Cholesterol

[Thornliebank]

hi all,
I’ve just been to” our future health , which is research for the future , which im very keen on , a blood test revealed that my
cholesterol, was high @ 7.27mmo/L looking that up on the British Heart foundation site it’s telling me to cut out a lot of the things I’m now eating on my low carb diet , which seems to be helping my diviticulas . I had just treated myself to a sausage roll while waiting , could that have been just a spike ?
any opinions welcome,
thanks

 

[LivingLightly]

Evening @Thornliebank.

We're advised to prepare for cholesterol and lipid blood tests by fasting for about 12 hours.

It's easiest to request an early morning time slot. That means finishing your evening meal no later than 8,00 pm and drinking water only until after your blood test the following morning.

 

[TheSecretCarbAddict]

I don't think food consumed before test would spike your cholosterol levels the same way it could your blood glucose. Not in any significant way, anyway.

 

[Antje77]

I don't think food consumed before test would spike your cholosterol levels the same way it could your blood glucose. Not in any significant way, anyway.

It will definitely affect your triglicerides, hence the lipids test being a fasting test usually

We're advised to prepare for cholesterol and lipid blood tests by fasting for about 12 hours.

It's easiest to request an early morning time slot. That means finishing your evening meal no later than 8,00 pm and drinking water only until after your blood test the following morning.

What time slot is easiest is highly personal.
I have no trouble fasting for 12 hours, but not eating after 8 PM (plus getting up very early for me) would be very hard!
I usually book my blood draws late morning/early afternoon, and I follow the official advice to fast for at least 10 hours, even though us T1's aren't expected to fast before a blood draw.

a blood test revealed that my
cholesterol, was high @ 7.27mmo/L looking that up on the British Heart foundation site it’s telling me to cut out a lot of the things I’m now eating on my low carb diet

Are you losing weight on your low carb diet?
Weightloss can cause a temporary increase in cholesterol.
Haven't you had your full lipid profile tested as part of your diabetes check ups? If so, it might be worth to compare those results with your current one. Especially the break up of the different parts, which is more important than total cholesterol.

For what it's worth, my lipids levels were out of whack when I was first diagnosed, and all returned back to perfect levels when I changed my diet to low carb without worrying about the fats.
So the official advice for what's healthy for cholesterol definitely doesn't work for me.

 

[LivingLightly]

a blood test revealed that my cholesterol, was high @ 7.27mmo/L looking that up on the British Heart foundation site it’s telling me to cut out a lot of the things I’m now eating on my low carb diet , which seems to be helping my diviticulas.

Hello again @Thornliebank.

The dietary advice on the BHF site may be an improvement on your average Brit's way of eating, but the emphasis on wholegrain cereals and fruit (rather than above ground vegetables) is questionable.

The following visual guides are diabetic friendly and suitable for folk with heart and diveriicular disease

Visual low carb guides - Diet Doctor

Visual low carb guides Which vegetables are best on a low carb diet, can you have berries and which nuts have the fewest carbs? What should I choose to drink at a party? Check out our visual guides to low carb, which can help you make better choices!

www.dietdoctor.com

 

[gogobroom]

Having had high Cholesterol last year, and just recently tested mine went down but was still high - the doc asked me if I had fasted and I hadn't so wasn't too worried - they advised that eating pre test can have a effect on the cholesterol readings especially if it was a high fat meal - it is best to have it fasted for 8 to 12 hours as mentioned above to get a clear picture.

 

[Thornliebank]

Thanks to you all

 

[KennyA]

I would advise fasting. Not fasting before the test (last year it was a couple of coffees with double cream) will put my reading up a bit, and they'll again try to get me to take statins, and I'll refuse. This year - in a week or two - I'll do at least a 12 hours fast before the test, and see whether "I've reduced my cholesterol". I'm not particularly bothered about it either way.

