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What's the test to identify the large, fluffy LDL component?


The deterioration in your lipid levels is something that should concerns you and that you should keep an eye on, even if for now at least you chose, as you are entitled to do, not to accept statin treatment.

Allow yourself a three month period to improve your levels through lifestyle changes, then ask for a new lipid profile to be done and review your options according to the outcome.

Pavlos
 
I thought I did when I was thinking about this last night but now not so certain. I think the answer is it depends on what the contents of the lipoprotein itself ie proportions of cholesterol or triglycerides carried within the sphere.
I'm still trudging through the Attia posts and thinking I've understood it but then end up losing it and being less certain. I think I'll take some time over working it out in my head.
 

Thank you for your comment, but do you not feel that the severe stress I was under at the time of the test has some impact on what have always been perfectly good results.

I do not know what the guidelines are Cyprus but here, contrary to popular belief, NICE have never set lipid control limits as:

“A target for total cholesterol or low-density lipoprotein (LDL) cholesterol is not recommended for primary prevention of cardiovascular disease.”

“The National Institute for Health and Clinical Excellence (NICE) does not recommend the use of target levels of cholesterol for people taking statins for primary prevention of cardiovascular disease. This is because it found no clinical trials in primary prevention that have evaluated the relative and absolute benefits of achieving different cholesterol targets in relation to clinical events.”

So if the controlling body in the UK don't set guidelines where do our GP's get their recommendations from?

Also it is not a case of 'for now at least' as I will never accept statin treatment. I am now more aware of the damage they do to your body at a cellular level. All testing has been funded by the people marketing and selling them, with no testing at all on women. I therefore have no trust in the tablets and the NHS for supplying them. The makers of 1 particular statin in the USAare currently in court as there is a link between it's product and patients developing diabetes. Why would I want to put that in my body.

Dr's can give advice but they do not have to live with this condition and it is us that have to make the best decision for our health.
 
The most recent NICE guidelines say to use the Qrisk2 score for people with T2 and to offer atorvastatin 20 mg for those with a 10% or greater 10 year risk of CVD.
They say to offer of statins for all T1s over the age of 40 or who have had it for more than 10 years, have nephropathy or have other CVD risks.
There are some guidelines on referral if total cholesterol or trigs are above certain levels in people with T2
http://www.nice.org.uk/guidance/cg181/chapter/1-recommendations
http://www.qrisk.org/
 
@forty six

With these results, my personal reaction would be to look at the trig score above everything else.
Had you lost any weight? That can temporarily raise scores.
And I totally accept your argument about the stress.

So, in your position, I would look for hidden carbs, up the saturated fats, try and avoid the stress (I know, easier said than done!) and ask for another test in 3 months.

And I won't take statins either. Ever.
 

I had a long discussion with my GP after my last bloods, where we went all around the houses on lipids and statins. Similarly, I'm not at all keen to accept statins as the way forward, and asked her for empirical evidence to support her recommendation, based on research including a statistically representative proportion of women. She couldn't supply that.

My very latest set of bloods mean I'm back to see her in a a couple of days, and that'll be another interesting discussion, where I don't intend to leave with any scripts. If she can come up with the sort of reasoning I am looking for, I might reconsider.

I started a thread around my last discussions, should it be of interest: http://www.diabetes.co.uk/forum/threads/anything-else-update.63298/
 
I have had a pretty bad night, laying awake thinking about all the government recommendations and what can and can't be proved. I am so grateful for this site and the contributors to it. You put my mind at rest and make me think logically and not emotionally. All health issues make us emotional and then all the bad things kick in like stress, cortisol etc. I have decided not to beat myself up over this. I am not too old to change this situation and I am so p+++++d off with the medical establishment now that I will weigh and measure all that I am told.

AndBreathe thank you for your encouraging words, it is nice to know I am not alone in trying to get my point across to GP's, who after all are not experts in nutrition.

