Type 2 Puzzled. Non-HDL lipids continue to rise.

Dr Snoddy · Jun 30, 2017

I would appreciate support and comments on the following. Type 2, female, 62, BMI 29, HbA1c in non-diabetic range for 3 years, 1000mg Metformin per day, much increased daily exercise.
At diagnosis I put myself onto Low carb - moderate fat diet. I quickly lost weight and all blood readings improved. Initially my total cholesterol reduced from 6.4 mm/ L to 6.1 but since then it has steady increased. Four months ago it was 7.3 so I cut out nearly all saturated fat. I had very little in my diet anyway. I do not eat meat, have very little cheese and no butter or cream. The lipid sources in my diet are avocado, rapeseed and olive oil and oily fish, all of which are supposed to help decrease LDL levels. I do not eat oats very often because of their carb content. Despite this my latest results are HDL 2.1 and non-HDL 5.3mmol/L. I realise that this a ratio of less than 4 which is deemed acceptable but I cannot understand why this increase is occurring when I am doing all the recommended things (and wasn't before diagnosis). I do not want to take statins. Am I mobilizing more body fat or something?

douglas99 · Jun 30, 2017

Are you still losing weight?

CherryAA · Jun 30, 2017

Dr Snoddy said:
I would appreciate support and comments on the following. Type 2, female, 62, BMI 29, HbA1c in non-diabetic range for 3 years, 1000mg Metformin per day, much increased daily exercise.
At diagnosis I put myself onto Low carb - moderate fat diet. I quickly lost weight and all blood readings improved. Initially my total cholesterol reduced from 6.4 mm/ L to 6.1 but since then it has steady increased. Four months ago it was 7.3 so I cut out nearly all saturated fat. I had very little in my diet anyway. I do not eat meat, have very little cheese and no butter or cream. The lipid sources in my diet are avocado, rapeseed and olive oil and oily fish, all of which are supposed to help decrease LDL levels. I do not eat oats very often because of their carb content. Despite this my latest results are HDL 2.1 and non-HDL 5.3mmol/L. I realise that this a ratio of less than 4 which is deemed acceptable but I cannot understand why this increase is occurring when I am doing all the recommended things (and wasn't before diagnosis). I do not want to take statins. Am I mobilizing more body fat or something?

my ow nvcholesterol readings LDL and totla went down, any my hdl went up when I started to eat more saturatad fat . My LDL went down when I replaced carbs with saturated fats . How many carbs are you eating ?

librarising · Jun 30, 2017

Dr Snoddy said:
I would appreciate support and comments on the following. Type 2, female, 62, BMI 29, HbA1c in non-diabetic range for 3 years, 1000mg Metformin per day, much increased daily exercise.
At diagnosis I put myself onto Low carb - moderate fat diet. I quickly lost weight and all blood readings improved. Initially my total cholesterol reduced from 6.4 mm/ L to 6.1 but since then it has steady increased. Four months ago it was 7.3 so I cut out nearly all saturated fat. I had very little in my diet anyway. I do not eat meat, have very little cheese and no butter or cream. The lipid sources in my diet are avocado, rapeseed and olive oil and oily fish, all of which are supposed to help decrease LDL levels. I do not eat oats very often because of their carb content. Despite this my latest results are HDL 2.1 and non-HDL 5.3mmol/L. I realise that this a ratio of less than 4 which is deemed acceptable but I cannot understand why this increase is occurring when I am doing all the recommended things (and wasn't before diagnosis). I do not want to take statins. Am I mobilizing more body fat or something?

