Statins

[VashtiB]

Her wording was quite careful about 4.0 being the number for "anyone who has ever been diagnosed with diabetes". But this strikes me as a bit strange if your T2 is controlled (A1c at normal levels) and has been controlled for an extended period of time -- in my case, fully controlled since my diagnosis three years ago. While I realise that T2 is a chronic disease, I had thought the CV dangers (and other consequences of T2) were not substantially "in play" if the disease is under tight control.

Part of my thinking is influenced by observing another generation (my parents, parents-in-law, and other elderly people) who ingest an amazing cornucopia of pills all day: for blood pressure, for cholesterol, for (fill in the blank). While I realise that I am unlikely to reach extreme old age without taking at least some drugs, it makes sense to try to delay this for as long as possible unless the treatment truly adds many years to your life.

Hi @Grateful - thanks for starting this thread,

I recently had a review with my doctor and low and behold my cholesterol was up- I told her that as I was losing weight I expected this- she tried the same line that diabetics have to have lower levels- in my head if the blood sugar levels are controlled in 'normal' levels I couldn't understand why this would be the case- I refused to take anything- she made a note- I suspect to say I refused advice.

For me she didn't want to know why I expected them to have increased- she agreed that as I was losing weight that the levels could be expected to go up but didn't explain what amount of risk she thought my levels were. This thread has been very reassuring- so thank you. My doctor now rates my cholesterol as a higher risk than my diabetes as my level is stable at 33% or 5.1 .

 

[Evie-D]

My Dr phoned me to congratulate me on getting my hba1c down to 39, then offered me a statin as my total cholesterol was 6.6. It’s always been in this range. I said that as far as I’m aware it’s the ratio that was more important and he agreed that while a little high was lower than the threshold they would normally offer a statin at. He said “ you’re not interested in a statin are you”. I said that since there was no history of heart disease in my family, and as I hadn’t had any issues there then no. I’m comfortable with this.

 

[DavidGrahamJones]

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

As you are already low carb I don't have to mention it, although as I have I can say that for me, when I started low carb my total cholesterol dropped a couple of points.

This drop actually encouraged me to throw away the statins and my TC has never been higher than 4, except for when I introduce full fat yogurt, cream in coffee and more red meat into my diet. As soon as I cut out the fat, down comes my TC. As I'm overweight the calorie reduction is no bad thing as I tend to gain when consuming more fat. Even when on a fattier diet my calorie intake is less than 1500 (BMR 2300, I wish!). It might be that for a thin person, fat reduction isn't so easy.

Two years? That went by quickly. I hope you're enjoying life back in the UK.

 

[KK123]

Lots of nonstarchy plant foods and exercise! Statins make me really ill. Weakness, extremely low blood pressure, and aches & pains in every joint. I use a product available in the US called Cholest-off and it has lowered my bad LDL cholesterol. The Green Keto diet has raised my good HDL cholesterol, along with lowering my Ha1c. Cholesterol, in and of itself, is not a bad thing. It is actually the body’s way of protecting our blood vessels. High cholesterol is rather a symptom of inflammation. It would be best to go after the inflammation instead of the LDL. It could be gut, liver, pancreas, or other kind of inflammation. Stop eating processed foods. Limit carbs to less than 50 net grams per day. Eat organic grass fed, free range, wild caught animal products. And HUGE amounts of nonstarchy veggies. Eliminate industrial oils in favor of coconut, olive, or avocado oils. This has worked miracles for me! I hope it can work for you!

Great advice but it's not always down to following a 'non healthy' lifestyle. Some of us do all of the above and more and still have cholesterol higher than their so called magic number. You can most certainly have a cholesterol level of above 4 that is still normal for you personally. I think the ultimate question is whether LDL is healthy or unhealthy rather than whether your numbers are above or below 4. If we accept that LDL is not necessarily evil then it matters not (cholesterol wise) whether we consume wild caught animal products or coconut oil, et al.

 

[DCUKMod]

Great advice but it's not always down to following a 'non healthy' lifestyle. Some of us do all of the above and more and still have cholesterol higher than their so called magic number. You can most certainly have a cholesterol level of above 4 that is still normal for you personally. I think the ultimate question is whether LDL is healthy or unhealthy rather than whether your numbers are above or below 4. If we accept that LDL is not necessarily evil then it matters not (cholesterol wise) whether we consume wild caught animal products or coconut oil, et al.

KK123, my total cholesterol has always been an inconveniently high number, but my ratios good. I too got bored of the repeated discussion around lipids, focusing on this inconvenient number.

I decided to tackle it by sharing my research and some learnings with my GP. It was Professor Ken Sikoris and a few others, on YouTube, plus a couple of papers, then "agreed" I wouldn't take statins at that point.

