Keto and high cholesterol

[Loken]

I have mostly been following a ketogenic diet sense I was diagnosed with type 2 diabetes. Started on 4 metformin a day, I managed to get my sugars under control and only 1 metformin with my bloods being a 44-47.

Until about a 6 months ago when I stopped eating the keto way due to the cost of it, had the tighten the belt for a bit an ate what we the rest of the family did. So my sugars when back up to 64. So back on the keto wagon and they are coming back down, but my cholesterol has gone up to 7.1 and the doctor wants me to go on statins what I don’t want to do.

Been reading about removing the obvious fats and fried food what has been my omelets for breakfast. Planning, on changing my breakfast to a keto friendly nut seed granola. Plus maybe start taking omega 3 supplements?

Anyone got experience bringing the cholesterol down and staying on keto?

 

[KennyA]

Hi and welcome

I have been on keto for about five years now and my cholesterol is what it was five years ago - and what it was 25 years ago for that matter. I don't bother with it as a concept. You might find these pieces of research, all within the last 10-12 years or so, interesting reading.

Cholesterol and all-cause mortality – Korean research on 12.8m adults

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

UK research showing lower cholesterol increases mortality

https://www.bmj.com/content/353/bmj.i1246

HUNT2 – Norwegian research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

Journal of the American College of Cardiology 2019:

"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".

https://www.sciencedirect.com/science/article/pii/S0735109720356874?via%3Dihub=&utm_source=arrow.proteinpower.com&utm_medium=referral&utm_campaign=the-arrow-188

[edited to remove dead link]

 

[Loken]

Hi and welcome

I have been on keto for about five years now and my cholesterol is what it was five years ago - and what it was 25 years ago for that matter. I don't bother with it as a concept. You might find these pieces of research, all within the last 10-12 years or so, interesting reading.

Cholesterol and all-cause mortality – Korean research on 12.8m adults

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

UK research showing lower cholesterol increases mortality

https://www.bmj.com/content/353/bmj.i1246

HUNT2 – Norwegian research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/

Journal of the American College of Cardiology 2019:

"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".

https://www.sciencedirect.com/science/article/pii/S0735109720356874?via%3Dihub=&utm_source=arrow.proteinpower.com&utm_medium=referral&utm_campaign=the-arrow-188

[edited to remove dead link]

Thanks for all that information. My doctor is insisting that I start taking statins, even when I said I would like the chance to reduce it with adjusting my diet, they prescribed me it.

 

[Outlier]

If you are in UK, there is a lot of pressure on GPs to prescribe statins.

 

[KennyA]

Thanks for all that information. My doctor is insisting that I start taking statins, even when I said I would like the chance to reduce it with adjusting my diet, they prescribed me it.

That's what I had too. My cholesterol level has gone from being described as "good" in the 1990s to "OK" to "too high" although it hasn't itself changed at all. I have no interest in reducing my cholesterol level. The evidence from the papers attached above is that mortality rises at cholesterol levels below 5, although that's where the current system thinks we should be. Statins will certainly reduce cholesterol, as will switching to a non-saturated fat diet, but to quote the Journal of the American College of Cardiology in 2019: 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.

There is a financial incentive for practices in the UK to prescribe statins to certain defined groups (T2 is one) through the Quality and Outcomes Framework, which is part of the way general practices are funded. Basically it rewards activity - practices doing something - rather than patient outcomes. So you get a payment eg for putting X % of your appropriate practice population on statins, and a bigger payment if it's X+10%. Whether the patients actually take the statins or see any benefit isn't part of the consideration.

The BMA, which agreed to the system when it was introduced just over 20 years ago, believes that this affects the relationship between patient and doctor, and has called for the entire system to be scrapped.

 

[Le Duan]

That's what I had too. My cholesterol level has gone from being described as "good" in the 1990s to "OK" to "too high" although it hasn't itself changed at all. I have no interest in reducing my cholesterol level. The evidence from the papers attached above is that mortality rises at cholesterol levels below 5, although that's where the current system thinks we should be. Statins will certainly reduce cholesterol, as will switching to a non-saturated fat diet, but to quote the Journal of the American College of Cardiology in 2019: 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.

There is a financial incentive for practices in the UK to prescribe statins to certain defined groups (T2 is one) through the Quality and Outcomes Framework, which is part of the way general practices are funded. Basically it rewards activity - practices doing something - rather than patient outcomes. So you get a payment eg for putting X % of your appropriate practice population on statins, and a bigger payment if it's X+10%. Whether the patients actually take the statins or see any benefit isn't part of the consideration.

The BMA, which agreed to the system when it was introduced just over 20 years ago, believes that this affects the relationship between patient and doctor, and has called for the entire system to be scrapped.

Interesting [and worrying] that GPs are being incentivised on inputs rather than outputs, outcomes and results! Typical, box-checking bureaucracy...

 

[KennyA]

Interesting [and worrying] that GPs are being incentivised on inputs rather than outputs, outcomes and results! Typical, box-checking bureaucracy...