Brunneria once again you have hit the nail on the head, I thought about this long and hard last night. What is constantly in my brain is the saying: If you want the same results keep doing the same thing. Therefore in the run up to Christmas some fundamental changes are happening in my house. LCHF is the way forward. I know some of you will probably wonder why it has taken me so long to reach this conclusion because I am not traditionally a bird of little brain - but there we go. I have 3 books on the subject but haven't done anything about it - apart from a half hearted attempt. So here we go.

Also in your information you say that xylitol artificial sweetener is very toxic to dogs, well so are statins. When they were first tested in the 1950's all the dogs they were tested on died but this did not seem to trigger that anything was wrong with the tests. These companies were so determined to push this through they just got more dogs and once they died they started testing on rats to get the answer they wanted.

The question is what is the difference between dogs and rats, the answer:

Rats have the ability to re-start their mevalonate pathway which is how our cells and specifically the DNA in them replicate.
Dogs and humans do not have this ability.

Statins block this pathway and so therefore are killing the body one cell at a time. Of course different cells die at different rates, if our cells replicated or renewed at the same rate as dogs, statins would probably not be on the market.

Ask your GP, I bet this will stop s/he their tracks.
 

Thank you for these links I have sat and read through the NICE document again this evening. What is interesting is that all the the way through they are advising Dr's to discuss lifestyle with the patient before offering statin therapy. In the section listed as 'Primary Prevention' this is what it says:

Before offering statin treatment for primary prevention, discuss the benefits of lifestyle modification and optimise the management of all other modifiable CVD risk factors if possible. Recognise that people may need support to change their lifestyle. To help them do this, refer them to programmes such as exercise referral schemes. Offer people the opportunity to have their risk of CVD assessed again after they have tried to change their lifestyle. If lifestyle modification is ineffective or inappropriate offer statin treatment after risk assessment.

I do not know of anyone who has been diagnosed with T2 who has been offered 'lifestyle information' first. In fact when I was diagnosed it was over the phone and was told that 2 prescriptions would be waiting for me at reception and I would be on them for the rest of my life. One was for statins. When I protested I was told I had no choice as my sugar levels were so high. My diagnosis level after my OGTT was 11.1. The first thing I did was buy a testing kit and have managed to maintain my sugars at a reasonable level.

Also I have completed the risk assessment tool and discovered that my risk is 4.6%. The most interesting thing is that this tool is basically saying that::

If I were in a room with 100 other people with the same risk factors as myself I would be one the 5 to have a heart attack or stroke.

How likely is it for that to happen, exactly the same risk factors, please they are having a laugh.

I give up.
 

Does your 4.6% include your T2?

You aren't interpreting the risk correctly. It means if there were 100 people identical to you, in a room, 5 of them could suffer a heart attack, within the timeframe stated. It's only a statistical likelihood. There are no definites.
 

The 4.6% does include my T2, I understand there is nothing definite in life, after all I could get hit by a bus tomorrow.

However what is not included in the questions are things like:

Alcohol intake
Regular exercise
General fluid intake

These all will contribute in making us more or less healthy and yet they are not mentioned. Also just because a direct relative died of a heart attack does not mean it is a risk for you. My mother died of a heart attack aged 63, after contracting a severe chest infection which infected her heart. She had no previous history of CVD, nor did anyone in her family, her relatives have all loved to a ripe old age.

I have been putting together risk assessments in my working life for the past 20 years and they should always be based on evidence. If I had ticked the box to say a relative had died of an MI my risk would have increased, without any evidence.

Also with no discussion on changing my lifestyle from my Dr, just take these and I'll see you in 3 months. That is not adequate medical advice or support, as mentioned in the NICE guidelines. It is bad practice.

It may seem hard to believe from what I am typing here, but I actually like my Dr and have always got on well with her, but I know this is going to crop up again and again unless I radically change my life and prove them wrong.
 

As a matter of interest, what is your score with the heart attack box ticked?

My suggestion is you go and have an open hearted discussion with your doctor about this. You are coming across as somewhat stressed by this whole thing, which doesn't help anything or anyone.