There is evidence from the HUNT2 work that elevated cholesterol is protective for women.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol ...

www.ncbi.nlm.nih.gov

here's the conclusion:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

 

[HairySmurf]

There is evidence from the HUNT2 work that elevated cholesterol is protective for women.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol ...

www.ncbi.nlm.nih.gov

here's the conclusion:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

Outside of that paper based on the HUNT2 study is there any evidence that elevated cholesterol is protective for women? There is plenty of evidence that women's risk of cardiovascular disease increases after menopause, reaches par with men after the age of around 80, and then exceeds that of men. It seems likely that this is because estrogen hormones cause reduced cholesterol output form the liver. When estrogen falls, cholesterol rises. That to me seems a fairly obvious hint that rising cholesterol is a bad thing - heart disease risk in women goes up after their cholesterol starts to rise naturally following menopause. Either cholesterol is the cause, or estrogen has some unknown, mysterious protective properties. Or cholesterol is the cause.

Here's another, similar, large, all-cause mortality study, from Korea. The results are very similar, but this one shows a U-shaped curve that is nearly identical for both genders after the age of 55. Elevated cholesterol is associated with greater risk of death in women above a certain age, just like it is in men. Which study is right? Which one reflects reality and which is the outlier? The mistake? What do all the other studies have to say on the subject? Do I even have to ask?

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com

 

[Thornliebank]

yes thank , I’m thinking I’m going to stick with my low carb and occasional treat ( really not many) but remember fast before any blood tests, as diabetes and my diviticulas are my priority.

 

[DeejayR]

My local surgery took an unexpected extra blood sample this week for cholesterol, lipids, HbA1C and other stuff when I was in for a cancer blood test, so I had breakfast as usual and the nurse just noted the fact. My cholesterol level has been ok (4.5-ish) for a while so I think I'll come off statins to see what happens. I will make sure my GP knows and he will hopefully get me checked from time to time. If my cholesterol level rises I've got some arguments from this forum I've stored over the years.
* My surgery says they don't do fasting tests any more anyway.

 

[Outlier]

My surgery says they don't do fasting tests any more anyway.

No more does mine, but I still fast before any blood test. The one occasion I didn't, a great fuss was made about the results, which of course showed "improvements" with every one since.

 

[Melgar]

hi all,
I’ve just been to” our future health , which is research for the future , which im very keen on , a blood test revealed that my
cholesterol, was high @ 7.27mmo/L looking that up on the British Heart foundation site it’s telling me to cut out a lot of the things I’m now eating on my low carb diet , which seems to be helping my diviticulas . I had just treated myself to a sausage roll while waiting , could that have been just a spike ?
any opinions welcome,
thanks

Cholesterol is always taken after fasting here in Canada. Is 7.27 mmol/ls your total Cholesterol? If so what is the breakdown LDL's, HDL's ? And what were your Triglycerides numbers? I have to admit after reading Malcolm Kendrick's book 'The Clot Thickens' it gave me pause for thought about LDL's being the bad guys. His hypothesis - that LDL's are getting a bad wrap and that they may not be the main cause of plaque formation in arteries, has some merit and he argues the point very convincingly.

 

[KennyA]

Outside of that paper based on the HUNT2 study is there any evidence that elevated cholesterol is protective for women? There is plenty of evidence that women's risk of cardiovascular disease increases after menopause, reaches par with men after the age of around 80, and then exceeds that of men. It seems likely that this is because estrogen hormones cause reduced cholesterol output form the liver. When estrogen falls, cholesterol rises. That to me seems a fairly obvious hint that rising cholesterol is a bad thing - heart disease risk in women goes up after their cholesterol starts to rise naturally following menopause. Either cholesterol is the cause, or estrogen has some unknown, mysterious protective properties. Or cholesterol is the cause.

Here's another, similar, large, all-cause mortality study, from Korea. The results are very similar, but this one shows a U-shaped curve that is nearly identical for both genders after the age of 55. Elevated cholesterol is associated with greater risk of death in women above a certain age, just like it is in men. Which study is right? Which one reflects reality and which is the outlier? The mistake? What do all the other studies have to say on the subject? Do I even have to ask?

