Cholesterol results, should I be worried?

[EBe66]

Had my blood tested today because for the first time in my live I have a bout of gout I think you call it in my big toe and the ball joint.
Went to the GP who was pretty positive in the gout diagnosis but wanted to do a blood test to confirm. She also decided it would be a good moment to also do my yearly blood tests. So maybe the cholesterol results are skewed by the gout.(?)
I have been doing the lchf diet since early 2021 and my cholesterol levels where pretty good last year. At that time I occasionally took a statin, but most of the time I forgot to take it or choose to not take it. Since the results of last year I stopped taking them al together.
But today my levels were pretty red which came as a big surprise to me! The only thing I consciously changed in the last year is that I started using coconut oil for cooking which can, I believe, elevate LDL cholesterol. The difficulty is that here (Netherlands) they only check for total LDL and make no distinction between large particle and small particle LDL.
I know there are some strong opinions on cholesterol/statin use on this forum but I would like to hear what you guys think about these results before my GP calls.
btw my HDL is the highest level since it is tested and the trig levels are one of my lowest... So if I understand correctly the only thing making my results "bad" is the LDL
The columns from left to right are todays results, last years results and the Dutch reference levels.

 

[IncogKeto]

I can't really add anything to what you've already highlighted - triglycerides and HDL have both moved in the right direction and without the subfractions then the LDL figure doesn't really tell you what's going on. Although I imagine it won't stop your doctor from drawing the conclusion that you definitely need a statin.

 

[AloeSvea]

Hi @EBe66 - well it's not just strong opinions on this site - but part of a very big controversy for sure. My own line to anyone is read up on it, and make your own decision, as it is a big deal.

At the bottom of it is the increased risk for cardiovascular disease having diabetes poses. And how you deal with this risk is very important, in my opinion at least.

Fitness levels are of course super important and part of your CVD/CV health.

I personally have dyslipidemia as part of my T2D profile - my cholesterol levels are super high, but, on a longterm LCHF diet, my ratios are in the healthy range (that's the chol/HDL one, and the trig/hdl one) - due to good trig and HDL levels, even if my LDL are way out of range for healthy. No medical professional hassles me about it though because I am clearly fit, and have articulated my opposition to taking a statin whilst working on maintaining cardio vascular fitness. That is, after all, what it is really about. I mention this because we all can lose sight of what it's all about all too easily, with the whole statins or not statins discussion being the focus of the equation all too many times.

Just to remind - blood pressure is about the health of your arterial system - it's not a state of disease or non-disease in itself. Keeping fit is a really good way of keeping your arterial system as well functioning as possible.

One thing you could do is talk to your medical professionals about the state of your arteries (at basic level it's your blood pressure), and if you have high blood pressure, talk about how you can work on that. I say - this is where 'exercise' comes into its own - along with eating truly' heart-healthy food'. And I don't mean wholegrains and lettuce! I mean offal and sardines, lol. And on a LCHF diet you are eating truly heart healthy food. (OK - I don't eat offal, even though I know I should - it's on my list of what to learn to cook...)

 

[EBe66]

Thanks for the extensive reply @AloeSvea !
Last year I was convinced I was doing pretty good but these, unexpected, results and the gout plus the conflicting information/ways to deal with it is driving me a bit bonkers.
My omad lchf diet most of the time consisting of a portion of meat for the calories and a selection of vegetables has made my hba1c results very good for me. The result this week was 38 which is the lowest I have in my records. But the meat part of the diet is a no no for gout leaving me with just "above ground vegetables".
The best diet for gout appears to be the dash diet which would mean more carbs...
The offal and sardines are rated among the highest on the "do not eat" list for gout btw

My blood pressure is to high depending on how it's measured. Manual measurements are always in the "good" ~130/80 range but electronical ones usually way higher although the last one (march) was 136/89. For this I get a water pill that is possibly also a cause of my high uric acid level which can cause the gout too.

My exercise level is normally good I think. Baring the corona years and this year actually, I cycle ~4000km a year which for me translates to exercising a little more than half an hour every day of the year.

Not a clue on how fast cholesterol levels can change but for the moment I have stopped with the coconut oil and I'm going to try to see if the doc is up for other blood pressure medication. When I asked last Friday if the water pill could be a cause the response was just a "maybe".

Sorry for the long message but I feel like I'm back at square one with nowhere to go to put it mildly.

 

[EBe66]

and without the subfractions

Could you please elaborate a bit on this? I take it you mean the build up of the LDL?

 

[IncogKeto]

Could you please elaborate a bit on this? I take it you mean the build up of the LDL?

Yeh. I was really just agreeing with your statement that -

The difficulty is that here (Netherlands) they only check for total LDL and make no distinction between large particle and small particle LDL.

Which is the same as here in the UK on the NHS.
I tend to view the large particle LDL as being 'neutral' and only the small particle LDL as being 'bad'. So without knowing what makes up a person's LDL it's difficult to draw any meaningful conclusion.
I've got a higher LDL than you, so I was toying with the idea of paying for a private test (such as the one linked below) to try to establish whether I need to do something about it. But the £300 price tag stopped me dead in my tracks.