Do you have the full lipid results including triglycerides ?
Geoff

librarising · Jun 30, 2017

Dr Snoddy said:
I would appreciate support and comments on the following. Type 2, female, 62, BMI 29, HbA1c in non-diabetic range for 3 years, 1000mg Metformin per day, much increased daily exercise.
At diagnosis I put myself onto Low carb - moderate fat diet. I quickly lost weight and all blood readings improved. Initially my total cholesterol reduced from 6.4 mm/ L to 6.1 but since then it has steady increased. Four months ago it was 7.3 so I cut out nearly all saturated fat. I had very little in my diet anyway. I do not eat meat, have very little cheese and no butter or cream. The lipid sources in my diet are avocado, rapeseed and olive oil and oily fish, all of which are supposed to help decrease LDL levels. I do not eat oats very often because of their carb content. Despite this my latest results are HDL 2.1 and non-HDL 5.3mmol/L. I realise that this a ratio of less than 4 which is deemed acceptable but I cannot understand why this increase is occurring when I am doing all the recommended things (and wasn't before diagnosis). I do not want to take statins. Am I mobilizing more body fat or something?

Some people's LDL goes up on lowcarb. High LDL is not the problem. High LDL when the LDL is largely composed of small particles is the problem. The best indicator of this is your trigs/HDL ratio. With a good ratio your LDL will be largely composed of large particles.
Also the trigs test needs to be a fasting one. If non fasting, it can still be good. Simply higher than a fasting would have been.
Geoff

Bluetit1802 · Jun 30, 2017

When your trigs are low and your HDL is high, your LDL will be full of large fluffy particles that are "good cholesterol". If on the other hand your HDL is low and your trigs high, the particles will be the bad sort. This is why the Trigs/HDL ratio is important. We need to aim for about 0.87. (UK measurements) (Divide trigs by HDL)

Dr Snoddy · Jun 30, 2017

Hi

douglas99 said:
Are you still losing weight?

, Douglas, no my weight has been stable for the last 2 years which is nothing short of a miracle!

Dr Snoddy · Jun 30, 2017

librarising said:
Some people's LDL goes up on lowcarb. High LDL is not the problem. High LDL when the LDL is largely composed of small particles is the problem. The best indicator of this is your trigs/HDL ratio. With a good ratio your LDL will be largely composed of large particles.
Also the trigs test needs to be a fasting one. If non fasting, it can still be good. Simply higher than a fasting would have been.
Geoff

Dr Snoddy · Jun 30, 2017

Hi,
This is really useful, thanks. I expected a full lipid profile to include triglycerides. This did not happen on this recent blood test, possibly because it was non-fasting. When triglycerides have been measured my trig/ HDL ratio has been favourable. However, when the HCA calls me in to discuss statins (we don't have a nurse anymore - NHS cuts?) I shall ask for a fasting lipid profile.

librarising · Jun 30, 2017

Dr Snoddy said:
Hi,

This is really useful, thanks. I expected a full lipid profile to include triglycerides. This did not happen on this recent blood test, possibly because it was non-fasting. When triglycerides have been measured my trig/ HDL ratio has been favourable. However, when the HCA calls me in to discuss statins (we don't have a nurse anymore - NHS cuts?) I shall ask for a fasting lipid profile.

If the bloods are taken early enough, simply don't eat beforehand, then no one needs to know.
Geoff

Bluetit1802 · Jun 30, 2017

Dr Snoddy said:
Hi,

This is really useful, thanks. I expected a full lipid profile to include triglycerides. This did not happen on this recent blood test, possibly because it was non-fasting. When triglycerides have been measured my trig/ HDL ratio has been favourable. However, when the HCA calls me in to discuss statins (we don't have a nurse anymore - NHS cuts?) I shall ask for a fasting lipid profile.

If your Non-HDL has been calculated, then you must have had the triglycerides tested, fasting or otherwise. Trigs are included in the Non-HDL calculation (Trigs + LDL) I suggest you get a print out so you can see exactly where you stand.

