Mastering diabetes approach - I don't get it!

Vectian

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89
Type of diabetes
LADA
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Diet only
Well yes, the DN asked how I had at last managed to lose a little weight. That's when I said it was by following LCHF. So win, win for me. Lower cholesterol, lower weight.

Also, I understood from various posts here that losing weight can put cholesterol UP temporarily?

I'm not too worried about trends re large populations. I know what works for me and also my non diabetic husband (whose cholesterol level and weight also went down on LCHF)
I think you will find the improvement was because of the weight loss, not specific diet and may be temporary. It's probably more keto rather than just low carb that causes more significant rises in LDL. The large populations I meant we can't come to any conclusions about whether saturated fat raises cholesterol based on individual cases, we have to look at large numbers to see trends as there are other factors that influence results like weight loss.
 
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Vectian

Well-Known Member
Messages
89
Type of diabetes
LADA
Treatment type
Diet only
When I asked about LDL rising on a low car way of eating, the reply I got from the most well-known 'Low Carb' GP surgery in the UK was;
'We have never seen that.'
Note both question and answer were in public on Twitter/X some time ago and at which time the surgery had over 100 T2D patients in remission on a Low Carb way of eating.

From that I deduced that on a Low Carb way of eating, only slim diabetics (like myself) tend to see a significant rise in LDL. However, in my case I'm content that the nearly halving of Trigs and near doubling of HDL more than compensates for large rise in LDL. Note that my LDL still isn't quite high enough for me to qualify for Dave Feldman's 'Lean Mass Hyper-responder' phenotype, but I am following the medical studies on those people with interest.
I guess it's more keto and carnivore rather than just low carb, my own LDL hasn't gone up either but I try to restrict saturated fat. LDL is well known to rise on a keto and especially carnivore diet. The LMHR thing is not accepted by all, see this:
 

zand

Master
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10,840
Type of diabetes
Type 2
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Diet only
I think you will find the improvement was because of the weight loss, not specific diet and may be temporary. It's probably more keto rather than just low carb that causes more significant rises in LDL. The large populations I meant we can't come to any conclusions about whether saturated fat raises cholesterol based on individual cases, we have to look at large numbers to see trends as there are other factors that influence results like weight loss.
Yes, OK, the weight loss...but I had tried so very many diet and exercise plans before and never lost any weight. LCHF was amazing for me, I consumed more calories and lost weight and lowered cholesterol. So yes you may say the weight loss caused the lower cholesterol, but LCHF was the only diet to help me lose weight, therefore I consider it also lowered cholesterol, which got slightly lower year after year, reaching a TC level of 4.8 in November last year.
 
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Vectian

Well-Known Member
Messages
89
Type of diabetes
LADA
Treatment type
Diet only
Yes, OK, the weight loss...but I had tried so very many diet and exercise plans before and never lost any weight. LCHF was amazing for me, I consumed more calories and lost weight and lowered cholesterol. So yes you may say the weight loss caused the lower cholesterol, but LCHF was the only diet to help me lose weight, therefore I consider it also lowered cholesterol, which got slightly lower year after year, reaching a TC level of 4.8 in November last year.
I am low carb myself so certainly not against it, it's what keeps my blood sugar in range with no meds. I do have stubborn slightly raised cholesterol and don't want to take statins because almost all raise blood sugar and that's the last thing I need! By the way the non HDL cholesterol is the most useful number on your cholesterol results. Anyway this is getting massively off topic as I was asking about the mastering diabetes diet.
 

Antje77

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Retired Moderator
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20,852
Type of diabetes
LADA
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Insulin
I think you will find the improvement was because of the weight loss, not specific diet and may be temporary. It's probably more keto rather than just low carb that causes more significant rises in LDL. The large populations I meant we can't come to any conclusions about whether saturated fat raises cholesterol based on individual cases, we have to look at large numbers to see trends as there are other factors that influence results like weight loss.
Have you clicked my link in this post and read my numbers on lipids? https://www.diabetes.co.uk/forum/th...es-approach-i-dont-get-it.208808/post-2755941
My weight has been stable at an obese BMI of around 35 for the first 6 years from diagnosis. It's only in the last two years I dropped some weght to a BMI of 32.
So at least for me, improving lipids had nothing to do with weightloss.
 
