Diabetes and high cholesterol

On diagnosis 8 years ago my chol was 7.6. Adding benecol/flora pro-v & oat bran to my low sugar/low fat/low salt/complex carbs diet reduced it to the low 5s.

Simvastatin caused muscle pains, as did niacin. Niacin also increased by BS readings.

A year ago my total chol was 5.4. I started reduced carb diet in May this year. My chol is 4.4 at the Nov check. That is in fact a reduction of 40% (7.6 to 4.4) by diet alone.

Hope that helps.

The diabetes guidelines are pushing for total cholesterol below 4 and LDLs below 2. This is usually only possible if you go on high doses of statins.

The thing is that total cholesterol and LDL have little if anything to do with cardiovascular mortality.

Much more important are:

normalising blood sugars
normalising blood pressure
avoiding kidney damage/proteinuria
not smoking
normalising HDL and triglycerides
exercising
normalising weight esp waistline.
reducing stress

All of the above can be achieved by not smoking, exercising esp interval / resistance training, sorting out things that contribute to personal stress or unhappiness and following a restricted carbohydrate diet.

I'm positive lowering of overall BG levels + statins reduced my lipids profile dramatically but how do you separate the 2 ? For me (I think) statins were important to reduce my cholesterol and I did not suffer any obvious ill effect from taking them. However, I have been able to keep them at a fairly low level through diet and reduced BG levels.

When I was diagnosed, I had an horendous lipid profile. From the description it sounds as if my blood was thick and gloopy. I took statins, and started insulin. On dietitians advice I reduced saturated and increased good fats, (more oil in salad dressings , oily fish twice a week, avocados) plus much more veg and fruit in diet. I did not reduce overall carbs (I do use insulin) but selected them more carefully and measured their glycemic effect. (whole mixed grain bread, wholegrain rice and pasta etc). I already exercised but probably increased it. The results were a dramatic change in lipid profile.
More recently I tend to take the stain ( a lower dose from before) very infrequently, although it is still prescribed. The LDL has risen but so has the HDL so the ratio is better. My diet has remained the same, as have exercise levels.

April 2005 / June 2005 (40 mg simvastatin) / March 2008
+ controlled BG (occasional
20mg statin)

fasting BG: 20.85mmol / HBA1c 6% / HBA1c 4.9%
plasma: opalescent / clear straw coloured / clear straw col
triglycerides: 3.19mmol / 1.45 mmol / 0.73mmol
total chol : 8.3mmol / 3.99mmol / 4.66mmol
HDL : 1.18mmol / 1.23mmol / 1.59mmol
LDL : 5.75mmol / 2.10mmol / 2.73mmol

total Ch/HDL: 7.06mmol / 3.22mmol / 2.91mmol
ratio

Sorry, my fairly clear chart didn't survive on posting

There's quite a lot of evidence that a low carb diet lowers LDL cholesterol and raises HDL cholesterol( which is what we need, but as Katharine has already written, there's no evidence on how much if any effect it has on the incidence of cardiovascular disease.)

there's no evidence on how much if any effect it has on the incidence of cardiovascular disease.)

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I'm not sure thats the case, there is plenty of evidence, just that its often contrary! see bandolier http://www.medicine.ox.ac.uk/bandolier/band66/b66-2.html

Twenty-three separate meta-analyses were found. Outcomes examined were those of total mortality, cardiovascular mortality and nonfatal cardiovascular disease. As the Table shows, the results of the analyses overwhelmingly supported cholesterol lowering for reduction in nonfatal cardiovascular disease and cardiovascular mortality, but not total mortality. (see original for table)

Garbage in - garbage out?

Of the 23 analyses, eight were not supportive of benefit. Of those eight, three included non-randomised studies, and one didn't state whether it did or not. None of the 15 studies supportive of benefit included non-randomised studies. So here is one lesson learned again: for treatments, including non-randomised studies has to be justified.

The supportive meta-analyses were also generally better designed. Not only did they include only randomised studies, but had more explicit exclusion criteria that allowed a more direct evaluation of the effects of cholesterol lowering without confounding factors. None of the non-supportive meta-analyses included authors with meta-analytic expertise. An interesting post-hoc observation was that only 4 of 10 analyses in British journals were supportive, compared with 11 of 13 in non-British journals

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phoenix said:

I'm positive lowering of overall BG levels + statins reduced my lipids profile dramatically but how do you separate the 2 ? For me (I think) statins were important to reduce my cholesterol and I did not suffer any obvious ill effect from taking them. However, I have been able to keep them at a fairly low level through diet and reduced BG levels.

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In general (with a fair degree of individual/genetic variation) reducing carbs can be guaranteed to bang down your trigs. In the absence of high levels of trigs the balance between HDL and LDL changes for the better - and the LDL molecules become fluffier and more benign (bearing in mind that LDL is an important substrate for the manufacture of hormones and many other important chemicals, some trials have shown a distinct J curve from reducing it too far)

It is often the case that LDL *increases* on a reduced carb diet - but this may be outweighed by the increase in HDL and the major improvement in trigs/HDL ratio. Statins focus almost exclusively on LDL reduction.

I was actually going to do a trial of dropping my statin for a month prior to my next bloods purely to see how much improvement was dietary and how much from the drug, however time passes and I found I had missed my Medication Review. I asked my GP if I could do it in January instead and she told me in view of my major and continuing improvements there was no need for another one for another six months, so I'm afraid this experiment will be deferred for a wee while.

results of the analyses overwhelmingly supported cholesterol lowering for reduction in nonfatal cardiovascular disease and cardiovascular mortality, but not total mortality.

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There is indeed some cardiovascular benefit but not in total mortality. Deaths from suicide, accidents and cancers balance out the reduced cardiovascular mortality. It is thought that very low cholesterol levels affect central nervous and immune system function.

The cardiovascular benefits are usually put as relative risk statistics and when numbers needed to treat, side effects and direct costs are considered any benefit to the individual remains very small but possibly statistically relevant to middle aged men who have diabetes or cardiovascular problems.

Katharine said:

The cardiovascular benefits are usually put as relative risk statistics and when numbers needed to treat, side effects and direct costs are considered any benefit to the individual remains very small but possibly statistically relevant to middle aged men who have diabetes or cardiovascular problems.

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Very statistically relevant if they have shares in drug companies <G>