At the end of the day your doctor is an advisor whose advice you can accept or reject. She is not a demo-God, but is rather hog-tied by the NHS guidelines. If they deviate too far and a catastrophic event occurs she would find herself in a cold, uninsured place. In many ways I feel for them.

Prepare before you go, so that you have a coherent case to make and see how it goes. If, after a two-way discussion, you still feel so emphatically, or if she is unwilling to allow you a period to try to change things, then it is your decision whether you tell her you will pass on the meds for now. But I think she deserves some air time.

Good luck with it.
 

That's about what mine would say if I asked her to go to the lengths you want yours to, to prove I should take statins.
Offered, - refused, - tick the box.
Tell me I know what I'm doing, then throw me out.
 

I think I will take your advice and I thank you for it, I am stressed, but more from the point of view that everything is so controlled, I understand about the litigation aspect, but there must still be room for them to treat us as individuals and not just tick boxes. NICE have turned them into puppets acting at their behest and that needs to change and can only do so from us.

I think what also makes me stressed is the knowing that I am going to have a battle on my hands, but I am in charge of my own destiny not my Doctor.

The next couple of weeks will be interesting.

Thank you,

I have just ticked the box for MI risk and I am now 10.2%, very interesting, I wonder if they are including that on my medical records, even though my mum's MI was outside of the norm?

Thanks again,
 
Just a small comment on NHS testing and health assessment by pratice nurse, had one in September where we parted with agreeing to disagree regarding cardiovascular risk, as I pointed out that neither lipid particle number/size test was used nor a sensitive measure for inflammation (which now is considered the major factor for CVD) and so practice nurse ability to make any prediction on cardiovascular risk was nest to nil. It will take years before NHS get there.
 
Well, that was interesting. I came away with more than I could have hoped for; some of it unexpected.

I'm a bit tied up this evening, but will write more tomorrow, when I have more time.
 
First I looked him up and he is from the US which has had guidelines suggesting relatively high levels of omega 6.
Their DRIs are for 5-10g omega 6 and 0.6-1.3 omega 3 They have even more than that in the diet, largely I believe due to oils, particularly soybean oil and corn oil, both commonly used oilin cooking and processed foods that have extremely large amounts of omega 6..

People in the UK have increased their oils but they aren't necessarily of the same variety. (rapeseed is lower in omega 6) I was favourably surprised when I looked at the ratio of omega 3/6 in the UK dietary survey recently . Actually the UK, FSA funded 3 studies looking into this balance in the UK and came to the conclusion that the concept of balance wasn't useful in the UK situation and that it was better to focus attention on increasing omega 3 which they agree has benefits http://www.ncbi.nlm.nih.gov/pubmed/18039412
.
That's of course why they tell people to eat 2 portions of oily fish a week (http://www.nhs.uk/Livewell/Goodfood/Pages/fish-shellfish.aspx) People don't do it though, dietary surveys show most people eat well under a portion a week.
The BHF does say that too much omega 6 from some oils can lead to lowered HDL.

I'm all for the Med diet . Did the Lyon study put a nail into UK advice concerning the total amount of fat ? The study dates to 1999 .and was evidence used when the present guidelines were formulated. These are for 30-35% fat witth not more than10% from saturated fat . (in the US the level is sometimes given as low as 20% with 5-7% sat fat. If you have no problems (and diabetes is a problem) then it may rise to 35%. They also have guideline amounts for cholesterol intake which have never been in UK guidelines)
The Lyon heart study,was a modified Cretan diet (a la A Keys). It had participants eating 30% fat , 8% of which was saturated so actually slightly lower than UK guidelines. The diet was high(ish) in monounsaturated fats . Omega 3 was increased through intake of a specially formulated margarine.
The Predimed diet was a bit higher at 40% but still not high in sat fat. It was also high in monounsaturated fat from the olive oil and walnuts and also contained relatively large amounts of fish and shellfish
See my post with shopping list here http://www.diabetes.co.uk/forum/thr...veyed-in-the-eatwell-plate.67542/#post-679691
Basically, I think that the paper has far more relevance to the US than to Europe.
There is a fascinating interactive gadget from National geographic which shows changes in the dietary pattern over 50 years in many countries including the UK and the US. There are significant differences between the two. (tip it doesn't work well in IE, works better in chrome) http://www.nationalgeographic.com/what-the-world-eats/






