• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

High ldl calcium plaque artries

annabell1

annabell1

Well-Known Member
Messages
639
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
rude people
not able to do as much as I used to do due to health issues
onions
leek
I've been seeing data that some people on keto diets have CAC high calcium plaque and high cholesterol, so I'm wondering how does one do keto diet without causing more plaque buildup and cholesterol etc. If one already has this. Any suggestions
 
annabell1 said:
I've been seeing data that some people on keto diets have CAC high calcium plaque and high cholesterol, so I'm wondering how does one do keto diet without causing more plaque buildup and cholesterol etc. If one already has this. Any suggestions
Click to expand...
Hi - this has been a stick that certain people have tried to beat keto with for some time. I don't doubt that some people on a keto diet have high plaque and high cholesterol, but so also do people who are not on keto diets.

My cholesterol hasn't shifted in the more than five years I've been in ketosis. Most of our cholesterol, which is essential for life, is produced by our own bodies anyway (around 80% is the usually quoted figure) and cholesterol from food is therefore a relatively minor source.

Is this something you are currently experiencing, or is it something you've read about?
 
We are all different and I'm sure all have different reactions to what we eat. Speaking for myself I had high LDL before I started Keto as always had had it as did my mum but I didn't continue with prescribed statins as I had side effects which meant I couldn't continue with them. Keto definitely raised my ldl more and my figures have remained high over last 8 years while I have stayed in remission by mainly eating keto/low carb.
I was concerned about what high ldl meant for my heart health and took part in a heart health study for diabetics in remission a few years ago and the tests included a CAC score and full heart imaging etc. I luckily had a full set of good heart health results including a zero CAC score so no obvious calcification despite my longstanding high LDL score. At my review early this year my LDL had become a little higher (I think 5.8, as part of a 9.2 total cholesterol) so I was persuaded to try a small dose of lipid lowering therapy - Ezetimibe - I take half of standard dose as couldn't tolerate whole dose but it has brought my ldl down to 2.9 as part of a total 5.8 cholesterol score. So my LDl has now lowered but I'm still not convinced 're the LDL leads to heart disease theory but was eventually worn down by the persistent medical pressure to lower it despite no heart disease family history or other risk factors that I'm aware of.
Not sure this answers your question but is my experience.
Edit to correct spelling
 
Last edited:
When I changed from 'healthy' eating to a 'fad diet' at diagnosis I went back to normal blood glucose levels, and saw a reduction in cholesterol, my blood pressure reduced a little from the top end of normal to more middling numbers - all the time since then I have been eating a very Atkins based diet.
In cooler months I have things like steak and mushrooms for breakfast, these days, some tinned fish and coleslaw.

I seem to be far stronger and more active than many 74 year olds.
 
The recent hyper-responders studies have shown that high LDL is not usually associated with artery calcium plaque (at least not in those on a keto or near keto diet).
I've never had a CAC test done, but I certainly had artery plaque when eating the high carb low fat diet as advised by my GP, the angiogram and subsequent 3x bypass showed that!
Unfortunately, I am/was a slim T2 (TOFI) slim all my life only slowly gaining weight slowly when put on a low fat diet, after which I first got plaque in my arteries , then a T2 Diabetes diagnosis. So I'm the typical body shape to get raised LDL on a LCHF way of eating. The experience of others on this forum (and the patients of Dr David Unwin) show that the vast majority of more typical T2D's who eat HCHF or Keto reduce their LDL as well as raising HDL and lowering Triglycerides. Fortunately even though my LDL is raised on LLCHF, both my HDl is almost doubled and my triglycerides are almost halved so many Cardiologists would consider that my Cardio risk has dropped despite my higher LDL.

HDL used to be called 'good cholesterol' because those with higher HDL had fewer heart attacks, but once it was found that all studies on drugs which raised HDL showed no benefit, the medical profession started to say that high HDL had no benefit despite the earlier studies which did show a benefit in those whose HDL was 'naturally' higher.