Along the way I did get frustrated and asked a thread which point I might expect to receive any credits for my A1cs being serially being tested in the very low 30s, adding if it hadn't been for that single 73, which I could never challenge as being non-diabetic, I'd never be under the same scrutiny. She agree, and promptly suggested if I agreed to annual screening she would take me off the diabetes register. She did offer to refer me to a lipidologist, just in case of familial hypercholesterolaemia. I would have been happy with that, but was about to go away, overseas for a few months, so deferred that, but at the next review, I had notched down a bit again and the GP having done a bit more reading and watching, declared my inconveniently high total and so on a great set of numbers.

Obviously, as a T1 that bit about the diabetes register couldn't apply to you!

I don't think I was the only reason she did her own reading and so on was my prompting She was an excellent GP and always tried to go the extra mile, so she did her own work. Sadly, she moved area, to well away from any credible registration. I was gutted. I'm imagining my next review, with any of the other GPS could be "interesting".

 

[KK123]

KK123, my total cholesterol has always been an inconveniently high number, but my ratios good. I too got bored of the repeated discussion around lipids, focusing on this inconvenient number.

I decided to tackle it by sharing my research and some learnings with my GP. It was Professor Ken Sikoris and a few others, on YouTube, plus a couple of papers, then "agreed" I wouldn't take statins at that point.

Along the way I did get frustrated and asked a thread which point I might expect to receive any credits for my A1cs being serially being tested in the very low 30s, adding if it hadn't been for that single 73, which I could never challenge as being non-diabetic, I'd never be under the same scrutiny. She agree, and promptly suggested if I agreed to annual screening she would take me off the diabetes register. She did offer to refer me to a lipidologist, just in case of familial hypercholesterolaemia. I would have been happy with that, but was about to go away, overseas for a few months, so deferred that, but at the next review, I had notched down a bit again and the GP having done a bit more reading and watching, declared my inconveniently high total and so on a great set of numbers.

Obviously, as a T1 that bit about the diabetes register couldn't apply to you!

I don't think I was the only reason she did her own reading and so on was my prompting She was an excellent GP and always tried to go the extra mile, so she did her own work. Sadly, she moved area, to well away from any credible registration. I was gutted. I'm imagining my next review, with any of the other GPS could be "interesting".

Hi DCUK, I actually did get referred to a lipidologist (Total cholesterol was 8,HDL 2.45, trigs 0.5). He went on about statins but did refer me to a team of Nurses that had been set up to look into a sort of DNA analysis as well as to test for FH. It was fascinating stuff. Anyway, I did not have FH but they did 12 other DNA type tests on various cholesterol signifiers (sorry I'm not being very scientific) and they came back as me naturally having markers that meant a higher cholesterol than an average person. Meaning I had inherited a propensity towards a higher than average level compared to Ms Average. They still recommended statins and said diet/lifestyle would make no difference, only statins would get it down to 4. Why should I get it down to 4 by artificial means?, I just don't get it. MY body makes that amount and that's that as far as I am concerned, obviously I do follow a healthy lifestyle anyway but the next time my Dr asks me how much cheese I eat I'm going to explode. x

 

[NicoleC1971]

So this is all very new to me. Here are the results of my blood tests a couple of weeks ago:

Serum cholesterol: 6.5 mmol/L
Serum HDL cholesterol level: 1.8 mmol/L
Ratio of the above: 3.6
Serum triglicerides: 1.9 mmol/L
Calculated LDL cholesterol level: 3.84 mmol/L
Se non HDL cholesterol level: 4.7 mmol/L

I am very new to all this, but according to my calculation, the trigs/HDL ratio (as mentioned by @Bluetit1802) is 1.05 (assuming that I understand how to do the maths). This is higher than the ideal ratio of 0.87 but how concerning is it really?

In the past total cholesterol and then high LDL (once this could be measured) were associated with heart disease risk being increased however it is reputed to be a weak indicator and at least half the people admitted to hospital in a US survey had low cholesterol.
The HDL/trig ratio is a better indicator of risk and one way to raise hdl and lower trigs is to heat high fat/low carb which probably seems counter intuitive in a world where we've been taught to believe that saturated fat 'clogs up the arteries' (does fat clog at 37 degrees?). Researchers have been trying to link sat fat with heart disease for decades but have never done so partly because the science of linking what people eat to their disease outcomes is notoriously hard (is often done on the basis of asking people to recall what they ate weeks ago and is always confounded by other things). Yet even the more reputable trials haven't shown a causal link and sometimes it is shown that people benefit from having higher cholesterol. WHen big pharma has a strong interest in finding the case for doling out more statins you'd think they would try very hard to find conclusive evidence that lowering ldl helps but it doesn't seem that way.
If you wanted to see great videos by cholesterol sceptics I'd recommend Ivor Cummins (the Fat Emporer and a chemical engineer) or Malcolm Kendrick (a doctor) and Dr Zoe Harcombe PhD who has an excellent site debunking some of our current dietary orthodoxies. Asseem Malhotra is a cardiologist who doesn't take the conventional line either. All of their YouTube videos are very watchable.
At the end of the day you could write a pros and cons list and see where you come out. As you rightly point out you could legitimately take a few weeks to make lifestyle changes but do be aware that the less cholesterol you eat the more your own liver will make so don't give up eggs or prawns just yet!

