Type 2, diet and cholesterol

[AnnM99]

Hi,
I am hoping someone can help me make sense of these results from recent blood tests. HBA1C came back as normal with a reading of 42. I take one x Metformin a day 500mg. I have a review and I think they will suggest ,me stopping it - just a gut feeling. Not sure how I would feel about stopping. I do low carb and try to stay active. Have been at his level for 2 years now. Start point was 86 3 years ago!
Everything else came back as normal except this one: satisfactory but no further action.
Should I make any changes? What does it mean? I am not looking for medical advice just to try to understand this. I have come so far with getting my hba1c down and if I need to address cholesterol then I will. I am 51, a non-smoker with a BMI of 22. I do drink the odd glass of red wine. Just wondering if I need to tweak my diet.

Serum lipid levels
Serum cholesterol level 6.9 mmol/L
Serum triglyceride levels 1.4 mmol/L
Serum HDL cholesterol level 1.7 mmol/L
Serum LDL cholesterol level 4.6 mmol/L
Serum cholesterol/HDL ratio 4.1 mmol/mmol;

Thanks in advance.

 

[HairySmurf]

Hi there,

Without offering medical advice, here is a list of links to information that I currently trust to guide me on the matter of cholesterol.

Heart UK, 'The cholesterol charity', 'Understanding your cholesterol results':

Understanding your cholesterol test results

When you have a cholesterol test, your results will include different types of cholesterol and sometimes triglycerides too. Find out what your results mean and whether they are in the healthy range.

www.heartuk.org.uk

Information booklet from Croi (Irish heart health charity) - includes lists of foods which are thought to be good, or bad, for cholesterol levels:

https://croi.ie/wp-content/uploads/2022/08/Croi-Cholesterol_2018.pdf

'An overview of the rationale for dietary recommendations for fat intake', a recent article in the Atherosclerosis Journal
Examines the studies on which the information found in booklets such as the one linked above is based.
Table 1, and the concluding statements, provide a quick summary of the recommendations in the article.

https://www.atherosclerosis-journal.com/article/S0021-9150(23)05354-6/fulltext

NICE (National Institute for Health and Care Excellence) guidelines relating to cardiovascular disease risk reduction

Recommendations | Cardiovascular disease: risk assessment and reduction, including lipid modification | Guidance | NICE

www.nice.org.uk

Excerpt that I found relevant to me personally:
"1.6.7 - Offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10‑year QRISK3 score of 10% or more. [May 2023]"

QRISK3 magic cardiovascular risk calculator referred to in the document linked above.
Note that this calculator is a bit dated by now, last updated in 2018, and you shouldn't be overly alarmed if you get a scary seeming result.

QRISK3

qrisk.org

My own GP used QRISK3 in October and read me the results, in very ominous tones, telling me I had a 56% chance of having a heart attack or stroke within the next 10 years if my blood pressure and cholesterol issues remained unresolved. A nurse in the GP practice directed me to the Croi booklet. I am currently on Atorvastatin 20mg and am trying to eat mostly fats that are recommended by Croi as the healthier ones.

Bear in mind my cholesterol numbers and blood pressure were ridiculously high at that time. Your cholesterol numbers are very much better than mine were.

I hope this information is helpful and doesn't just add to your confusion. Best of luck

 

[IncogKeto]

Sorry, I can't really offer any advice, I just felt that I needed to offer an additional response to the links that @HairySmurf has provided.

I found the following conversation between Casey Means and Robert Lustig quite educational. It's about an hour long so is probably better suited to having on whilst you're doing something around the house rather than sitting down and watching. As well as discussing cholesterol levels they also talk about some other things related to diabetes. Unfortunately, the values they refer to won't mean anything unless you're prepared to do the conversions, but you may find the conversation interesting anyway.

 

[KennyA]

Hi,
I am hoping someone can help me make sense of these results from recent blood tests. HBA1C came back as normal with a reading of 42. I take one x Metformin a day 500mg. I have a review and I think they will suggest ,me stopping it - just a gut feeling. Not sure how I would feel about stopping. I do low carb and try to stay active. Have been at his level for 2 years now. Start point was 86 3 years ago!
Everything else came back as normal except this one: satisfactory but no further action.
Should I make any changes? What does it mean? I am not looking for medical advice just to try to understand this. I have come so far with getting my hba1c down and if I need to address cholesterol then I will. I am 51, a non-smoker with a BMI of 22. I do drink the odd glass of red wine. Just wondering if I need to tweak my diet.

Serum lipid levels
Serum cholesterol level 6.9 mmol/L
Serum triglyceride levels 1.4 mmol/L
Serum HDL cholesterol level 1.7 mmol/L
Serum LDL cholesterol level 4.6 mmol/L
Serum cholesterol/HDL ratio 4.1 mmol/mmol;

Thanks in advance.

Hi. I have been on 20g carb /day for over four years. My total cholesterol as calculated hasn't changed in that time, providing I test fasted. If I have a coffee with cream before the test, I will not surprisingly get a higher reading. In fact my fasted cholesterol hasn't altered since my very first test, when my level was good. It's now officially "too high" but not because my figures have changed - the definitions have.

The official guidance still says what it says. Bear in mind that we have had quite a bit of recent research calling the "cholesterol risk hypothesis" into question - I'll attach one recent paper, on a very large group, which argues that the risk is over-stated.

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol ...

www.ncbi.nlm.nih.gov

Here's their conclusion:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

 

[hankjam]

Been low carb and in remission for 10 years.
My lipids have been off the scale every test.
They are what they are.
Happy with my remission.

Interesting GP chats have been on going.

 

[MissMuffett]

my bA nurse in the GP practice directed me to the Croi booklet. I am currently on Atorvastatin 20mg and am trying to eat mostly fats that are recommended by Croi as the healthier ones.

if my practice nurse gave me that Croi leaflet I’d toss it in the bin on the way out of the surgery! Low Fat diets are the reason most of us have diabetes and the reason it is now a pandemic. Even children as young as 10 now have diabetes. Updated studies are telling us to steer clear of seed oils and that saturated fat does not cause heart attacks.
I recently heard (and if I find it I’ll post it here) that statins lower cholesterol but they don’t prevent heart attacks by the percentages they’re bragging about.