I was on statins while on a low fat diet (Simvastatin) I got muscle pain and skin rashes, so came off them. I tried again after my 3x CAB (Atorvastatin) got brain fog and higher Blood Glucose, so came off those too.
Statins may be beneficial for those who can tolerate them - but not for the 20% or so who can't. I know this latter number is disputed, but Prof. Rory Collins (a leading statins advocate) patented a test as to who could not tolerate statins and sold it for several million dollars and the 20% number comes from that company.

Here are the best threads on this subject:
bulkbiker

Thread 'Cholesterol and Statins'

There are always a lot of threads about Statins and Cholesterol and we all post our various favourite bits of current presentations about them but I thought it might be handy to have them all in one thread. I meant to put this together soon after the get together in Birmingham (sorry @Debandez) but have been a bit distracted (thanks to twitter) since then so thought it was about time I pulled my finger out and put something down. I'll try and take the best bits of what I have posted previously and nick some bits from others... please anyone feel free to add what you find so we can...
  • Like
  • Informative

I

Thread 'Dave Feldman's "CholesterolJoe" experiment'

Dave says:
Big thanks to @shawnbaker1967 for his mention of our work on
@joerogan
. #LEM/#LMHR/#LMHRstudy It has inspired me to go ahead with my most ambitious experiment yet... Demonstrating realtime LDL changes against a random number generator -- in this case, I'll be using the JRE podcast itself as the source of the randomness. (The #CholesterolJoe Experiment) For details on the experiment, watch this video

https://twitter.com/x/status/1729407545876328577

However, I’ve long wanted to provide a demonstration of rapid cholesterol changes in realtime.

From my various...
  • Like
  • Informative
 
shelley262 said:
We are all different and I'm sure all have different reactions to what we eat. Speaking for myself I had high LDL before I started Keto as always had had it as did my mum but I didn't continue with prescribed statins as I had side effects which meant I couldn't continue with them. Keto definitely raised my ldl more and my figures have remained high over last 8 years while I have stayed in remission by mainly eating keto/low carb.
I was concerned about what high ldl meant for my heart health and took part in a heart health study for diabetics in remission a few years ago and the tests included a CAC score and full heart imaging etc. I luckily had a full set of good heart health results including a zero CAC score so no obvious calcification despite my longstanding high LDL score. At my review early this year my LDL had become a little higher (I think 5.8, as part of a 9.2 total cholesterol) so I was persuaded to try a small dose of lipid lowering therapy - Ezetimibe - I take half of standard dose as couldn't tolerate whole dose but it has brought my ldl down to 2.9 as part of a total 5.8 cholesterol score. So my LDl has now lowered but I'm still not convinced 're the LDL leads to heart disease theory but was eventually worn down by the persistent medical pressure to lower it despite no heart disease family history or other risk factors that I'm aware of.
Not sure this answers your question but is my experience.
Edit to correct spelling
Click to expand...
Interesting post @shelley262 . As a matter of interest were your Triglycerides low? I had high LDL's , normal HDL's but very low Triglycerides. I'm a lean and fit 64 year old . My liver stats were and are normal. The Dr's convinced me to go on statins. Unlike you I have suffered no ill effects from statins, they have not even increased my blood sugars. I must admit I feel more at ease having lower LDL's. Despite what I have read about LDL's not being the bad guys. I was not comfortable having high LDL's. Maybe that's because for years we were told LDL's were bad. I would fret every time I had a blood panel done seeing those out of range blood sugars and total cholesterol figures. I feel better physiologically for being on them when I see my normal lipid panel results. As an aside, my Grandmother on my dad's side had angina, and one of my aunts on my mom's side died of a heart attack. That aunt ate a healthy diet and weight wise she was thin.
 
