The Cholesterol Conundrum

Art Of Flowers

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My total cholesterol was 5.2 back last October when first diagnosed. Last February it had dropped to 4.8 as I cut out a lot of carbs, but this May it has risen to 6.1 when I have cut out even more carbs. I had the diabetes nurse asking me if I wanted statins this morning, but I declined as I think they are dangerous. It made me wonder if I should fine tune my diet to reduce cholesterol, but still keep things low carb to keep my blood sugars as low as possible. My recent HbA1C was 44, which is a big reduction from 99 at diagnosis.

I have changed my diet a lot over the last six months. In December I started to eat porridge for breakfast every other day, but stopped eating it in February. I was eating pulses such as beans in home made soups, but haven't recently. I have been eating more strawberries, but less citrus fruit like oranges over the last few months. I have also been eating more cheese and a lot of cream with strawberries.

Any advice as to what I should do?
 
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daisyduck

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Do you know the breakdown of your result ? Mine initially lowered and then raised on LCHF .. but it was the "good HDL" rising.
 
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Freema

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both fibres like those in oats and olive oil is said to lower cholesterol and exercise .. olives..
 

DeejayR

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Well done for getting such a big reduction in your HbA1C. I can't advise you what to do, but if it were me I wouldn't worry and certainly wouldn't start taking statins. My cholesterol overall is higher than yours but I'm working on getting a full breakdown of the figures. There are other threads on the forum about cholesterol and they include suggestions on fine-tuning our food intake.
 

Bluetit1802

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Your new total cholesterol means absolutely nothing without the full breakdown of all your previous tests including this latest one. You don't know if it is your good cholesterol that has caused the increase, and without knowing your triglycerides you can't make a judgement on whether your LDL is mostly good or mostly bad.

Did you fast for any of these cholesterol tests?
 
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Art Of Flowers

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Do you know the breakdown of your result ? Mine initially lowered and then raised on LCHF .. but it was the "good HDL" rising.
My HDL is 1.0 and Trigs 1.5, so it is mostly LDL that has been rising. My ratio of trigs/HDL is 1.5 which suggests only a small amount of sdLDL (small dense LDL, so my LDL is mostly the big fluffy harmless variety). I did fast for the cholesterol tests.

I think the porridge + beans was possibly responsible for the reduction from 5.1 to 4.8, but stopping them and eating a lot of cream along with cheese has caused it to rise to 6.1.

Foods which reduce cholesterol include: oats, beans, nuts, citrus fruits and soy. Maybe eating more fat from avocados and nuts and less from dairy may also help. I might try some porridge occasionally, but keep the portion size down to about 20g and see what that does to my blood sugar
 
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Bluetit1802

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My HDL is 1.0 and Trigs 1.5, so it is mostly LDL that has been rising. My ratio of trigs/HDL is 1.5 which suggests only a small amount of sdLDL (small dense LDL, so my LDL is mostly the big fluffy harmless variety). I did fast for the cholesterol tests.

Can you tell me how you have worked out that your LDL is most likely the big fluffy variety? (your LDL calculates at 4.41)
 

Art Of Flowers

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Can you tell me how you have worked out that your LDL is most likely the big fluffy variety? (your LDL calculates at 4.41)
There is a correlation between the ratio Trigs/HDL to the amount of sdLDL in the blood. The higher the number, the greater the amount of dsLDL. See https://www.cooperinstitute.org/2015/12/10/the-blood-triglyceridehdl-ratio-and-ldl-particle-size-critical-issues-for-determining-risk-of-coronary-heart-disease.
Ideally, you want a Trig/HDL ratio of 2 or less. https://www.drsinatra.com/the-most-important-cholesterol-ratio-to-watch
 

Bluetit1802

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There is a correlation between the ratio Trigs/HDL to the amount of sdLDL in the blood. The higher the number, the greater the amount of dsLDL. See https://www.cooperinstitute.org/2015/12/10/the-blood-triglyceridehdl-ratio-and-ldl-particle-size-critical-issues-for-determining-risk-of-coronary-heart-disease.
Ideally, you want a Trig/HDL ratio of 2 or less. https://www.drsinatra.com/the-most-important-cholesterol-ratio-to-watch

Those two links are to American sites. They are using different measurement units (mg/dl). In the UK the trig/HDL ratio should ideally be under 0.87mmol/l

http://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/

However, when looking at the ideal ratio, you have to check if your lipid values are provided in mg/dl like in the US or mmol/L like in Australia, Canada, and most European countries.

If lipid values are expressed as mg/dl (like in the US);

TG/HDL-C ratio less than 2 is ideal

TG/HDL-C ratio above 4 is too high

TG/HDL-C ratio above 6 is much too high

If you live outside the US or are using mmol/L, you have to multiply this ratio by 0.4366 to attain the correct reference values. You can also multiply your ratio by 2.3 and use the reference values above.