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Melgar

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Other
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Tablets (oral)
I'm on statins. I could not get my cholesterol down despite all the exercise I do. I'm likely a Lean Mass Hyper Responder, even though my cholesterol was above range on carbs. When I did my very low carb diet, which I'm not on now, my cholesterol probably went through the roof. I'm glad I did not see how high it went. I do have very low Triglycerides, despite having a history of high cholesterol, which I believe sits well within the LMHR phenotype.

I was told the only way to assess your CVD risk is through a apo B test. It seems just guess work on whether your LDL particles are light or of the dense variety.
The apo B test is used to help assess your risk of heart and blood vessel disease.

I have attached a link which explains the apo B test. I have also attached a couple of interesting links on concerns around the keto diet. I do not have any strong views on very low carb diets. I've been on them twice, the Atkins diet back in 2010. Which I had to come off it after 3 months as I got sick on it, and the second time I went on it , I was trying to reduce my blood sugars, but they remained stubbornly elevated despite being on it fir 9 months.
The last link I have included is a research paper arguing that nutritional ketosis is a harmful metabolic state. The researchers suggests that ketone bodies can induce the same protein modifications as those responsible for the vascular damage caused by glucose. It concludes that nutritional ketosis is a harmful metabolic state.

Sometimes we tend towards confirmation bias when reading on subjects we feel passionate about, but to my mind its best to look at the possible negatives too. So I guess I have moved from LDLs to Ketone bodies in my post. Here are the links.

https://my.clevelandclinic.org/health/diagnostics/24992-apolipoprotein-b-test

https://www.health.harvard.edu/heart-health/keto-diet-is-not-healthy-and-may-harm-the-heart

https://pubmed.ncbi.nlm.nih.gov/32248054/


Edited for spelling
 
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Vectian

Well-Known Member
Messages
89
Type of diabetes
LADA
Treatment type
Diet only
I'm on statins. I could not get my cholesterol down despite all the exercise I do. I'm likely a Lean Mass Hyper Responder, even though my cholesterol was above range on carbs. When I did my very low carb diet, which I'm not on now, my cholesterol probably went through the roof. I'm glad I did not see how high it went. I do have very low Triglycerides, despite having a history of high cholesterol, which I believe sits well within the LMHR phenotype.

I was told the only way to assess your CVD risk is through a apo B test. It seems just guess work on whether your LDL particles are light or of the dense variety.
The apo B test is used to help assess your risk of heart and blood vessel disease.

I have attached a link which explains the apo B test. I have also attached a couple of interesting links on concerns around the keto diet. I do not have any strong views on very low carb diets. I've been on them twice, the Atkins diet back in 2010. Which I had to come off it after 3 months as I got sick on it, and the second time I went on it , I was trying to reduce my blood sugars, but they remained stubbornly elevated despite being on it fir 9 months.
The last link I have included is a research paper arguing that nutritional ketosis is a harmful metabolic state. The researchers suggests that ketone bodies can induce the same protein modifications as those responsible for the vascular damage caused by glucose. It concludes that nutritional ketosis is a harmful metabolic state.

Sometimes we tend towards confirmation bias when reading on subjects we feel passionate about, but to my mind its best to look at the possible negatives too. So I guess I have moved from LDLs to Ketone bodies in my post. Here are the links.

https://my.clevelandclinic.org/health/diagnostics/24992-apolipoprotein-b-test

https://www.health.harvard.edu/heart-health/keto-diet-is-not-healthy-and-may-harm-the-heart

https://pubmed.ncbi.nlm.nih.gov/32248054/


Edited for spelling
ApoB yes, used much more in America but the NHS don't do it. The non HDL cholesterol on a standard lipid panel has been shown to correlate quite well with ApoB, better than total or LDL. The influence of particle size is controversial and not all accept that has much value. ApoB measures all particles, and if that is the best measure it shows all sizes, which are all atherogenic.

The main concern I have with statins is that almost all have been shown to raise blood sugar. As I am controlling it with diet and have worked really hard to get to this point I don't want to mess that up. Did you find your BS increased after the statin?
 
