T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

Melgar

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@Chris24Main I really wasn’t happy with my LDL’s being that high. I just wanted then within range, not low. Yes you are right my Triglycerides rose slightly, but they have bounced between those two numbers for years so I’m not concerned at all. They are still comfortably low. Now I would have been worried if they had dropped below 0.40. I have read that below that range , if you are not on a low fat diet , is not desirable. Of course, these statements can be challenged and no doubt people do.

Am I going to be taking Coenzyme Q10 supplements for the disruption in production that the statins will cause ? I’m going to have to look that up. I have no idea. I will take a look.

I do know that I need to find something that I can take that will off set my lack of fats. In the last few days I have been able to tolerate a small amount of olive oil and an avocado so that was a positive.
 
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Chris24Main

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For what it's worth @Melgar - you have no idea how glad I am to hear that.

And I really don't mean to suggest that your triglyceride levels should be a source of concern - just curious that they have gone up, but I totally agree - they are both very low, so the absolute level is just noise.

There is a complicated sequence of reactions that ends up with a cholesterol molecule - the first generation of cholesterol lowering drugs were even more effective in dropping cholesterol levels, by blocking all of it, trouble is that that turned out to be extremely harmful, as the body needs some of the by-products ... so the use of those drugs were banned pretty fast. This generation stops the production of cholesterol further down the chain, but the most obvious by-product that then also gets stopped is coenzyme Q10, and that pops up quite regularly in interviews I watch where people are getting into the small detail of why you may want to consider the broader effects of statins - BUT - even if you accept that - there are supplements, so it really is just a thing that you can dig into.

Of course, when I was first diagnosed, I was very much on a low-fat diet, and my triglyceride levels were literally off the scale.

May be a totally useless point, but I'm finding great success (or at least enjoyment) in home-made bullet-proof coffee. One of these in the morning totally fuels me till well past lunch - a spoonful of unsalted butter, a spoonful of coconut oil, a spoonful of clotted cream, and a mug of coffee, blended in a smoothie maker. I've just had an Amazon delivery of collagen powder (so I'm not 100% averse to supplements) and my plan is to add a spoonful of this too (I have an old knee injury that I'm interested to see if this might help with).

Tastes just like a cappuccino, so maybe you could trick your digestion into thinking is wasn't fat?
 
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Chris24Main

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Chris24main….i have a question for you. I’m pretty sure I know the answer but love your insights!
I do have high cholesterol and not worried about it BUT….my latest tests had my triglycerides up a bit and HDL down a bit and I’m not impressed. My ratio is now at .57
so, what happened during those six months? I am a tiny thing and do a lot of heavy weight lifting, takes forever for me to gain any muscle. This last month we were on holidays and although I walked an awful lot I did not lift anything heavy and as a consequence I lost over five pounds, all muscle I am sure (on a frame of 5’7” I now weigh just 111 lb). Then I was sick. As soon as we were home, and feeling better these new tests were done.
So, did my muscle loss have anything to do with the poorer results? I have heard that lifting heavy increases HDL. Does illness affect results?

thanks in advance

Melgar, glad you’re happy with your results. Question, did your doctor persuade you with the statins?
@Bcgirl - I accept the challenge and the compliment, but first I need to explain what the challenge is, this one has strangely been troubling me.

On the most simplistic level, the forum rules are primarily, thou must not diagnose, and thou must not advise. So, I cannot say anything that even smacks of advice to do anything. I know that isn't what you are asking...

But, that got me thinking, particularly in light of conversations around LDL. I go into my GP with a chart showing a number that isn't part of medical training, (average fasting ketones) and I'm 100% convinced that it's meaningful for me. Nobody else is using it, and nobody else cares, only me. So, what right do I have to comment on anyone else's results on the basis that I have an opinion on a totally different set of numbers that the medical profession does find meaningful?

I don't know... and I don't have an answer to that that I feel comfortable with.

Despite my ...mechanistic... outlook, I also totally believe that the efficacy of any medical treatment has a relationship with what the patient brings into the surgery - beliefs, expectations, willingness - all of that plays a part. So, if someone is getting something positive from a number changing that I personally have no truck in; who the hell am I to get in the way of the positive part that plays ? -

I don't have any training medically, I can read and draw a conclusion, but I have no way of knowing, really, whether I'm right. There could be a study in progress now that overturns the last 80 years of research and proves conclusively that lowering LDL is actually a good thing (and I say that advisedly, many of course think it is, but it really hasn't ever been a proven thing).

So - let's just say that your question led me to a night of trying to sort the hubris from the humility, so to speak...

And - I think that the important thing is often to try to hold two thoughts at the same time - this is what I think explains the big picture, but at the same time, I can't know that, and if anything, all my medical history research has taught me that charismatic people offering simple sounding explanations are the most dangerous.