LDL Subfractions Blood Test

LDL subfraction blood testing is useful in assessing risk in patients who have a personal or family history of early heart disease, especially if their total and LDL cholesterol values are not significantly elevated. Order securely online today.

www.medichecks.com

 

[EBe66]

Thanks for explaning @IncogKeto and wow, guess the price tag explains why they don't test for this!

 

[AloeSvea]

Hi @EBe66. Er - I'm a chatty kind of gal so there is absolutely no need to apologise to me for lengthy posts! (And my post to you was not one of my lengthy ones,I promise, lol.)

I had to look up foods suggested to drop for gout, and the dash diet. I had a galpal with bad gout, so I had heard of the purine factor in food before, and - I'm very sorry about the meat and offal thing! Not to mention seafood.

As a fellow arthritis sufferer, with emphasis on the word 'suffer' - I feel for you indeed.

But, with your great results getting into the non-diabetes blood glucose zone,(and HBA1c of 38) I would hate to see you up your intake in wholegrains and fruit! And, I am suspicious whenever any governmental authority suggests wholegrains as a great food for folks with any issues, let alone joint issues. (having been seriously on the bad side of that recommendation before!)

Regarding your blood pressure, and checking out how your arteries are doing in practice - could you take your own blood pressure at home? Certainly before taking medication for such, especially as you are already a fit person - even with the diabetes and the gout! then you can experiement with different kinds of exercise regimes and strength resistance training - I say that, as that is what I do myself.

And the good thing for those of us with blood glucose regulation problems - there are lots of low carb vegetarian way of eating programs and cook books and so on out there. Not to mention great support and community in this Forum for such. And you are in the enviable position of doing it for maintenance - a great position to be in indeed.

 

[EBe66]

Hi @EBe66. Er - I'm a chatty kind of gal so there is absolutely no need to apologise to me for lengthy posts! (And my post to you was not one of my lengthy ones,I promise, lol.)

I had to look up foods suggested to drop for gout, and the dash diet. I had a galpal with bad gout, so I had heard of the purine factor in food before, and - I'm very sorry about the meat and offal thing! Not to mention seafood.

As a fellow arthritis sufferer, with emphasis on the word 'suffer' - I feel for you indeed.

But, with your great results getting into the non-diabetes blood glucose zone,(and HBA1c of 38) I would hate to see you up your intake in wholegrains and fruit! And, I am suspicious whenever any governmental authority suggests wholegrains as a great food for folks with any issues, let alone joint issues. (having been seriously on the bad side of that recommendation before!)

Regarding your blood pressure, and checking out how your arteries are doing in practice - could you take your own blood pressure at home? Certainly before taking medication for such, especially as you are already a fit person - even with the diabetes and the gout! then you can experiement with different kinds of exercise regimes and strength resistance training - I say that, as that is what I do myself.

And the good thing for those of us with blood glucose regulation problems - there are lots of low carb vegetarian way of eating programs and cook books and so on out there. Not to mention great support and community in this Forum for such. And you are in the enviable position of doing it for maintenance - a great position to be in indeed.

Hi @AloeSvea I let myself be talked into starting the statin again (Atorvastatin) and regretting it already. I biked to work last Thursday hoping it would be good for the gout. Started the statin the next day after the doctors visit and still having muscle pain in my calves the next Wednesday. This really came as somewhat of a shock as as I did not have any problems with this statin before and I used it for years. I am scheduled for a small operation tomorrow but if if this keeps up I'm going back.

Food wise I'm still clueless and wondering where to get the calories from on a gout/diabetic friendly diet. For the moment I have just halved my meat portions and hope for the best. I use some nuts to try to fill the calorie gap.
Not exactly looking forward to going vegetarian, but if you or someone else knows any good sites?
Also started on the Montmorency cherry caps and vitamin C I found in an other tread here. Time will tell if it makes a difference.

I can take my own blood pressure but the few times I did it was on par with the, also, electronically measured values at the doctors.
On the up side, when he measured it last Friday, manually, it was 120/80. That was also a long time ago that I had these values.

So strangely enough a number of things are going in the right direction but some not so much.

Bottom line is I'm open to all suggestions!

 

[AloeSvea]

Hi there @EBe66!

I feel for you on the muscle pain aspect - and you put it down to the statin? I know my father found the muscle pain side effect of statins really delibilatating. It's a common reaction, I understand, to that medication.

I am a total meat lover, and eat seafood and fish for health reasons. So I have enormous sympathy for having a painful condition that something in meat sparks off!

Firstly, though, do you know what foods do actually spark off a gout pain incident for you personally? For that you would need to keep a food journal - however suits you as in digital or paper - and take good note and notes on what foods do what to you re the gout. And for the diabetes on a vegetarian diet? If you go that route. I am a huge supporter of food journals for any condition that is food related, or supposedly food related. It's how you know if what you are reading or what the websites/research/pharmaceutical companies say is true for you, or not. It's really the only way.

