means, but as you already know, weight loss results in total cholesterol going up to levels which give GP’s palpitations! Mine does with a total of 6.6, but I have perfect ratios! You’ll need to work out your ratios too when you have breakdowns. So at least I can provide two calculators for you:
https://cholesterolcode.com/new-report-tool-launched/
http://www.hughcalc.org/chol-si.php
Then remember bottom line is you do not have to accept Statins, yours HCPs are there to advise not dictate. If you have done your research and can discuss things in a knowledgeable manner, then your HCPs should accept your decision.

Great links thanks Rachox, seeing DN on Wed next week - will get all the results then and calculate!

 

[CondorX]

My suggestions would be:

Just make sure the test is a fasting one (even if they tell you it doesn’t matter!)

And get the breakdown of the results, incl trigs, then run them through the hughs calc calculator to get the ratios and the assessment of the ratios

Personally, I wouldn’t accept a statin prescription from a doc who didn’t show a comprehensive knowledge of the research, the difference between relative and absolute risk, the controversies about the research, the ratios, the relevance of trigs to heart disease, the different types/sizes of LDL, and who could justify (with evidence) why an older woman like myself would benefit from lowered cholesterol when all cause mortality research shows better longevity for older women with higher cholesterol.

If they can do all that AND still justify why my body would benefit from a statin, I would definitely be listening, not necessarily agreeing but definitely listening...

I did make sure it was a fasting one (and yes, he said it didn't matter!!! )
Seeing DN on Wed and will get the Lipid profile from this test and the last one. My GP is unfortunately clueless and yes, based his "must have statin now" on the 8.4 result..........

Perfect sense about the GP actually knowing something about the research..........I agree entirely.

 

[DCUKMod]

@CondorX - Don't you have online access to your results?

 

[CondorX]

No sadly our surgery doesn't offer that. They have a very limited online booking system which is really worthless and a waste of time, but no results access. I plan to attend the PPG in 2 weeks time...............

 

[millenium]

I’m not a guru by any means, but as you already know, weight loss results in total cholesterol going up to levels which give GP’s palpitations! Mine does with a total of 6.6, but I have perfect ratios! You’ll need to work out your ratios too when you have breakdowns. So at least I can provide two calculators for you:
https://cholesterolcode.com/new-report-tool-launched/
http://www.hughcalc.org/chol-si.php
Then remember bottom line is you do not have to accept Statins, yours HCPs are there to advise not dictate. If you have done your research and can discuss things in a knowledgeable manner, then your HCPs should accept your decision.

I do not understand why weight loss will increase cholesterol level as you have said? Usually it will be the reverse as cholesterol level in the body has a rather strong correlation to body weight.

 

[Rachox]

I do not understand why weight loss will increase cholesterol level as you have said? Usually it will be the reverse as cholesterol level in the body has a rather strong correlation to body weight.

I believe it is literally the weight (fat) has to go somewhere and ends up in your blood stream, I can’t explain it scientifically, sorry! I lost a shed load of weight and my total cholesterol went up, my weight loss has slowed right down now but my cholesterol total has stayed high, however my ratios have improved and are now perfect.

 

[Walking Girl]

I do not understand why weight loss will increase cholesterol level as you have said? Usually it will be the reverse as cholesterol level in the body has a rather strong correlation to body weight.

Here’s my totally layman’s understanding. Our body stores lipids for future use - if you store more than you use, you gain weight. When you are in weight loss mode (eating less than you need), the cells are in “out Mode only” and aren’t accepting any more lipids, so it basically has no where to go, and floats around in the blood. At a stable weight, the cells are in equal “in/out” mode. So, it’s a temporary increase during weight loss. Otherwise, you are correct that generally weight loss lowers lipids.

 

[Daphne917]

No sadly our surgery doesn't offer that. They have a very limited online booking system which is really worthless and a waste of time, but no results access. I plan to attend the PPG in 2 weeks time...............

Same here - I asked the other day why I wasn’t allowed access to my results online and was told it was due to what the surgery originally signed up to. However here in Somerset they have rolled out ‘diabetes my way’ which means I have access, albeit very limited, to those results related to diabetes such as hba1c, cholesterol etc.

 

[millenium]

I believe it is literally the weight (fat) has to go somewhere and ends up in your blood stream, I can’t explain it scientifically, sorry! I lost a shed load of weight and my total cholesterol went up, my weight loss has slowed right down now but my cholesterol total has stayed high, however my ratios have improved and are now perfect.

Stimulation of lipolysis enhances the rate of cholesterol efflux to HDL in adipocytes.
Verghese PB, et al. Mol Cell Biochem. 2007.
Show full citation
Abstract
Adipose tissue constitutes a major location for cholesterol storage and, as such, it may play a role in the regulation of circulating cholesterol levels. A possible metabolic link between the lipolytic activity of adipocytes and their ability to release cholesterol to reconstituted human high density lipoprotein, HDL, was investigated in 3T3-L1 adipocytes. In the presence of HDL, composed of human apoA-I and phosphatidylcholine, adipocytes release cholesterol in a lipoprotein-dose and time dependent fashion. beta-adrenergic activation of the lipolysis promotes a 22% increase in the extent of cholesterol efflux to reconstituted discoidal HDL particles. Activation of lipolysis promotes a rapid decrease in the cholesterol content of the plasma membrane and a concomitant increase in lipid droplet cholesterol. This change is independent of the presence of HDL. Activation of the lipolysis does not affect the levels of ABCA1 and SR-BI. Therefore, the enhancement of cholesterol efflux is not due to the level of plasma membrane cholesterol, or to the levels of the cholesterol transporters ABCA1 and scavenger receptor SR-BI. Brefeldin A did not affect the rate of cholesterol efflux under basal lipolytic conditions, but it abolished the lipolysis-dependent enhancement of cholesterol efflux to HDL. This study suggests that activation of lipolysis is accompanied by an increase in BFA-sensitive vesicular transport that in turn enhances cholesterol efflux to HDL. The study supports a metabolic link between the lipolytic activity of adipocytes and the rate of cellular cholesterol efflux to HDL.

Seems like u are correct. And seems like the process is actually beneficial to health and the cholesterol are "carried" by HDL to be removed.

 

[NicoleC1971]

They have now come up with a pill that contains Aspirin plus a Statin and two blood pressure lowering drugs all in one cheap pill heady days indeed.

Yes but that's for countries with low doctor/patient numbers where a universal 'poly pill' may be of use in preventing CD and is also a great way of expanding the stains market now that GPs have rejected prescribing them to toddlers or adding them to our water supply.