Melgar said:
Interesting post @shelley262 . As a matter of interest were your Triglycerides low? I had high LDL's , normal HDL's but very low Triglycerides. I'm a lean and fit 64 year old . My liver stats were and are normal. The Dr's convinced me to go on statins. Unlike you I have suffered no ill effects from statins, they have not even increased my blood sugars. I must admit I feel more at ease having lower LDL's. Despite what I have read about LDL's not being the bad guys. I was not comfortable having high LDL's. Maybe that's because for years we were told LDL's were bad. I would fret every time I had a blood panel done seeing those out of range blood sugars and total cholesterol figures. I feel better physiologically for being on them when I see my normal lipid panel results. As an aside, my Grandmother on my dad's side had angina, and one of my aunts on my mom's side died of a heart attack. That aunt ate a healthy diet and weight wise she was thin.
Click to expand...
I have always had high HDL around 2.5 and up to 3.5 on one test and always had low triglycerides of between 0.5 to 0.7. I have no family history of heart disease and so with me it was more the pressure to lower the LDL and I was made to feel anxious about it with gloom and doom predictions about my heart health risk. Interestingly they are still not happy with my much lower figure and want more meds but the half a tablet is as far as I'm going! As an aside too 20ish years ago I spoke to my then gp about my concerns - as my cholesterol total was 6.2 and he said then that it was a really healthy figure especially as my HDL was 2.5 and trigs below one! Funny how advice on healthy cholesterol has changed....
 
shelley262 said:
I have always had high HDL around 2.5 and up to 3.5 on one test and always had low triglycerides of between 0.5 to 0.7. I have no family history of heart disease and so with me it was more the pressure to lower the LDL and I was made to feel anxious about it with gloom and doom predictions about my heart health risk. Interestingly they are still not happy with my much lower figure and want more meds but the half a tablet is as far as I'm going! As an aside too 20ish years ago I spoke to my then gp about my concerns - as my cholesterol total was 6.2 and he said then that it was a really healthy figure especially as my HDL was 2.5 and trigs below one! Funny how advice on healthy cholesterol has changed....
Click to expand...
I agree. My LDL's have always been raised even though my Triglycerides hover between 0.5 - 0.6. I can understand everyones concerns, particularly those who feel pressured to go on statins, even though their LDL figures are normal! I can also understand why people think it's to do with money and kickbacks because of this pressure. I personally don't think that is the case at all. It's doing an injustice to HCPs implying that they are all in it for the pennies they get for statin uptake.

I do think there is an element of biased research by pharma, but then cardiologists are split on the matter. The jury is still out for me. Both sides can cite arguments for and against. Confirmation bias when looking for information plays a role. I honestly don't know. It's a polarizing topic. I would say that some people absolutely need statins and these drugs do save lives. I wouldn't like to be complicit in persuading someone to stop using statins when that drug could be , in part, saving their life.

For me, going on statins was a phycological decision. There is too much debate going on right now with no clear winner, so I aired on the side of caution.
 
Melgar said:
I agree. My LDL's have always been raised even though my Triglycerides hover between 0.5 - 0.6. I can understand everyones concerns, particularly those who feel pressured to go on statins, even though their LDL figures are normal! I can also understand why people think it's to do with money and kickbacks because of this pressure. I personally don't think that is the case at all. It's doing an injustice to HCPs implying that they are all in it for the pennies they get for statin uptake.

I do think there is an element of biased research by pharma, but then cardiologists are split on the matter. The jury is still out for me. Both sides can cite arguments for and against. Confirmation bias when looking for information plays a role. I honestly don't know. It's a polarizing topic. I would say that some people absolutely need statins and these drugs do save lives. I wouldn't like to be complicit in persuading someone to stop using statins when that drug could be , in part, saving their life.

For me, going on statins was a phycological decision. There is too much debate going on right now with no clear winner, so I aired on the side of caution.
Click to expand...
My agreement to taking the lipid lowering half a pill which lowers LDL and works in a different way to a statin- was me erring on side of caution too. I was also really heartened when I came across a study of Ezetimibe which showed half a dose had a similar effect to a full dose was a good compromise for me. It has no effect on my bgs and I can tolerate and accept the half dose. It's also a relief to have the number come down.
 