On which note - here is a quote from the man who invented the entire basis for the reason why anyone takes statins, Ancel Keys himself:
There’s no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”
 

Chris24Main

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And to try to actually answer the question @Bcgirl - having noted that really, I cannot and stay on the right side of the forum rules, maybe I can offer some big picture stuff.

Triglycerides and lipoproteins. If you take the venerable Dr Keys above - these things have nothing to do with what you eat. Fats are broken down into fatty acids in the lower intestine and transported to the liver, as are proteins (as amino acids). Carbs are broken down to sugars and bypassed to the liver directly.

What your liver does with all of these building blocks can be described simply (high carb -> high insulin -> fat storage) or it can be described in a way that would take you a lifetime of study to follow - really, food is just the start of the process, but it's like the argonauts running around thinking they are in charge, while the gods look down from Olympus as they release hormones to do their bidding.

Someone who's view I really respect described it to me this way - it's like passengers in the tube - there are lots of stations, and people come in and go out. If you measure the number of passengers in any given train at any given time, it's a number, and it will go up and down, but what does it tell you? I've been pondering that ever since, and there is real wisdom in it - for example, there may be a surge of passengers, and if you already knew that there was a big football match, you might say - "well, it's clearly because of that football match traffic" - and you might be right .. but think of all the different effects on numbers of people in a single train on the central line on the London underground - take the number of people in that train every three months, and tell me that you can deduce anything useful from it...

I don't know that you can.

To stretch it a bit - if you are repeatedly finding that people are getting injuries because of overcrowding (triglicerides very high) then you can do something about it, like lowering carbs, but beyond that... The absolute number of LDL particles in your body is a function of the number of LDL receptors in the liver cells - your liver will regulate that perfectly well, if everything else is in balance.

But - there are some things that we do know.
As humans, we are mainly animal fat and animal protein.
Protein, and a wide variety of it, is used for all the stuff in our bodies - at the smallest level, metabolism is really just protein structures bending in certain ways.
Fat, and a wide variety of it, is used for all the linings of the cells, and for almost all of what the brain is. We have downplayed the importance of fat for the last couple of generations, thinking of it as something inconvenient. This is like thinking of sleep as something inconvenient.
Sugar and refined starches - not as important as some (mainly those selling us stuff with lots of sugar and starch) think - we can do fine without, but man, do we ever like eating them.
Vegetable oils - maybe when we hear about the danger of fad diets, we should think again about substances industrially forced through complex processing in order not to be poisonous sludge, and liable to turning into thousands of toxins during cooking and in our bodies. Maybe filling our diets with so much of it might not have been a good idea.
Energy - all of our major systems need energy, and it is regulated through fat. Maybe that means that fat is more important to us as a species than we think.
Stress will tip everything else out of balance - we should maybe put more effort into "stress hygiene" - the way that we think about "sleep hygiene".

That's where I keep coming back to...
 
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Chris24Main

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I should finish off (at least for now) with the thought that if I believe all of the above (and I do) then what I'm left with is the fact that my own blood glucose levels seem to be in control for now, but that it's inevitable that for most of my life, I've lived and eaten in a way that doesn't match to those set of points at all - and that my major priority should be more along the lines of re-building my cells in a way that is more conducive to longer term health and mental capacity and wellbeing.

Given that the half-life of a fatty acid coming from a seed oil is around 5 years - this could take some time, but I'm fully of the opinion that this is what I want to be putting effort into - not worrying about the composition of fat carrying particles in the blood around my liver.

So - I need to burn it all off, and replaces with a healthier composition of fats (again, throughout my body, not just in the blood around my liver) - and to do that, what do I need to do?

Mainly - keep insulin low so that fat can be mobilised and used as fuel, so we come straight back to low sugar/starch and higher fats (and lets say historically relevant fats).
 

Melgar

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Great discussion @Chris24Main and thanks for the questions @Bcgirl . Firstly, your quote from Ancel Keys :

There’s no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

I could not agree more. My cholesterol was high no matter what I ate or did. It had nothing to do with food. My Triglycerides are very low. I tried to get to the bottom of why my Cholesterol was high yet my Triglycerides very low. I tended to see these two as linked in someway. If you have high cholesterol, then high Triglycerides will seen. Well that’s patently not so. There was no satisfactory answer upon digging. (That’s where I got don’t go below 0.40 for your Trigs) The simplest explanations for the imbalance were given as low fat diets to the more complex reasoning ending up with autoimmune issues. The lean hyper responder model fit until it didn’t. When I left my very low carb diet behind and started to eat carbs my cholesterol remained high.
Dare I say this, technically you are in the same position as me, until I started statins, high cholesterol, very low Triglycerides. Ketones in pee. At its crudest of course.

@Bcgirl if you don’t mind me asking what are your Triglycerides at ?