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So, yesterday was my post results catch up with my GP. It went really well, I think, although I’m pretty surprised by almost everything that transpired. Memo to self; don’t make too many assumptions!

I let the doc lead the meeting, which she did, by recapturing our last discussion, and confirming she feels my lipid levels are endogenous, and she therefore feels “a bit of help would be useful”. I asked her to clarify for me the factors she was taking into account in suggesting intervention. Disappointingly, she confirmed “Total Cholesterol”. Further discussion around the components ensued, and also I touched on my understanding of how statins work, with the potential for all the good elements being suppressed along with the perceived poorer areas, plus the potential for statins to impact on sugar levels. I summarised by saying, based on my research I am not comfortable to take statins, without research based input and further clarity on the mak-up of my LDL component. I also explained that I feared if I agreed to statins, in my current frame of mind, I couldn’t be certain I wouldn’t suffer side effects; real or otherwise. I don’t mean I’d make them up, but at my current level of belief I might just conjour up some psychosomatic aches and pains.

She suggested we had two ways to move forward:
- Document our discussion, and revisit by re-running panels regularly, with an open ended option for either party to change their approach
- I could be referred to a Lipid Clinic, at one of our major hospitals to explore matters further with someone with greater expertise than she has. (She was pretty candid about her generalised level of expertise.)

I have to say, I wasn’t expecting the potential referral, so that put me onto the back foot for a full millisecond. When we explored that further, it seems prudent to make the referral after my next panel, as we’re running quite short of time to have a couple of appointments before I go away again. So, our agreement was bloods immediately I’m next in UK, then referral to the Lipid Clinic. I call that a bit of a result.

I was then keen to understand how that will be recorded on my records, so that I can make accurate disclosures (but to over disclosures) to my overseas health insurers. I wanted to understand if I had just declined treatment. She confirmed that was not the case. Another result.

Being on a roll; I thought I’d expand the scope of the discussion a little wider. We had already touched on my wider diabetes. Last time around, I had mentioned Professor Taylor’s impressive work, and this time around she had clearly done some digging for herself. I asked her what her views were on the work and its implications for T2s who replicate his successes. She was very open to the concept of reversal, and agreed it appears to be work that can’t be ignored by her profession.

By a circuitous route I eventually asked her when she would consider a T2 to have reversed their diabetes, with a view to removing them from the Register. She quickly responded that she would be content to remove me now, if I wanted it. She was also quick to point out that she would not consider removal would mean cessation of regular blood panels, and realistically, I would never be refused bloods, if I thought there was value in running a panel. So, she has gone off to find out how she puts that into action.

I’m relaxed if she finds she can’t just remove me from the register, as that was never really an objective for the meeting. The only things I’d lose would be retinopathy screening; but my local optician does retinal photography and always shows and discusses the images, and my foot check, which I can probably do for myself, most of the time. I could probably even “train” Mr B in the therapeutic use of a light bristle brush, and a stiff-ish nylon filament on my feet as I keep my eyes closed. Obviously, I’d restart paying for my vision tests, but I’m not fussed by that prospect.

So, I’m happy with how that went. I’m very pleased I had done quite a bit of work before going to see her. She did acknowledge how engaged and well-informed I appear to be. That we have differing views of the “Next Steps” wasn’t anything contentious or anything to fall out over.

Should anyone feel I am being hasty in allowing myself to be removed from the Register, please give me your feedback. I’m happy to listen.
 
If no longer being a diabetic means that you will stop posting on this forum, then I would like to lodge an objection!
 
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