I must say, I find it very concerning how pervasive some fringe attitudes towards cholesterol are on this forum, with not just users, but multiple moderators promoting these views.
High LDL cholesterol is well established as a cause of cardiovascular disease. This is uncontroversial and accepted in all of mainstream reputable science. One could easily get the opposite impression when browsing this forum.
 
Westley said:
I must say, I find it very concerning how pervasive some fringe attitudes towards cholesterol are on this forum, with not just users, but multiple moderators promoting these views.
High LDL cholesterol is well established as a cause of cardiovascular disease. This is uncontroversial and accepted in all of mainstream reputable science. One could easily get the opposite impression when browsing this forum.
Click to expand...
You might find these interesting reading. The Journal of the American College of Cardiology and the British Medical Journal are probably everyone's idea of mainstream reputable science.

https://www.sciencedirect.com/scien...tm_medium=referral&utm_campaign=the-arrow-188

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

https://pubmed.ncbi.nlm.nih.gov/40077635/

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

www.bmj.com

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and...
www.bmj.com www.bmj.com

And this recent judgement in the High Court, while not a scientific paper, demonstrates that the argument is not as resolved as the popular media often suggest.

 
Westley said:
I must say, I find it very concerning how pervasive some fringe attitudes towards cholesterol are on this forum, with not just users, but multiple moderators promoting these views.
High LDL cholesterol is well established as a cause of cardiovascular disease. This is uncontroversial and accepted in all of mainstream reputable science. One could easily get the opposite impression when browsing this forum.
Click to expand...
I am 74 years old - I have seen money bend science, I have been told of research being abandoned when it was not showing the desired results at the first evaluation, also large numbers of prospective test subjects being carefully sifted for the right ones to test - well established seems to mean accepted due to constant repetition, with no one actually doing any checking.
Some time ago now the death rate in France reduced when there was a reduction in the acceptance of medication for high cholesterol. The number of predicted deaths was almost exactly that reported - except for the little minus sign in front of it, which few people actually recognised for what it was, there was a resounding 'told you so' response, until realisation dawned and then there was an abrupt silence on the matter.
I have asked various GPs and nurses over the years for the research and the numbers on cholesterol, statins and death rates - so far none have materialised.
 
I'm going to respond to some of the posts in this thread with questions.

ianf0ster wrote above:
"and the patients of Dr David Unwin) show that the vast majority of more typical T2D's who eat HCHF or Keto reduce their LDL"
I was curious about this claim, so tried to find some supporting papers from Dr Unwin.
This one
Low-carbohydrate diets in the management of obesity and type 2 diabetes: a review from clinicians using the approach in practice
appears to be the main relevant publication from him.

Here's what it has to say about LDL:
"Clinical trials lasting up to two years have shown that low-carbohydrate diets (in which total and saturated fats have replaced carbohydrates) have had beneficial effects on excess body weight, lipids (including high-density lipoprotein (HDL) cholesterol and triglycerides, but not low-density lipoprotein LDL cholesterol)" (emphasis added)

The other mention:
"A second consideration is the increase in LDL-cholesterol that is described with some [27] but not all [108] low-carbohydrate interventions"
is a link to 2 studies.
The first (https://pubmed.ncbi.nlm.nih.gov/26768850/) finds a significant increase in LDL on an Atkins type keto diet.
The second (https://pubmed.ncbi.nlm.nih.gov/26224300/) finds a small decrease in LDL, when following a low carb diet which was also low saturated fat.

Therefore it seems the claim is quite incorrect.