Just like getting your blood lipid results and understanding them/getting them explained by the medical-professionals , and, reading up on the actual stats on various meds, and certainly the range of side effects, is the way to check out whether or not you should be taking a statin, or indeed, any medication. A really good question to ask yourself is - does this medication improve my quality of life? my symptoms of the underlying disease this med is prescribed for? and does it extend my life expectancy?.These are the big questions regarding statin usage, I think at least. (You might be really surprised to read the answer on the third question there.) (All this information is available online by reputable sources, and of course - your own reaction to the med.)

Anyhow, to the vegetarian diet. Even as an out and out meat lover I have had to research vegetarian diets for those with diabetes for a project I am working on, and these two sites below were the ones I personally was most impressed by. But I have a big soft spot for the Paleo way of eating, and the Diet Doctor site - well! Huge fan like many in this Forum. But I am supposing by now you have explored the vegetarian sub-forum on this site? That will be far more informative than me on the subject.

But here are links to two of my personal faves -

https://drhyman.com/blog/2014/11/07/pegan-paleo-vegan/

https://www.dietdoctor.com/low-carb/keto/vegetarian

 

[Mathewted]

Hello

Really interesting convo, albeit so sad about arthritic inflammation and pain.

I appear to react to ketogenic lifestyle in the way that Dave Feldman describes as a lean mass hyper responder - my LDL elevated. My total lipid measurement was 8.5 and was referred to ab endo with a lipidology specialism. I refused his statin because 1) my biggest risk - blood glucose levels - was reduced to normal and I was then (6minths between referral and our appointment ) eating high carb & low fat. My LDL, and total reduced but please note - a really important matter for living with T1D - I'm still non-diabetic according to HbA1c.

My feeling is that there's lots of medical opinion that LDL is the problem but there are prominent clinicians, even cardiologists, who say that at worst it's a marker.



I do hope things go well for you.

ATB

Mat

Edited by moderator

 

[Mathewted]

I forgot to mention that eradicating ultra-processed products appears to be key to all successful nutrition paradigms and, while I'd love to eat paleo because it combines fats and carbs I don't, because it combines fats and carbs.

Also on statins I liked Malcolm Kendrick's working through to the dress hypothesis being the likely cause of CVD.

This last point is important because in terms of lifestyle if you follow one that removes 95% of enjoyment... well I'm not sure it'd be best. For my part I advocate enjoying the fruits of good health even if all around me like to eat take away pizza and fish and chips deep fried in vegetable oil.

 

[AloeSvea]

Hi @Mathewted. Arthiritis sure is a massive pain in the.... joints! And gout - that purine thing. Yes, painful indeed with and without the dietary restrictions.

I personally have a super soft spot for paleo ways of eating. I made the big transition from High Carb Low Fat to much lower carbs via the paleo diet, and as high protein suits me, it introduced me to the world of healthy fats.But I know what you mean about the fats and carbs - it was great cooking with banana and fruit and I seem to remember a recipe with (real) maple syrup once? At least at the beginning while I was re-training my sweet tooth.

It still fits a lower to moderate carb paradigm though! I lost the bulk of my T2D weight being a 'paleobetic', into the normal range pretty pronto smart. And it was easy to figure it - half a plate of meat or fish, half veges, lots of herbs and spices. I also went into the prediabetes range also, HBA1c wise. After four months, and stayed there till the vile virus...

As for the lipids. I'm afraid I'm not a good example for getting lovely lipids. Part of my T2D profile is dyslipidemia - so I have had a very high total cholesterol count for the duration of my screwed up blood glucose regulation. They don't rush me off to hospital (although I was initiially prescribed statins), because the rest of my blood lipid profile is pretty good for an older broad with diabetes. ie - normal, or even - good! And I am clearly fit. When it comes to heart-health being fit is HUGE.

 

[oldgreymare]

Hi @Mathewted. So feel for you trying to manoeuvre your way between diabetes and gout. Good news on your triglycerides and HDL. To get a better idea of whether you are genetically susceptible to high lipids, there is a marker called Lipoprotein(a) that is associated with too high LDL levels. It can be aggravated by some other conditions including uncontrolled diabetes. You may need to source privately, but it is usually recommended to test just once. The other test gaining increasing favour is Apoprotein B (ApoB) which may be a more accurate marker for CVD risk than LDL or cholesterol ratios. I'm Type 1 and my UK endocrinologist now always orders ApoB in addition to the standard lipid panel.

I bounce around the upper normal levels of ApoB for a non-diabetic, but realistically should aim to get it much lower. So far I'm refusing statins...

Sorry to hear that you feel you need to drop using coconut oil. After a lifetime of exposure to toxically refined seed oils, the only ones allowed now in my home are coconut and virgin cold pressed olive oils, plus grass fed butter, beef suet and goose fat.

 

[AloeSvea]

Yes - me too. Coconut oil and extra virgin olive oil, and yes - the good ol' butter.

Great info @oldgreymare, on those (like me) who get too high LDL. Both my father and his brother also have had this LDL profile (father aged 90, uncle coming up for 80 and one of those post big stroke success stories).