 

[carty]

My cholesterol levels dropped from 7 to 5 when I went lower carb and age more cream ,full fat yoghurt ,eggs etc ,all supposedly (at the time ) upped your cholesterol .When I told my GP that I was saving him money by not taking statins ( I was trying to get strips prescribed ) His reply was "not everyone gets side effects ! "
Carol

 

[PeterHud]

My hbc1a last one was 37 and now on Metformin ... The old subject came up of statins ... Because I am diabetic they immediately say take statins ..

I told my diabetic consultant I wasn't going to take them ever .. she wasn't pleased but after all it's my body and they do have side effects.

You are best reading up about them before taking the plunge. They can only advise you to take them they cannot force you

Interestingly my diabetic nurse never mentioned statins to me.

 

[Tophat1900]

This may be odd, but in 20yrs of being diabetic, no HCP has ever mentioned statins to me.... not even once.

 

[Grateful]

This may be odd, but in 20yrs of being diabetic, no HCP has ever mentioned statins to me.... not even once.

That probably means your cholesterol numbers are within whatever range they consider OK. What seems to be happening with me is that most of the time they take my blood for an HbA1c (which should be about every six months in my case), they also check various other things including "serum" numbers which include cholesterol.

Or perhaps your surgery is as casual as one nurse here was 15 months ago. She said my cholesterol number was high, but did not suggest anything or prescribe anything.

 

[Grateful]

Thank you everyone for your advice. I am still researching this. I am willing to have a go at lowering my cholesterol (or improving the ratio) through diet and lifestyle adjustments, although I must admit that the dietary advice seems much more nebulous (and confusing) than the straightforward causation, for T2 diabetes, between a low-carb diet and a lowered HbA1c.

This gives me a chance to improve my health more generally, mainly by (a) drinking less alcohol and (b) taking more exercise. Neither of these things is likely to have much impact on serum cholesterol numbers, however. One problem is that I am already following quite a lot of the cholesterol-lowering diet, such as, for example, eating oily fish regularly.

I will start off by, for example, adding tuna (instead of chicken) to the green salads that I usually have for lunch. I do eat a lot of meat (much more than before I went on the low-carb diet). It sounds like reducing meat intake, particularly fats, and increasing vegetable intake will help, although I do already eat a lot of vegetables. Where I will get my energy from, after reducing the fat, is less clear!

I am not at all convinced that high-ish cholesterol per se is necessarily a big deal and if I cannot reduce the number naturally with diet or lifestyle changes I will probably refuse the statins anyway, when my next clinical assessment comes up three months from now.

I am particularly concerned that, had I not three years ago been diagnosed with T2 diabetes, it is unlikely that doctors and nurses would be prescribing me statins. Since my T2 is completely under control, I don't feel the need to start taking a drug that (presumably) would be part of my daily regimen for the rest of my life.

 

[Resurgam]

The combination of Atorvastatin and Metformin was dreadful - I have had to relearn all my songs and I have only just begun to sing without the words in front of me, three years after stopping the tablets. The practice nurses have tried to get me to try them again, but I am afraid that I might not come back a second time. What use is a healthy body if the mind has gone? My poor mother in law was fit abut gradually became unable to look after herself, languished for years in a care home.

 

[Tophat1900]

That probably means your cholesterol numbers are within whatever range they consider OK. What seems to be happening with me is that most of the time they take my blood for an HbA1c (which should be about every six months in my case), they also check various other things including "serum" numbers which include cholesterol.

Or perhaps your surgery is as casual as one nurse here was 15 months ago. She said my cholesterol number was high, but did not suggest anything or prescribe anything.

Yeah, you'd think so, but they have been in a high range or what is considered high in the past with high trigs, trigs at 2.6 and total above 6, cose to 7, but can't remember the exact number. I guess maybe I was lucky because I would not of known a thing about statins at that time and would of taken them.

Maybe it was the casual approach...

 

[Grateful]

Maybe it was the casual approach...