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HSSS

Expert
Messages
7,673
Type of diabetes
Type 2
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Diet only
If you accept that saturated fat generally raises LDL which doesn't seem to be in dispute
Ah but it is in dispute. Not just by the many low carbers and their personal experiences I see online but by some of the other experts too. I’m not going to start a back and forth of papers between us though. You’re obviously able to look them up. As you saying differing expert opinions and conflicting studies muddy the water. Little in medicine is or was solid fact, it’s accepted consensus - until it’s not and new knowledge superceeds it.
but well designed trials account for those as much as possible and mention them. A big one is weight loss - that will usually result in better lipid results regardless of the diet. Yes there certainly is strong evidence that LDL causes atherosclerosis, here it is:
Yes they aim to account for them. They don’t always succeed. They sometime base conclusions on “assumed facts” and if those aren’t correct the whole house of cards falls. If weight loss lowers LDL and more specifically and importantly lowers risk I’ll take that and don’t really care how it works. Weight loss for me on calorie deficit low fat regimes doesn’t work and puts glucose up. On low carb everything improves, including all other lipid measures. That link to a summary appears to confirm association (not disputed as far as I’m aware) and in that snippet I can’t see how causality is proved by the analysis or in which direction.
 

Vectian

Well-Known Member
Messages
89
Type of diabetes
LADA
Treatment type
Diet only
Ah but it is in dispute. Not just by the many low carbers and their personal experiences I see online but by some of the other experts too. I’m not going to start a back and forth of papers between us though. You’re obviously able to look them up. As you saying differing expert opinions and conflicting studies muddy the water. Little in medicine is or was solid fact, it’s accepted consensus - until it’s not and new knowledge superceeds it.

Yes they aim to account for them. They don’t always succeed. They sometime base conclusions on “assumed facts” and if those aren’t correct the whole house of cards falls. If weight loss lowers LDL and more specifically and importantly lowers risk I’ll take that and don’t really care how it works. Weight loss for me on calorie deficit low fat regimes doesn’t work and puts glucose up. On low carb everything improves, including all other lipid measures. That link to a summary appears to confirm association (not disputed as far as I’m aware) and in that snippet I can’t see how causality is proved by the analysis or in which direction.
The entire point of that paper and the massive amount of research and studies it pools was to show the causality which was not conclusively shown before. It's all there if you read it! Even in the summary:

Aims: To appraise the clinical and genetic evidence that low-density lipoproteins (LDLs) cause atherosclerotic cardiovascular disease (ASCVD).

 Conclusion: Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.
 
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Vectian

Well-Known Member
Messages
89
Type of diabetes
LADA
Treatment type
Diet only
Have you clicked my link in this post and read my numbers on lipids? https://www.diabetes.co.uk/forum/th...es-approach-i-dont-get-it.208808/post-2755941
My weight has been stable at an obese BMI of around 35 for the first 6 years from diagnosis. It's only in the last two years I dropped some weght to a BMI of 32.
So at least for me, improving lipids had nothing to do with weightloss.
There will always be individual variation, that is why studies must look at large populations to see trends. You see this all the time on social media - "I know someone who got cancer after the covid jab" does not show that the jab causes cancer.

There are many factors that could influence individual results, for example did you eat less junk or processed food after going low carb? Less harmful fats like palm oil, more exercise? Improving BS would reduce metabolic syndrome. Genetics are also a strong factor. So individual cases can't be used to show associations, there are too many variables.
 
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Melgar

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1,567
Type of diabetes
Other
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Tablets (oral)
ApoB yes, used much more in America but the NHS don't do it. The non HDL cholesterol on a standard lipid panel has been shown to correlate quite well with ApoB, better than total or LDL. The influence of particle size is controversial and not all accept that has much value. ApoB measures all particles, and if that is the best measure it shows all sizes, which are all atherogenic.

The main concern I have with statins is that almost all have been shown to raise blood sugar. As I am controlling it with diet and have worked really hard to get to this point I don't want to mess that up. Did you find your BS increased after the statin?
I have to say @Vectian I'm on a relatively low dose of Rosuvastin 10mg. I haven't noticed any difference to my blood sugars. I know statins are known for raising your blood sugars, but I think it depends on the dosage.