He also links a post by BulkBiker, which links as evidence a paper which claims that 'LDL Does Not Cause Cardiovascular Disease'. That paper has been found to fail many basic scientific standards:

CEBM response: 'Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review' - a post publication peer review — Centre for Evidence-Based Medicine (CEBM), University o

www.cebm.ox.ac.uk www.cebm.ox.ac.uk

There is also a link to the work of David Feldman, who as far as I can tell is a software developer and a sort of 'social media personality amateur lipidologist'. He has been a co-author on some papers pushing these ideas about LDL, which have been reviewed and found severely lacking in scientific rigour https://cdn.nutrition.org/article/S2475-2991(22)00065-8/fulltext

As for KennyA's reply, the first paper he links goes into the topic of LDL particle size. While I think it is quite well accepted that the smaller particles are more harmful, that is not to say that the large ones aren't. Here's a very clear video on the topic, well referenced with links to the studies in the description

I responded to the other papers he also linked in this thread:
Westley

Post in thread 'Weight loss'

I fully expected some pushback, as I'm familiar with how prevalent these views are within this particular forum. I'll try and respond to some, but as you see, in a short space of time, we have 7 responses in support of these views, with a mix of personal 'anecdata' and links to multiple studies, each of which will take some time to look at. I'm clearly in a minority here (and not by coincidence, diabetes.co.uk sells low carb programs), but I repeat, what I am sharing is the consensus view in mainstream science. This forum is very far from representative.

My own views on this have...

(in summary, if you actually read the papers they are not really supportive at all of a claim that high saturated fat intake does not cause elevated LDL, or that elevated LDL does not cause heart disease)

I have no affiliation with any of the authors or video creators I linked above. I'm just another diabetic trying to be healthy, and wanting to to avoid getting led astray.
I post these questions and criticisms not as any sort of 'gotcha', and they are not personal.

I'd dearly love to believe I can eat copious amounts of butter and ribeye and stay healthy, so if some genuinely high quality science comes along supporting that I'll be thrilled.
 
Westley said:
I'd dearly love to believe I can eat copious amounts of butter and ribeye and stay healthy, so if some genuinely high quality science comes along
Click to expand...
What about your own annual lipid tests?
Not everyone reacts the same to many things, and while I'm one of those whose lipids have completely normalised after changing my diet to copious amounts of butter (not ribeye, pork is cheaper), we also have members whose lipids have stayed out of range.

Those tests tell us what works for us individually, just like testing our BG tells us how much insulin we need or what amount of carbs our individual bodies can deal with. Which is vastly different between different people, so large population studies may not give the answer taylored to you or me.
 
Westley said:
... they are not really supportive at all of a claim that high saturated fat intake does not cause elevated LDL, or that elevated LDL does not cause heart disease
Click to expand...
This rather over the top generalisation is not borne out by the research. Take the American College of Cardiology paper. Below are their "highlights", which would be downright perverse if what you assert were indeed to be true. If saturated fats raise LDL and if LDL causes heart disease, why would these be their recommendations?


-The U.S. Dietary Guidelines recommend the restriction of SFA intake to <10% of calories to reduce CVD.

-Different SFAs have different biologic effects, which are further modified by the food matrix and the carbohydrate content of the diet.

-Several foods relatively rich in SFAs, such as whole-fat dairy, dark chocolate, and unprocessed meat, are not associated with increased CVD or diabetes risk.

-There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the United States will prevent CVD or reduce mortality.
 
For some balance, here's the response from several of the UK's top nutrition experts to a similar piece by Arne Astrup (the author of the ACC paper you're quoting) where he repeats the same points:


This is also some interesting context on Astrup:
t.co

Novo Nordisk Foundation’s obesity head works as paid adviser to chocolate maker Ferrero

Professor Arne Astrup is also involved in project to change widely-accepted definition of ultra-processed food
t.co t.co
 
Last edited:
Westley said:
I'm going to respond to some of the posts in this thread with questions.

ianf0ster wrote above:
"and the patients of Dr David Unwin) show that the vast majority of more typical T2D's who eat HCHF or Keto reduce their LDL"
I was curious about this claim, so tried to find some supporting papers from Dr Unwin.
This one
Low-carbohydrate diets in the management of obesity and type 2 diabetes: a review from clinicians using the approach in practice
appears to be the main relevant publication from him.