My memory may be defective, but I think that when I was living in America my doctor noticed a high cholesterol number and merely shrugged his shoulders.

Anyway today is the day that I start the new regime.

--Alcohol. Biggest change (not really related to getting lower cholesterol) is to stop drinking beer at home, and switch to having a couple of glasses of red wine with dinner. The restriction does not apply when going to the pub or socializing outside the home.

--Food. I am changing my breakfast: for the past two years it was bacon and eggs. Will switch to something that has fiber. This morning, yogurt and half a banana, but eventually this will be supplemented with low-carb home-made muesli. For lunch, a green salad (as usual) but instead of adding chicken chunks, it will be a small quantity of tuna, which allegedly helps with lowering cholesterol. For dinner, my wife and I share the cooking (alternate days, with both of us cooking low-carb meals). On my nights I will now do more non-meat meals.

--Losing weight and exercise. I have put on 9 kilos since moving to the UK nearly two years ago. I am not considered overweight when you look at BMI, but that is a flawed measure at best, and my body weight is now not much less than it was at the time of my T2 diagnosis three years ago. I will try to make sure to go out for a vigorous walk, including good uphill sections (easy to find around here), for at least one hour every day. I will also try to take other breaks from my home-based desk job during the day: even just walking around the village for 15 minutes every few hours.

I am rather assuming that after all of the above, my general health will improve. It will be interesting to see whether it budges the cholesterol needle one whit. I will know three months from now, when they check it again.

My main goal in all this, as I approach late middle age, is to delay become "medicalised" with all sorts of daily drugs that I might not really need.

 

[bulkbiker]

My main goal in all this, as I approach late middle age, is to delay become "medicalised" with all sorts of daily drugs that I might not really need.

If you haven't been through it then at least watch the Nick Mailer video on the first page..

"lowering" your cholesterol through medication is highly likely not a good thing..

https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/

 

[Grateful]

I've now looked up my medical records for the past 11 years and by cholesterol "ratio" was:
--3.9 in September 2009.
--4.0 in February 2017 (this is also when my T2 was diagnosed, with an A1c of 67).
--2.1 in February 2018.
--2.4 in August 2018.
--3.6 in January 2020 (i.e. now).

According to DCUK (https://www.diabetes.co.uk/cholesterol-to-hdl-ratio-calculator.html) a ratio of 4.0 or below is healthy! So as of now I am officially ceasing to worry about cholesterol although, in order to improve my general health, I will try the regime described in my earlier post. Main thing is drinking less, eating somewhat less meat, and exercising more, none of which is particularly controversial.

 

[Bluetit1802]

I've now looked up my medical records for the past 11 years and by cholesterol "ratio" was:
--3.9 in September 2009.
--4.0 in February 2017 (this is also when my T2 was diagnosed, with an A1c of 67).
--2.1 in February 2018.
--2.4 in August 2018.
--3.6 in January 2020 (i.e. now).

According to DCUK (https://www.diabetes.co.uk/cholesterol-to-hdl-ratio-calculator.html) a ratio of 4.0 or below is healthy! So as of now I am officially ceasing to worry about cholesterol although, in order to improve my general health, I will try the regime described in my earlier post. Main thing is drinking less, eating somewhat less meat, and exercising more, none of which is particularly controversial.

You are looking at the wrong ratio. The best ratio is one the NHS hasn't discovered as yet, but the real experts have. It is the triglycerides/HDL ratio, which ideally should be under 0.87 (in UK measurements. It is different in the USA. (Be aware that in the UK the trigs are measured using different units from the ones used in the USA so those figures won't bear much resemblance to the ones you have had here.)

Just to refer back to a comment you made earlier. We all have cholesterol and lipids tested when we have our HbA1cs. It is part of the care plan.

 

[BrianTheElder]

You are looking at the wrong ratio. The best ratio is one the NHS hasn't discovered as yet, but the real experts have. It is the triglycerides/HDL ratio, which ideally should be under 0.87 (in UK measurements. It is different in the USA. (Be aware that in the UK the trigs are measured using different units from the ones used in the USA so those figures won't bear much resemblance to the ones you have had here.)

Just to refer back to a comment you made earlier. We all have cholesterol and lipids tested when we have our HbA1cs. It is part of the care plan.

The problems with this are that triglycerides are constantly varying, so a single measurement at a particular time of day is useless; and that triglycerides are often not included in blood test results.
For comparative purposes, TC/HDL is a better indicator of triglyceride levels, a result < 3.5 being good. Ref Prof Sikaris.

 

[bulkbiker]

eating somewhat less meat, , none of which is particularly controversial.

Not sure I can agree about eating less meat!