@Chris24Main you are in ketosis , I am not. You eat low carb and high fats, I eat no fats and gain my energy source from carbs, because I cannot effectively deal with fats. Your energy is from being in a fat adapted state. What’s the connection? Now, your blood sugars are great. Mine are not. My lab fasting blood sugars were 5.8 mmol/ls after 14 hours fasted. The lab range, interestingly stated, after a 14 hour fast, should be between 3.3 - 5.5 mmol/ls. So I was outside of the lab range also I’m on blood sugar lowering meds. I’m assuming your blood sugars after 14 hours of no food would be significantly lower. As an aside I was surprised to see the lab range dipping as low as 3.3 mmol/ls which suggests 3.3 is perfectly acceptable whilst being in a fasted state of that duration. I had my C-Peptides taken at the same time. I haven’t had then done for over 3 years. I’m keen to know how much insulin resistance I’m carrying. Has it gone up, stated the same, or gone down.

I’m assuming your C-Peptides are low. I’m awaiting my lab results.

One thing I have noticed, if I eat very few carbs on a particular day, I’m very reactive to them the following day. I’m sure that is true for everyone. A question arises from that simple statement, does this mean that people on a very low carb diet become intolerant of carbs in the long term?

Oh, I’ve ordered some coenzyme Q10 from Amazon, although I am not feeling any side effects from the statins.
 

Bcgirl

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Great discussion @Chris24Main and thanks for the questions @Bcgirl . Firstly, your quote from Ancel Keys :

There’s no connection whatsoever between cholesterol in food and cholesterol in the blood. None. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

I could not agree more. My cholesterol was high no matter what I ate or did. It had nothing to do with food. My Triglycerides are very low. I tried to get to the bottom of why my Cholesterol was high yet my Triglycerides very low. I tended to see these two as linked in someway. If you have high cholesterol, then high Triglycerides will seen. Well that’s patently not so. There was no satisfactory answer upon digging. (That’s where I got don’t go below 0.40 for your Trigs) The simplest explanations for the imbalance were given as low fat diets to the more complex reasoning ending up with autoimmune issues. The lean hyper responder model fit until it didn’t. When I left my very low carb diet behind and started to eat carbs my cholesterol remained high.
Dare I say this, technically you are in the same position as me, until I started statins, high cholesterol, very low Triglycerides. Ketones in pee. At its crudest of course.

@Bcgirl if you don’t mind me asking what are your Triglycerides at ?

@Chris24Main you are in ketosis , I am not. You eat low carb and high fats, I eat no fats and gain my energy source from carbs, because I cannot effectively deal with fats. Your energy is from being in a fat adapted state. What’s the connection? Now, your blood sugars are great. Mine are not. My lab fasting blood sugars were 5.8 mmol/ls after 14 hours fasted. The lab range, interestingly stated, after a 14 hour fast, should be between 3.3 - 5.5 mmol/ls. So I was outside of the lab range also I’m on blood sugar lowering meds. I’m assuming your blood sugars after 14 hours of no food would be significantly lower. As an aside I was surprised to see the lab range dipping as low as 3.3 mmol/ls which suggests 3.3 is perfectly acceptable whilst being in a fasted state of that duration. I had my C-Peptides taken at the same time. I haven’t had then done for over 3 years. I’m keen to know how much insulin resistance I’m carrying. Has it gone up, stated the same, or gone down.

I’m assuming your C-Peptides are low. I’m awaiting my lab results.

One thing I have noticed, if I eat very few carbs on a particular day, I’m very reactive to them the following day. I’m sure that is true for everyone. A question arises from that simple statement, does this mean that people on a very low carb diet become intolerant of carbs in the long term?

Oh, I’ve ordered some coenzyme Q10 from Amazon, although I am not feeling any side effects from the statins.
Melgar…my triglycerides were .89, up from .77. Much higher than I would like
its my HDL that really bugs me, it’s way down! That’s why I’m thinking it’s related to muscle mass for me.
fyi, my c peptide was 508 pmol/l. Curious what yours will be
my fasting blood glucose is always high, last time was 6.3
 
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Bcgirl

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Chris24Main….oh my, thanks for all the thoughts! Certainly didn’t want any medical advice, so we’re good! Just curious about any association between muscle mass and HDL. Looking back at years of results it does appear that after long holidays my HDL does decrease….i don’t weight lift on holidays. Coincidence?

I too enjoy a bullet proof coffee every morning, but I just use butter but maybe I’ll try a bit of coconut oil too for the medium chain fatty acids. I do use collagen and also add a few drops of iodine. Oh…and a touch of cinnamon just because.