I am never told to fast for my tests, but I always do.

douglas99 · Jun 30, 2017

librarising said:
If the bloods are taken early enough, simply don't eat beforehand, then no one needs to know.
Geoff

I find it's far, far easier to keep the doctor's on board, then to think you have to score points over them everytime.
Is there a reason you think it's better to keep it a secret you haven't eaten?

librarising · Jun 30, 2017

douglas99 said:
I find it's far, far easier to keep the doctor's on board, then to think you have to score points over them everytime.
Is there a reason you think it's better to keep it a secret you haven't eaten?

To save time and stay focussed on what matters.
Geoff

douglas99 · Jun 30, 2017

librarising said:
To save time and stay focussed on what matters.
Geoff

Fair enough.
I like to have a good chat personally, and we can both decide what matters then.

librarising · Jun 30, 2017

douglas99 said:
Fair enough.
I like to have a good chat personally, and we can both decide what matters then.

I find psychological health comes from taking all input, and then ME deciding.
That's what I found also in my former role of counsellor (the client deciding).
But whatever works for the individual.
Geoff

douglas99 · Jun 30, 2017

librarising said:
I find psychological health comes from taking all input, and then ME deciding.
That's what I found also in my former role of counsellor (the client deciding).
But whatever works for the individual.
Geoff

As you say, whatever works for the individual, but me, I like to get all the input, sometimes, I don't don't actually know as much as someone that trained for seven years to do their job.
So I never walk in knowing they're wrong before they speak.
I won't tell you my former job.

Dr Snoddy · Jun 30, 2017

Bluetit1802 said:
If your Non-HDL has been calculated, then you must have had the triglycerides tested, fasting or otherwise. Trigs are included in the Non-HDL calculation (Trigs + LDL) I suggest you get a print out so you can see exactly where you stand.

I am never told to fast for my tests, but I always do.

Thanks, Bluetit. Very good advice!

Indy51 · Jul 1, 2017

Tagging @DaveKeto as I'm sure he can explain this better than I can. I think you may be a hyper-responder to the LCHF diet - I seem to be as well (my latest lipid test results are in my profile). If Dave is right, the more saturated fat you eat, the less your LDL will be.

You might want to check out Dave's site: http://cholesterolcode.com/

I don't ever plan on going back on a statin - the first go-round cured me of ever wanting to try them again. Plus all the reading I've done indicates that higher cholesterol is beneficial for post menopausal women. It seems we're more likely to have cardiac events with normal/low cholesterol:

douglas99 · Jul 1, 2017

Indy51 said:
Tagging @DaveKeto as I'm sure he can explain this better than I can. I think you may be a hyper-responder to the LCHF diet - I seem to be as well (my latest lipid test results are in my profile). If Dave is right, the more saturated fat you eat, the less your LDL will be.

You might want to check out Dave's site: http://cholesterolcode.com/

I don't ever plan on going back on a statin - the first go-round cured me of ever wanting to try them again. Plus all the reading I've done indicates that higher cholesterol is beneficial for post menopausal women. It seems we're more likely to have cardiac events with normal/low cholesterol:

I did think I asked a question, either it disappeared, or I forget to press 'post reply'

What is the link to the graph?
Is there a cut off point for raised cholesterol, as the WHO curve has a clear fall, then a rapid rise as cholesterol increases?
Can you provide a link to the data or the study the graph is from?

(checking the 'post reply' this time)

Speedbird · Jul 1, 2017

Dr Snoddy said:
Hi,

This is really useful, thanks. I expected a full lipid profile to include triglycerides. This did not happen on this recent blood test, possibly because it was non-fasting. When triglycerides have been measured my trig/ HDL ratio has been favourable. However, when the HCA calls me in to discuss statins (we don't have a nurse anymore - NHS cuts?) I shall ask for a fasting lipid profile.

Hi Dr Snoddy,
I was in the same predicament as you.

Here are my readings:
HDL 2.41
LDL 5.6
TRI 0.6
So my ratio HDL/TRI is 0.24

I'm happy with that. I hope this helps.
X

Type 2 Puzzled. Non-HDL lipids continue to rise.

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