If lipid values are expressed as mmol/L (like in Australia, Canada, and Europe);

TG/HDL-C ratio less than 0.87 is ideal

TG/HDL-C ratio above 1.74 is too high


TG/HDL-C ratio above 2.62 is much too high
 
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Daibell

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Yes, don't let the DN/GP offer statins based on just the total measure or the 'at risk' calculation. Use a fasting lipids breakdown
 
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bulkbiker

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Firstly do you believe the diet heart hypothesis? i.e. higher cholesterol is a contributor to CVD? If not then forget about your levels.
If you do believe it do you think that what you eat contributes to your cholesterol levels?
Most science shows it doesn't.
Do you think our cholesterol levels are static during any given day or do they move around like our blood sugars? i.e. what does the cholesterol test show us apart from a snapshot in time. I recently found a study from the late 1950's that showed that people's cholesterol levels do move around during the day. So what is your measure actually showing?
I bet your GP or DN has never even thought about these questions but is asking if you want to artificially lower your cholesterol levels (something that we would die without) using drugs which anecdotally we know may have nasty side effects -seems to be an odd thing to do. First do no harm.... hmmmm
 

librarising

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This study has a useful graph, which shows that the TG/HDL ratio has a crossover point of 1.33 in UK measurements (3 in US)
Below 1.33, the lower the ratio the lower the number of small particles, and the higher the number of large particles. Over 1.33 the trend is reversed. Scroll down to p.1683 for the graph
https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwiF0M-B_YbUAhWMCcAKHWAOBDsQFgguMAE&url=http://care.diabetesjournals.org/content/diacare/23/11/1679.full.pdf&usg=AFQjCNE8T3wbxArAxTlYxUkMtbp_X59C7g&sig2=7wOUxPysWjGRfzwRc5ds1w
Geoff
 
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DavidGrahamJones

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I have also been eating more cheese and a lot of cream with strawberries.

My experience is that at Christmas my total cholesterol was 4, in March it was 5.7. What changed? More cheese and real yoghurt plus a smattering of double cream in January through March. I have now stopped all dairy and feel relatively confident that my TC will go back to 4 when next tested in June. GP seems to think it's a good idea and hasn't pushed (won't push) for me to take statins again. I tolerated statins for 17 years and had all the usual side effects of muscle pain, poor sleep and brain fog (cognitive impairment) and also had to tolerate a stupid doctor giving me all sorts of rubbish excuses for my symptoms when I knew it was the statins. I don't take then now and so long as my cholesterol is around 5.4 I'm not worrying. It's worth me mentioning that not everyone feels the side effects that I did.
 

kokhongw

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One might reconsider if the prevailing assumption about cholesterol/CVD is correct...
http://www.fiercebiotech.com/r-d/failure-of-lilly-s-evacetrapib-may-prove-final-nail-coffin-for-cetp
Improving HDL via CETP inhibition had been seen as the great hope of this next-gen class of statins, but Steve Nissen, chairman of cardiovascular medicine at Cleveland Clinic, said: "Here we have a paradox. The drug more than doubled HDL and lowered LDL levels by as much as many statins--but had no effect on cardiac events. These findings illustrate the importance of performing large, high-quality outcome trials. Just looking at the effects a therapy has on cholesterol levels doesn't always translate into clinical benefits."

https://en.wikipedia.org/wiki/Evacetrapib
On April 3, 2016 at the American College of Cardiology cardiologists first saw the data for Eli Lilly's ACCELERATE trial of Evacetrapib involving 12,000 patients.[9] They were "stunned" by the result which showed there was no benefit from taking evacetrapib—434 participants who took Evacetrapib died from "cardiovascular disease, such as a heart attack or a stroke" and 444 participants who took a placebo died.[9] The ACCELERATE trial led by Dr. Stephen J. Nicholls who observed,[9]

"“It’s the most mind-boggling question. How can a drug that lowers something that is associated with benefit not show any benefit?"

— Dr. Stephen J. Nicholls 2016
 
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noblehead

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Foods which reduce cholesterol include: oats, beans, nuts, citrus fruits and soy.

Foods like oats contain a powerful soluble fibre called Beta Glucan:

https://authoritynutrition.com/9-benefits-oats-oatmeal/

I might try some porridge occasionally, but keep the portion size down to about 20g and see what that does to my blood sugar

There's a gp on the forum (I think his username is Southport GP) who advises his type 2 patients to follow a low-cab diet, included in his dietary recommendations is oats so I assume he is well aware of the health benefits of eating them, 20g of oats is around 13g of carbs @Art Of Flowers
 
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