I've been off seed oils for at least five years but I do know that some just have to sneak in when away from home.

new topic. Allulose. I remembered hearing something about allulose and blood sugar regulation….maybe Nick Norwitz. Well, I did order some just to have (I almost never have anything sweet) and the other day made myself some crustless mini cheesecakes using the allulose. So, for a treat after supper I had two. Out of curiosity I tested my before bed blood…and it was a surprising 5.3 (I’m usually in the 6’s before bed). I did a quick bit of googling and did find some interesting studies on this with conclusions pointing to a reduced post prandial blood glucose reading with small amounts of allulose added to a meal. Need to do more research on this but it’s super interesting!
 
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Melgar

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Melgar…my triglycerides were .89, up from .77. Much higher than I would like
its my HDL that really bugs me, it’s way down! That’s why I’m thinking it’s related to muscle mass for me.
fyi, my c peptide was 508 pmol/l. Curious what yours will be
My C-peptides 3 years ago were something like 540 pmol/ls. Yes, @Bcgirl I am very interested to see what they are now. I will flip if they’ve gone up lol. I have to wait because it takes about a week apparently, for C-Peptides. I took your advice and paid for the test at Life Labs, $34 which is great. Your Triglycerides are still great , I know it’s always a concern when results go up, because you question whether it’s the start of a climb.
 
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Bcgirl

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My C-peptides 3 years ago were something like 540 pmol/ls. Yes, @Bcgirl I am very interested to see what they are now. I will flip if they’ve gone up lol. I have to wait because it takes about a week apparently, for C-Peptides. I took your advice and paid for the test at Life Labs, $34 which is great. Your Triglycerides are still great , I know it’s always a concern when results go up, because you question whether it’s the start of a climb.
So glad you were able to order the test! It does take a few extra days to get the results for c peptide but I was surprised at how fast my last one came back. Do you use the mycarecompass site For your results?
My last c peptide was lower than the first one I did. I was very happy for that! Oddly my fasting insulin went up a wee bit…but it’s still low
 

Chris24Main

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Lots of really interesting threads to pull on...
I do like a little Nick Horwitz - and iodine is something I can definitely think about - cinnamon too. Very nice. (I'm trying to use some table salt in my daily sodium intake for that reason, I do think I'm maybe not getting enough).

So - the quote from Ancel Keys - Keys is really the godfather of the cholesterol/ saturated fat heart health hypothesis, he pioneered all the early studies, ferociously marketed and publicised it, got on to the advisory board of the AHA and really bedded it in. The very reason that statins are seen as a good thing is almost uniquely influenced by him. This quote was from much later in life when he had backpedalled quite a bit, and worried about the effect that his work had had. My point is that if even he came to that conclusion, the rest of us just don't need to even think about our serum lipid panel - except when, like in my case, trigs are off the scale.

The direct risks for CVD events are:
High blood pressure
High blood glucose
Smoking
Elevated stress hormones.

The only two direct causes of CVD absent anything else are sickle cell anaemia and lupus (though I would need to check my notes on that) - in other words it's really about anything that attacks the endothelium. This from Dr Malcolm Kendrick, in "the clot thickens".

Thus - HDL and lifting weight - who knows, but its back to counting passengers on the tube. lifting weight and building muscle is good because muscle is the most metabolically active tissue in the body, and will add to your glycogen storage capacity. That is good in itself. Spitballing, but building muscle is about damaging muscle fibre to force it to regrow - HDL is involved in the healing process, ergo less HDL when you are not lifting - but I'm guessing..

Nick is involved commercially in a company selling Allulose, but I do think it sounds quite promising..
 
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Bcgirl

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Oh…I need to clone myself. After lunch (2nours) and a 3km walk (which always raises my glucose) I measured at5.7. I had one little cheesecake (cream cheese, egg, allulose…that’s it) with my eggs, ground beef, and cheese lunch. That’s low for me. I need a control subject….i really want to get another Cgm too…

i HATE that Nick is involved with a food company….but I’m still really interested in the studies, although they are very limited, on allulose.
I don’t even think it’s approved for sale in Canada, I bought mine from the states.
 

Bcgirl

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I especially was drawn to this observation from a meta analysis of these allulose studies as someone with a withered pancreas

Allulose's ability to reduce glucose levels without significantly increasing insulin secretion may help preserve pancreatic β-cell function and improve insulin sensitivity over time, making it particularly beneficial for individuals with insulin resistance or those looking to preserve pancreatic function.

link to meta analysis
 

MrsA2

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Robert Lustig is talking more about Allulose too. Involved in a company in Kuwait apparently. In a talk I just heard he has 3 different views in it, depending whether he wears his clinician"s, his scientist's or his (can't remember his third!) hat.
It's not approved in Europe UK or Canada yet, still very early days, and its heavily processed
 

MrsA2

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@Chris24Main
A new name to me, maybe to you too?
Dr Garrett Smith, American, very into liver function/dysfunction, misuse of supplements, and all thing metabolism.
Has videos out here somewhere, I just heard him on a summit today
 
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MrsA2

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More discussion on Allulose here today. Seems to be topic of the moment