It's been that way for quite a while now, and unfortunately the objections voiced back in 2002/3 all appear to have been well-founded. Here's a link to the current guidance for England 2024/25:

NHS England » Quality and outcomes framework guidance for 2024/25

NHS England » Quality and outcomes framework guidance for 2024/25

www.england.nhs.uk

 

[jeano999]

For me every GP follow up Statins are suggested - I just say no thanks! I too have read the research that calls into question the efficacy of taking statins and the (almost nil) effect on mortality. Plus there are also reports that it can cause Type 2 diabetes for some people as well as other adverse side effects. Still the NHS are pushing to prescribe. Strangely enough only today I bought a book by Dr Malcolm Kendrick on this very issue "A Statin Nation--Damaging Millions in a Brave New Post-Health World" which I am looking forward to reading. There have also been studies that concluded that dietary fats are not directly connected to cholesterol in the blood - so you should still be able to eat your omelettes and stay on the keto journey.

 

[parro55]

Drs are getting paid for getting their patients on statins and vaccinations.

 

[KD65]

This is great information. At a recent practice nurse appointment, I was told my cholesterol was 5.8 and the target with diabetes is below 5 at my age. Statins were suggested, but as my body is still getting used to the change, I pushed back and said I want to see how everything settles down for a few months. With the information in this thread, I am inclined to continue pushing back, as I am a lifelong non-smoker, I live a relatively healthy lifestyle, and have no family heart problem history. It does sound like statins are an easy answer, not necessarily the right one, and quite possibly not necessary or even beneficial for me.

 

[Grant_Vicat]

I wouldn't like to judge either way regarding statins. I was put on Pravastatin in the 90s and suffered muscular pain. I was eventually put on Simvastatin, which was fine until I was exposed to bright sunshine. In 2011 I had a severe all-body rash and a dermatologist diagnosed an allergic reaction to Simvastatin. Since then I have not taken any Statins and my Cholesterol stands at 3.9. Maybe if my lifestyle was different, statins might be beneficial?

 

[Chris24Main]

There must be easier ways to make a buck than study for the six years or so to get a medical degree, then study for three years as a specialist GP, then once you pass the various tests that essentially show that you have a good enough understanding of ...everything.., then enlist in a practice, and then put up with all the cr*p that GPs have to put up with.. having to decide the best course of action for someone every 10 minutes of every day, to have the practice receive the funding for some of the drugs and vaccines in order to pay your salary.

Doesn't sound like a very good plan to me. If money was your sole aim.

I personally have an ongoing ...discussion... about the suitability of Statins with my GP. My LDL is very definitely higher than the advisory level, but my personal reading of my lipid panel, and my understanding of the medical science (or non-science) that led to the current advice leaves me able to continue that discussion, politely, and positively - and I'm not planning on starting statins any time now.

But - I have some agency in following the guidelines. I can make informed choices. I may be wrong, and if that's the case, so be it. I feel like I have a good grip on the risks either way for me. GPs don't have that flexibility, or frankly the time I've put into investigating this one question. Or my understanding of my own physiology. Or even the total confidence that what I'm telling them is the truth. I could be secretly scoffing doughnuts every morning, in which case my finely polished arguments that I don't need to be taking statins might be completely bogus - they cannot know for sure.

I think it's totally fair (in fact it's essential) to question the science. It's totally fair to question the guidelines. There have been doctors who failed their Socratic oath - but only one or two that I can think of in my lifetime, compared to thousands of hard working, dedicated professionals. I think there are very few things you can put your life into - more essential or honorable than general practice, and they deserve our support.

Which may include some gentle education - I'm not advocating blind subservience; but your relationship with your GP is like any other, it has to be built on good faith respect. That cuts both ways.

 

[Lainie71]

There must be easier ways to make a buck than study for the six years or so to get a medical degree, then study for three years as a specialist GP, then once you pass the various tests that essentially show that you have a good enough understanding of ...everything.., then enlist in a practice, and then put up with all the cr*p that GPs have to put up with.. having to decide the best course of action for someone every 10 minutes of every day, to have the practice receive the funding for some of the drugs and vaccines in order to pay your salary.

Doesn't sound like a very good plan to me. If money was your sole aim.

I personally have an ongoing ...discussion... about the suitability of Statins with my GP. My LDL is very definitely higher than the advisory level, but my personal reading of my lipid panel, and my understanding of the medical science (or non-science) that led to the current advice leaves me able to continue that discussion, politely, and positively - and I'm not planning on starting statins any time now.

But - I have some agency in following the guidelines. I can make informed choices. I may be wrong, and if that's the case, so be it. I feel like I have a good grip on the risks either way for me. GPs don't have that flexibility, or frankly the time I've put into investigating this one question. Or my understanding of my own physiology. Or even the total confidence that what I'm telling them is the truth. I could be secretly scoffing doughnuts every morning, in which case my finely polished arguments that I don't need to be taking statins might be completely bogus - they cannot know for sure.

I think it's totally fair (in fact it's essential) to question the science. It's totally fair to question the guidelines. There have been doctors who failed their Socratic oath - but only one or two that I can think of in my lifetime, compared to thousands of hard working, dedicated professionals. I think there are very few things you can put your life into - more essential or honorable than general practice, and they deserve our support.

Which may include some gentle education - I'm not advocating blind subservience; but your relationship with your GP is like any other, it has to be built on good faith respect. That cuts both ways.

Totally agree with what you have said