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com

I don't think this paper (thank you for posting it) says what you think it does. It rather confirms the HUNT2 findings - which also show a similar u-shaped effect. For example, the authors say:

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age.

“The lower, the better” cholesterol hypothesis has been accepted by many health professionals. However, the statin trials were mainly performed in persons at a high risk of heart disease, especially in men with manifest CVD, in whom heart disease mortality constituted approximately 50% of all deaths.

In the current study, however, TC levels of 210–249 mg/dL (my note: 5.2 mmol/lto approx 6.5 mmol/l - this is usually defined as "high" or "borderline high" total cholesterol) and approximately 200–240 mg/dL were associated with the lowest mortality in the categorical and spline analyses, respectively.

Even within CVD subtypes, TC ranges associated with lowest risk have not been consistent. For example, for stroke, TC levels <200 mg/dL were not associated with the lowest mortality in prospective cohort studies, and randomized trials have not provided clear evidence of whether lipid-lowering therapies, including statins, reduce stroke mortality. Hemorrhagic stroke, respiratory diseases (especially chronic obstructive pulmonary disease), digestive diseases (especially liver disease), and several cancers have been suggested to be associated with lower TC levels; thus, the ranges associated with lowest risk might be even higher for these diseases than those for all-cause mortality.

It's well worth a read in full. It provides additional evidence that the "low cholesterol" approach is not one that results in decreased risk.

 

[HairySmurf]

It's well worth a read in full. It provides additional evidence that the "low cholesterol" approach is not one that results in decreased risk.

I've read it, in full. Did I miss the part about elevated cholesterol being 'protective' for women? Or there being any significant difference between men and women over 55?

Whether low cholesterol levels are more beneficial for overall health than 'normal' levels is arguable. What the 'ideal' levels are is arguable. Every study seems to say something a little different. The notion that elevated cholesterol, as in levels well above normal, is 'protective' in some way, is not even close to supportable by a wide body of science.

You post that link a lot Kenny. 'Protective'. 'Evidence'. The words of a Moderator, a Staff Member. People take your words seriously; trust that you know your stuff. What if you're wrong? What are the potential consequences of diabetics coming to believe high cholesterol is 'protective', in a world where around 70% of type 2 diabetics die of cardiovascular causes?

 

[ianf0ster]

"You post that link a lot Kenny. 'Protective'. 'Evidence'. The words of a Moderator, a Staff Member. People take your words seriously; trust that you know your stuff. What if you're wrong? What are the potential consequences of diabetics coming to believe high cholesterol is 'protective', in a world where around 70% of type 2 diabetics die of cardiovascular causes?"

We are Moderators - I don't know why we get that Staff Member tag, since we are all unpaid volunteers and are not part of the Administration team.
We are experts in our own diabetes, not medical experts - Medical Orthodoxy changes over time and even medical experts get things wrong, so the idea that anyone can be trusted to always be right is just ludicrous!

Members need to make their own decisions, and that applies to us moderators too.

"What if you're wrong? What are the potential consequences of diabetics coming to believe high cholesterol is 'protective', in a world where around 70% of type 2 diabetics die of cardiovascular causes?"

Do you have a reference for that claim of around 70% of T2D's dying of cardiovascular disease? In particular, does that mean 70% of all those ever diagnosed with T2D - Or just those not in remission? I'm sure you know that there is a huge difference between those two statements!

 

[KennyA]

I've read it, in full. Did I miss the part about elevated cholesterol being 'protective' for women? Or there being any significant difference between men and women over 55?

Whether low cholesterol levels are more beneficial for overall health than 'normal' levels is arguable. What the 'ideal' levels are is arguable. Every study seems to say something a little different. The notion that elevated cholesterol, as in levels well above normal, is 'protective' in some way, is not even close to supportable by a wide body of science.

You post that link a lot Kenny. 'Protective'. 'Evidence'. The words of a Moderator, a Staff Member. People take your words seriously; trust that you know your stuff. What if you're wrong? What are the potential consequences of diabetics coming to believe high cholesterol is 'protective', in a world where around 70% of type 2 diabetics die of cardiovascular causes?