Here's what it has to say about LDL:
"Clinical trials lasting up to two years have shown that low-carbohydrate diets (in which total and saturated fats have replaced carbohydrates) have had beneficial effects on excess body weight, lipids (including high-density lipoprotein (HDL) cholesterol and triglycerides, but not low-density lipoprotein LDL cholesterol)" (emphasis added)

The other mention:
"A second consideration is the increase in LDL-cholesterol that is described with some [27] but not all [108] low-carbohydrate interventions"
is a link to 2 studies.
The first (https://pubmed.ncbi.nlm.nih.gov/26768850/) finds a significant increase in LDL on an Atkins type keto diet.
The second (https://pubmed.ncbi.nlm.nih.gov/26224300/) finds a small decrease in LDL, when following a low carb diet which was also low saturated fat.

Therefore it seems the claim is quite incorrect.

He also links a post by BulkBiker, which links as evidence a paper which claims that 'LDL Does Not Cause Cardiovascular Disease'. That paper has been found to fail many basic scientific standards:

CEBM response: 'Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review' - a post publication peer review — Centre for Evidence-Based Medicine (CEBM), University o

www.cebm.ox.ac.uk www.cebm.ox.ac.uk

There is also a link to the work of David Feldman, who as far as I can tell is a software developer and a sort of 'social media personality amateur lipidologist'. He has been a co-author on some papers pushing these ideas about LDL, which have been reviewed and found severely lacking in scientific rigour https://cdn.nutrition.org/article/S2475-2991(22)00065-8/fulltext

As for KennyA's reply, the first paper he links goes into the topic of LDL particle size. While I think it is quite well accepted that the smaller particles are more harmful, that is not to say that the large ones aren't. Here's a very clear video on the topic, well referenced with links to the studies in the description

I responded to the other papers he also linked in this thread:
Westley

Post in thread 'Weight loss'

I fully expected some pushback, as I'm familiar with how prevalent these views are within this particular forum. I'll try and respond to some, but as you see, in a short space of time, we have 7 responses in support of these views, with a mix of personal 'anecdata' and links to multiple studies, each of which will take some time to look at. I'm clearly in a minority here (and not by coincidence, diabetes.co.uk sells low carb programs), but I repeat, what I am sharing is the consensus view in mainstream science. This forum is very far from representative.

My own views on this have...

(in summary, if you actually read the papers they are not really supportive at all of a claim that high saturated fat intake does not cause elevated LDL, or that elevated LDL does not cause heart disease)

I have no affiliation with any of the authors or video creators I linked above. I'm just another diabetic trying to be healthy, and wanting to to avoid getting led astray.
I post these questions and criticisms not as any sort of 'gotcha', and they are not personal.

I'd dearly love to believe I can eat copious amounts of butter and ribeye and stay healthy, so if some genuinely high quality science comes along supporting that I'll be thrilled.
Click to expand...

Regarding LDL: You are quoting his paper's quote from the (referenced) studies not what he found in his own patients on Low Carb. I have not delved into the data supporting that finding in those studies, but the highlight is written to imply that low carb increased LDL whilst only saying that it didn't decrease it. This is a common trick used to conjure the desired headlines from a report where the data doesn't match the outcome desired by the funder.
When I contacted Dr Unwin (on Twitter /X) about lean mass hyper-responders he said that he had never seen a patient whose LDL got significantly worse on Low Carb and was surprised that mine increased so much.

Regarding Dave Feldman. he is a Lean Mass Hyper-responder who spent years (and lots of his time and money) funding studies on them after discovering that he could change his LDL from very High to normal and back purely by diet within only 3 days. He has done this tens of times and has demonstrated this at many low carb conferences. Because it was so easy for him to manipulate, he couldn't believe that this could be a significant cause of Coronary Heart Disease.

I have tested using Dave Feldman's protocol for manipulating LDL myself and it does have a large effect even on me, but since it means eating a lot more carbs per day, I chose to stay in T2D remission instead. More recently some US doctors working with LMHR have found that as little as an extra 100gms carbs per day can show the same effect that Dave Feldman discovered.
 
Back
Top