What you've missed is the increasing evidence, including the Korean reserach, that what current orthodoxy calls "high cholesterol" - ie over 5.0 mmol/l and up to around 6.5mmol/l - possibly higher, according to your Korean research - is in fact the lowest mortality risk.

The "elevated cholesterol" quote, as I think you know quite well, is not mine but is taken directly from the published HUNT2 work. You may not like the conclusions, but the Korean research you yourself posted not only references the HUNT2 study but backs it up. It also found that what orthodoxy currently calls "high" cholesterol provides the lowest risk of mortality. That is important information, to my mind.

You say - The notion that elevated cholesterol, as in levels well above normal, is 'protective' in some way, is not even close to supportable by a wide body of science.

But the research you yourself posted supports just that position. It also criticises the pro-statin research. Now, having advanced it, you're arguing against it. By the way, what (in your view) is "normal" cholesterol? Mine hasn't shifted in thirty years - it used to be described as "good", now it's "high".

I don't know where your 70% mortality figure comes from. Google will show you a mortality range of 50% (BioMed Central) two-thirds (American Diabetes Association) and 30% (nih.gov). As these figures are without context, I have no idea whether this is headcount, absolute or relative risk, or whether it has anything to do with cholesterol levels at all.

And ask yourself this question: if this research is correct, and there is a higher risk of mortality from lower cholesterol levels, is that not a good enough reason to draw people's attention to the information?

 

[HairySmurf]

I got the 70% figure here - Link The reference for the claim is behind a paywall. There is no information available for T2s in remission that I can find. The idea that being in remission - having a 'normal' HbA1c after a diabetes diagnosis - makes a 'huge difference' to cardiovascular risk, is in some ways an article of faith. I believe that it probably does, but I don't know for a fact that it does. Nobody knows that.

I apologise for the the Staff Member bit - I took that literally. I did actually believe you were paid for your services to the forum.

I did not miss the reference or conclusions of either study. The idea that a total cholesterol level in the range of 5 to 6.5 mmol/L is abnormal and in need of treatment in an otherwise healthy person is indeed questionable in my opinion. That range is pretty close to the 'normal' range for the UK - Link

Both studies do a good job of illustrating that low, supposedly 'healthy' levels are not at all a good indicator of overall health. However, there are some obvious reasons why very low total cholesterol is associated with increased overall mortality - for example, it's a marker of malnutrition, with all the health complications that entails - Link Neither study makes the claim that lowering total cholesterol artificially with statins increases the overall mortality risk. That would be a very dodgy claim to make, as the many statin clinical trials would have shown up any such risks. Of the many side effects of statins that have been identified, sudden death is not among them. To the best of my knowledge every all-cause mortality study that's ever been done on statins shows an improvement. The point both studies make in their conclusions however is that total cholesterol somewhat above average levels probably does not need to be lowered - that's it's pointless, not that it's dangerous.

The current 'orthodoxy' does not claim that lower total cholesterol is associated with the lowest total risk of mortality, it claims it's associated with lower risk of cardiovascular health problems specifically; heart attacks and strokes. The QRISK calculator is not a total mortality risk calculator. That notion about total cholesterol is indeed questionable in my opinion. From what I can gather it is elevated LDL specifically, with the implied issues with high Apo-B levels in the bloodstream, that is very strongly associated with atherosclerosis, which appears to be the primary underlying cause of cardiovascular health issues linked to diet. I do not personally believe, based on my very limited understanding, that a person with moderately elevated total cholesterol (around the 6 mmol/L mark) but with good HDL levels and low LDL levels should automatically be prescribed statins.

I do not like or dislike the conclusions of either study, or any study. I dislike (understatement) the claim that elevated total cholesterol in women is in any way 'protective'. It's a claim that is right out on the ragged fringe of dangerous pseudo-science. The cholesterol study based on HUNT2 is an outlier as regards differences between men and women, and it does not justify any claim that high total cholesterol levels are 'protective' in any way.